Do you get to know yourself better as you age? Does it become more important to you to be who you are? If you said yes to either of these questions you probably understand how meaningful it is to embrace one's identity in later life. Celebrating identity is at the root of Pride month. Pride parades and educational events lift awareness of the gay, lesbian, bi-sexual, transgender, and queer (LGBTQ) experience. Often lost in that energetic and youthful fanfare though is the voice of the aging LGBTQ community. What's it like to be an LGBTQ elder? Are LGBTQ elders getting what they need? Is the health care system ready to care for this cohort?

4.5 % of Americans identify as LGBTQ. 2.4 million are 65+ according to the International Council on Active Aging.  That large number may surprise you because many elders lived and still live their lives in relative privacy often out of concern for safety or motivated by the desire for acceptance. While aging is a similar experience for any community LGBTQ people also face unique realities shaped by lifelong political and social forces. Consequently, LGBTQ members are more apt to age alone, lack support, be denied services and live in poverty. Take a look at the short video below comparing how policy and social views impacted the fortunes of two different women, one heterosexual and one lesbian. 

Today much of the gay community is visible and flourishing. In fact you might be thinking, "What's the big deal about being gay?"  We see gay and lesbian women heading businesses and corporations, we're entertained by famous LGBTQ celebrities, we voted for 150 LGBTQ elected officials, and our second openly gay presidential candidate is scaling the polls. This groundswell of recent visibility however doesn't mean that LGBTQ safety is no longer a concern in America or that discrimination and hate have vanished. LGBTQ rights are very recent and elders look back on a lifetime of struggle and danger. "It's very easy to forget how many didn't make it," Vito, 72, tells us in the video below. "The people that committed suicide, the people that ended up in psychiatric hospitals, the prejudice is still there. We can forget now because we've got gay marriage and everything else like that. There's been a tremendous cost and we've got that in our memories. Some people may still be alive that are going back in the closet as a way of surviving into their very old age."

Ted, 79, concludes in the video above that the direction of elder housing (and I submit most aging resources) is to encourage people to take charge of their own destiny. For LGBTQ elders seizing their destiny and meeting their needs means encouraging more studies on the issues they face, educating caregivers on their unique needs, cultivating increased awareness of LGBTQ aging and renewing support networks. 

LGBTQ people face several unique issues: serious physical and mental effects from lifelong stress, greater chances of elder abuse, homelessness, higher risk of isolation, changing government policies, and mistrust of a healthcare system that used to stigmatize their reality. Research on the health challenges of LGBTQ is in its early stages grounded largely on a recent longitudinal study led by Karen Fredriksen Goldsen of the University of Washington School of Social Work. Goldsen will soon extend research to focus on LGBTQ people experiencing dementia. “Unique life experiences of LGBTQ older adults," she reported, "including lifetime experiences of discrimination and victimization they may have encountered in health care settings, often result in difficulty accessing services, which can be especially challenging when memory loss and dementia enter the equation.”  

As LGBTQ elders age into care facilities the community is stepping up to train future caregivers. In the movie, Gen Silent, about the LGBTQ journey into old age and programs for lifting LGBTQ awareness in care facilities, we learn that training sometimes starts at the door when administrator's say, "We don't have any gay or lesbian people here." Yet, that's statistically unlikely and exactly why awareness and training is needed. As we age it's so important to be who are and to feel comfortable asking for the help we need. If LGBTQ elders feel unsafe they may not access necessary help or have the joy of sharing memories. 

The video below is an excellent example of the training needed in care facilities. One maxim it stresses is: don't assume everyone that you meet is heterosexual. It's a simple step we all can take and it gives gay men and women the space and trust to share their rich stories.

Throughout their lives LGBTQ people have often chosen their family or turned to support groups because they may have difficulty accessing support from blood relations or because they need to be with people who intimately understand the LGBTQ lifestyle--who share history and experience.  However, as LGBTQ elders find themselves unable to travel to access those groups, perhaps feeling too old for most gatherings, or confined to a care facility they realize they face one last life challenge: will they continue to live out and proud in the manner that achieved greater equality or fade into the closet for safety once more. Can they find the support and connectedness that is so important in later years or will they age alone? in her 1976 poem, Islands, the poet Muriel Rukeyser writes about the tension between our need for connectedness and the painful, artificial, and tragic feeling of being separate. Rukeyser lived in a very private relationship with her literary agent and long time partner, Monica McCall. She never publicly acknowledged her sexual orientation. 

Islands

O for God’s sake
they are connected
underneath

They look at each other
across the glittering sea
some keep a low profile

Some are cliffs
The bathers think
islands are separate like them

-Muriel Rukeyser

Many of todays LGBTQ elders were on the front lines fighting for the right to love and lifting awareness about our commonalities-- our human need for love, dignity and family---needs that unite us. That fight was not without cost though and today's elders face unique consequences to their mental and physical health because of long time exposure to discrimination.  Now, vulnerable and perhaps apart from the LGBTQ community in retirement or assisted liviing settings, elders test the reach of recent social advances and wonder, "Are we safe yet?" In too many places the answer is still no. Lifting awareness is an ongoing process. Equality and visibility has improved at the national level but neighborhoods and nursing homes are the compass. Care facilities across the nation have LGBTQ elders in their midst and it's time, once again, to spread the word that our differences are important but we are all "connected underneath." We share the same needs for love and caring---the same need to be accepted and valued for who we are.