Even now, at 81 and with her memory beginning to fade, Gloria Donadello recalls her painful brush with bigotry at an assisted-living center in Sante Fe, N.M. Sitting with those she considered friends, “people were laughing and making certain kinds of comments, and I told them, ‘Please don’t do that, because I’m gay.”‘
The result of her outspokenness, Donadello said, was swift and merciless. “Everyone looked horrified,” she said. No longer included in conversation or welcome at meals, she plunged into depression. Medication did not help. With her emotional health deteriorating, Donadello moved into an adult community nearby that caters to gay men and lesbians.
“I felt like I was a pariah,” she said, settled in her new home. “For me, it was a choice between life and death.”
Elderly gay people like Donadello, living in nursing homes or assisted-living centers or receiving home care, increasingly report that they have been disrespected, shunned or mistreated in ways that range from hurtful to deadly, even leading some to commit suicide.
Some have seen their partners and friends insulted or isolated. Others live in fear of the day when they are dependent on strangers for the most personal care. That dread alone can be damaging, physically and emotionally, say geriatric doctors, psychiatrists and social workers.
The plight of the gay elderly has been taken up by a generation of gay men and lesbians, concerned about their own futures, who have begun a national drive to educate care providers about the social isolation, even outright discrimination, that gay, lesbian bisexual and transgender clients face.
Several solutions are emerging. In Boston, New York, Chicago, Atlanta and other urban centers, so-called LGBT Aging Projects are springing up, to train long-term care providers. There are also openly gay geriatric case managers who can guide clients to compassionate services.
At the same time, there is a move to separate-but-equal care. In the Boston suburbs, the Chelsea Jewish Nursing Home will break ground in December for a complex that includes a unit for the gay and lesbian elderly. And Stonewall Communities in Boston has begun selling homes designed for older gay people with supportive services similar to assisted-living centers, available to both new homebuyers and those living in their own homes.
“Many times gay people avoid seeking help at all because of their fears about how they’ll be treated,” said David Aronstein, president of Stonewall Communities. “Unless they see affirming actions, they’ll assume the worst.”
Homophobia directed at the elderly has many faces.
Home health aides must be reminded not to wear gloves at inappropriate times, for example while opening the front door or making the bed, when there is no evidence of HIV infection, said Joe Collura, a nurse at the largest home care agency in the Greenwich Village neighborhood of Manhattan.
A lesbian checking into a double room at a Chicago rehabilitation center was greeted by a roommate yelling, “Get the man out of here!” The lesbian patient, Renae Ogletree, summoned a friend to take her elsewhere.
Sometimes tragedy results. In a nursing home in an East Coast city, an openly gay man, without family or friends, was recently moved off his floor to quiet the protests of other residents and their families. He was given a room among patients with severe disabilities or dementia. The home called upon Amber Hollibaugh, now a senior strategist at the National Gay and Lesbian Task Force and the author of the first training curriculum for nursing homes. Hollibaugh said she assured the 79-year-old man that a more humane solution would be found, but he hanged himself. She was unwilling to identify the nursing home, because she still consults there, among other places.
While this outcome is exceedingly rare, moving gay residents to placate others is common, said Dr. Melinda Lantz, chief of geriatric psychiatry at Beth Israel Medical Center in New York, who spent 13 years in a similar post at the Jewish Home and Hospital Lifecare System. “When you’re stuck and have to move someone because they’re being ganged up on, you put them with people who are very confused,” Lantz said. “That’s a terrible nuts-and-bolts reality.”
The most common reaction, in a generation accustomed to being in the closet, is a retreat back to the invisibility that was necessary for most of their lives, when homosexuality was considered both a crime and a mental illness. A partner is identified as a brother. No pictures or gay-themed books are left around.
Elderly heterosexuals also suffer the indignities of old age, but not to the same extent, Lantz said. “There is something special about having to hide this part of your identity at a time when your entire identity is threatened,” she said. “That’s a faster pathway to depression, failure to thrive and even premature death.”
The movement to improve conditions for the gay elderly is driven by demographics. There are an estimated 2.4 million gay, lesbian or bisexual Americans over the age of 55, said Gary Gates, a senior research fellow at the Williams Institute at the University of California, Los Angeles. That estimate was extrapolated by Gates using census data that counts only same-sex couples along with other government data that counts both single and coupled gay people. Among those in same-sex couples, the number of gay men and women over 55 has almost doubled from 2000 to 2006, Gates said, to 416,000, from 222,000.
California is the only state with a law saying the gay elderly have special needs, like other members of minority groups. A new law encourages training for employees and contractors who work with the elderly and permits state financing of projects like gay senior centers.
Federal law provides no antidiscrimination protections to gay people. Twenty states explicitly outlaw such discrimination in housing and public accommodations. But no civil rights claims have been made by gay residents of nursing homes, according to the Lambda Legal Defense Fund, which litigates and monitors such cases. Potential plaintiffs, the organization says, are too frail or frightened to bring action.
The problem is compounded, experts say, because most of the gay elderly do not declare their identity, and institutions rarely make an effort to find out who they are to prepare staff members and residents for what may be an unfamiliar situation.
So that is where Lisa Krinsky, the director of the LGBT Aging Project in Massachusetts, begins her “cultural competency” training sessions, including one last month at North Shore Elder Services in Danvers, outside Boston.
Admissions forms for long-term care have boxes to check for marital status and next of kin. But none of the boxes match the circumstances of gay men or lesbians. Krinsky suggested follow-up questions like “Who is important in your life?”
In the last two years, Krinsky has trained more than 2,000 employees of agencies serving the elderly across Massachusetts. She presents them with common problems and nudges them toward solutions.
A gay man fired his home health aide. Did the case manager ask why? The patient might be receiving unwanted Bible readings from someone who thinks homosexuality is a sin. What about a lesbian at an assisted-living center refusing visitors? Maybe she is afraid that her friends’ appearance will give her away to fellow residents.
“We need to be open and sensitive,” Krinsky said, “but not wrap them in a rainbow flag and make them march in a parade.”