Cheri Callanan, Community Education Specialist with the LGBT Aging Project, recently presented to staff at North Shore Elder Services in response to their concerns with collecting sexual orientation and gender identity (SO/GI) data. The addition of three questions to the case management assessment tool is as a result of the Executive Office of Elder Affairs, the Executive Office of Health & Human Services, and the Department of Housing & Community Development being directed to collect voluntary, confidential sexual orientation and gender identity data as a standard practice. Gathering this sensitive information can be difficult and Cheri provided this training to help in how our direct care staff can approach these changes.
It was in 2001 that the LGBT Aging Project began. Before this time period, LGBT issues were not on the radar screen of Elder Services and elder issues were not on the LGBT radar screen. As a result, LGBT older adults were being overlooked. The Aging Project’s mission became to ensure that all LGBT older adults and caregivers “have equal access to the life-prolonging benefits, protections, services, and institutions that their neighbors take for granted so that they can grow older with the dignity and respect they deserve. Our goal is not to develop a separate service network for LGBT older adults but to be catalysts of change to make the existing system inclusive of all older adults and caregivers.”
Today our best guesstimate puts the number of LGBT older adults in the United States at 1.4 – 3.8 million but the data collection is inadequate. That is why those new questions on the assessment tool are being asked. In order to ensure that the entire elder service network is safe, welcoming and inclusive for all older adults and their caregivers, we need to be able to identify the population and what the needs are. LGBT elders have faced a lifetime of discrimination and have been invisible in aging service demographics. Accurate data collection will promote development of programs and services for the LGBT population.
The challenges for LGBT older adults are many. Cheri discussed how in thirty-two states there are no laws prohibiting discrimination based on sexual orientation, leaving people vulnerable to firing if they disclose their status. A history of discrimination leaves many LGBT older adults with a general distrust of mainstream institutions. Findings from 2011 indicate that twenty-one percent do not disclose their sexual orientation or gender identity to their physician. The consequence of distrust is that the LGBT person becomes invisible in order to cope. Their circle of support dwindles.
Cheri encouraged the participating staff to find their own style in asking the questions on the assessment tool, reminding all that they are already gathering sensitive information (topics such as incontinence, finances, and dementia) in a compassionate way. If you are comfortable and matter of fact, the more comfortable the elder will be answering honestly. The role of the direct care staff is to make the consumer feel valued and safe so it is critical to be unbiased and non-judgmental.
In asking the questions, there are helpful recommendations in the approach. Explaining that these are questions that you are having to ask of everyone and that it is an attempt to learn as much about each client to provide the best possible care plan, may help ease the discomfort for all. All clients should be informed that they can choose to not answer and that the information is confidential.
You can refer to the document prepared by the Fenway Institute and LGBT Aging Project to learn more about the collection of sexual orientation and gender identity data by clicking on the link,
There are also new fact sheets that can help consumers learn how recent developments may have changed Medicare and Medicaid, whether they are LGBT individuals married to someone of the same sex, or transgender individuals needing to access health care. Medicare has begun covering Gender Reassignment Surgery and issued new rules that protect transgender older adults from sex discrimination in healthcare. These fact sheets were produced in partnership with SAGE (Services & Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders), the SHIP National Network (State Health Insurance Assistance Programs), and Administration for Community Living (ACL).
The three fact sheets are;
- Medicare Changes for Transgender Older Adults
- Marriage, Medicare, and Medicaid: What Same-Sex Couples Need to Know
- Accessing Information on Medicare Benefits for LGBT People
All are available for download at the National Resource Center for LGBT Aging at the National Resource Center for LGBT Aging
Cheri Callanan is available for training sessions and to address questions and concerns. She can be reached at firstname.lastname@example.org or at 617-927-6462.