By Jessica Alpert
Margueritte Wilkins was, as she likes to say, "born, bred, and buttered" in Manhattan's Sugar Hill neigborhood, a northern section of Harlem. Wilkins remembers that she came out to her family when she was in kindergarten: "My brother called me an early bloomer."
Her family didn't really know how to respond to her homosexuality and so they just "played it by ear." As she found support in friendships throughout middle and high school, her relationship with family deteriorated. Now, at age 66, Wilkins has no contact with her family. "They think something is wrong with me," she sighs.
Recent analyses suggest that there are at least 1.5 million lesbian, gay, bisexual, and transgender (LGBT) Americans over the age of 60. These numbers are based on an estimate from UCLA's Williams Institute on Sexual Orientation and the Law which has calculated that approximately 3.8 percent of Americans identify as LGBT.
LGBT elders deal with significant economic and health disparities as compared with heterosexual seniors. According to a 2011 national health study co-authored by the Center for American Progress and Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE), more than half of LGBT respondents have been told by a doctor that they have depression; 39 percent have seriously contemplated suicide; and 53 percent feel isolated from others. Social isolation remains a major issue as LGBT seniors are 3-4 times less likely to have children, twice as likely to live alone, and twice as likely to be single.
According to a 2010 MetLife Study of Boomers from the MetLife Mature Market Institute, about 42% of the LGBT population identified their relationship status as single, far higher than the 27% of the general population. Like Margueritte Wilkins, many LGBT seniors may also be estranged from their biological families.
"This generation came of age when homosexuality was considered criminal, a form of mental illness, or a security risk," says Brian De Vries, a professor of gerontology at San Francisco State University. "They don’t have the safety net available to them that heterosexuals have."
A new program funded by the state of New York is looking to fill in some of those gaps. SAGE and the Bronx-based Hebrew Home have come together to create SAGEDay, the first inclusive social adult day program for LGBT seniors in the state. "The needs are different and... we are able to produce programming that builds a network of social support for participants given that many of them don’t have caregivers and relationships as it relates to this age." says Doreen Bermudez, Program Manager for SAGEDay. "We are pioneers of this care."
Out of the Closet and Right Back In
Margueritte Wilkins spent 20 years doing HIV counseling and referral at the Manhattan State Psychiatric Center. "I had a long term partnership and was a productive member of society," she says. But when she got sick, all of that changed. In the days after the 9/11 attacks, Wilkins worked with the Manhattan Borough President's staff to assess damages at Ground Zero. "When it [the assessments] first happened, we didn’t have any masks. We were there everyday." she says. Eight years later, she had an emergency aortic dissection — something she believes was the result of her work at Ground Zero.
With no partner, children, or family to take care of her, Wilkins was forced to move into a state-subsidized adult home. "I was very sick and in this adult home they didn’t like gay folks and I couldn’t be who I was. I had to go other places to meet people who had the same thoughts as me. I went from living an independent full life to being back in the closet."
Brian De Vries of San Francisco State University says these stories are all too common. In a 2014 study co-authored by De Vries, of 400 midlife and older gay men and lesbians surveyed, about one-third maintained some fear of openly disclosing their sexual orientation. A 2010 Williams Institute study reported that, compared to LGBT persons under the age of 30, those between the ages of 30 and 54 were at least 16 times more likely to be ‘‘closeted’’ and those over the age of 55 are 83 times more likely to be ‘‘closeted.’’
"LGBT individuals turned away from formal services because in part, they were turned away" says De Vries. This experience makes asking for help even more challenging as they age. Despite some advances and greater awareness of LGBT issues, De Vries, who is currently doing extensive research in Palm Springs and San Francisco, says his investigation finds that things aren't necessarily improving across the board. "We hear particularly from older transgender people, horrible stories of how they’ve been treated by service providers."
So how do you bring people back into the fold?
"Outreach is a big part of this work," says Doreen Bermudez of SAGE. "We identify places where we can come in and talk to staff and members...we are able to make connections to the aging network. We invite potential participants to a complimentary day just for them to test it out." says Doreen Bermudez of SAGE. But it's not without its challenges. Deborah Messina, Vice President of Strategic Planning and Business Development at the Hebrew Home adds that "this community has been typically underserved...there is an isolation barrier....so we have to do serious work to communicate that this is a safe space."
Deborah Messina reports that the Hebrew Home's entire executive staff has been trained to be more sensitive to the specific needs of LGBT elderly. "We’re developing a training with SAGE that will touch upon our line staff and it is actually very comprehensive and eye-opening. There was a lot of information that I did not know even as someone who works with the aging population...I had the notion not to ask questions and now I realize people want to be able to self-identify and have their needs known."
De Vries commends SAGEDay but says there is more to consider when LGBT seniors form part of a facility with a heterosexual majority. "Here in California and increasingly elsewhere around the country, there is a mandate for providers to have LGBT sensitivity training-- but that training does not apply to other residents of these facilities. We have to remember that those individuals [heterosexuals] came of age at the same time."
This history has given LGBT seniors grit, says De Vries. De Vries remembers a scene from Harvey Fierstein's 1988 film "Torch Song Trilogy," in which the lead character Arnold (played by Fierstein) has a fight with his mother (played by Ann Bancroft) about her inability to accept his sexuality. In a small apartment living room, Arnold looks at his mother straight in the eye. "I have taught myself to sew, cook, fix plumbing, build furniture... I can even pat myself on the back when necessary...all so I don’t have to ask anyone for anything. There’s nothing I need from anyone except for love and respect…" De Vries says this scene exemplifies a trait held by many LGBT seniors. "There is this crisis competence. By being alone, these seniors have developed strength and resilience and they're bringing that into their later years."
End of Life and AIDS
This doesn't just apply to gay people. De Vries says that more and more people are aging outside of traditional structures, without children and without partners. "People are not going to age in the way their parents did — they are going to expect different sorts of things" he says.
As a gay man, De Vries is particularly invested in changing the way his community approaches end of life. "Heterosexuals in traditional family settings have others who will raise this issue whether they like it or not," says De Vries. "But here we are as gay men or lesbians with people we have chosen as our family... so how can we introduce this discussion in those settings so we can be better prepared?"
To add more complexity, sometimes that chosen family may not be readily available. "AIDS has become salient once again in a way it hasn't been for years," according to De Vries. "Especially when it comes to older gay men....aging can be re-traumatizing. Again they are acutely aware of the people that they have lost...people that they would have otherwise called for care."
SAGEDay is painfully aware of this reality and seeks to include these conversations in their daily meetings. In addition to social activities, weekly yoga and tai chi, cultural programming is a central part of the program. "We create connections within LGBT history," says Doreen Bermudez of SAGE. "We ask participants to reflect on their experience in the past... in order to be able to acknowledge their place in the community."
SAGEDay, a Medicaid-eligible program, has been funded for 18 months through a 1.1 million dollar state grant. The idea is to "establish a social model adult day care and provide training and outreach to members of the managed long-term care community," says Deborah Messina of the Hebrew Home. "It’s my hope that this type of sensitivity training is just for now — and that we won't need this forever.”