THE LGBT OLDER ADULT PROJECT Carolyn Bradley, PhD, LCSW Associate Professor, School of Social Work Laura Kelly, PhD, APN Associate Professor, Marjorie K. Unterberg School of Nursing and Health Studies Introductions . Presenters . Topic . The Importance of the topic Today’s Discussion . Aging . The LGBT Older Adult Project at MU . LGBT Aging . Initial Research . Health Care Issues Findings . Provider Awareness . What‟s next? The Issue of Aging 19.0 14.2 85+ 8.7 65-84 6.6 5.8 4.2 67.0 69.5 3.1 63.3 2.2 48.2 1.5 34.5 0.9 28.2 30.8 0.6 23.3 0.3 0.4 15.6 18.6 0.1 0.2 0.2 8.7 11.7 3.0 3.8 4.7 6.4 Successful Aging . Life satisfaction and a sense of wellbeing in the face of: - An aging body - Valued roles left behind (skilled worker professional, fulltime parent) - Bereavement at the death of family or friends - Perhaps a period of frailty and dependency at the end of life LGBT Aging Challenges . Cumulative effects of a life time of stigma . Having to rely often on “families of choice” for support . Legal inequalities which create barriers to access to services Barriers to Healthcare . LGBT elders’ health disparities are not adequately addressed . Medical providers & nursing homes are often insensitive, even hostile . Only limited government and legal support for ‘families of choice” who provide care and should be making medical decisions Health Issues . HIV/AIDS . Other issues 32% increase in HIV+ No government data people age 50-59 from 2004 to collection and little research on 2007 LGBT elder health 2x as many people living Rates of substance with AIDS are 50+ than <24 abuse, obesity, suicide, depression, and interpersonal Virtually no HIV violence are 3x -10x higher prevention programs for older adults LGBT people age 50+ report problems such as asthma Little understanding of and diabetes at rates similar to how HIV/AIDS drugs interact those usually found among with other medications people a decade older common in old age Long Term Care Issues • Potentially hostile staff members and fellow patients • Denial of visits from family of choice • Refusal to allow same-sex partners to room together . Refusal to involve family of choice in medical decision- making . Refusal to place transgender individuals in ward that matches their gender identity Provider Awareness . In 1998, 42% of nursing students said LGBT people should keep their sexuality private . In 2006, less than half of LGB baby boomers believed healthcare professionals would treat them with dignity and respect . In 2008, the Public Advocate of New York found that health providers “lack knowledge about transgender anatomy, health disparities affecting LGBT people, and appropriate behavior dealing with … LGBT individuals” The LGBT OAP at MU . A joint initiative of the School of Social Work and the Marjorie K. Unterberg School of Nursing and Health Studies . The LGBT Older Adult Project was started to improve the quality of the lives of older LGBT adults. The Project seeks to accomplish this goal, not by replicating the vast array of services available through existing mainstream agencies, but by offering education and technical assistance to these agencies, advocacy regarding legislation impacting LGBT older adults and the eventual development of social activities for LGBT older adults, caregivers, and their friends. Inspired by the movie GenSilent . http://www.youtube.com/watch?v=fV3O8qz6Y5g LGBT OAP Mission . The next generation of global healthcare leaders must be prepared to meet the needs of the much heralded arrival of “the Baby Boomers” into the ranks of older adults seeking services. While Nursing, Social Work and Health Studies programs create curriculum to increase awareness, knowledge and skills for addressing the needs of this demographic, there exists within this population a distinct subculture that is often hidden and therefore left underserved. The LGBT OAP seeks to develop a curriculum, a “Training of the Trainers” and an on- site training program to be delivered to agencies providing services to older adults so as to enable them to deal with the specific health care and social service needs of older lesbian, gay, bisexual and transgendered (LGBT) adults. Needs Assessment . 27 health and social service agencies were interviewed in the fall of 2011. The agencies were located in three counties: Monmouth, Ocean and Middlesex . All agencies were asked a series of questions to ascertain whether they provided services to LGBT elders and whether they provided inservice education or training to their employees about the specific needs of LGBT elders. One agency asserted that they provided cultural competence training specific to LGBT issues (a large hospital corporation). Many could not answer the question. Most stated “we treat everyone the same” LGBT Elders . We also wanted to know what area LGBT elders thought about aging. We asked about concerns they had about aging, interactions with health care and community service providers, and what they wanted providers to know about being an older LGBT person. Interviews were conducted in the spring and summer, 2012 . The summary of the data supports the need for LGBT education for area providers as well as education and support to area LGBT residents Demographics . 13 women (all identified as lesbians) . 7 men (6 identified as gay, 1 as bisexual) . 18 were Caucasian . 1 Latina . 1 African American . Ave age-61 Initial Analysis . Lack of knowledge about important health issues . “I don‟t eat sweets to avoid diabetes, it runs in my family” . “I am HIV positive as of 3 years ago. I feel like I am cheating myself out of years. With medication it probably won‟t affect me… “ . “I got a rash. I went to a Middlesex County doctor who sent me to get tests, sent me to get VD test, and I thought it had something to do with being a lesbian…I always told them I‟d never gotten any bad anything…being female means not worrying about AIDS” . “I didn‟t know about sexually transmitted diseases between women…any issues at all…I have not thought about it…didn‟t know there were things to check” Initial Analysis . Family conflict raising concerns about what might happen in the future . “My biological daughter doesn‟t like my partner, she is not speaking to him. She got angry about my accident in Mexico—she was not the first person notified. She cut both of us off. We have no contact.” . “ Many unresolved issues come out, related to LGBT elders…find out people you think accepted you unconditionally really haven‟t or accept you but not your partner. Ultimatums between partner and family…why have to choose? It‟s also harder for the person not out. Can result in family members not talking to you” . “Dad got wind of it (her being a lesbian)…I have no relationship with him and that‟s hurts me a great deal. It‟s a struggle; it makes me sad…at 56 years old I am still struggling with it. I came out in my 40‟s. I have younger sister that I haven‟t spoken to in years”. ”I asked my parents to stay with them after the break up. My father said no. He said I made my bed, now lie in it. It took me time to find my way again but I did find my way & I am hoping, still thinking about how I want to do things.” Initial Analysis . Negative experiences with providers . “They have a health office here, run by community volunteers and nurses… 24 hrs…a woman there volunteering she said something derogatory about gay people and I said, „well I am gay‟ and she said, „No you‟re not!‟ I was furious. I‟ve seen a bit of that around and I just avoid those people”. “But I don‟t give a crap, I will tell if they ask me or I‟ll say it…the only problem I have had is we have a couple friend…we are friends with this other couple that are so nice, and that couple had another couple that came to dinner with us, and said they wouldn‟t come back if we were there….it hurt me, but it felt worse for nice people who were my friends, knowing their friends are going to avoid them if we were around.” (regarding experience in a retirement village) . When we had a homecare provider, we were nervous, we had to have to “straighten up”-- hide gay stuff-- that was an extra burden in time of sickness and need… Initial Analysis . Negative experiences with providers . “Three years ago I had home care. I had 2 persons who came to me and kept praying for me because I was gay. I called the agency and complained. It was clear the agency staff needed training. Some people feel strongly about this, would it be appropriate if we were straight? No!! Praying for me to be straight…” “My second hospitalization was in a Catholic hospital and we had a lot of problems. I needed assistance to the bathroom…but the nurses got into an argument in the hallway so I took myself to the bathroom and fell getting up. I heard the nurses say „that fag in there yelling‟. I did report it. The next day I got transferred…but what about the nurse?” “An allergist looked at NL and said, „who are you?‟ She said, „I am her partner.‟ She said, „business partner‟? She said, „no, I am not a business partner‟. He said „you‟re family, that‟s what you say.‟ He was completely at home and at ease…he was giving us a lesson, saying let‟s cut to the chase…he was very nice.