Aging-Related Information Needs and Barriers Experienced by LGBT+ Older Adults

4.1.1 Affirming Necessities

Affirming necessities speaks to the fact that in order to thrive, there are things everyone – regardless of sexual or gender identity – requires such as access to resources such as food, transportation, legal services, and social opportunities (Pantazis, Gordon, and Townsend 2006). The belief in the importance of affirming necessities was represented in these and other ways by interview participants. Quincy, for instance, in comparing the needs of LGBT+ people to non-LGBT people, said, “Well, I think it’s pretty much the same as straight older people, because there are times when you need somebody to drive you to the doctor.” Similarly, Ulysses opined, “I might need rides to the doctor. I might need help getting groceries. Those sorts of things. But whether that’s different, I’m not buying gay groceries; I am just buying groceries.” But despite recognizing that many of these necessities are not that different between LGBT+ and non-LGBT+ older people, participants also shared that just because there are similarities doesn’t mean that the needs are equally met. While aging services providers such as the local office on aging often do have resources to meet necessities such as food programs, transportation, and senior centers, equitable affirmation is essential for LGBT+ older people to fully be able to benefit from them.

4.1.2 Affirming Long Term Housing

Long term housing is an umbrella term meant to represent the full housing continuum from independent housing (such as subsidized public housing or private residences) to long term care facilities which include independent living units, as well as assisted living and nursing homes (White and Gendron 2016). Housing is a complex subject which elicited varied responses from participants. At the core, though, of the participants’ housing needs was the desire to feel supported by the institutions who would treat them, whether that be in their own home or in a facility. Chester confided that: “When I look at nursing homes, you know there’s nothing about whether they’re going to tolerate gays or pick on gays or harass gays or not, so I would say housing, gay affirming or accepting housing would be an area that I have not seen much on.”

More information is needed on whether or not mainstream housing options can competently meet the needs of LGBT+ older adults in particular.

4.1.3 Affirming Medical Care

Affirming medical care refers to any non-mental health related health care, a distinction that is less about the actual differences between these two forms of health needs (Malla, Joober, and Garcia 2015) and more about how many interviewees talked about physical care in contrast to mental care. Numerous participants discussed the importance of having a supportive primary care physician. Abraham revealed that he had been outed to his doctor years ago but that despite the topic of his sexuality being “opened up for me in a bad way, it’s been beneficial” in getting him information related to sexual health.

4.1.4 Affirming Advocates

Affirming advocates were discussed as being those with various titles such as social workers, case managers, or personal care aides who work to help an older adult receive the varied assistance they require (Portz et al. 2014). “I think we need more healthcare navigators,” Eleanor described, “people that can help people find resources… [They can find] very helpful resources for older people. LGBT older people.” Some participants, such as Theodore, felt that there was a lack of supportive advocates in general: “There are not enough social workers to help people in crisis. [My husband] and I have been together forty-seven years. For us if one of was to be gone, we would need help with all kinds of things. We’d need help with our chickens.”

A lack of supportive advocates means a variety of complex problems come home to roost.

4.1.5 Affirming Mental Health Care

Affirming mental health care refers to counselors or therapists as well as any other mental health related service providers capable and willing to meet the needs of this specific population (Israel et al. 2008). Rutherford reported that having access to mental health help might not be enough: “We can tend to isolate ourselves more in mental health issues… mental health professionals don’t have a lot of information on aging populations and even less on LGBTQ aging.” Mental healthcare was often discussed by participants as being separate from medical care which they saw more as fixing physical problems. The continued discussion of this as separate but equally important to the overall health of LGBT+ older adults made it clear that it should be listed separately as to warrant its own attention.

4.2.1 LGBT+ Only Aging Organization

LGBT+ only aging organizations are those such as SAGE (Services & Advocacy for GLBT Elders) (Kling and Kimmel 2006) that seek to meet the specific needs of LGBT+ older adults around health and social wellbeing. While many participants were fine with inclusive services, several noted the value of LGBT+ only services. Abigail stated that:

It would be great if there was a way to you know kind of corral the services that are [LGBT+] specifically. It’s such a nebulous term to say that it’s LGBTQ affirming or whatever, or they work with [LGBT+ people] just because, they say that they’ve worked with that that group before or a lot doesn’t mean that they’re not going to try and tell you you’re going to hell, and you, your problems are because of the way you live.

This desire for LGBT+ only related services translated to other areas as well, such as housing.

4.2.2 LGBT+ Only Retirement Community

LGBT+ only retirement community refers to various forms of housing (e.g., independent living, assisted living, nursing home, etc.) that are developed to meet the needs of LGBT+ older people in particular (Ross 2016). “My mom went into assisted living, and it was just extremely hetero, extremely backward, and extremely religious even though my mom was agnostic herself,” Zachary recounted. There might be numerous reasons as to why LGBT+ older people would enjoy living with a mostly LGBT+ population as they age.

4.2.3 LGBT+ Only Information and Socialization Club

Several participants also mentioned the need for information specific to the needs of LGBT+ older adults but suggested that it should be paired with socialization like a sports league or a meeting with information so it is not only about the information itself but about the social aspects of information receiving and sharing (Harley, Gassaway, and Dunkley 2016). In describing his vacation in a popular gay beach community, James remembered that “Older people prefer to come to a meeting and discuss current events and important information that’s going on. It’s extremely beneficial because you can access any kind of information… that keeps people involved.”

4.3.1 Reducing Isolation

Isolation, “the objective absence of meaningful and sustained connections with other people,” is a common challenge for older adults (Perone, Ingersoll-Dayton, and Watkins-Dukhie 2020, 126). Whether seeking a romantic partner or just a friend, increased social support can help reduce loneliness among older LGBT+ people. Some participants thought about isolation in relation to their future selves: “I don’t know what is going to be important to me 15–20 years from now,” Ulysses shared, “but I think a sense of community of knowing people… those kinds of social interactions events and things are important.” Building support networks may help minimize isolation even for the most vulnerable of LGBT+ older people.

4.3.2 Building Sustainable LGBT+ Support Networks

Social support also creates the opportunity to build sustainable LGBT+ support networks among others in the community (Pereira and Silva 2021). Generational diversity in these networks is essential. Dolley describes the problems with only depending on others who are your age: “When my wife, my mom, and I got COVID in June, like we were all sick and we were all who can we turn to right who is there, and so it just kind of like opened our eyes to my God who will be there when we get older?”

Ensuring sustainability of these networks through intergenerational ties also gives younger LGBT+ people a connection to the history of the community and to individuals with whom special relationships may be built across generational differences, which is also where community building spaces come in.

4.3.3 Community Building Spaces

Places like affirming churches or online groups can serve as community building spaces where there may not be direct services but LGBT+ older adults can build relationships with one another and other community members (Goh 2018; Gray 2018). “More open churches would be wonderful,” Rosalynn dreamed. “They become family, and they do not even look at your sexual orientation. My wife… she stayed home yesterday, and everyone was like “Where is [Rosalynn’s wife]”? Just like if I was married to Joe Bob. Where’s Joe Bob? I don’t feel any different, alienation or anything.” Community building spaces exist beyond the dichotomy of LGBT+ affirming exclusive spaces.

4.4.1 Legal Planning

Legal planning focuses on the steps that LGBT+ people can take to protect themselves and their married or unmarried partners through powers of attorney, wills, and other legal documents. Thomas remarked that “I don’t need anything, but I would if something happens to [Thomas’ husband]. I mean we got our wills and everything but I’m going to need someone to execute it.” Shifting political winds in the country might make what was routine into the extreme so legal planning has special benefit for LGBT+ older people living in communities hostile to their rights.

4.4.2 Care Planning

Care planning refers to the planning people do for their own wellbeing as they age. While social support is an important goal to hope and work towards, it is not guaranteed. Chester rattled off a list of precautionary steps he is taking ahead of getting much older: “Well, I spent the last year and a half, trying to get my house handicapped accessible, based on the assumption that if I live long enough, I need to have a ramp and I didn’t have one, and doors that are wheelchair accessible and I need to have a shower you can get in.”

Caring for oneself is not, however, purely about the ability to care. One has to be able to afford to care.

4.4.3 Financial Planning

Financial planning is the financial decisions that need to be made as one gets older in order to maximize the financial resources available for personal care. Only one participant, Thomas, made specific mention of financial planning in the form of tax choices: “I mean for the longest time [Thomas’ husband], and I, he would file separately and even after we got married we still filed separately for a while to leave figured out, it would be cheaper I guess. And when we were both still working at first it was safer for us to file separately, but then for a while he finally figured out somehow because I don’t know if the tax laws changed or what but then we started filing jointly.”

Despite not being mentioned, there is likely other types of financial issues that could be part of planning for LGBT+ older adults.

5.1.1 Social Expectations

There are social expectations which assume people are heterosexual and live their life in the form that larger society has come to expect of people as it relates to sexual mores and lifestyle (Tadele 2011). People might not outright discriminate because of this assumed heteronormativity, but it can loom large for LGBT+ older adults. Rosalynn described how, in coming out to her physician, she was told that “I will treat you all day long, but it doesn’t mean that I approve of your lifestyle” as a signal that she was deemed lesser because she did not conform to social expectations of heteronormativity.

5.1.2 Economic Consequences

Participants shared how some providers are concerned about the real or perceived economic consequence of being associated with LGBT+ customers in the mind of potential straight customers and therefore seek to create space between themselves and potential LGBT+ patrons, despite the economic opportunities that exist around LGBT+ inclusion (Badgett 2020). William commented that “Maybe some fear about that in terms of practice and what people leave the practice. I can imagine that still being an issue in certain places.” Providers were often seen by participants as being afraid of being thought of as a LGBT+ provider.

5.1.3 Fear of the Unknown

Fear of the unknown is also a reason why some might stigmatize the LGBT+ community they have no knowledge of or relationship with and why LGBT+ might be cautious opening up to non-LGBT+ people (Moran et al. 2003). The root of this fear, given the lack of a positive relationship between parties, is an absence of trust. Eleanor espoused the challenges around:

Not trusting the source of the services. I think that the real challenge is, if you’ve found a different way that you’ve had to live differently. It’s hard to see that there’s value in the other way, because you’ve grown so accustomed to doing it on your own or you have alternative means for meeting your needs or you have neglected your needs.

While fear of the known might lead some to seek assistance anyway, many of the participants shared that without greater trust, LGBT+ older people may go without even in dire situations.

5.1.4 Othering

There is also a strong amount of “othering” of LGBT+ people or making this population feel as if they are outside the mainstream of society because they are thought about as being different (Dixon and Dougherty 2014). This is separate from social expectations because it goes beyond the often unrealized assumption of heterosexuality and straightness into actively considering that LGBT+ people are separate from the rest of society. Franklin shared his own experience with this phenomenon: “I think [talking about sexuality] would bring up a discussion that wouldn’t go anywhere. Not that my son and his family are homophobic. They’re just not very comfortable with me being gay. If that makes sense.”

Being made to feel different or otherwise not fitting into a group can lead to further isolation and consideration of certain parts of one’s identity – such as gender or sexual identity – as being what separates oneself from others in the group.

5.1.5 Religious

Religious-based stigma came up with some of the participants. Ida bemoaned that “We’re in the South. They’re all sinners; they’re all going to Hell. It’s a choice. You have heard all of this, I’m sure or not.” While these religious views might not result in much beyond judgement, stigma is often a root of something even more nefarious: discrimination.

5.2.1 Historical Trauma

Historical trauma refers to the reasons that LGBT+ people might not seek information based on personal and community level experience with past discrimination (Prussing 2014). Some examples of this provided by participants include how different the experience of being gay was for young people in the past versus young people now and how that influences the behavior of today’s older LGBT population. William recounted:

When I was young and in college I can remember, you just snuck to the gay bar and hope nobody saw you going, park in the back. It was a very, very closed thing, and that was community wide. We got together in homes and in small areas, but you know, to bring the community together for a Pride event – it wouldn’t happen.

This historical trauma and expectation of discrimination might keep participants from seeking needed information.

5.2.2 Refused Engagement

Fear of refused engagement by religious organizations who have resources like food banks was on display with several participants. Abraham brainstormed: “You can do the walk up or the drive through and get the food as easily as the next person because when you put the box in your trunk you don’t have to look over and say thank you from a gay man or thank you I’m a lesbian woman. You just say thank you.”

Without conforming, at least publicly, to the views of organizations who control local resources, LGBT+ older adults might lose out on necessary resources.

5.2.3 Abuse

Abuse-related discrimination took form as wielding political power to block services to LGBT+ people or direct physical and emotional attacks on LGBT+ service seekers (Dworkin and Yi 2003). Martha talked more about the prospect of direct violence:

When you’re going through transition, especially male to female, you tend to become more hyper vigilant about where you’re going and what you’re doing and what time you don’t do it at… there are people who have been transitioning and have been abused in their own work environments, so you know just finding a job is a scary proposition for many people.

The range of forms abuse can take are a reminder of the concern of escalation of anti-LGBT+ sentiment and actions.

5.2.4 Mediocre Engagement

Some providers were described as engaging with LGBT+ older adults but offered inadequate services perhaps in hopes of leading the LGBT+ person to cease seeking assistance. Andrew shared that: “government based organizations that get government funding they pretty much have to [serve LGBT+ people]. There’s a little more of a mandate there. Although they might not be as helpful as others that were allies… they probably do as little as possible.”

These and other examples demonstrated just how varied the examples of discrimination found in the lives of some LGBT+ older adults can be.

5.3.1 Lacking Money

Money was the most common form of fewer personal resources mentioned by participants. Benjamin noted how lacking money might shape an LGBT person’s later years:

There’s a place, I think, when you get older, especially if you don’t have money, that you cannot afford an assisted living. And from what I am told going to a nursing home now is not a permanent thing anymore. It is just sort of you can be there as long as you are sick and need to be there incapacitated but then they want to send you home… Well, the first thing, you have got to have a home because rents are getting so expensive now.

Lacking money compounds other challenges raised by Benjamin and other participants.

5.3.2 Lacking Public Investment

Just as many participants shared examples of personal resource limitations which are connected to a lack of public investment, such as a dearth of resources in rural places despite their being people in need of those resources (Klinenberg 2018). Franklin posed that the needs of LGBT+ older adults is largely not considered by service providers: “I think partially here, it probably never occurred to them. I think most organizations probably just really haven’t thought about it or don’t have the resources to do it.”

The lack of public investment speaks to systemic issues in society but becomes acute for people who have to experience multiple systemic challenges.

5.3.3 Lacking Social Network

Small or nonexistent social networks mean that there are less people to seek support from in difficult times and less individuals to enjoy time with otherwise (Breder and Bockting 2022). Louisa felt that “so many more people in the LGBT community don’t have supportive families, so they can’t turn to family. So, they remain extra isolated.”

Creating and sustaining health social networks may be beyond the capabilities and resources of some.

5.3.4 Lacking Information Literacy

LGBT+ people do not always have information literacy or the skills to find, understand, and use helpful information (Hardy 2021). While this study did not focus on the individual practices of LGBT+ people, they did come up with some in connection to larger social challenges. In reference to getting their aging related needs met, Ulysses stated that “not knowing what’s available” is the significant challenge to meeting the need.

5.3.5 Lacking Digital Literacy

Lacking digital literacy is LGBT+ people not having the skills to utilize modern technologies like computers, smart phones, smart watches, etc. (Jaffe 2016). Abigail explained the challenges that many older LGBT+ people face in regard to digital literacy: “Well there’s so many older people who just or even not necessarily older just you know people who are not real familiar with like computers and making a zoom call or doing you know doing a chat or something like that, but they panic… they think that they’ll get made fun of.”

Digital literacy represents a systemic issue for populations such as older people who did not grow up with the technology and might not have used them much previously in personal or professional settings.

5.4.1 Safety

Feeling safer, whether that be physically, emotionally, financially, etc. in the closet than being out, was a reason LGBT+ participants might conceal their identity. Abraham shared that he was outed at one point: “But as fast as I was kicked out of the closet – which is my phrase – I opened that door and went right back in. But I was able to partially come out of the closet with retirement.”

5.4.2 Comfort

Beyond concerns for their safety, some participants discussed just feeling more comfortable in daily life by concealing identity. Sometimes the desire to withhold LGBT+ identity comes from not seeing any advantage to sharing it. Tyler said: “People my age, you know, went for so long and not telling anybody anything but now hey I’m gay… My coworkers all know my orientation. I’m just not that open or that comfortable stating that I guess.”

5.4.3 To Access Services

Some interviewees discussed feeling the need to hide one’s identity to obtain services even if it means they receive less helpful care by not disclosing their identity. Benjamin explained that a problem with sharing one’s LGBT identity with providers can result in not being their favorite anymore: “That’s always a problem to know whether to tell them you’re gay or not, because a lot of times it’s just better to stay under the radar. And you know that’s still a problem, especially around here.” Changes in relationship could also change access.

5.4.4 Close Relationships

LGBT+ people often decide to stay in the closest in order to preserve close relationships such as family and friends. Chester discussed his relationship with his niece and the need for her to follow his last wishes: “I told my niece I’m gay and she’s not very happy about it. She’s certainly not accepting or affirming for me, but we still are family friendly. I mean she’ll have to legally – she has to follow the will. But if it’s minor stuff, I’m dead, so I don’t really care; she can do what she wants to.”

Beyond losing access to services, coming out could result in losing access to relationships – including ones that have been special or fundamental to a LGBT+ person’s development.

5.5.1 Lack of Staff Resources

This is staff not having the resources to do more to recruit and serve LGBT+ older adults specifically. Zachary shared: “I think one of the offices of aging would be to help them to understand that they have to give what older people need, but of course these assisted livings, they have no money, they’re all understaffed and very unprofessional, so I don’t know how much it would help.”

Ida pointed out a flaw in the system: “You know the educational things to get the word out are important, but the other part of it is if you’re looking at government services, people who are already overworked and underpaid. Why would they want to go out and recruit more work?”

This can come into play as it relates to serving a small and often marginalized population as there might not be many upsides to serving LGBT+ older people in the eyes of some providers.

5.5.2 Lack of Staff Knowledge

Staff in the examples do not have the knowledge base to understand the specific needs of LGBT+ older people. This might be, as Louisa suggested, because they “Probably don’t realize there are special needs” for LGBT+ older adults. A knowledge gap could affect how they view the needs of this population in reference to their organization’s mission. Staff may need to actively seek out opportunities to increase their knowledge of specific populations in order to ensure they get that knowledge rather than waiting on supervisors or other entities to provide it.

5.5.3 Lack of Staff Skills

Staff in these examples do not have the skills necessary for better serving the specific needs of LGBT+ older people. William shared that some providers might not feel that they have the skills to interact with LGBT+ older people effectively: “It is the same thing with the racial situation sometimes, you know. Maybe providers just are not feeling competent in understanding that community or what they need to feel like.”

Knowledge is often not enough to ensure specific populations receive the resources they require. It may become clearer how to successfully meet the needs of LGBT+ older people after learning more about what they see as their needs.

5.6.1 Individualism

Individualism is a perspective commonly espoused in the United States about the importance of taking care of oneself rather than expecting the government or some other entity to assist you (Shain 2021). Participants shared how this way of thinking might be a barrier for some LGBT+ older people who would benefit from help. Rutherford expanded upon this point stating: “I think older folks now are so used to just do it on their own, I think that’s kind of the American way, if you will, the rugged – pull yourself up by the bootstraps is already there, but I think it gets even more so with our community, because we’ve had to depend on ourselves and if we don’t trust each other, then that’s even more isolating.”

Individualism can become a barrier for older people who develop health needs. Living on your own, for instance, may no longer be safe, but LGBT+ older people may choose to risk falling with no way to get up rather than surround themselves with others who are unaccepting.

5.6.2 Upbringing

A person’s upbringing can strongly influence how they think about issues throughout their life. An upbringing around religious or social hostility towards being LGBT+ was described as keeping some LGBT+ older people from seeking services for LGBT+ people. Tyler shared how his upbringing shaped his public persona as a gay man: “I guess the old values that I grew up with that I’ve taught my parents and grandparents is that you act a certain way, and most of the people nowadays don’t have that anchorage.”

While a person’s upbringing can appear to be individualized, greater society factors such as religion and political affiliations can influence seemingly personal choices.

5.7.1 Ageism

Ageism refers to negative feelings and stereotypes held about someone because of their age (Averett, Yoon, and Jenkins 2011). Abigail talked about how feelings about aging have evolved across generations but yet younger people still often dismiss older people within the LGBT+ community: “I was just gonna say that’s true just in general about older people, because younger people have a really bad tendency to just completely dismiss them and think that they’re stuck in the past… I don’t get that. I mean my mom’s generation was like that they just sat down to die, but we don’t do that anymore.”

Ageism can be directed towards any older person, though the youth-orientation of some segments of the LGBT+ community may increase its occurrence among LGBT+ older adults.

5.7.2 Elder Abuse

Elder abuse is the mistreatment of a person because they are considered more vulnerable due to age (Westwood 2019). This mistreatment can take many forms such as emotional, psychological, physical, financial, sexual, neglect, etc. Abigail talked about elder abuse being an issue that older people face, even within the LGBT+ community: “I mean you know there’s elderly people who are being harassed and assaulted just because they’re old and they’re slow when they’re in the way. Terrifying. It’s absolutely terrifying.”

Older generations of LGBT+ people experiencing elder abuse would also be the same age groups of trailblazers who helped make it easier for subsequent LGBT+ people to be open and free.