Annals of Long Term Care

Recognizing and responding to the needs of lesbian, gay, bisexual and transgender elders will promote better services for ALL elders because it promotes sensitivity and respect for diversity in all its aspects, as well as creating a space where sexuality and aging in general can be explored and discussed
--Quam (n.d.)

Introduction
Similar to other aging Americans who are constrained by ageist stereotyping and misconceptions, older lesbians and gay men face such problems as loss of family and friends, health concerns, increased isolation from community, fear of dependency, and reduced income.1 Older lesbians and gay men may experience additional challenges as they approach mainstream health and social service agencies and programs. As young and middle-aged adults, lesbians and gay men experienced structural and institutional homophobia, heterosexism, and anti-gay violence in healthcare, housing, employment, and civil rights.2 Now as older adults, they also experience inequality and disparity because of unequal coverage for same-sex couples under policies regulating Social Security and private pension plans.3

When the caregiving needs of older lesbian and gay men can no longer be met by trusted partners, friends, and relatives, they may be reluctant to access traditional community-based and institutional long-term care (LTC) services. 4 Unrecognized caregiving needs, concerns about affordable housing, and real or anticipated homophobia and heterosexist attitudes by agency staff in LTC facilities further marginalize older lesbians and gay men5 and can compromise their quality of care.

Demographics
Current demographic trends reveal that the U.S. population is aging. The gay and lesbian population over 65 is also aging,6 and by 2030, there will be 4-6 million older lesbian, gay, and bisexual people.7 This approximation is conservative because neither the U.S. Census Bureau nor other population studies ask about sexual orientation. Based on the commonly used estimate that 3-5% of the older population utilizes nursing home care,8 by 2030 between 120,000 to 300,000 older lesbians and gay men will reside in nursing homes across the United States, while others will reside in the community with the support and assistance of friends, family, and utilization of health, social service, and community-based LTC services.

Although there is a lack of information about specific demographic characteristics of this population, what is known is that this older lesbian and gay population is heterogeneous. In addition to cultural, ethnic, and racial diversity, older lesbians and gay men differ in other factors such as education, income, abilities, history of partnerships (including previous heterosexual marriage), length of current or past same-sex relationships, children, age and experience of coming out, and the degree of identification as gay or lesbian.9 The life course perspective emphasizes the diversity of life paths of individuals and recognizes the impact of historical events on age cohorts.10 Regardless of their diversity, older lesbians and gay men share a common history of discrimination, such as rejection, oppression, invisibility, and threats of violence.11

History of Oppression
Older lesbians and gay men are sometimes referred to as the “pre-liberation” generation who were labeled “sick by doctors, immoral by clergy, unfit by the military, and a menace by the police.”12 For them the “the heavy moral, social and legal injunctions against homosexuality have weighed heavily.”13 Hutchison10 emphasizes that the life course perspective links childhood and adolescent experiences with later experiences in adulthood.