Outing Age 2010 PUBLIC POLICY ISSUES AFFECTING LESBIAN, GAY, BISEXUAL AND TRANSGENDER ELDERS BY JAIME M. GRANT NATIONAL GAY AND LESBIAN TASK FORCE POLICY INSTITUTE WITH GERARD KOSKOVICH, M. SOMJEN FRAZER, SUNNY BJERK, AND LEAD COLLABORATOR, SERVICES & ADVOCACY FOR GLBT ELDERS (SAGE) Outing Age 2010 PUBLIC POLICY ISSUES AFFECTING LESBIAN, GAY, BISEXUAL AND TRANSGENDER ELDERS BY JAIME M. GRANT NATIONAL GAY AND LESBIAN TASK FORCE POLICY INSTITUTE WITH GERARD KOSKOVICH, M. SOMJEN FRAZER, SUNNY BJERK, AND LEAD COLLABORATOR, SERVICES & ADVOCACY FOR GLBT ELDERS (SAGE) OUTING AGE 2010 1 Acknowledgements he Task Force is grateful for the generous support of the Arcus Foundation, which funded the research, development and publication of TOuting Age 2010. AARP also provided critical support for this research. This book has been years in the making and has required the careful attention of many talented researchers and advocates. The Task Force greatly appreciates the vision and dedication of Amber Hollibaugh who, in her time as Senior Strategist on Aging at the Task Force, created a national network of advocates and pioneered many of the perspectives and positions herein. We want to thank Task Force interns and fellows whose research was critical to this volume: Ernest Gonzales, Carla Herbitter, Erica Grace Nelson, Tey Meadow, Patrick Paschall, Angie Gambone, Jesse Zatloff, Meredith Palmer and also former Senior Policy Analyst Nicholas Ray. Several experts in LGBT aging helped refine our drafts and hone our perspectives: Dr. Kimberly Acquaviva, Loree Cook-Daniels, and Dr. Brian DeVries. At the Task Force, our resident expert on Aging, Dr. Laurie Young, made essential contributions to the book. Thank you, Laurie, for your patience, guidance and above all, good humor. Staffers Amy Sagalkin and Darlene Nipper made extremely helpful editorial comments. The intrepid Karen Taylor at SAGE in New York kept us on task and gave critical support, comments and feedback throughout. SAGE has served as a lead collaborator on this project, and their contribution has been invaluable. Task Force Vaid fellow Jack Harrison performed the “heavy lifting” on fact and reference checking and the book’s appendices. He made it possible to get our final draft across the finish line. Finally, the shape of this book owes much to its predecessor, Outing Age, and the sharp thinking of its authors, Sean Cahill, Ken South and Dean Spade. Thanks for setting such a high bar in research and advocacy for LGBT elders. Your work has had an enormous impact on the field and the movement as a whole. 2 TABLE OF CONTENTS Table of Contents Foreword by Rea Carey ...............................................................................................................................4 Executive Summary and Recommendations ................................................................................7 Why This Book? .............................................................................................................................................. 13 Who Are Elders in America in General?......................................................................................... 19 What Do We Know About LGBT Elders? ....................................................................................... 24 How Many LGBT Elders Are There? ........................................................................................... 26 Class, Race and Gender in Aging ................................................................................................ 26 The Diversity of LGBT Elder Experience ................................................................................. 28 Living Arrangements: Alone but not Lonely? ........................................................................ 30 LGBT Singlehood, Partnership and Kinship .......................................................................... 31 Geography ................................................................................................................................................. 33 Sexuality Over the Lifespan ............................................................................................................. 35 Ageism in LGBT Communities ....................................................................................................... 37 LGBT Elders in Prison ......................................................................................................................... 39 The Way Forward........................................................................................................................................... 42 Discrimination and Access to Services .................................................................................... 43 Cultural Competency..................................................................................................................... 44 Violence ................................................................................................................................................. 48 Hate Violence ............................................................................................................................. 48 Domestic Violence .................................................................................................................. 50 Elder Abuse................................................................................................................................. 51 Policy Recommendations ................................................................................................................... 53 Financial and Family Security ......................................................................................................... 54 Social Security Spousal Benefits ............................................................................................ 57 Social Security Survivor Benefits ........................................................................................... 58 Military and Veterans Benefits .................................................................................................. 59 Medicaid Long-Term Care Benefits ...................................................................................... 59 Pensions ............................................................................................................................................... 60 Hospital Visitation and End-of-Life Decision Making .................................................. 61 Policy Recommendations ................................................................................................................... 62 Health ............................................................................................................................................................. 63 Access to Health Care .................................................................................................................. 64 Lack of Insurance .................................................................................................................... 64 Experiences of Fear and Stigma ..................................................................................... 69 HIV/AIDS ............................................................................................................................................... 73 OUTING AGE 2010 3 Cancer ................................................................................................................................................. 75 Chronic Disease ............................................................................................................................... 77 Mental Health ..................................................................................................................................... 80 Public Health Programs and Outreach ................................................................................ 84 Policy Recommendations ................................................................................................................... 85 Caregiving, Social Isolation, and Housing .............................................................................. 86 Caregiving ........................................................................................................................................... 86 Social Isolation .................................................................................................................................. 89 Housing ................................................................................................................................................. 94 Housing Options for LGBT Older Adults .................................................................... 95 Homecare .................................................................................................................................... 97 Assisted Living .......................................................................................................................... 97 Naturally Occurring Retirement Communities...................................................... 100 LGBT-Targeted Elder Housing ....................................................................................... 101 Policy Recommendations ................................................................................................................ 103 Civic Engagement, Lifelong Learning and Elders in the Workplace .......................................................................................................