Outing the Issue.
Long-term care has come a long way from the drab, institutional settings of the 1960s, when residents literally waited to die in facilities not designed to provide an inspirational. environment. Today's new and improved facilities rush to meet residents' needs, celebrating their individuality through specially designed activities. Homes are beautifully decorated and staff are trained to make the facility feel welcoming to new residents.
Well, at least for most residents.
Admissions questions asking a male resident about his wife and children; pictures on the wall showing only malefemale couples; a woman's lesbian partner questioned about her relationship to the resident when she visits; staff not trained to handle gender-variant residents; and the possibility of abuse and discrimination--all these factors can lead a lesbian, gay, bisexual or transgender (LGBT) resident of a long-term care facility to feel depressed, isolated, unappreciated and unacknowledged. So says Sandy Warshaw, director of policy and education of Senior Action in a Gay Environment (SAGE), the nation's oldest and largest advocacy organization for LGBT seniors.
"Even when a place is not openly homophobic, everything you see as you go into most nursing homes comes from a heterosexist bias."
Adds David S. Buckel, senior staff attorney for the Lambda Legal Defense & Education Fund, which provides legal assistance to members of the gay community, "The last of all boxes in the closet that gay people have been forced into is the one containing senior issues."
Many facilities are probably not deliberately ignoring the needs of current or potential gay and lesbian residents. As Rev. Ken South, an aging-initiative fellow with the Policy Institute of the National Gay and Lesbian Task Force, explains, many seniors in their seventies and eighties in long-term care facilities today are not interested in being out "A lot of facilities will rightly say, 'Well, I've never had a gay senior callus, send us a letter or ask us for a service. I don't think we have any.' They do have gay and lesbian clients, who are very proud of the fact that they can 'pass,' because that is how they learned to survive."
Once Again, the Boomers Change Everything
As the baby boomers age, gays and lesbians who have been out most of their adult lives will increasingly refuse to hide their identities, such as in circumstances where a facility's policy bars them from living with their lifetime partners, suggests Lambda Legal's Buckel, who is looking at legal challenges to such policies.
"LGBT seniors, like all seniors, often need to turn to mementos, friends and family to enrich their final years, but that can't happen in facilities where it is scary to have photos oflifetime partners on the bureau, and where lifetime partners are barred from living with each other or having the visitation privileges of spouses."
These concerns have led to calls for the development of long-term care facilities and retirement communities specifically designed and marketed for gay and lesbian residents. Plans for such facilities have been proposed for many areas of the country, although perhaps the only project already constructed is the Palms of Manasota (Figure 1).
"It's a community that is caring, safe and supportive of gays and lesbians," explains Val Filipski, director of sales and marketing and a resident of the Palms. "People are free to be who they are here. They are free to walk hand in hand down the street and cuddle under the stars without the stares, snide remarks and comments to which we are frequently subjected."
Recently completed phase one has 21 single-family, independent living homes priced from $130,000 to 200,000. To allow residents to age in place, the homes have wider doorways, sliding pocket doors, no stairs and can be adapted for handicapped accessibility. The next phase will add independent living villas or town homes costing about $144,900 to 149,900. Filipski says an assisted living facility is planned and a market study is under way.
While the Palms is open to any resident who wishes to live there, it is marketed specifically for gays and lesbians because "straight people have unlimited options," Filipski notes. She adds that the larger heterosexual community has accepted the Palms because it has raised surrounding property values and "we're active in the community. We don't just stay in our little enclave."
Besides scattered trailer park and prefabricated home retirement communities, there don't appear to be many gay and lesbian retirement communities--or facilities for that matter--other than the Palms. However, many projects are planned. One that is close to groundbreaking (scheduled for November) is Arbours Cathedral City, developed by the Arbours Development Group, Inc. (Figure 2). John DeLeo, president, CEO and chairman of Arbours, notes, however, "Although we are catering to the gay and lesbian population in relation to their lifestyle and personal care needs, this facility will be an open facility and inclusive of all folks who would like to live there."
Located in Cathedral City, California, the facility will have 130,000 square feet of commercial space (retail, restaurants, etc.) and 40,000 square feet of office space (some reserved for medical use), in addition to a variety of units, including independent living and assisted living units, units for the infirm elderly and for those with dementia, and time-share "condo-hotel" units for people of any age.
The latter types of units allow Cathedral City to be an "intergenerational community," DeLeo says.
"An intergenerational living environment creates the real dynamics of a family," says Dr. Stephen Karpiak, executive director of Pride Senior Network, which assists aging LGBT seniors. As Dr. Karpiak indicates, gay men and lesbians might be alienated from their biologic families and might not have children of their own. Thus, an "intergenerational" atmosphere allows gays and lesbians to rely on each other--young and old--as they commonly do in the community at large.
Besides being "intergenerational," Cathedral City will offer services that DeLeo believes are specifically designed with gays and lesbians in mind: "Residents' option for eating will start at 5:30 at night and will probably extend to 10 p.m. to reflect the traditional lifestyle of gays and lesbians," who, according to DeLeo, tend to have later mealtimes. Medical consultants will be available for gay men with HIV, and gynecologic services will be provided for lesbians. Add those features to the promise of an open, accepting and affirming community, and you get a community ready to capitalize on what Arbours' Chief Operating Officer Jeffrey Dillon sees as a huge market.
"Research presented in the National Gay and Lesbian Task Force's Outing Age report suggests that there could have been 2.8 million gay men and lesbians age 65 and older in the United States in 1999. We [Arbours] took that number and overlayed U.S. Census data and came up with a figure indicating that in the next 20 years, there will be a net buildable demand of 66,000 units of housing for this community, and 6,000 more each year for the next 20 years."
Assistance Is Available
Certainly, some gays and lesbians will find living in a community designed especially for and marketed to them to be an attractive option for their golden years, but it won't solve all gay seniors' needs for senior housing.
"It's not the answer, but an answer," says the Task Force's Rev. South. For example, cost is certainly an issue--like the rest of the population, many gays and lesbians cannot afford high-priced retirement communities/long-term care facilities such as the Palms and Cathedral City. Even if they have the money, gay and lesbian seniors might not choose to live in such a community: "Many people in their seventies and eighties right now don't want to go near a place called 'Rainbow Gardens,' because they haven't lived their lives that way," says Rev. South. Gay and lesbian seniors have straight friends, family members and coworkers, and might not want to live in an exclusively gay facility, he adds.
Dr. Karpiak of Pride Senior Network, however, points out that a person's attitude might change over time. "When a gay person is in good health, generally speaking, he might not be thinking that he wants to go into a healthcare facility that is exclusively gay. But, as one becomes frail and life becomes more difficult, I think one begins to consider the possibility more seriously, because the last thing one wants is not to be in an affirming, comfortable or safe environment."
There's plenty that current long-term care facilities can do to make their gay, lesbian, bisexual and transgender residents feel welcome. SAGE's Warshaw suggests that facilities develop statements of nondiscrimination that include sexual orientation. In fact, Marianna Grachek, executive director for long-term care and assisted living at the Joint Commission on Accreditation of Healthcare Organizations, says language to include sexual orientation in its nondiscrimination standard is expected to be included, pending committee approval, in the next edition of the Comprehensive Accreditation Manual for Long Term Care to be released this fall.
Other suggestions Warshaw offers include:
* hanging pictures showing same-sex couples together or a group of men or women in a park setting
* asking "questions on the intake interview that don't assume a person is part of a heterosexual family experience" by using terms such as "partner" instead of "husband" or "wife"
* training staff to be culturally aware and sensitive of the needs of LGBT seniors
* providing private rooms for gay and lesbian couples if they are made available for straight couples
* incorporating "gay pride" activities into events that celebrate the facility's diversity
Many groups are eager to help existing facilities with these issues. Sarah Greene Burger, a consultant with and former interim executive director of the National Citizens' Coalition for Nursing Home Reform (NCCNHR), says NCCNHR can help administrators connect with practitioners and researchers with expertise in aging and sexuality. The National Gay and Lesbian Task Force offers the 145-page report Outing Age: Public Policy Issues Affecting Gay, Lesbian, Bisexual and Transgender Elders. In fact, the Task Force's Rev. South, one of the report's authors, points out that "It is very important for administrators to understand that LGBT client issues are a part of cultural competency. LGBT culture--family, relationships, friendships, philosophy, sex roles, etc.--is the issue. Human sexuality is part of this discussion, but in my mind, and with many others, same-sex sexuality is a tiny part of the discussion."
Another resource, The Networker, Pride Senior Network's newsletter, is free. SAGE currently provides training for caregivers and expects to have its training materials available for distribution within the next year; Lambda Legal offers resources to help gay and lesbian residents prepare living wills, power-of-attorney forms, healthcare proxies, etc.
Although the needs of gay and lesbian residents are certainly on the minds of many, Burger admits that it will take time to make progress on the issue: "This aspect of long-term care is going to be the last to be addressed. After all, we are trying to address such issues as being fed and toileted, so sexuality won't be first on the list. That is really too bad, because this is where we should be: addressing these issues, not having to worry if people are being fed, hydrated, toileted, dressed and cleaned."
Douglas J. Edwards is an assistant editor with Nursing Homes/Long Term Care Management.
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|Author:||EDWARDS, DOUGLAS J.|
|Date:||Aug 1, 2001|
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