GLBT ELDERS experience a number of particular concerns as they age. In a recent study (Shippy, et al., 2001), three in four gay elders reported not being completely open about their sexual orientation to healthcare workers. Discrimination following disclosure of sexual orientation has been reported in nursing homes and senior centers. Social Security and retirement plan regulations deny gay elders access to funds from systems they pay into throughout their working lives, but cannot access due to the unequal treatment of same-sex couples.
Social Security and Pensions Nearly two-thirds of U.S. retirees rely on Social Security for more than half of their annual income; for fifteen percent of seniors, Social Security is their only source of income (Liu, 1999). Social Security survivor benefits allow widows, widowers, and dependent children to put food on the table, and fairly compensate them when their spouse pays into the system his or her whole life but dies before being able to enjoy these retirement savings. But gay and lesbian survivors are not eligible for these benefits, even though they’ve paid taxes into the system for their entire lives. The 9/11 attacks illustrated the unfairness of this policy: same-sex survivors of victims were denied Social Security and worker’s comp survivor benefits. They also had to struggle to access funds from the victims compensation fund administered by the U.S. Justice Department. Gay partners are also ineligible for spousal benefits, which allow a partner to earn about half his or her life partner’s Social Security payment if that rate is higher. What’s more, partners of workers with defined-benefit pensions do not receive the same legal protections as married spouses. The Retirement Equity Act of 1984 created spousal rights to a worker’s pension benefits while both are living and after the worker’s death. While such rights can be waived, the measure was intended to protect widows or widowers from a severe loss of income. However, the gay or lesbian partner of a pension plan participant cannot claim such rights. When a retired worker dies, gay or straight, the remaining pension wealth can be distributed to any beneficiary. But certain tax rollover treatment for these distributions—a significant advantage—is only available to a spouse. If a person dies after becoming vested in a pension plan but before reaching retirement age, a spouse is entitled to begin receiving benefits the year that the deceased would have started drawing on the pension; or the spouse can take a lump-sum distribution and roll the full amount over into an individual retirement account (IRA), where it maintains its tax-deferred status. A surviving same-sex partner can be a named beneficiary of the pension upon the participant’s death, but the proceeds are not tax-favored. If someone with a 401(k) plan dies, and the beneficiary is a married spouse, then he or she may roll over the total amount of the distribution into an IRA without paying income tax. But if the surviving beneficiary is a same-sex partner, the pension distribution is subject to a twenty percent federal withholding tax. The unfairness of pension policy was underlined in October 2006 following the death of the nation’s first openly gay Congressman, Gerry Studds. Studds’ husband, Dean Hara, was denied pension death benefits by the federal government. According to The Lowell Sun (10/16/06): “If Hara were a woman and married to Studds—rather than a same-sex spouse—he would receive $62,000 a year from Studds’ pension program under the congressional retirement system.” Instead, because of the 1996 Defense of Marriage Act, the federal government refuses to recognize the 2004 marriage between Studds and Hara in Massachusetts. Large majorities of Americans supported treating same-sex couples equally under Social Security policy (68 percent) and inheritance rights (73 percent) in a Kaiser Family Foundation study (2001). In January 2002 the Democratic National Committee called for equal treatment of gay and lesbian couples by the Social Security Administration. All the Democratic candidates for president in 2004 supported equal treatment of gay partners under Social Security except Senator Joseph Lieberman, who said he was studying the issue. The Bush-Cheney administration, however, has opposed equal treatment of same-sex couples under Social Security. Other senior family issues include the Medicaid spend-down provision. Following the death of a spouse in a nursing home or assisted care facility, Medicaid regulations allow the surviving widow or widower of a married heterosexual couple to remain in the couple’s home for the rest of his or her life without jeopardizing the right to Medicaid coverage. Upon the survivor’s death, the state may then take the home to recoup the costs of terminal care. Because same-sex couples cannot marry, they can be forced into choosing between a home and life’s savings or medical coverage. (Two states—Vermont, which allows civil unions, and Massachusetts, which allows full marriage—have devised ways to circumvent this inequality in federal Medicaid policy by taking advantage of the fact that states match Medicaid dollars one-to-one.) Health care Same-sex partners have a harder time obtaining insurance than do married heterosexual couples, since many insurance companies and employers do not provide domestic partner benefits. Even partners lucky enough to get domestic partner Studies have found that uninsured levels are higher for lesbians and gay men than for heterosexual individuals (Diamont, et al. 2000; Stahl, 2000) and that uninsured levels are highest among transgender people. GLBT people may be at increased risk for stress-related mental health disorders such as depression, anxiety, and suicidal ideation, abuse of tobacco, alcohol, and other drugs, and physical ailments such as breast, ovarian, and anal cancers, heart disease, and sexually transmitted diseases such as HIV. According to a 2002 Gay and Lesbian Medical Association (GLMA) survey of over 500 health practitioners, the top health concerns for gay men are hiv/aids and other sexually transmitted diseases, substance use, depression/anxiety, and certain forms of cancer. Top lesbian health concerns are breast cancer, depression/anxiety, gynecological cancer, fitness (diet and exercise), substance use, domestic violence, osteoporosis, and heart health. Bisexuals may face many of the same health issues as their gay and lesbian counterparts, while also contending with healthcare providers who may provide effective interventions to homosexuals and heterosexuals but do not understand the particular needs and experiences of bisexuals. Studies have shown that a lack of health coverage makes transgender health services prohibitively expensive for most transgender people. These issues play out in particular ways for older GLBT people. For example, a number of studies indicate that HIV prevention messages are not working for older men who have sex with men. Also, many HIV drug trials are not done on older men; it could be that drugs interact in different ways with older men than with middle aged and younger men.* In times of illness, most people rely on the support of their families. Hospitals routinely call on an incapacitated patient’s next of kin to make medical decisions. Many people receive their health insurance through family members. But because of lack of recognition of their families, gay and lesbian couples face unique problems when dealing with the health care system, and often have to struggle to have their relationships respected. Among the many rights to which heterosexual partners are automatically entitled—but lesbian and gay partners are routinely denied—are the ability to visit hospitalized loved ones, the authority to make medical, legal, and financial decisions for an incapacitated partner, the ability to take time from work to care for an ill partner, access to health insurance for one’s partner and partner’s children, and the power to make funeral arrangements for a deceased partner. Even when same-sex partners are eligible for domestic partner health benefits, they have to report this as income and pay taxes on it. If a gay man or lesbian is incapacitated in the hospital, his or her closest blood relative will automatically be given the power to make decisions about their care unless a medical power of attorney form has been completed. If this form exists, then the specified healthcare proxy may act on behalf of the incapacitated person and make decisions as their agent. But even if armed with a durable power of attorney, a healthcare proxy, or other legally binding documents, gay couples’ familial rights are still regularly ignored by hospital staff. The Family and Medical Leave Act (FMLA), a federal law passed in 1993, discriminates against same-sex couple families, as do all but one of the two dozen state medical leave laws. The federal FMLA provides up to twelve weeks of unpaid leave after the birth or adoption of a child to facilitate recovery from a “serious health condition” or to care for an immediate family member who is extremely sick. But “family” is defined specifically to exclude same-sex couple families, preventing gay men and lesbians from taking care of their partners on equal terms with their heterosexual counterparts. (California is the only state that provides paid family leave to employees, allowing state residents to take six weeks of paid leave from work to care for a sick relative, including a domestic partner, or after the birth, adoption or foster placement of a child. While on leave, most workers are paid at a rate of about 55 percent of their salary. This is funded by a payroll tax that averages $26 per year per employee. Two other states, Hawaii and Vermont, provide unpaid family leave for domestic partners.) Elder Caregiving and Housing In 2004 the Task Force Policy Institute released the largest-ever study of gay people’s caregiving experiences (Cantor, et al., 2004). We found that older gays are heavily involved in caregiving both to members of the families they grew up in (family of origin) and to same-sex partners and close friends. (Caregiving consists of extensive, hands-on help with the tasks of daily living, usually to very sick or frail elders.) Yet key policy frameworks that support caregivers—such as the federal Family and Medical Leave Act—discriminate against same-sex partners who need to care for their loved ones. Nearly half of 341 GLBT New Yorkers age fifty and older surveyed were providing or had recently provided caregiving assistance to a family of origin member, same-sex partner, or close friend. GLBT caregivers—whether they were helping aunts, parents, or partners—provided care for an average of eight years. Nearly a fourth of those surveyed had cared for or were caring for a member of their family of origin. Ninety-five percent of those “family of origin” care recipients were heterosexual. More than two-thirds of family of origin caregivers were the primary caregiver to that person. Half provided assistance on a daily basis, and another 24 percent provided caregiving help several times a week. One in four respondents was providing or had recently provided caregiving assistance to a same-sex partner or close friend (one’s “family of choice”). Fifty-eight percent provided assistance on a daily basis, and another 23 percent provided care several times a week. The study also found that three quarters of those providing care reported a great deal of emotional stress as a result. GLBT caregivers providing assistance to members of their families of origin reported that their family members expected more of them because of their sexual orientation. The report showed that many lesbians and gay men form intense bonds with life partners and friends while maintaining close ties to their parents and siblings. Despite right-wing claims that “gay” and “family” are mutually exclusive, this elder caregiving study underscored how integral gay and lesbian people are to the fabric of American families. Finally, a word about elder housing: under the Clinton-Gore administration, the Department of Housing and Urban Development’s practice was to make decisions about rental of the country’s three million subsidized senior apartments without regard to an applicant’s sexual orientation. This administrative practice lacked the legal force of a written regulation or federal nondiscrimination law. The inclusion of sexual orientation and gender identity in the Fair Housing Act of 1968 would ban anti-GLBT discrimination in senior housing. There are now several gay senior housing projects in various stages of development in Seattle, Boston, New Mexico, North Carolina, Florida, and elsewhere. While gay housing developments are welcoming, most units will only be accessible to upper-income people. The housing needs of rural, poor, and middle-income GLBT elders can best be addressed by making senior housing gay-friendly and passing a federal nondiscrimination law that covers housing as well as employment. Conclusion There has been a “White House Conference on Aging” roughly once every decade since 1950. These conferences have led to major breakthroughs in elder policy, including the creation of Medicare and Medicaid and the passage of the Older Americans Act, which funds most community-based and home services to seniors. In 1995, three openly lesbian delegates to the White House Conference—Del Martin, Phyllis Lyon, and Nancy Moldenhauer—challenged delegates to include gay and lesbian issues in the conference agenda and report. Despite resistance, the final White House Conference on Aging report listed gay men and lesbians as a “special population,” and added sexual orientation to the nondiscrimination statements of the conference. The report on the 2005 White House Conference went further, urging aging policymakers to “expand the definition of minority populations to include—gays, lesbians, bisexuals and transgenders and seniors with disabilities, and increase federal funding to NIH, CDC, Title 3 and other federal agencies to reduce health disparities and promote health promotion programming for all minority populations.” This was thanks to advocacy by Amber Hollibaugh of the Task Force, Terry Kaelber of Senior Action in a Gay Environment, and others, who organized a counter summit to the White House Conference after it became clear that sexual orientation and gender identity would be ignored at the White House event. The number of GLBT seniors—one to three million today—will double over the next quarter century. GLBT baby boomers who’ve been “out” for most of their lives cannot be expected to retreat to the closet when they encounter homophobia or bias in aging services. The mainstream aging advocacy organizations have been increasingly supportive of efforts to address the particular needs of GLBT elders, and many pro-GLBT activists have been working within those organizations for years. This is true of the American Society on Aging, the Older Women’s League, AARP, and other groups. While the policy changes required to treat GLBT seniors equally are significant, most enjoy majority support as well as the support of aging experts and advocates. Just as we want mainstream aging groups to work on GLBT issues, it is important that younger gay activists support efforts to change aging policy for the better. References Cantor, Marjorie, Mark Brennan, and R. Andrew Shippy, Caregiving Among Lesbian, Gay, Bisexual, and Transgender New Yorkers. National Gay and Lesbian Task Force Policy Institute, 2004. Diamant, A.L., Wold, C., Spritzer, K., & Gelberg, L. “Health behaviors, health status and access to and use of health care: A populations-based study of lesbian, bisexual and heterosexual women.” Archives of Family Medicine 9(10), 2000. Henry J. Kaiser Family Foundation, Inside-OUT: A report on the experiences of lesbians, gays and bisexuals in America and the public’s views on issues and policies related to sexual orientation. Menlo Park, CA, 2001. Liu, G. “Social Security and the treatment of marriage; spousal benefits, earnings sharing and the challenge of reform,” Wisconsin Law Review 1 (1999): 1-64. Shippy, A., M. Cantor, and M. Brennan, “Patterns of support for lesbians and gays as they age,” presented at the 54th Annual Scientific Meeting of the Gerontological Society of America, Chicago, November 2001. Stall, R. “Access to health care among men who have sex with men: data from the Urban Men’s Health Roundtable, Los Angeles Gay and Lesbian Center” (January 2000). Sean Cahill, director of the National Gay and Lesbian Task Force Policy Institute, is co-author (with Sarah Tobias) of Family Policy Issues Affecting Lesbian, Gay, Bisexual and Transgender People (Michigan).
health insurance have to pay income tax, while married spouses do not. Nine of the 13 anti-marriage amendments passed in 2004, and six of the eight on the ballot in 2006, threaten domestic partner health insurance. Public employers in Michigan, Ohio, and Utah have stripped employees of domestic partner health insurance as a result of those amendments.
