When asked about how she feels about the possibility of one day entering a long-term care facility, one participant in the Minnesota Trans Aging Project commented, “I’ve contemplated simply stepping in front of a bus or something rather than going into a nursing home.” This 63-year-old trans woman was one of 24 trans elders interviewed about their experiences with health and aging services in Minnesota. While aging is difficult for many, LGBT elders face additional challenges due to systemic transphobia and homophobia, resulting in significant health, economic, and social disparities compared to their peers.

This sobering statement sums up much of the fear experienced by lesbian, gay, bisexual, transgender, and/or queer older adults when considering the need for long-term services and support. The sentiment stems from past experience with healthcare providers, employers, faith communities, and even family and friends. Historically, LGBTQ people were criminalized, deemed immoral or deviant, and pathologized as psychologically “sick” or disordered individuals. Older sexual and gender minorities have experienced pervasive discrimination in their lives.

Institutionalized homophobia and transphobia can result in a lifetime of trauma and impact the health and wellness of individuals, as well as one’s willingness to seek help.

LGBTQ Aging Paradox

National research such as the Aging With Pride study shows stark health, economic, and social disparities experienced by sexual and gender minorities in comparison to their peers.

LGBTQ older adults are:

●      twice as likely to be a caregiver,

●      less likely to have a caregiver,

●      half as likely to have children,

●      more likely to live alone, and

●      more likely to experience some chronic conditions and mental illness. 

Therein lies the LGBTQ aging paradox. LGBTQ older adults are at higher risk for health conditions, and are less likely to have informal support from friends and family members so are more likely to require formal support but are also less likely to seek formal support due to fear of mistreatment.

In 2021 the University of Minnesota partnered with Rainbow Health to replicate a needs assessment first conducted in 2002 and then again in 2012. The 2021 study found that LGBTQ older Minnesotans were more likely to serve as a caregiver, less likely to have a caregiver, less likely to have children, and more likely to live alone than the general population.

As a result, LGBTQ older Minnesotans struggle with both additional care burdens and lack of care. Half experienced some form of discrimination and even more knew someone who experienced discrimination due to their sexual orientation and/or gender identity.

Training Care Providers

What can be done to close the gap between the fear and stigma experienced by LGBT elders and the service providers and systems they engage in?

Results from both the 2012 and 2022 Minnesota LGBTQ Aging Needs Assessment show that the majority of LGBTQ older adults desire to receive services from a mainstream service provider that is LGBTQ-welcoming rather than a provider that only serves the LGBTQ community. This is not surprising given that in Minnesota we lack a historically LGBTQ neighborhood or area. Sexual and gender minorities live across communities across the state and access services and supports within their neighborhood.

In the early 2000s, a collaboration of community advocates, service providers, and older adults came together to launch Training to Serve. For over a decade, this non-profit educated mainstream service providers on the unique needs of LGBTQ older adults. Over 15,000 professionals were trained in the state of Minnesota. In 2018, Training to Serve merged with Rainbow Health, a non-profit that was founded with the merger of the Minnesota AIDS Project and Rainbow Health Initiative. Rainbow Health continues the education workshops now named “Training to Serve” after the former non-profit.

LGBTQ+ Welcoming Services

Foundational to the success of the Training to Serve curriculum is the connection to research that lifts the voices of LGBTQ older adults. One important question asked in our LGBTQ Needs Assessment was “What signals an LGBTQ-welcoming service provider to you?” Based on the survey responses, an LGBTQ welcoming service provider:

1. Treats people respectfully, including not showing signs of surprise or shock when sexual orientation and/or gender identity is revealed.
2. Hires LGBTQ staff and engages LGBTQ community members as volunteers and/or board members.
3. Uses material signs such as a rainbow flag or same sex couples in marketing materials to affirm LGBTQ clients.
4. Identifies explicitly as an LGBTQ-welcoming provider.

Like much of the nation, Minnesota is experiencing an unprecedented demographic shift. Today there are over 1 million older Minnesotans.

There are more older adults than children in school. As we experience this demographic shift now and into the future service providers must understand the unique experiences of LGBTQ older adults and their families.

As noted earlier, many were deemed immoral, illegal, or pathologized by healthcare providers. Many carry these traumas and microaggressions with them into older adulthood. Taking steps to become a welcoming provider can increase the quality of life of LGBTQ older adults allowing them to live well and age well.

A Better Future for LGBT Elders

In addition to partnering on the Minnesota LGBTQ Aging Needs Assessment, the University of Minnesota is leading a National Institute on Aging-funded research project to explore policies and practices of nursing homes and assisted living communities related to LGBTQ people, measure the effectiveness of the Training to Serve curriculum and test the curriculum as both an in-person and asynchronous e-training. The goals of the study are to share emerging practices in policies related to LGBTQ care and to determine if training impacts a care provider’s attitudes and care practices. If successful, Training to Serve could be adopted across the nation as a model to ensure that LGBTQ older adults receive high-quality services in senior care.

The following recommendations were developed based on the results of the LGBTQ Aging Needs Assessment:

1.     Service providers should have access to and participate in education on LGBTQ aging and trauma-informed care.

2.     Service providers should make a deliberate effort to offer support to LGBTQ older adults, particularly those who are aging alone.

3.     Minnesota state government must expand data collection on older adults to include sexual orientation and gender identity to better understand their unique assets, needs, and challenges.