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Improving the Lives of LGBT Older Adults

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Improving the Lives of LGBT Older Adults IMPROVING THE LIVES OF LGBT OLDER ADULTS March 2010 © Big Cheese Photos on FotoSearch.com. Disclaimer: the woman in this photo is a model and the image is being used for illustrative purposes illustrative only. Disclaimer: is a model and the image being used for in this photo the woman on FotoSearch.com. © Big Cheese Photos Services & A d vocacy fo r G a y , Lesbian, Bisexual & T r a n s g e n d e r Eld e r s With a foreword by 1 Authors Partners This report was authored by: LGBT Movement Advancement Project (MAP) National Senior Citizen’s Law Center (NSCLC) The LGBT Movement Advancement Project is an independent The National Senior Citizens Law Center works to promote intellectual resource for the LGBT movement. MAP’s mission is the independence and well-being of low-income elderly and to speed achievement of full social and political equality for disabled Americans, especially women, people of color, and other LGBT people by providing strategic information, insights, and disadvantaged minorities. NSCLC believes in publicly-funded analyses that help increase and align resources for highest safety net programs, and works to preserve and strengthen impact. For more information, go to www.lgbtmap.org. Medicaid, Medicare, Social Security and Supplemental Security Income. To guarantee fair treatment, NSCLS works for greater Services and Advocacy for Gay, Lesbian, Bisexual and access to federal courts for citizens and for better enforcement Transgender Elders (SAGE) of consumers’ legal rights in safety net programs. NSCLC works SAGE is the world’s oldest and largest nonprofit agency toward an America in which elderly people and people with dedicated to serving LGBT older people. Since its inception, disabilities can: live in dignity and safety, free of the worries and SAGE has pioneered programs and services for the aging pain of poverty; afford health care to the end of their days; and LGBT community, provided technical assistance and training contribute to their families and societies to the best of their to expand opportunities for LGBT older people across the abilities. For more information, see www.nsclc.org. country, and provided a national voice on LGBT aging issues. In 2005, SAGE became the first official LGBT delegate at a White House Conference on Aging. In 2010, SAGE was awarded a 3-year, $900,000 grant from the U.S. Department of Health and Contact Information Human Services and the Administration on Aging to create LGBT Movement Advancement Project (MAP) the nation’s only national resource center on LGBT aging. For 2215 Market Street more information go to www.sageusa.org. Denver, CO 80205 720-274-3263 This report was developed in partnership with: www.lgbtmap.org American Society on Aging (ASA) Services and Advocacy for Gay, Lesbian, Bisexual and The American Society on Aging is an association of diverse Transgender Elders (SAGE) individuals bound by a common goal: to support the 305 7th Avenue, 6th Floor commitment and enhance the knowledge and skills of those New York, NY 10001 who seek to improve the quality of life of older adults and 212-741-2247 their families. The membership of ASA is a multidisciplinary www.sageusa.org array of professionals who are concerned with the physical, emotional, social, economic and spiritual aspects of aging. ASA’s 6000 members are researchers, practitioners, educators, MAP thanks the following funders, without whom business people and policymakers concerned with the this report would not have been possible. physical, emotional, social, economic and spiritual aspects of aging. For more information go to www.asaging.org. Arcus Foundation David Bohnett Foundation Center for American Progress (CAP) David Dechman The Center for American Progress is a think tank dedicated Gill Foundation to improving the lives of Americans through ideas and Jim Hormel action. CAP combines bold policy ideas with a modern Johnson Family Foundation communications platform to help shape the national debate. Amy Mandel and Katina Rodis CAP is designed to provide long-term leadership and support Weston Milliken to the progressive movement. CAP’s policy experts cover a Kevin J. Mossier Foundation wide range of issue areas, and often work across disciplines to Mona Pittenger tackle complex, interrelated issues such as national security, H. van Ameringen Foundation energy, and climate change. For more information see www.americanprogress.org. 2 For a large print version of this report, please visit www.lgbtmap.org or www.sageusa.org TABLE OF CONTENTS FOREWORD ...................................................................................................................................................................i EXECUTIVE SUMMARY ................................................................................................................................................ii INTRODUCTION ............................................................................................................................................................1 LGBT Older Adults in Profile ...............................................................................................................................2 OVERVIEW: KEY CHALLENGES FACING LGBT ELDERS .............................................................................................4 Challenge 1 —Effects of Social Stigma and Prejudice ...................................................................................4 Challenge 2 —Reliance on Informal Families of Choice ................................................................................6 Challenge 3 —Unequal Treatment Under Laws, Programs and Services ....................................................7 How the Three Challenges Impede LGBT Elders’ Successful Aging ..............................................................10 AT ISSUE: FINANCIAL SECURITY FOR LGBT ELDERS ................................................................................................10 Assessing LGBT Elders’ Financial Well-Being ...................................................................................................11 Unequal Impact: Government Programs and LGBT Elders’ Finances...........................................................12 Social Security ...................................................................................................................................................................12 Medicaid and Long-Term Care .....................................................................................................................................15 Tax-Qualified Retirement Plans ....................................................................................................................................19 Employee Pensions/Defined-Benefit Plans ..............................................................................................................19 Retiree Health Insurance Benefits ...............................................................................................................................20 Estate Taxes ........................................................................................................................................................................22 Veterans’ Benefits .............................................................................................................................................................22 Inheritance Laws...............................................................................................................................................................23 Recommendations: Helping LGBT Elders Achieve Financial Security .........................................................24 AT ISSUE: HEALTH AND HEALTH CARE ......................................................................................................................30 How the Health Care System Fails LGBT Elders ...............................................................................................30 Inattention to LGBT Elders’ Health Disparities ........................................................................................................30 Limited Support for Family-of-Choice Caregivers .................................................................................................33 An Often Inhospitable Health Care Environment ..................................................................................................34 Failure of Nursing Homes to Protect LGBT Elders ..................................................................................................35 Exclusion of Families of Choice in Visitation and Medical Decision Making .................................................38 Recommendations: Helping LGBT Elders Achieve Good Health and Health Care .....................................40 AT ISSUE: SOCIAL SUPPORT AND COMMUNITY ENGAGEMENT ............................................................................48 Key Obstacles to Social Support and Community Engagement for LGBT Elders ......................................48 Unwelcoming Mainstream Aging Programs............................................................................................................48 Isolation From the Broader LGBT Community ........................................................................................................49 Insufficient Opportunities to Contribute ..................................................................................................................49
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