Beyond Age Discrimination

Sexual Orientation

Comments from Barbara Satin, a Transgender Activist

From the Rights Stuff Newsletter, July 2009

In a series of interviews, Minnesotans offer their perspectives and experiences on issues facing older Americans seeking care with dignity and respect for their individuality, cultural identity and human rights.

Comments from Barbara Satin

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Question: What are the expectations of members of the GLBT (Gay, Lesbian, Bisexual and Transgender) community as they think about growing older and possibly finding themselves in a nursing home or otherwise dependent upon others for care?

Barbara SatinIf you go back in history, it was significantly worse for the GLBT community then, than it is today. So many people, as they have aged, have gone through some really difficult times as gay and lesbian, bisexual and transgender individuals. That has shaped their expectation of how they are going to be treated when they need to depend on other people for senior care services, healthcare, a nursing home, or even medical care. Their expectation is that they are going to receive that same kind of inappropriate behavior or discriminatory behavior.

Question: Is that expectation or fear of discrimination realistic?

It has been. It’s changing. And part of what I and an organization called GLBT Generations do is to work with senior care providers and educate them around the issues that GLBT people face as they age—trying to help develop an environment where senior care providers are sensitive to the issues, and, hopefully, are willing to modify their services or train their staff to be sensitive. That’s slowly beginning to happen.

You really have two things going on. We have the old GLBT generation that is currently looking at services, and these are the ones who for the most part are apprehensive about how they’re going to be treated if people know that they are G, L, B or T. We did a survey about four years ago among the Twin Cities GLBT community, and 95 percent of the respondents said their expectation is that they’re not going to be treated well by service providers. What’s interesting is that 95 percent of them also said they want to access these services.

The other thing is that since 1993, Minnesota has had a Human Rights Act that protects GLBT people. So for 16 years, we’ve had a large segment of all our community that has lived knowing that they have rights, and that they need to affirm those rights. So the new generation, the baby boomers coming through beginning now, are coming through with a whole different attitude. Their expectation is that we need services, and we expect that we will be treated appropriately. And if we aren’t we will do what we need to do to make sure that we are treated right. There is a whole different mindset among a younger aging population that is going to be far more—I won’t say militant—but affirmative in the way in which they push for receiving services.

Question: When you talk about the older generation being afraid they won’t be treated well, what does that mean? What is it that they fear?

That they’re going to be judged by care providers, that they’re going to be lectured about what some people would call their lifestyle, their choices. That they may not receive treatment to the full extent—they may feel that the service provider is shortchanging them because they are G, L, B or T. They may find that service providers will say that we don’t want to provide services to you. Or they may find that while management may say that we serve all, staff may for a variety of reasons —not the least of which would be religious convictions—have some real problems in providing home care, or Meals on Wheels, or even treating someone in a doctor’s office, who is GLBT, with appropriate respect.

Question: Do you see evidence that older people in the GLBT community, who are seeking services, aren’t being treated with appropriate respect now?

I think things have improved dramatically.

Question: What do you make of the fact that agencies charged with handling complaints about health care and related services for seniors report few complaints about mistreatment and sexual orientation?

There are not a lot of situations that get to that point. In many cases, GLBT old people will not identify as G, L, B or T, because of the expectation that they’re not going to be treated appropriately. So if they can fly under the radar, access services without identifying their sexual orientation, many of them want to do that, rather than run a risk. On the other hand, when somebody does provide services that aren’t appropriate, it may well be that GLBT people will not come forward, because it requires them to identify further.

A lot of the current old are hesitant to even venture out as GLBT people when they access services. They’ll stay isolated until something turns into a traumatic situation. Where people under other circumstances would probably just go to the doctor, when you’re GLB or T, you may stay away simply because you don’t want to run the risk of somebody identifying you, or you having to do something to identify yourself as a different sexual orientation or gender identity.

Question: Have you heard of cases in which a service provider has refused to provide services to a person because of that person’s sexual orientation?

Yes. That happens. I have to say that as churches work harder in becoming welcoming to a wide variety of congregants, whether it’s around race or other cultural identities, many also have become far more willing to at least explore what it means to be welcoming to GLBT people. But there are still a number of churches and denominations that believe that who we are is sinful. And they not only hate the sin, in many cases they hate the sinner.

Question: As we think about nursing homes, assisted living facilities, home health care, and other services that GLBT seniors might need, are some of these services more problematic than others?

I think nursing homes and assisted living facilities are more problematic, simply because you are so dependent on others for your care in those settings. At least in home care, it’s your home, and you’re in effect inviting somebody in to provide you with services in your setting. But that also has its problems—somebody can come in who is not comfortable dealing with you, and then you’re in a situation of having to say you no longer want those services.

I can give you one iconic example. I am a member of a church in Minneapolis called Spirit of the Lakes, and one of our members was a transgender woman who on a Sunday evening suffered a stroke at her home. In going to Hennepin County Medical Center, and then to the VA Hospital for services, and then to a nursing home for recovery, basically she was told that they wanted not Gale, but Glenn. They wanted to treat the person of masculine identity, even though this was a transgender woman.

People have raised the issue: we have a Human Rights Act in Minnesota—why didn’t he push for appropriate treatment? Well, when you’re facing a life threatening situation, and you’ve got people who are willing to help you under certain circumstances, you’re probably going to give in to those circumstances, even though they may not be what in a normal situation you’d agree to.
The trans community is probably the more challenged one of the four (gay, lesbian, bisexual and transgender). Because for many in the transgender community, you’re talking about a presentation that can’t be denied. If you’re gay, lesbian or bisexual you can sort of fly under the radar if you want to.

Question: What do you see happening as those in the GLBT community who have grown up in a new era begin to enter nursing homes, or seek other senior care services? Do you foresee a confrontation as they demand appropriate care?

I would hope that’s not what’s going to happen. I would think that senior care providers are going to see that the GLBT community is a substantive market, and many of them are going to want to be part of that, and have that clientele as part of their service.

We have seen a change in society around people’s understanding of sexual orientation and of gender identity. So now, we’re not dealing in most cases with people who have no understanding of who we are as a community. They just don’t know how to reach out, and how to establish their credibility. They may want to serve, but they’re not sure how to get people to accept the fact that they would be getting good, appropriate services. That’s one of the things that GLBT Generations has worked on. We’ve developed a curriculum, in collaboration with the Metropolitan Area Agency on Aging, the Department of Human Services and the state of Minnesota, that is available to senior care providers.

Question: When you talk about the need to educate service providers, what is it that they need to know that a lot of them don’t seem to know now?

In many cases they need to understand that the traditional family situation may not be in place, that there is a partner rather than a wife or a husband, and that the decision-making may be coming from a partner of 25 or 30 years. That there is this underlying fear that many have that they’re not going to be treated appropriately, that they’re going to be put in situations where the climate is "hetero-sexist"—where everything is sort of straight, so that even the application forms may not indicate that the service provider is aware of the fact that there may be a partner, rather than a husband and wife.

Question: Are we finding that increasingly, same-sex partners are getting the rights and recognition that would be given to a spouse, with respect to visitation, decision-making and other issues?

It is changing. And I’m thrilled about that—not too many years ago that it just was completely the opposite.

Now, in most hospital settings in the Twin Cities, immediate family would include a partner. So if someone had to go into an intensive care unit, a partner would be allowed to be a part of that. I think it’s happened in the Twin Cities simply because we have a relatively strong, vibrant and large GLBT population, and people have just become aware of it, and comfortable with being open to our community.

Question: Nursing homes may often have staff who may come from other places and other cultures, cultures that may not always understand sexual orientation and gender in the same way. How does this affect things?

You get at that through education and training, but also through the commitment of management. You can do all sorts of training of staff, but if management is not committed to what we’re trying to accomplish, you’re going to end up with situations where a staff worker may do something inappropriate, because they don’t believe or agree that this (GLBT) person is deserving of appropriate treatment.

There is also another side of this: particularly when you’re dealing with nursing homes and assisted living facilities, oftentimes the clients themselves are pretty homophobic or transphobic. That is another issue. And how that’s handled will be critical to how the GLBT client feels about their treatment.

One of the things we’re trying to develop at GLBT Generations is some form of seal of approval, a "lavender label" for senior care providers who have gone through the training that we’ve developed, or other trainings that are appropriate. They can use that as a marketing tool to market to the GLBT community; we can use it as a way to provide information to members of our community, or their relatives, who are looking for appropriate care. We can say, here are a list of nursing homes that are lavender labeled providers, or home care providers who have gone through the lavender label program. That’s not in place yet; we’re hoping to get there over the next year or year and a half. We don’t expect that all care providers are going to be flocking to get a "lavender label," but some will. And that’s important.

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