Kathy Greenlee is a badass.
At the Aging in America 2013 Conference in Chicago, she gave the bold charge to advocates for older adults and advocates for people with disabilities to partner together. After all, it makes sense– long-term care is a concern for older adults and people with disabilities alike. We don’t currently have good options for long-term care: institutionalization is often expensive and often results in poor health outcomes, and aging in place is also expensive and strains caregiver resources. People tend not to buy long-term care insurance, even if they have the resources to do so, because who plans for the day that they need help wiping their arse (hey, that counts as an Activity of Daily Living)?
Medicaid is a common provider of long-term care, but it requires people to spend down their assets to qualify. Thus, we get the awkward situation of people who were formerly middle class, spending down their assets in order to qualify for Medicaid so that they can get care for multiple chronic conditions or disabilities. Awkward because just as no one plans for the day they need help wiping their arse, no one plans for the day that all that they have ever worked for to be forked over in medical expenses until they qualify for Medicaid. It just happens, and happens often.
She also gave a shout out to caregivers (they need to be compensated better, because they often pay for the care of older adults and people with disabilities, with no vacation time or financial compensation) and called for the elder justice movement (because apparently, elder justice isn’t already a thing– boo).
Rode the Greyhound for the first time. It is a place with a blue chemical pool of a toilet and no food. Bring lunch. Or be prepared to buy things from vending machines at truck stops. Know that change from a vending machine is going to be in quarters, not bills. Take your ID out when going through security, or else you will gruffly told to do so. Gruffness is scary.
Ate two samosas after arriving in Chicago at 9 PM. Samosas are delicious. If a restaurant is closing at 10 PM, choose scarfable things. Impress the waiter with your ability to scarf things quickly. Smile and say thank you a lot.
Got a dorky bag with lots of logos on it, filled with information about Medicare and being a volunteer (because I was a volunteer). Learned that the Chicago Hyatt Regency layout is confusing because of construction and a valiant effort to name things poetically. “This part has Chicago-y names. This part has cities in America. These floors can be remembered by the mnemonic ‘Every cloud has a silver lining,’ but don’t use colors to reference floors. That will confuse visitors.” Was confused.
Session: M’LANA LGBT Older Adults Diversity and Inclusion with Congregate Meal Sites. Met Lisa from the LGBT Aging Project, and her intern, Laura. Research was done with the Fenway Institute. Congregate meal programs are funded through the Older Americans Act, Title III, to reduce social isolation, nutritional deficiencies and reduce institutionalization. Kristen Porter, MS, MA did research across 48 states with a 94% return rate of surveys, and found that 64% of states have congregate meal programs targeting an ethnic/racial/cultural community, but that only 10% have LGBT meal sites. This is indicative of how the Older Americans Act (OAA) targets people with “greatest social need,” which is currently defined as racial and ethnic minorities, but not minorities with respect to sexual orientation and gender identity. The LGBT Elder Americans Act of 2012 aims to amend the OAA to include minorities with respect to sexual orientation and gender identity.
Interestingly, there was no correlation between legalization of same-sex marriage and the presence of LGBT congregate meal sites. What does make a difference is the presence of employment protections that are inclusive of LGBT individuals. Maybe same-sex marriage has gotten so far into mainstream thought that real culture change that welcomes LGBT individuals is really only indicated by specific policies, such as those relating to employment, but that’s just my guess.
MASSACHUSETTS MEAL SITE SURVEY
Massachusetts has the highest number of LGBT congregate meal sites in the country. This survey was unique because it contained a comparison group, comparing the 6 existing LGBT sites in Massachusetts to 6 randomly selected “mainstream” sites. Method – 294 surveys, with 128 surveys from LGBT sites. Sample – mainstream site contained 96% heterosexual, 4% LGBT; LGBT sites contained 95% gay/lesbian, 5% heterosexual. Transgender individuals were included in the sample, but for the purposes of comparison, sexual orientation was used, rather than gender identity.
Mainstream sites had an older population, with a majority being 75+ years. LGBT sites had a younger population, with the majority being 45-74 years. There were overwhelmingly more females in the mainstream sites, indicating age differences (women live longer). LGBT sites showed a 49% (female), 51% (male) split. Race was not quite diverse for both sites, suggesting a possible need for better racial/ethnic targeting among congregate meal sites.
More lesbian/bisexual women were employed than heterosexual women, which may indicate gender roles (heterosexual women may be more likely to be provided for) and age (younger individuals are more likely to work). Fewer employment differences existed among gay and heterosexual men.
LGBT individuals exhibited higher education, which is consistent with general research. There was much higher graduate school education among lesbian and bisexual women. However, 50% of LGB individuals earned less than $30,000 annually.
Findings related to social isolation
LGB individuals were less likely to have children, but lesbian and bisexual women are more likely to have children from previous marriages.
However, heterosexual individuals are more likely to spend Thanksgiving with children, while LGB individuals are more likely to spend Thanksgiving with friends. This is telling when you consider that heterosexual individuals more likely to feel like they could call their children for help, while LGB individuals were more likely to rely on their friends. LGB individuals also felt challenged when filling out “in case of emergency” forms, with some feeling like they had no one they could call.
Even more concerning, LGB individuals experienced or perceived that they were in a “last closet” in their later years. 15% were not out to aging service providers, which is compelling, considering that these were individuals already attending an LGBT congregate meal site. Furthermore, only 61% of LGB individuals over 70 years had experience with a senior center. Considering that there are already barriers toward in-home care and elder care among heterosexual individuals, LGB individuals face even greater challenges when it comes to finding aging service providers they can trust.
OUTNESS AND LONELINESS BY SARA KEARY, MSW
Literature review on loneliness in LGB older adults: Grossman, D’Augelli & O’Connell (2001), Frederiksen, Goldsen et al. (2011). Method – UCLA 3-item loneliness scale: lack companionship, feel left out, feel isolated.
LGB older adults are lonely, regardless of whether or not they spend time with other LGB older adults or are part of LGB programs. There was no significant difference in loneliness between LGB older adults who spent time with other LGB older adults or were part of LGB programs versus LGB older adults who didn’t. Clearly, it’s not enough just to stick LGB older adults together and say, “You belong together and not with anyone else.” LGB older adults exhibited significantly higher levels of loneliness than their heterosexual counterparts.
Outness levels aren’t dichotomous– you aren’t either in or out; you can be somewhere in between. LGB older adults were often out to friends, siblings and children, but there was a steep drop in the number who were out to other family. So… family reunions. Fun times? Being closeted (less out) to children and siblings was significantly associated with greater loneliness. Being closeted is often manifested in travel patterns of LGB older adults who visit LGBT congregate meal sites– LGB older adults often come from all different zip codes, for fear of being seen by family or other people at an LGBT meal site, whereas people who attend mainstream meal sites often come from the same zip code.
Findings related to social isolation
LGB older adults are at a high risk of institutional care because they often lack children and are often isolated. Fortunately, they can be resilient, and there are other places where they do find a sense of belonging.
Compared to heterosexual older adults, LGB older adults are less likely to consider congregate meal sites as one of the few places where they belong or can socialize. This is possibly because LGB older adults at congregate meal sites tend to be younger and working, so they may not be as socially restricted as heterosexual older adults. However, LGB older adults, like heterosexual older adults, are just as likely to see the social value of congregate meal sites for being with friends, connecting with community and feeling welcome.
It is important to recognize how affiliate models for congregate meal sites can reduce social isolation and fear of service providers. Keary gave a quote from someone who is out to their family and single, who feared that their family would make end-of-life decisions sooner than if they were not gay. Keary also gave an anecdote about a Holocaust survivor who became deeply closeted in later life and isolated because his whole world was opera, and the men at his congregate meal site wanted to talk about football, and the women wouldn’t talk to him. In addition, Keary noted that people have expressed concern about feeling disconnected and having to come out to people again.
Keary likened senior centers to junior high– sometimes it can feel just as daunting to find a seat at a congregate meal site as it is to find a seat in the cafeteria. This is partly why Massachusetts has preferred an affiliate social cafe model, which is targeted to LGBT older adults, but is inclusive for all who come. LGBT older adults are an affiliate group, not a ghettoized group, and can thus gather together for friendship, belonging and community, sometimes in areas that are traditionally places of fear: churches, assisted living centers and senior centers. Providers have found that quality of meal matters a lot in attracting attendees, and that they can take donations to defray the cost. Having high-quality meals or fun events such as music performances can help incorporate LGBT attendance at a congregate meal site in a positive manner, where “everyone is really excited when the gays come into town because they know they are going to have a great meal” and “everyone wants to be gay for a day if there’s a great concert.”