September 2014 Bar Bulletin
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September 2014 Bar Bulletin

As the Rainbow Grays:

Discrimination of LGBT Elders in Long-Term Care Facilities

By Eleanor Doermann


As legal recognition of same-sex marriage continues on the legal fast track, barriers to equality other than access to marriage remain for many in the LGBT community, including the 60 percent of LGBT elders without spouses or partners.1 Until recently the only information available regarding the experiences of LGBT elders was anecdotal, but new research now shows that accumulated lifetime experiences of discrimination, victimization and restricted access to health care of LGBT elders often manifest as poor health in old age.

Historically, little data have been collected on LGBT health in general, much less LGBT elder health, due to stigma, fear and underreporting, but this is changing. Health researchers are starting to include and ask questions about sexual orientation and gender identity in their studies, and LGBT elders are starting to answer them.2

"Caring and Aging with Pride" is the first ever federally funded study of LGBT elder health and culminated in publication of the 2011 Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults. The author, Karen Fredricksen-Goldsen, was the keynote speaker at the "Over the Rainbow Summit" held in Seattle in 2013, where she described how fellow researchers told her the study could only fail because LGBT elders would not participate.

Instead, more than 2,500 diverse LGBT older adults ranging in age from 50 to 95 from across the country eagerly contributed because they wanted their life experiences to matter, including some who had never before come out to anyone.3 This large sample size allowed researchers to further break down the data by age, race, income and educational level, and by subgroup (lesbian, gay, bisexual and transgender), illustrating the tremendous diversity in the LGBT community and highlighting the importance of studying the impact of intersecting group identities on health and well-being.

The data revealed significant negative health disparities between LGBT elders and their demographically matched heterosexual counterparts. Researchers found LGBT elders had higher rates of social risk, disability, mental distress, poor health habits and disease prevalence including cardiovascular disease, obesity and HIV. Data also revealed a strong correlation between these disparities and a personal history of victimization, discrimination, internalized stigma and restricted access to health services.

Along with these negative disparities, researchers also identified resilience factors among LGBT elders. They found that coming out and the experience of community belonging correlated with better mental health, even though being "out" carries its own social and economic risks. They found the vast majority of participants engage in regular wellness activities and attend spiritual and religious activities more frequently than their heterosexual counterparts.4

Washington's DSHS website now includes LGBT health information, including that LGBT adults in general are more likely to lack health insurance, to delay or not seek medical care or obtain needed prescription medications, to receive health care services in emergency rooms, and not to receive screenings, diagnoses and treatment for important medical problems.

LGBT adults are more likely to have cancer, to suffer psychological distress, to require medication for emotional health issues, and to engage in risky behavior such as heavy drinking and smoking cigarettes. Gay men are at higher risk of HIV and other sexually transmitted diseases, especially among communities of color.5

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