Aging Back in the Closet 

Lesbian and gay seniors in long-term care facilities face subtle — and sometimes outright — discrimination. Yes, it even happens in the liberal Bay Area.

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He didn't talk about his sexuality, at least not to those immediately around him — not to his physician, the nurses, or his roommate. When asked about his wife and children, he would say that he didn't have either and blamed it on an inability to have sex.

"Which is cheating, and it still bothers me, because it was not an honest answer. I should say, 'Well, my adult life I've been gay,'" said McDonald.

He chose not to disclose his sexuality for fear of what the staff would think of him. Although there are elements of truth wrapped up in his little white lie. He contracted colon cancer in his early forties, just when he was getting used to the idea of living openly gay. The doctors successfully removed his tumor, but the operation killed his bladder, and his ability to have sex went out the door, too.

McDonald speaks matter-of-factly of the pouch that protrudes from underneath his white hospital gown, on the right side of his stomach. "It holds the excreta," he explains as we sit across from each other in his room on a recent visit. He has just finished a dinner of scrambled eggs. A large hardcover book on Socrates sits prominently next to the food tray. He points to the thin tube sliding down from between his pale legs. "That's where the urine goes."

"It's a struggle to live," he says.

The one thing that has kept McDonald afloat, in mind and spirit, has been an intermittent connection to the outside world.

The loneliness and isolation that LGBT seniors face in 24-hour care is one of the biggest challenges to their overall well-being, say advocates. Dan Ashbrook calls it "isolation by culture." Organizations such as Lavender Seniors of the East Bay have addressed this problem by creating friendly visitor programs — that is, they match volunteers with gay seniors like McDonald, who have no family, live alone or in a long-term care facility, and could use a friend who's like them.

Over the past three years, as McDonald has transitioned from living in his own apartment to residing in nursing homes, Ashbrook has partnered McDonald with a handful of volunteers who've taken him out for lunch, to run errands, or accompany him to the Whole Foods Market on Ashby Avenue. McDonald says he enjoys catching a glimpse of the "eye candy" strolling down the aisles.

But of all the volunteers — which McDonald says he is very grateful for — no one has meant more to him than River Lebow.

"Bob's a very outgoing, gregarious gentleman," said Lebow, acknowledging the affection that has grown between the two.

"We have a lot of fun checking out sexy men," said Lebow. "That we can share the pure joy of looking at something that is beautiful and the camaraderie, it's been continually fun."

Lebow, 60, is a hospice nurse by profession. Over the years he's worked with people who are dying in their homes. He says he understands what McDonald is going through and was there for him when he moved first into a board-and-care and then into a nursing home. But in the last couple of months, Lebow has seen McDonald at his worst. His health has deteriorated, in part due to old age and in part to the isolation that awaits him each time he enters the senior home.

"Yesterday was the most depressed I've ever seen him," said Lebow, who tries to encourage McDonald to get out of bed and at least stroll around the neighborhood.

"He's talked for months about wanting to just move on," said Lebow. "He wishes he could just end his life by some stroke of the cosmic clock."

In the time since I first met McDonald, he's fallen two times in the shower. He also suffered a mild stroke. He's had to permanently replace his cane with a walker. He doesn't feel up to going out on his friendly visits as much.

"All it takes is depression, leading to lack of moving, leading to muscle deterioration, and then it's just downhill," said Dianna Garrett, the planning director at the Center for Elder's Independence, an adult day care center in Oakland that promotes holistic well-being. "Without understanding what's meaningful to a person, it's hard to address their needs and keep them resilient."

Once a month, Marin County's Section on Aging invites speakers to discuss topics related to improving the health of older adults. On a recent Thursday morning at the assisted-living facility AlmaVia of San Rafael, Paula Pilecki was sharing the best practices for serving LGBT seniors to a room full of senior health care providers.

"We're not pulling people out of the closet, by the way. That's not what we do," said Pilecki, who's the director of Spectrum, an LGBT center that serves the gay community in the North Bay.

Despite the work that local advocates such as Pilecki have done for the past two decades, it's only in the last five years that policies have been enacted in California to ensure that health care providers receive this kind of information.

In 2006, the Older Californians Equality and Protection Act was amended so that programs and services for older adults take into account the needs of LGBT seniors. This could be in the form of trainings for staff and volunteers or developing needs-assessment plans that include LGBT seniors; as well as ensuring they're not being discriminated against. A tougher piece of legislation was passed two years later, mandating that staff at 24-hour care facilities receive cultural competency training.

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