Outing Age PUBLIC POLICY ISSUES AFFECTING GAY, LESBIAN, BISEXUAL AND TRANSGENDER ELDERS by Sean Cahill, Ken South and Jane Spade the Policy Institute of the National Gay and Lesbian Task Force Foundation Contents Preface by Urvashi Vaid . .iv Executive Summary and Recommendations . .1 GLBT Elders and Aging . .4 Who are Elderly Americans in General? . .4 What Do We Know about Gay, Lesbian, Bisexual, and Transgender Elders? . .7 The Context: Heterosexism . .17 Ageism within the GLBT Community . .18 Elderly GLBT Veterans . .19 GLBT Aging Organizations . .20 Policy Issues Affecting Seniors . .23 Services . .23 Older Americans Act . .23 Caregiving Needs . .24 Long Term Care . .25 Social Security . .25 Health Policy . .29 Medicare . .29 Medicaid . .30 Managed Care . .31 Housing and Nursing Homes . .32 Nondiscrimination and Anti-Poverty Policy . .33 Employment . .33 Supplemental Security Income . .34 Disability Policy . .34 How Aging Policy Frameworks Can Benefit GLBT Elders . .36 Research and Needs Assessment . .36 Local Research . .36 Advocacy for Inclusion in Research . .37 Services . .40 The Need for Access for GLBT Elders . .40 The Need for Training . .40 Caregiving Needs . .41 Recognition of GLBT Families . .42 Social Security . .43 401(k)s and Pensions . .45 The Medicaid Spend-Down . .47 Grandparenting Relationships . .47 Domestic Partnership and Civil Unions . .48 Housing and Nursing Homes . .51 Subsidized Housing . .52 GLBT Senior Housing Developments . .52 Nursing Homes and Homophobia . .53 Changing Practices and Regulations . .54 Options for Independent Living . .55 Health Care . .57 Medicare . .57 Medicaid . .58 Public Health . .59 Managed Care . .59 HIV/AIDS . .61 Mental health . .62 Hate Violence as a Public Health Concern . .64 Nondiscrimination and Anti-Poverty Policy . .65 Employment . .65 Supplemental Security Income . .65 Welfare Reform and Charitable Choice . .66 Non-Discrimination Legislation . .67 Outing ii Age Recommendations for Policy Advocacy and Activism . .70 Policy Recommendations . .70 Research . .70 Services, Training, and Caregiving . .71 Recognition of GLBT Families . .73 Housing . .74 Health Care . .74 Discrimination and Income Support . .76 Recommendations for Activism for GLBT and Social Justice Activists . .78 Conclusion . .80 Appendix A: Estimates of the GLBT Population in the United States . .82 Appendix B: Lesbian and Gay Activism at the White House Conference on Aging . .84 Appendix C: Legal Issues Facing Same-Sex Couples . .86 Appendix D: Resources . .88 Appendix E: General Research on Latino/-a, Asian Pacific Islander, and Native American GLBT and Two-Spirit People . .93 Notes . .95 Bibliography . .123 Contributors . .143 Table of Contents iii Preface BY URVASHI VAID Director, NGLTF Policy Institute Age is dirty word to many people in America. People lie about it. Others avoid or ignore those who are old. Youth is a virtue, but old age is just plain sad, so we are told. Politicians pander to the senior vote each election cycle, but fail to authorize urgently needed funds for social service programs, as the re-authorization of the still-not-yet- fully-funded Older Americans Act would do. And with the notable exception of some extraordinary individuals and organizations, the gay, lesbian, bisexual and transgender (GLBT) movement has followed this overall cultural pattern. Today we stand at the edge of two tidal waves: a growing wave of GLBT people aging and entering the social service and community institutions which care for and advo- cate for the elderly; and a tidal wave of reaction against government, and against gov- ernment funding for social service needs. How will GLBT people fare as these waves wash over our communities? To date, aging service providers are not ready for the new wave of GLBT elders, policy makers are running away from it, and until very recently, frankly, the GLBT community has not faced this wave either. This report aims to change these responses by increasing the awareness of policy makers, advocates and ser- vice providers about the realities facing GLBT elders. Federal and state governments offer a wide variety of social programs and services that aim to support the lives of elderly people. Yet none of these programs recognize or sup- port, in even the most rudimentary ways, the families GLBT people build. Social Security survivor benefits are an essential part of a widow or widower’s income, yet same-sex partners do not receive this benefit, even after decades of building a family together. Nursing homes and assisted living facilities have ignored the special needs of GLBT elderly, and the dearth of data on old GLBT people makes identifying problems and advocating for solutions very difficult. Little thought has been given to the special caregiving needs and realities of GLBT seniors. Plans are made, surveys conducted, research on the elderly done—all with no awareness of the existence of GLBT seniors and of their sometimes unique situations. Outing iv Age This country’s aging policies assume heterosexuality and close relationships with chil- dren and extended families to provide basic needs as we age. Yet what of those people without such family ties or those who are not parents? Should the ability to access good care in old age be dependent on one’s parental status or one’s relationship to one’s fam- ily of origin? As a matter of public policy, what kind of support do the elderly need? How does that need for support change based on sexuality, or income status, or race or ethnicity? What is the responsibility of government, if any, to provide such support? Even as GLBT old people face oblivious or alienating social service agencies, they also face devastating race, class and age bias within GLBT communities. Part of this is due to simple ignorance: because the “out” GLBT community is still an emerging commu- nity, many GLBT people just do not think of old people and the issues they face when they conceptualize community and prioritize issues. But some of our denial is certainly due to the persistent youth bias in the broader culture and in the GLBT subculture. Ageism operates to deprecate old people, and to ignore the serious problems presented by aging in a political culture that pays lip service to concern for the elderly but will not deliver the support needed to fulfill the promises made. Ageism operates when the involvement and participation of old GLBT people is not evident or even sought as desirable by our national and local organizations. And like heterosexism, ageism has consequences for the health, security, and lives of GLBT seniors. In order to address ageism in our society and to spark advocacy for GLBT seniors, the Aging Initiative was launched in 1999 by the National Gay and Lesbian Task Force (NGLTF) Policy Institute. Through research, relationship building with GLBT and non-GLBT aging policy organizations, training, and advocacy, NGLTF works to ensure that the needs of GLBT seniors become a visible and conscious part of public policy frameworks and service programs. The NGLTF Aging Initiative includes four main strategies: • To collect and disseminate factual, empirically-based information and analysis on the lives, realities, and policy needs of GLBT seniors; • To raise consciousness within the GLBT community to confront ageism that keeps older people invisible and robs the.