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Aging Back in the Closet

Lesbian and gay seniors in long-term care facilities face subtle — and sometimes outright — discrimination. Yes, it even happens in the liberal Bay Area.



The first time Bob McDonald was "cruised and picked up on," he was near the campanile on the UC Berkeley campus. "I was astonished," McDonald, now 78, recalls about the experience. Back then, the young UC Berkeley literature student was naive and inhibited. Which was understandable, given the times.

It was the 1950s. All across the country people were thrown in jail, institutionalized, beaten, or given electroshock treatment for being gay. Gay bars in San Francisco were raided on a regular basis, with police looking to "de-gay" and rid the city of such "deviant" behavior. McDonald knew not to talk about his attraction to men because "it was just the way things were." It would be another twenty years before psychiatrists ruled that homosexuality was not a mental illness.

That's about how long it took for McDonald to begin living openly as a gay man. He got his master's degree in European literature and art, and was writing art reviews for local magazines by his early forties. He became a curator of art museums and had cautiously come into his own in San Francisco's art world.

"There was always experimentation and exploration, and I think that's what saved me, frankly," says McDonald. "Otherwise, I would be an old fuddy duddy, and in lots of ways I probably still am. On the other hand, I know that I've been liberated and I'm very grateful for that."

But now, at the sunset of his life, McDonald has found himself back in the closet. Since moving into a nursing home in Berkeley, he says he has become isolated and feels pressure to hide his sexuality because of the largely conservative and institutional environment of his long-term care facility.

While McDonald's generation was the first to live openly and achieve equalities in civil rights, it's now experiencing what it's like to age in the health care system. And so far, the health care system's efforts to consider the particular needs of LGBT elders have been woefully inadequate. While California law prohibits discrimination against LGBT seniors in state-funded programs and services, McDonald and others like him still face subtle to outright discrimination. And while not many studies have been completed on the subject, evidence suggests this leads to health disparities.

But things are starting to change. National LGBT organizations like the National Gay and Lesbian Task Force, the National Center for Lesbian Rights, and SAGE (Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders) are working to promote LGBT senior rights, and have gotten groups like AARP and the American Society on Aging to consider this population in their efforts. The nation's first affordable housing development for LGBT elders, Triangle Square Hollywood, opened its doors in Los Angeles in 2007. A similar project is underway in San Francisco to build affordable housing for LGBT seniors. Meanwhile, in Santa Rosa, the construction of the first LGBT-specific retirement community with continuing care services is in its final stages.

Locally, organizations such as Lavender Seniors of the East Bay have advocated on behalf of this vulnerable population for close to two decades. They've made considerable strides, giving cultural competency training to caregivers and providing gay seniors with a space to socialize and feel connected to their community. But with shrinking funds and unenforceable policies, such efforts have limited reach.

Meanwhile, seniors like McDonald find that their old instincts are kicking in. They've learned to hide and keep quiet.

"I don't know that I'd stand up here and say, 'Hey everybody, I'm gay,'" said McDonald, as we sat outside his nursing home on Ashby Avenue. "I think that people here, a lot of them would say, 'What's that mean?'"

Gay Seniors Face Challenges in Nursing Homes from Nancy Lopez on Vimeo.

Part of the problem is that we know very little about LGBT seniors — their fears, the extent of their health needs, and how to begin to address them.

Currently, no national health data exist to keep tabs on the size of this population or adequately assess their particular health needs. The National Health Interview Survey — the most referenced federal health survey — doesn't include lesbian and gay people, much less seniors. The lack of evidence-based research has resulted in little to no funding from federal and state governments toward LGBT-specific programs or education. According to Outing Age 2010, a recent report by the National Gay and Lesbian Task Force, "due to a lack of commitment by federal and state governments to study LGBT people, the specific vulnerabilities of LGBT elders are hidden from view and thus impossible to address."

But recently, the lack of awareness has begun to change as national advocacy groups have stepped up efforts to measure health disparities among LGBT seniors. In the last few years they have released groundbreaking reports that begin to paint a portrait of who these seniors are and what their needs and experiences are. Outing Age 2010 found that LGBT people are vulnerable to certain health problems: Lesbians face higher risks for drug and alcohol addiction, cancer, and obesity, while gay men have higher risks for HIV/AIDS and drug and alcohol use. Male-to-female transgender people are also at higher risk for HIV/AIDS.

Anecdotal evidence suggests that lesbian and gay seniors can end up in nursing homes prematurely. They're less likely than heterosexual seniors to have the family support that would otherwise help them age at home. Once in long-term care facilities — nursing homes, senior centers, retirement communities — they're also more vulnerable to isolation, depression, and elder abuse, according to Outing Age 2010. During intake, staff members often assume the senior is heterosexual, asking if she or he has children or a spouse to rely on. The lack of awareness can subtly create an unwelcoming environment. Many LGBT seniors in long-term care facilities continue to hide their sexual orientation for fear of being mistreated.

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