Resources for the Aging LGBTQ+ Community: Healthcare, Financial Planning, & Long Term-Care
In the United States, the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community is large; in fact, this group makes up approximately 4.5% of the country’s total population. Despite their size and prevalence, the LGBTQ+ community still experiences myriad hurdles and challenges, especially when it comes to healthcare. Roughly 56% of lesbian, gay, and bisexual individuals and 70% of transgender individuals have encountered anti-LGBTQ+ discrimination when attempting to access healthcare. Further, the LGBTQ+ community faces unique health concerns that their heterosexual and cisgender peers do not, including mental health problems, HIV prevention and treatment, and substance use.
This difficulty of access to quality care is an even greater issue for older members of the LGBTQ+ community, as they must also contend with any health issues that are associated with aging. An estimated 2.7 million adults in the US are both LGBTQ+ and over the age of 50, with 1.1 million individuals who are over the age of 65. Each and every person who is LGBTQ+ deserves to receive high-quality healthcare, but as the number of older adults in the US continues to grow, it’s particularly important that aging members of this community can easily access the care they need.
Family members, friends, healthcare professionals, and caregivers can help fight for and improve the care that LGBTQ+ individuals receive, but nurses and those who are considering or actively pursuing a career in nursing are in a unique position to affect change. Working in hospitals, patients’ homes, assisted-living facilities, and nursing homes provides nurses with the chance to work directly with aging LGBTQ+ patients, ensuring they receive proper healthcare. Older LBGTQ+ adults will need this support, as well as that of their loved ones, as they plan for their future health, finances, and long-term care.
LGBTQ+ Health Disparities
In addition to issues with obtaining care, the LGTBQ+ community faces a number of other health disparities. From covering the costs associated with care to acquiring proper legal documentation, these disparities have a huge impact on the quality of healthcare received by, and thus the health outcomes of, LGBTQ+ patients. Healthcare professionals, friends and family, and caregivers must know what these disparities are and how they affect LGBTQ+ seniors in order to begin to bridge the gap and improve the healthcare they receive. Further, according to Healthy People 2010, additional research is needed to fully understand and address these disparities, but doing so will help eliminate them and increase the quality of life for all LGBTQ+ individuals.
Reduced Access to Care
In general, LGBTQ+ individuals have reduced access to healthcare. Not only do they potentially face discrimination when attempting to get care, but they are also much less likely to seek care in the future if they have a negative experience with a provider, even if they are experiencing a severe health problem. Additionally, roughly 7% of all LGBTQ+ individuals have avoided going to see a doctor simply out of fear of discrimination, whether or not they’ve previously experienced it. And almost 20% of transgender or gender non-conforming individuals have been refused care or treatment outright because of their gender identities.
LGBTQ+ seniors must do their best to find a healthcare provider who is either friendly to or a part of the community. This will help reduce the chances of a negative experience during regular and routine appointments. Online directories and search tools can be helpful, such as GLMA’s Provider Directory, Lighthouse, or OutCare. Having an open and friendly provider can help alleviate fears of discrimination and create a more positive experience with healthcare professionals who are knowledgeable about the health concerns and needs of the LGBTQ+ community.
Paying for Care
People who are LGBTQ+ often have more difficulty paying for healthcare and any needed treatment than the general population. They are less likely to be employed and therefore less likely to have any sort of health insurance coverage. Without a job, they cannot receive health insurance through their employers and may not be able to afford insurance from a private provider. In addition, many US seniors are already struggling with high healthcare costs, pulling from their long-term savings to pay for necessary treatment and prescription medications.
For many LGBTQ+ seniors, government-funded healthcare is the only option. Private health insurance can cost several hundred dollars just for a monthly premium, which may not be feasible for older adults who live on a budget. Medicare is typically only available to people age 65 or older, but Medicaid provides coverage to people who are low-income, regardless of their age. Healthcare in the US has been in a state of flux in recent years, which can make it even more difficult to find affordable and comprehensive coverage, but it’s a necessity for LGBTQ+ seniors and their health.
There are huge mental health disparities between the LGBTQ+ community and the general population, which is largely attributed to minority stress. LGBTQ+ individuals are more likely to experience higher rates of anxiety and depression, substance use and abuse, and think about or attempt suicide compared to people who are heterosexual and cisgender. Research indicates that transgender individuals are at the highest risk of experiencing mental health issues of all types, including depression and suicidal ideation. Further, about 20% of older adults experience a mental illness or substance use disorder as they age. This puts LGBTQ+ seniors at an even higher risk of experiencing a mental health condition.
LGBTQ+ individuals, and especially older adults, must be aware of these issues and understand how they are at an increased risk of developing them, because of their age as well as their sexual orientation and/or gender identity. Being cognizant of the signs of mental illnesses and behavioral changes, cultivating a support network, and openly discussing these issues with a trained nurse, physician, or healthcare professional are all helpful ways to protect against mental health conditions.
In addition to mental health conditions, the LGBTQ+ community is also at a higher risk of experiencing certain physical health problems than the general population. Physical issues that LGBTQ+ individuals are more likely to develop include:
- Body image issues and eating disorders;
- Certain types of sex-related and reproductive cancers, such as breast and cervical cancer;
- Chronic conditions and illnesses, as well as disabilities;
- Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS);
- Obesity and its associated complications;
- Sexually transmitted diseases (STDs).
Combined with common health issues associated with aging, LGBTQ+ seniors must be highly aware of and prioritize their physical health. Understanding these common problems and discussing them openly with a nurse or healthcare provider can help older LGBTQ+ adults better protect against and treat these conditions.
FMLA and LGBTQ+ Familie
The Family Medical Leave Act (FMLA) allows eligible employees to take unpaid leave from their jobs for certain family or medical reasons, with continued insurance coverage and job protection. Common situations that are covered under the FMLA include the birth of a child, caring for a spouse or child that has a serious health condition, or personally experiencing a serious health condition. Until it was expanded in 2014, LGBTQ+ employees had little to no coverage under the FMLA to care for a same-sex spouse. Despite this expansion, many LGBTQ+ individuals struggle or are unable to access FMLA benefits, such as for gender identity-related procedures or a same-sex domestic partner.
For older LGBTQ+ adults, being unable to take job-protected leave to care for a loved one or to deal with a serious health condition is a huge problem. Even if they can, the fact remains that leave under the FMLA is unpaid, which many individuals cannot afford to take. FMLA may not be perfect, but under the right circumstances for certain people, it can be a helpful option for improving access to healthcare.
Obtaining Legal Documentation
There is a variety of complicated legal documentation associated with healthcare, such as durable power of attorney and advanced directives, which gets even more complex for LGBTQ+ individuals. Many people in the LGBTQ+ community may not have a relationship with their biological family members — almost 40% of LGBTQ+ adults report being rejected by a family member or close friend — and without the proper legal documentation in place, their “chosen” or “found” family may not be legally recognized in a medical emergency. Without clear and established legal documentation, biological family members may have the power to make medical decisions for the individual.
End-of-life planning is a necessity for all seniors, but it’s of particular importance for older LGBTQ+ adults to obtain the proper legal documentation. They must identify a durable power of attorney, determine who is authorized to visit them in a hospital, and create a living will and medical directive. It is also important to keep this information up-to-date as circumstances change, to ensure that the documents are still legally viable and the individual’s wishes are actually carried out when the time comes.
LGBTQ+ Financial Planning
Financial planning can be a difficult and daunting task, particularly when planning for the last phase of life. Though many financial experts agree that retirement planning must start early, it’s important to re-evaluate and update financial strategies later on. Financial planning for LGBTQ+ seniors likely won’t differ much from that of other older adults; one key difference, however, is that they must find accountants, lawyers, and other professionals who are open and friendly to LGBTQ+ individuals. Having professionals who are supportive and accepting will be able to better help LGBTQ+ seniors organize their finances and live the next phase of their lives fully and freely.
Generally, retirement marks the time in life when people are primarily spending, rather than saving, their money. However, there are still ways to earn an income that can lead to greater financial security during retirement. It may be more difficult for members of the LGBTQ+ community to begin saving for retirement, as they are less likely to be employed and more likely to have trouble keeping a job.
If offered by an employer, any type of retirement plan will allow older LGBTQ+ adults to build up their retirement funds while they’re still working and earning a regular income. If an employer doesn’t offer retirement plans or an LGBTQ+ individual cannot stay at a job, there are other options available that aren’t necessarily tied to employment, such as an Individual Retirement Account (IRA). This way, they can still make contributions whenever possible and create a nest egg that will allow them to live more comfortably once they’ve retired.
Social Security Income
The federal government’s Social Security program provides income to retired individuals and is one of the most important aspects of financial planning for retirement. For working adults, a portion of each paycheck is deducted and put into the government’s Social Security fund. This fund goes to people who are currently retired, and older LGBTQ+ adults can claim these benefits upon retiring themselves. The amount of money received after retirement will reflect whatever the individual contributed while working.
In addition to Social Security benefits that individuals can earn once they reach their full retirement age, there are two programs that offer additional benefits: Supplemental Security Income (SSI) and Social Security Survivor Benefits. SSI is funded by the taxpayers and its meant to provide funds to help individuals over the age of 65 and people with disabilities meet their basic needs. The Social Security Survivors Benefits program offers monthly payments to the family members of an individual who has passed away, typically to their spouse, former spouse, or children. For LGBTQ+ individuals, these benefits can greatly increase financial security during retirement, especially if they have strained relationships with biological family members or experience discrimination at work.
Pensions differ slightly from employer-based retirement plans. A retirement plan like a 401k is funded through employee contributions and puts employees in control of investment decisions. A pension, on the other hand, provides guaranteed income for life, but leaves the employer in charge of the investment. Though they are thought to be less risky, pensions are significantly more difficult to come by than other retirement plans in the private sector. There are several ways to obtain a pension, some of which are more creative than others; though they can be hard to get, pensions are one of the best ways to make retirement more comfortable and secure for all seniors.
Retiree Health Insurance Benefits
Medicare isn’t the only way to get health insurance after retirement. Some employers continue to offer health insurance benefits to retirees, though this depends entirely on the organization. Purchasing insurance on the Health Insurance Marketplace is another option available to retirees who don’t have benefits from their former employer, want different coverage, or don’t qualify for Medicare or Medicaid.
For older LGBTQ+ adults, health insurance is a necessity after retirement. Between common conditions that affect seniors and issues associated with being LGBTQ+, being able to get affordable and quality care is crucial to maintaining long-term health and wellness in this new phase of life. Whether it comes from a former employer, the government, or the open marketplace, LGBTQ+ seniors need health insurance benefits after retirement.
Estate taxes are levied on the estate and inheritance of someone who has passed away. The tax is based on the fair market value of the estate, and only the amount that exceeds a given minimum threshold is subject to the tax. Estate taxes are relatively uncommon in the modern age — the federal government only taxes estates worth more than $11.4 million, and though states’ tax thresholds are much lower, only 19 states have an estate or inheritance tax of some kind.
Although they’re rare, in the event that a senior’s estate is greater than the threshold minimums at either the state or federal level, it’s important for older adults to plan ahead. Determining who will pay them and where the funds will come from in advance can make the process of dealing with estate taxes much easier for survivors and loved ones. This is even more important for LGBTQ+ individuals who have complicated relationships with biological family members and relatives, as they’ll need to identify who should handle estate taxes if they don’t want the task to fall to their next of kin.
Finally, LGBTQ+ individuals who have served in the military should consider how their veteran’s benefits will factor into their retirement planning. Benefits eligibility largely depends on the time, length, and type of military service. Older LGBTQ+ adults should determine what their veteran benefits are, what other benefits they may qualify for, and how these benefits can continue to their family members after their passing. Benefits can be accessed and managed on the Veterans Affairs website.
Estate Planning Issues for LGBTQ+
Estate planning is a necessary task for any older adult, but it is absolutely vital for LGBTQ+ individuals and couples. Though same-sex marriage was legalized in 2015, same-sex couples must navigate a confusing legal world, where they may face discrimination or prejudiced attitudes while dealing with an uncomfortable aspect of life. Estate planning is different for LGBTQ+ couples, however, and it’s important to take the necessary steps to ensure their wishes are properly recognized.
Inheritance laws govern who is entitled to receive what from the estate of a relative who has passed away. These laws vary from state to state, but generally, assets flow directly to the legal spouse, especially when there is no will. It’s important for LGBTQ+ couples to know what their marital status is, as some civil unions or domestic partnerships have since been converted into marriages, and to ensure that any prior unions (whether with someone of the same or of a different gender) are legally terminated. This will ensure that the correct individual receives the inheritance.
A funeral directive is a legal document that lists instructions for funeral arrangements for a deceased individual, including who will be responsible for executing these wishes, what to do with the body, and who can or cannot attend the funeral. Essentially, funeral directives simplify the process of making arrangements after someone passes away. Without a funeral directive, these decisions typically fall to the next of kin, which could be a blood relative with whom the deceased has a negative or strained relationship. This means they can decide to do whatever they choose with the arrangements — such as excluding same-sex but unmarried partners from the decision-making process or using a deadname or incorrect pronouns — regardless of what the deceased individual wanted. For LGBTQ+ individuals, a funeral directive doesn’t just clarify their wishes; it also protects them legally.
A will is a necessity for all older adults, as it details exactly what should be done with assets and property after death. Similar to how a funeral directive protects an individual’s wishes for their funeral arrangements, a will helps to ensure that the correct people receive their inheritance in the way that the deceased party wants. Despite their importance, only 55% of Americans over the age of 55 have a will. For LGBTQ+ individuals and couples, this could result in estranged relatives receiving inheritances by default, whether or not the deceased individual wants them to. Further, wills are important for naming a guardian for any children, which is particularly important if they came from a previous union or were born or adopted before the individual was legally married. Wills can be created well before someone passes away and updated as needed or desired.
A revocable trust is a living trust, created while the individual is alive, and outlines which assets will go to which people upon their death. Unlike a will, a revocable trust is active while the grantor is alive and highly flexible, allowing them to control, move, sell, give away, or add assets at any time they choose. They are particularly useful for LGBTQ+ individuals, as, unlike a will, they are less likely to be contested by family members. Further, revocable trusts are also less likely to be invalidated or challenged in court, as the trust was created while the individual was still alive. They are an incredibly valuable and safe life planning tool, especially for LGBTQ+ families.
Senior LGBTQ+ Inclusive Housing and Long Term Care
Many seniors and older adults will need long-term care, specialized senior housing, or some other form of support or assistance. as they enter their golden years, including those who are LGBTQ+. In fact, someone turning age 65 today has a 70% chance of needing long-term care and support in their remaining years. And though 117 million American adults are expected to need care by the year 2020, there will only be 50 million caregivers able to assist them.
This caregiver gap is hugely problematic for the growing number of LGBTQ+ seniors. They must find caregivers who are supportive and inclusive of different gender identities and sexual orientations. A greater number of qualified and supportive healthcare professionals are needed to help meet this demand. Nurses, specifically, are on the front lines of care, and those who are pursuing an advanced nursing degree will have the higher-level education needed to effectively care for LGBTQ+ patients well into their twilight years.
Senior housing refers to any sort of housing specifically created to meet the needs of aging adults. It can range from retirement communities designed for independent older adults to intensive memory care facilities for seniors with Alzheimer’s or dementia. Though there are over 19,000 senior living units in the United States, few of these facilities are welcoming to LGBTQ+ elders.
In senior housing facilities of all types, LGBTQ+ seniors could potentially face discrimination or prejudice from fellow residents or from staff members, but there are many benefits of living in these communities. Primarily, there is a wealth of healthcare professionals who can provide care, guide treatment, and offer any extra support that may be needed. Even culturally competent, specialized family nurse practitioners can be an active part of these communities, able to diagnose the unique issues of residents, prescribe medications, educate residents about wellness, and help manage treatment plans — all in the comfort of home.
Nursing homes are a common housing situation for older adults; roughly 1.3 million seniors live in a nursing home, of which there are over 15,000 across the country. However, over 60% of LGBTQ+ adults are concerned about receiving care, believing that nursing homes and other long-term care facilities may provide limited care or refuse them outright.
Although anti-discrimination and LGBTQ+ inclusive policies can help ensure these facilities properly care for all of their patients, it comes down to individual caregivers and employees to provide adequate care. Inclusive adult-gerontology nurse practitioners and nurses, in particular, will be needed to work with elderly LGBTQ+ patients in nursing homes, assisted living facilities, and other long-term care facilities. Nurses and nurse practitioners who specialize in gerontology have the education necessary to provide care to aging patients and the up-to-date training to be supportive of all people, regardless of their gender identity or sexual orientation.
At-home care provides the benefits of medical care or extra assistance to individuals in the comfort of their own home. This is the preferred aging option for the overwhelming majority of seniors, as 90% of Americans over the age of 65 want to stay in their homes for as long as they can. Receiving care at home may be an attractive option for LGBTQ+ seniors, as it reduces the likelihood of experiencing discrimination or prejudice from other caregivers or employees at a facility.
Additionally, recent research indicates that at-home care is beneficial for patients who are struggling with mental and psychiatric illnesses. Because members of the LGBTQ+ community are more likely to experience these conditions, in-home care can prove highly valuable. An in-home caregiver can help with the execution of daily tasks, while a physician, mental health professional, or nurse practitioner who specializes in mental health can provide more support and help guide both daily and long-term treatment.
Long-Term Care Insurance
Long-term care insurance helps offset the costs of day-to-day care and typically covers services that aren’t covered by standard health insurance, such as routine daily activities. It’s beneficial for individuals who have a disability or chronic condition, but can also be costly. Long-term care insurance is usually valid wherever care is received, including in the home, at a retirement community, or in an assisted living facility.
Long-term care insurance may be particularly helpful for members of the LGBTQ+ community. More than 75% of LGBTQ+ seniors fear they won’t have the caregiving support they need as they get older; this is likely because LGBTQ+ individuals are more likely to be estranged from biological family members and have non-traditional familial structures. Long-term care insurance can ensure care for aging LGBTQ+ adults, regardless of their family situation.
General Resources for the LGBTQ+ Community
For further reading and information on aging and the LGBTQ+ community, consult the following organizations and resources:
- Advocacy and Services for LGBT Elders (SAGE): SAGE is a non-profit organization that advocates for LGBTQ+ seniors and demonstrates for LGBTQ+ rights.
- Gay & Lesbian Association of Retiring Persons (GLARP): This organization provides a voice to the issues of the aging LGBTQ+ community and provides a network for them to connect with each other.
- Human Rights Campaign (HRC): HRC is one of the largest LGBTQ+ organizations in the world. It fights for the basic human rights of LGBTQ+ individuals.
- Lambda Legal: This non-profit group fights for the civil rights of the LGBTQ+ community through “impact litigation, education, and public policy work.”
- The LGBT Aging Issues Network (LAIN): LAIN raises awareness about issues facing the aging LGBTQ+ community and the challenges they face when gaining access to housing, healthcare, and long-term care.
- The LGBT Aging Project: This non-profit group works to ensure that older LGBTQ+ adults can access the “life-prolonging benefits, protections, services and institutions” as equally and easily as their heterosexual and cisgender peers.
- The National Resource on LGBT Aging: A project of SAGE, this resource center provides training, technical assistance, and educational materials to healthcare providers, LGBTQ+ organizations, and older LGBTQ+ adults.
- Old Lesbians Organizing for Change: This organization works to improve the visibility of aging lesbians and helps connect older lesbians with each other for support and friendship.
- Parents, Family, and Friends of Lesbians and Gays (PFLAG): This non-profit organization is comprised of both LGBTQ+ individuals and their loved ones to show support and advocate for this community.
- Prime Timers Worldwide: This group helps mature gay and bisexual men connect with each other for “friendship, activities, support, and personal growth” and works to create a world that is accepting of all forms of human diversity.