LGBTQ+ aging and care managers

There is a potential synergy between Aging Life Care Managers® and the LGBTQ+ community. This is an underserved population that needs advocacy and referral support. According to SAGE USA, a national LGBTQ+ advocacy group:

  • By 2030 there will likely be 7 million LGBTQ+ adults who are 50 years old or older.
  • A sizable number of older LGBTQ+ adults fear they will be harassed or receive substandard care in medical settings. (In the United States, 40% of homosexual and bisexual people do not disclose their sexual orientation; 46% of trans people do not disclose their gender identity, and 23% of trans people simply avoid going to the doctor altogether.)
  • Many in the LGBTQ+ community do not partake of eldercare services (senior center activities, congregate meals) for fear they would not be welcomed.
  • Many are concerned that independent living, retirement, and assisted living communities will not be accepting of them and their same-sex partners.

Despite major cultural changes, LGBTQ+ older adults feel the pressure to go back into the closet and hide who they are again. This is both demoralizing and unhealthy.

Demographically, older members of this community are:

  • Four times as likely to be without children
  • Twice as likely to be without a spouse
  • More likely to serve as a caregiver for friends (21% have done so, compared with only 6% of non-LGBTQ+ people)
  • More educated than their heterosexual peers (67% graduated college vs. 59% among those ages 50–64, 71% vs. 57% among those age 65 and older)
  • Relatively secure financially (nearly one third—31%—reported annual incomes of $100,000 or more during their working years)
  • More likely to be gay men (52%). Lesbians in this generation seem to make up only 33% of the community. Bisexuals only 15% (not separated by gender in this sexual orientation study).

Many similarities to solo agers
With so many who are child free and many who are estranged from their families of origin, the LGBTQ+ community shares some of the same attributes and needs as solo agers:

  • Their primary support community is dwindling because peers are coping with their own aging issues.
  • They need to proactively plan for decision makers and care when they are no longer able to provide it themselves.
  • They often have a greater awareness of their needs, because they either provided care for their own parents or have been providing care for peers.
  • With more education and fewer facing the demands of child rearing, as with the heterosexual population, many were able to devote their time and resources to greater career development and a more substantial financial base.

Special care needs of LGBTQ+ clients
Looking at the current generation of older adults in the LGBTQ+ community (essentially boomers), many came of age with the Gay Pride movement. They have seen profound changes, from federal protection of same-sex marriage to increasing acceptance of sexual orientation and gender fluidity. They may have become estranged from their birth families, but they have created a “family of choice” with other LGBTQ+ persons. They have lived a rich life of belonging.

As we know, though, aging brings challenges. Peers may not be able to be the source of support they once were. Here’s how you, as a care manager, can help:

  • Develop a network of affirming professionals to assist with legal needs
    • Healthcare power of attorney
    • Durable power of attorney
    • Perhaps a trust to manage finances before they die
    • A trust and/or will to arrange for the disbursement of assets after death
  • Awareness about protecting same-sex partners. Although those that are married will have the same legal rights as heterosexual married spouses, there are still other factors to address that will protect spouses.
    • Working with Social Security to be sure spouses get the benefits coming to them (as partners and also as survivors after death)
    • Making sure other paperwork is in order: The deed on the house. Named beneficiaries of bank accounts and investments. Insurance coverage (e.g., Medicare, life insurance, long-term care insurance). Pension and survivor benefits.
  • Fighting isolation. Nearly six out of ten (58%) of LGBTQ+ elders report feeling isolated from others. The pressure to go back in the closet becomes more pronounced with aging. While younger generations in the LGBTQ+ community are welcoming, when gay or trans individuals start doing more with their agemates, they are exposed to a generation that was not raised with the same tolerance. LGBTQ+ elders face the same issues as all older adults, but with a more constricted pool of accepting options.
  • Understanding medical needs. Depression is higher overall for the LGBTQ+ community, as is suicidality (39% have suicidal thoughts). HIV and HPV are big health issues among gay and trans men. (Half of the people living with HIV are individuals age 50 and older). Trans individuals need providers who will respect their decisions: From doctors who are staying current on emerging issues in long-term hormone usage, to home care and skilled nursing staff who will remain professional if they need to provide incontinence care to individuals who have not undergone surgical transition.

As a care manager, you can offer a tremendous amount of support and advocacy tailored to this community’s unique needs.

The business advantages
As with any niche market, once you become known as the local LGBTQ+ expert, you will be in demand because the LGBTQ+ community is highly networked and always looking for affirming professionals. This also gives you an opportunity to present yourself as unique to professionals in your area, especially if you practice in a market with many competing care managers.

For example
Mir Senior Care Management and Care Consultants serving south and central Texas. Mir has been quite outspoken in their service area, providing staff training for LTCs, home-care companies, and other eldercare providers. They collaborate with ALFs to assist with staff training and transition for new LGBTQ+ residents. Mir has chosen to become SAGE-certified at the silver level, which provides them their own staff training, as well as support for modifying office forms and procedures. They are active participants in the Austin LGBT Coalition on Aging and are frequently called to serve on local panels. Their high visibility has gained them referrals they might not otherwise have gotten and has established them in a thriving network of referrers.

How to make sure you telegraph your inclusiveness
Your commitment, of course, needs to be genuine. Having LGBTQ+ members on your staff says a lot. But you can also do the following:

  • Put the rainbow flag, or better yet the Intersex-Inclusive Progress Pride Flag (above), on your website, brochure, and other marketing collateral.
  • List pronouns in the signature of company emails.
  • Ask about pronouns and same-sex partner information during intake. Also include “sex at birth,” “gender identity,” and “sexual preference” as questions in your charting.
  • Take the SAGE USA training and incorporate their suggestions for business processes. Display their certification badge on your marketing collateral.
  • Participate in Pride activities in June.
  • Give presentations locally about LGBTQ+ aging.

Would you like help promoting your services to the LGBTQ+ community?
Pride Month is coming up in June. Now is a great time to prepare for presentations.

Care managers who license our Aging Well Blog can also license our LGBTQ+ marketing package.

  • A PowerPoint presentation
  • A branded handout discussing changing support needs, protecting your partnership, and the needs of trans individuals
  • A promotional blog or email for letting others know about your upcoming presentation
  • Text and graphics for six social media updates about your presentation
  • A presentation planning timeline
  • A signup sheet for collecting email addresses at the door. (The true power of a presentation is the ability to get email addresses and then follow up with tailored engagement, affirming the ways you can help, in this case, LGBTQ+ individuals, with planning for their aging needs.)

Check to see if your territory is available!

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