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At the heart of the problem, say advocates, is that no one ever thought of gay and lesbian people getting old. "In a nursing home, where you have this tightly controlled environment, staff there are really not set up with the idea that 10 percent of their clients are most likely gay or lesbian," said Dan Ashbrook, executive director of Lavender Seniors of the East Bay. The overall LGBT senior population is estimated to be at 5 to 10 percent.
Indeed, an informal phone survey of a dozen nursing homes in the East Bay found that many facilities lacked awareness of LGBT seniors. Responses to the question, "How many LGBT seniors do you serve?" ranged from "Unknown" to "What is that?" to "We don't dwell on it" — and that was from the staff who were willing to talk.
That lack of awareness can lead to health disparities that advocates know exist, yet are difficult to prove. Because of that nagging fear of being mistreated for being gay, LGBT seniors don't always disclose details of their health. This can limit the quality of care they receive.
"We shut down," said Ben Barr, executive director of the Rainbow Community Center of Contra Costa County, a group that provides services and activities for the LGBT community in that county. "'All right,' the person thinks, 'this is a situation where I'm not going to be treated with respect.' So it's more likely they're not going to say, 'I haven't had a bowel movement in three days,'" said Barr.
Advocates have also documented instances of outright discrimination, sometimes leading to heartbreaking outcomes — such as transgender seniors who are segregated from other residents, same-sex partners who are separated or denied visitation rights, and even worse.
In one instance about a year and a half ago, Barr said a senior who frequents the Rainbow Community Center's senior lunches had to move his partner of nearly forty years into a small board and care — typically, this kind of facility is family-run and more affordable. His partner had been diagnosed with Alzheimer's. One day as he was hugging and kissing his partner, a staff person walked into the room.
"The staff decided that the healthy partner was molesting the other partner and reported him to the state," said Barr, noting that management went so far as to try to have the healthy partner's benefits taken away. Barr said the healthy partner managed to stop the complaint.
"If this had been a heterosexual couple, a wife hugging her husband, they wouldn't have set off alarm bells," said Barr.
Which points to other challenges same-sex couples confront. Unlike heterosexual married couples, who can keep their home and assets when one spouse goes into long-term care, same-sex couples don't enjoy the same benefits and can lose their home to cover the costs of assisted living.
In one particularly egregious case a few years ago in Sonoma County, an elderly gay couple was separated by county employees after one of them fell in an accident, even though the couple had executed both mutual powers of attorney for medical and financial decisions and wills naming each other as beneficiaries. Officials then unlawfully auctioned their possessions, terminated their lease, and forced the other partner into an assisted-living facility against his will, while preventing him from visiting his partner of twenty years before he died. A lawsuit brought by the surviving partner against the county was settled last year for $650,000.
Ashbrook points out that the move into assisted living can be harsh for any senior, gay or straight. Seniors, in general, are a group that tends to be overlooked and underserved. But these examples show that for older adults who are gay, lesbian, bisexual, or transgender, the transition into a long-term-care facility can be completely disarming.
One way to look at it, explained Ashbrook, is that "just like society, long-term care facilities are set up without considerations for gay and lesbians. It's very similar to marriage law and Don't Ask, Don't Tell."
Bob McDonald is a charming and likeable man. He speaks quite properly, but is also surprisingly candid. Bushy eyebrows adorn his face, rising and falling over expressive blue eyes. There are few things he likes to do more than to listen to classical music on his Discman. It's one of the few things he can still do for himself.
Reclined against a couple pillows, McDonald slides his hand through the back handle of the round portable device. He puts on his headphones, shuts his eyes, heaving a huge sigh. He lets the melodies of Johann Sebastian Bach transport him to a time when he was young and a lot more able.
These days, it's painful for him to lift his tall frame out of bed and hunch over his walker. And it's been just as painful to lose an important sense of self.
After the epileptic seizure that landed him in a string of nursing homes two years ago, McDonald went back in the closet. He kept mostly to himself — reading, listening to NPR on his small clock radio, and eating his meals alone.
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