Alternative lifestyles in LTC.

Joy Lewis and her life-partner, Sheila Ortiz-Taylor, were allowed residency at a Tallahassee, Fla., retirement community, but only if they agreed to pose as sisters and not as an openly lesbian couple. In 2003 Lewis and Ortiz-Taylor sued and this year gained the right to move in as a couple.

"We're happy with the outcome," Ortiz-Taylor said of the settlement she and Lewis reached with the Tallahassee facility. "(The facility) agreed to 'clarify' its position (on) unmarried couples in stable relationships and intends to treat them the same as married couples," Ortiz-Taylor said. "So our case had national implications, a fact that pleases us."

The facility declined to comment.

While the couple is "quite serious" about moving into the Tallahassee facility, which Ortiz-Taylor called "the finest place in the city," the women have placed their names on a waiting list for the forthcoming Rainbow Vision Properties in Santa Fe, N.M.

"We like to have options," Ortiz-Taylor said. "What we ultimately do will depend on finances, health, and our five children."

Despite the legal battle, Lewis and Ortiz-Taylor have had more success than most lesbian, gay, bisexual and transgender (LGBT) people looking for same-sex housing in conventional retirement communities. Amber Hollibaugh, director of education and advocacy Senior Action in a Gay Environment (SAGE) in New York City, said facilities need to be prepared for a changing environment.

"Whether you've seen many openly LGBT persons--elders or not to this point--you're going to see a whole lot of them in the next 10 years," she said. "So, however uncomfortable you are with this, you're going to have to realize that this is a profoundly important category of elder (resident) that you'll be serving. Therefore, you'll need to understand who this population is so you can serve them well."

Here, there, everywhere ...

Experts estimate that roughly 7 percent of Americans age 65 or older are among the LGBT group. That's 2.5 million of the 36 million seniors cited in the July 2003 U.S. Census Bureau figures. Using the bureau's projection of an additional 30 percent in the number of seniors by 2030, when the last of the 78-million-member baby boomer crowd turns 65, that 7 percent figure would mean nearly 3.3 million LGBTs.

Yet, the 7 percent figure might be low. "The current generation of elders came of age when there was so much discrimination that they don't want to be counted," said Lisa Krinsky, director of the LGBT Aging Project in Jamaica Plain, Mass. "These older folks grew up when there was the potential to be arrested, to lose or not get a job, to not get housing, or even end up in a mental institution. A lot of them are going to fly off the radar screen."

Because LGBT baby boomers have spent their lives in the open, they're going to be open about their sexuality as they age and go into institutions, Hollibaugh said. "It's not going to be a quiet homosexual in a bed," she said. "It's going to be five guys who set up the first Old Gays Club at the nursing home."

Even so, change won't be quite so simple. Understanding how to contend with the senior LGBT contingent begins with acknowledging the emotional baggage they carry.

For starters, elder LGBTs feel ignored, Hollibaugh said. Many Depression-era or older LGBTs who stayed in hiding for fear of public reprisal are stuck in "invisible" status, Hollibaugh noted. "In the world of senior and gerontological policies and services, there's very little recognition that LGBT seniors even exist," she said. "Ask some doctors about LGBTs needing senior care and they'll tell you there are no LGBT elders--only persons 'suffering from dementia that causes same-sex behavior.'"

Andrew Shippy, associate researcher with Pride Senior Network in New York City, cited a SAGE survey, which found that physicians and medical students were routinely aware of substandard care or of care denied to LGBTs A second study indicated near, half of New York's Area Agencies or Aging would not welcome LGBTs at senior centers if their sexual orientation were known, Shippy said.

"These people are scared to death to go into a nursing home for fear of being exposed," said Loree Cook-Daniels founder of the Transgender Aging Network Glendale, Wis. "They don't want the disruption in their lives

Elderly LGBTs fear they'll have no one to relate to at traditional long term care facilities.

Joy Silver, president of Rainbow Vision Properties in Santa Fe, N.M., which markets to the LGBT community, recalled an 81-year-old lesbian who moved to an assisted living facility after net longtime relationship ended. "When she first walked into that retirement center, she cried because she didn't see one person like her," Silver said t wasn't just because no one else there was gay. The atmosphere was too old-fashioned for her. It was like they were handing her Knitting needles when she wanted to go to a dance."

Depression often becomes a major issue, Hollibaugh added. explaining that some residents tell friends and lovers not to visit and they hide anything that would expose their or orientation. "What happens is they give up--they're living completely isolated lives in institutions and can't bear it," she said. "And they just ... waste away."

LGBTs can also be taken advantage of by staff or other residents their secret becomes known. Shippy said a classic example is that of the health care worker who threatened to "out" the resident if he complained about her failure to properly do her job.

"We are talking about a generation of eiders who risked losing everything if they were open," Hollibaugh said. "If that's your history of being an LGBT, your trust in institutional safety is going to be very lacking. The chance of you demanding respect for your identity is very unlikely."

Cook-Daniels warned that legal battles such as with Lewis/Ortiz-Taylor mark the start of a trend of which long term care facilities should be aware. "The leading edge of the gay activists have spent their lives fighting for gay rights. Chances are they're not going to quit when they start getting into the retirement homes," she said. "You're going to have more of that population coming through that won't play any games."

Social issues involved when dealing with LGBTs range from the classic example of the woman no one would bathe because she was lesbian, to the question of what rights LGBT persons should have to freely express themselves. But nothing causes a bigger community ripple than sexual relations, according to Tarynn Witten, executive director of the TranScience Research Institute in Richmond, Va.

Most--but not all--long term care facilities frown on the idea of relations between any residents, gay or straight. Some allow straight married coupes to share a room or live in adjacent quarters. But most nursing homes and elder care facilities don't have a clue how to deal with the concept of same-sex intimate relations, Witten stressed.

"There's a general idea that sexuality is no longer an issue with old people," Witten said. "It does happen its not a lowed. Elder LGBTs are stigmatized more. Not only should they not be having sex, they should not be having it with same-sex people."

Facilities must also deal with the question of LGBTs' freedom of expression and what it means to be "open." Hollibaugh recalled a gay man who was "devastated" because he had to move into a long term care facility. The facility was OK with his sexual preference, but he had to give up wearing negligees while watching television. Hollibaugh said the issue was not whether the man could be gay, but what kind of gay he could be.

A lesbian who dresses like every other woman at her facility and doesn't discuss her sexuality will be more socially accepted than the woman who walks around in boxer shorts, Hollibaugh said. "The more 'normal'--meaning heterosexually identifiable--that you can be, the better," she said.

At The Village Nursing Home in Greenwich Village, N.Y., no one would blink an eye at a man wearing a dress, according to Arthur Webb, president and chief executive officer of Village Care of New York, VNH's parent company. Although exact numbers aren't known--the facility doesn't track such things--lesbians and gays do make up a significant portion of VNH's 200 residents, Webb said.

"We've created a work and care environment that is very open and diverse," Webb said. "We almost don't know or care whether someone is LGBT because we've essentially adopted the idea that everyone needs to be treated with respect and dignity."

Gay rights advocates note that much has happened in the past 35 years--from domestic partner acts in various states to gay marriage licenses in Massachusetts and attempts to permanently legalize or ban such unions on a national level. Public opinion on homosexuality has become increasingly less negative, with 60 percent of respondents to an April 2004 Los Angeles Times poll saying they were now sympathetic to the gay community, compared to 30 percent in 1985.

But when it comes to rights and attitudes toward LGBT elders, there's still progress to be made, according to Hollibaugh. "Certainly things are different than they were 20 years ago--there's no LGBT person who wouldn't say that," Hollibaugh said. "(But) it doesn't mean there's no more discrimination or stigma. Is it a perfect world? No. But it is a changed world."

Hollibaugh and other researchers and advocates noted how several decades ago, housing African-Americans and Caucasians in the same nursing home was unacceptable to residents and staff. That mix will soon include LGBT.

RELATED ARTICLE: Not so different.

It's not a question of if your facility will field questions about LGBT residents but when. In some respects, elder LGBTs are prime candidates for placement in long term care facilities.

Unlike mainstream elders, who can rely on spouses and family for care--often in their own homes--LGBTs typically lack this immediate support network. Two-thirds of gay and lesbian seniors live alone, about twice as many as the heterosexual senior population, according to Senior Action in a Gay Environment (SAGE) in New York City.

According to SAGE, 90 percent of gay and lesbian soldiers have no children, compared to 20 percent of heterosexual elders without children. And 80 percent of gay and lesbian seniors have no life-partner or significant other, compared to roughly one-third of straight seniors.

Family networks--or lack thereof--can cause legal difficulties for long term care facilities, particularly when same-sex relationships are involved. Because most same-sex marriages are not legally recognized--only 11 states plus the District of Columbia permitted or recognized such unions and the issue has been hotly debated at the Congressional level--a partner without power of attorney usually has no rights when it comes to making decisions such as whether to keep a dying resident on life support.

Instead, that decision defers to next of kin, however distant that relation might be, according to Vicki Schmall, president of Aging Concerns in West Linn, Ore.

This can mean a messy situation for tong term care facilities faced with partner's rights issues, said Arthur Webb, president and chief executive officer of Village Care of New York, the parent company for The Village Nursing Home in Greenwich Village, N.V. "When they don't have directives, they don't have health proxies [and] they don't have legal relationships," he said, "but the partnership has been there for many years in a wonderful loving relationship, it gets very tricky."

Facility staff make sure to talk to the partners and other loved ones or the extended support group about what is in the resident's best interest, according to Webb, "We don't necessarily get hung up because someone does not have a legal bases for making this decision," he said.

Webb added that the same-sex partner issue isn't very different from survivors' rights issues involving contemporary families, "More than half the people who come into these nursing homes don't have directives or proxies for guardianship," he said. "So you have the same set of issues: one daughter wants this done, another daughter wants that done. They both speak for their dad, We have to work through that situation in the same way as someone who's had a partner for many years and is at odds with the family."--AN

RELATED ARTICLE: Open to all.

If you've decided to accommodate openly gay, lesbian and transgender people in your facility, you have preparations to make. Your existing operational structure may not intentionally exclude LGBTs, but there could be problems that might result in a lawsuit--or at least give your facility a bad reputation among straight and LGBT communities.

Here are ways to make your facility more "demographically" friendly:

Do an aesthetic exam. Would an LGBT person feel comfortable in your facility? "Seeing some (religious iconography or family photos) is going to be pretty normal and acceptable," said Becca Calhoun, project manager at Rainbow Train in Seattle, But a diversity of images makes it more accessible.

Assess activities. Does your facility regularly observe or plan activities for special non-national holidays? "If they notice that the facility observes Black History Month, Women's History Month or Cinco de Mayo, they may see it as a place where in June they put up something because it's Gay Pride Month," said Lisa Krinsky, director of the LGBT Aging Project in Jamaica Plain, Mass. That says, "This is a place that recognizes different types of people who may or may not live here."

Check the fine print. Your facility's promotional literature may say all the right things--if your customers are straight. Include references to "life-partners" as well as married couples and remember to update written policies on items such as personal relationships, personal appearance and whether you recognize life-partners as next-of-kin.

Don't overdo it, warned Arthur Webb, president and chief executive officer of Village Care of New York, the parent to The Village Nursing Home in Greenwich Village, New York City. While its language is sensitive to its diverse clientelle, "we've tried to not make it so explicitly sensitive that it treats people differently."

Survey staff. Get feedback from staff and residents before you start inviting LGBTs. A predominantly hostile environment is not a place anyone wants to move into, Positive feedback is an additional selling point with prospective newcomers.

--AN