Comments from Phil Duran, the Staff Attorney from OutFront, Minnesota
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.
Forum Links | ViewPoints
Introduction & Overview
Question: What are the most important issues confronting the GLBT community as GLBT people get older?
Before we get to that—there is a huge generational difference in terms of approach to their own lives and their own expectations. Many of the people who are currently GLBT senior citizens are people who came of age in the 50s or early 60s, an era where being gay was understood in such phenomenally different terms—where hiding was not merely a choice, but the only obvious choice. Later generations have obviously grown up with some very different expectations. But many GLBT senior citizens right now approach an issue or a concern with a default assumption of, "I have to just suck it up, because if I come out, it will just make things worse."
If I’m just coming out now at 60, for example, have I been married all this time? Have I got a spouse? Have I got kids? Grandkids? If I have kids or grandkids, what does it mean if I come out to them? Am I afraid of losing my children, my grandchildren? If you’ve got 60 years of hiding and you perceive rightly or wrongly that you’re putting your relationship with your kids and your grandkids at risk, what’s the choice you’re going to make?
One of the obvious issues that virtually any older person is going to deal with is health care. For example, in home health-care situations, you’ve got an agency who’s sending a nurse or an aid into a person’s home to provide care for them. Many older GLBT people are afraid that if they have pictures of their partner on the shelf, or if they have books that relate to the GLBT community, the aid will refuse to provide care, or will mistreat them in their own home. So they’ll go to some lengths to hide their identity as GLBT people, so as not to jeopardize the care that they need. There is a perceived need of having to choose: am I "out," or am I going to get care?
Question: Is there reason to
believe that this fear is that realistic—that care providers might
refuse to provide care for individuals who acknowledge that
they are GLBT?
Yes. There have been anecdotal situations where GLBT people have had that exact experience. It’s a very delicate situation—some of these home health care aides come from other cultures where there is no background with GLBT people, or to the extent that there is, it’s not a positive one. So you put these individuals together in this situation, and there is a tremendous concern about how that’s going to play out.
And when you get into institutional settings, again, there is tremendous fear. If you’re in a nursing home, for example, is your partner going to be able to visit? Your partner is not "family." If there is a crisis or concern, this person is not viewed as your family member because there is not a blood, marriage, or adoption tie.
Question: Despite protections against discrimination under state and federal law, it appears that there are very few complaints filed by older GLBT individuals over treatment received in nursing homes, or in any other healthcare situation. Does that surprise you?
What is the person going to do? If you’re sitting in a nursing home and you are feeling very vulnerable and dependent on these people, are you going to sit there in your hospital bed with tubes sticking out of your arms and say, "Hey, I’m gay, you need to treat me better." Or are you going to suck it up? And a person in their 80s who has grown up in that era may not even be willing to articulate that there is a problem.
Question: Have cases come to your attention in which seniors have been abused or mistreated because of their sexual orientation or gender identity, in health care settings?
Yes. And one of the things that we find frequently in GLBT people, regardless of age, is that there are always going to be people who will experience a problem, and not want to pursue it. On some level, there is an expectation that they’re going to be discriminated against, or even if it’s not precisely a Human Rights Act violation—it may be a patient bill of rights issue. But frequently people in our community, for any number of reasons, are just willing to let it go. And I think older people are particularly susceptible to that kind of an approach.
Question: When GLBT people experience discrimination in a nursing home or other health care setting, what form is it likely to take?
It could be derisive comments. It could be that a provider will say, I don’t want to work with this person—either because "they’re gay, and I don’t like gay people," or "they’re gay, therefore they must have AIDS." There have been instances where people feel that the care that they’ve received is less than what their neighbor gets, because they are or seem to be gay, lesbian, bisexual or transgender. And that there are also situations, particularly with trans people, where there may be unique medical issues. They may be taking hormones, for example, as part of the transition process—but maintaining those prescriptions and getting those medications is seen as secondary, so there’s an uphill battle to deal with some of that. A lot of these things ultimately do get worked out, but it is obviously difficult for the GLBT person.
Question: How prevalent are situations in which a GLBT person living in a nursing home finds that other residents aren’t comfortable with their sexual orientation or identity?
Of course they (the other residents) grew up in the 50s and 60s also, with those kinds of attitudes, and may feel they don’t want a gay neighbor, roommate or whatever. But the reality is that a lot of GLBT people, if they’ve gotten to 80, are survivors. And this may be something they don’t really care about, something they may even have come to expect, sadly. We all deal with the idea that people may not particularly like us because of our sexual orientation or gender identity, and that’s par for the course. But it can lead to situations where again, the patient defaults to, "I can’t rock the boat. I can’t stand up for myself because I won’t have support among my peers, let alone support among the providers."