Ep 05: What’s It like to Reach Older Age When You’re LGBTQ+?

Due to a lifetime of discrimination, millions of LGBTQ+ older adults struggle economically and face entrenched barriers in employment, housing, and healthcare. They also routinely encounter discrimination in long-term care environments, and the law rarely supports their urgent needs.

In this episode of A Question of Care™, Robert Espinoza speaks with Michael Adams, CEO at SAGE (Advocacy and Services for LGBTQ+ Elders). They discuss the unique challenges facing LGBTQ+ older people, Michael’s own experiences, and what our country should do to improve the current situation.

Robert Espinoza: How did the wealthiest country in the world get to a point where it can't support the health and long-term care needs of more than 54 million older adults? Welcome to A Question of Care™, a podcast that explores the many answers to this question through different viewpoints and topics. I'm your host, Robert Espinoza, a national expert and frequent speaker on aging, long-term care, and the workforce.

On today's episode, we'll pose the question, what's it like to age when you're LGBTQ+? And we'll take a closer look at older adults who are lesbian, gay, bisexual, transgender, and/or queer–both both their unique challenges and their contributions to society. Here to guide us through the subject is our guest Michael Adams, a leading thinker on aging and LGBTQ communities.

Michael Adams: My name is Michael Adams, and I'm the CEO of SAGE.

Robert Espinoza: For those not familiar with SAGE…

Michael Adams: SAGE is the country's national organization focused on LGBTQ aging issues, and we were founded in 1978 in New York City with the mission of improving the quality of life of LGBTQ older adults.

Robert Espinoza: Many of us recognize the term "LGBTQ," but for those who don't, it stands for lesbian, gay, bisexual, transgender, and queer. These terms capture the spectrum of today's sexual and gender identities, from being sexually attracted to one or multiple genders to the word "transgender," which, according to the National Center for Transgender Equality, refers to people "whose gender identity is different from the gender they were thought to be at birth." And if you add a plus sign to the term "LGBTQ," it allows for even more variety of identity and expression, which is constantly evolving.

However, what's less familiar to most people are the unique experiences and challenges of LGBTQ older adults. The best available research, which is far from perfect, shows there are at least 2.4 million LGBTQ older people over age 50 in the United States. And this number will more than double to 5 million by 2030.

Because this community has faced discrimination throughout their lives and to the present day, many of them suffer financially, physically, and emotionally. Researchers have shown high rates of poverty and disproportionately high rates of diabetes, asthma, heart disease, HIV, cancer, and more among older people who are LGBTQ. Likewise, depression is more than two times as common among LGBTQ+ older adults than among the general older adult population.

Michael Adams: This particular older population we're talking about is a group of older adults who, among other things, tend to have very high levels of social isolation and thin support networks. A big part of the reason for that is differences in family structure–LGBTQ+ older adults are four times less likely to be parents than older adults in general, twice as likely to be single and to grow old living alone, and much more likely to be disconnected from their families of origin–all of which adds up to very high levels of social isolation and thin support networks.

And then we layer on top of that a variety of other challenges: significantly higher levels of poverty than older Americans in general, as a population; significantly greater challenges with health conditions and health disparities; and unfortunately, a significant level of discrimination in eldercare, elder services, and older adult housing that many LGBTQ older adults face.

Robert Espinoza: You've often talked about how discrimination in long-term care settings and under the law affects LGBTQ older adults. What's the impact of that discrimination?

Michael Adams: The impact of discrimination on LGBTQ older people is huge, and to start with one example in the area of housing. The fact is that housing is a particular challenge for many older folks in our country in terms of affordability and availability. So, this is a huge challenge for older Americans in general.

But then throw into the mix that research indicates that almost 50 percent of LGBTQ plus older adults are subjected to discrimination in some form if they apply for senior rental housing. That's an astonishingly high level of discrimination. And so what that means is that the challenges that older Americans face, generally speaking, are significantly exacerbated for LGBTQ+ older adults in housing. And often, what we hear from SAGE's constituents is that the place that they feel least safe, least protected from discrimination and harassment, is actually where they live. So that's just one example of how discrimination plays out and where the lack of available and consistent protections against discrimination is a serious problem.

But it's not the only place. As you referenced, Robert, in the long-term care sector, there has been significant, anecdotal evidence over the years of discrimination against LGBTQ older folks. And that also is a real challenge because when we get to the point later in life where folks need to avail themselves of long-term care, often with that comes a much higher level of dependence and vulnerability, and therefore, fears of discrimination are much greater. So much so that what we often hear from older folks and LGBTQ communities is that they feel compelled to go back into the closet to access long-term care, eldercare, and elder services because they're just afraid. They're just afraid of being mistreated because of who they are at this late and vulnerable stage of their lives.

Robert Espinoza: One of the subjects that we'll be exploring on this podcast is the subject of ageism. And I'm curious if you can talk about how ageism affects LGBTQ+ people in particular.

Michael Adams: I mean, certainly, ageism affects older folks in general, in terms of assumptions about people's inability to contribute and ability to have agency in the decisions they make. But I think in the context of LGBTQ older folks, we see some quite particular manifestations, and some of that shows up with regards to assumptions about sexuality, for example, which is not unique to LGBTQ older folks. Still, I think it has a particular significance for LGBTQ people.

Often, there is an ageist assumption made that older people aren't sexual beings, right? And that's not true. And we know from life experience and data that's not true. But it's often an assumption. That assumption in the context of LGBTQ people can be particularly damaging because, for many people, so much of their identity and stepping into their own as LGBTQ people was embracing their sexuality, embracing themselves as sexual beings, and being essentially denied by society or by the community that recognition as sexual beings is significant for LGBTQ people.

There's also something that I've seen over time that is really harmful to LGBTQ older folks—the ageist assumption that old people don't matter, that they're not relevant, that we're unable to make contributions and make a difference.

And here again, that ageist assumption is not unique to LGBTQ older folks. It has a particular impact because if you think about it, we're talking about the Stonewall generation. We're talking about the folks who actually built LGBTQ communities, who fought for the rights that LGBTQ people have, who actually transformed the LGBTQ experience. And to be given the message by society and, frankly, by our own community sometimes, that as older people, we're not relevant, we're not important.

But it's not just about attitudes. You know, it's also about structures and structural ageism, and there are plenty of examples of how that manifests for LGBTQ people in very meaningful ways.

Robert Espinoza: What are the structures of ageism facing LGBTQ older people? First, many of them face discrimination in housing and long-term care settings, such as nursing homes and assisted living. The law also leaves them behind, or they are targeted by it. For example, many people live in parts of the country without enough non-discrimination protections in employment, housing, or public accommodations. And it is only getting worse. Earlier this year, the ACLU tracked more than 400 anti-LGBTQ bills at the state level. They include proposals that would allow a business or a hospital to turn away a person simply because of their sexuality or gender identity, and much more.

Another structural challenge is that LGBTQ older adults often don't feel comfortable in queer spaces, such as a bar or online dating site, which can be unfriendly to older people. Or they don't feel comfortable in aging spaces, such as a senior center, which can be homophobic and transphobic at times. And if it's hard for LGBTQ older adults as a whole, it's even more challenging for those who are people of color, transgender and non-binary, bisexual, and living with HIV and AIDS. In turn, these groups are often the most overlooked by the public discourse, which is precisely how inequality works.

And yet, it might also be that these experiences have created a profound, personal, and political agency among LGBTQ older adults–resilience, for lack of a better word.

We've been talking a lot about the hardship that LGBTQ+ older adults have faced and are facing. Yet, we also know that research shows that hardship and a lifetime of discrimination can also build resilience. And I'm curious: what has your work at SAGE revealed in this regard?

Michael Adams: I'm so glad you asked that question, Robert, because I think that it's probably one of the things that's most exciting to talk about and to think about and to aspire to, right, is the extraordinary resilience that we see among LGBTQ+ older folks.

We're talking about people who lived through generations where it was downright life-threatening to be who they were. That's still true today, particularly in certain conservative parts of the country and for some folks everywhere. But it was even more true and a more generalizable starker truth in the 1950s, 1960s, and 1970s when many of our older folks came of age.

And what is so inspiring and energizing is to see the resilience, the power that comes from struggling through difficult times—from struggling to come out, from struggling to survive a pandemic. And now I'm talking about the AIDS pandemic, right, before we even got to COVID. You know, LGBTQ folks who did live through the AIDS epidemic, in some ways, had more tools, had more resilience, had more to work with in navigating through COVID, but we see that play out in so many different contexts.

In the context of activism, you know, the context of activism, it was fascinating to see in 2016 and 2017 when a fiercely dramatic anti-LGBTQ president took over this country, and similar forces controlled Congress for the first couple of years. What I saw was that it was the elders in our community who were least afraid, who were most energized, and who were most ready to pick up and push and fight against that. Again, this is because of the resilience built over decades.

Robert Espinoza: It's impossible to talk about today's older LGBTQ adults without discussing some of the significant historical moments they have lived through and the political moments they have led. Dr. Karen Frederickson Goldson at the University of Washington proposes that we consider this demographic to comprise three distinct generations.

The oldest segment is part of "the invisible generation," born around 1920, living through the Depression and WWII, and growing up when these issues were virtually absent from the public conversation. The second generation is "the silenced generation," born in the 1930s and 1940s. They grew up when LGBTQ workers were openly targeted by employers and the government and when homosexuality was deemed a mental illness by groups like the American Psychological Association. This was also the era when electric shock therapy was considered a treatment for homosexuality. And yet, in contrast, The Kinsey Report described sexuality as a spectrum and much more widespread than imagined.

The third generation is "the Pride generation," born after the 1950s and 1960s and growing up during the Stonewall era. Stonewall was named after a rebellion against routine police raids in New York City that sparked a national movement and the gradual decriminalization of sodomy laws.

All three generations lived through the AIDS epidemic, which ravaged and helped politicize this population in the 1980s. And since then, these generations have witnessed and contributed to the growth of a national LGBTQ political infrastructure, major political victories, and disappointing setbacks.

Now stop for a moment and consider: what has this lifetime of events, the horror, the progress, and the retrenchment done to the physical, emotional, and economic lives of today's LGBTQ older adults? The answer? A lot.

You turned 60 not too long ago. What is going through your mind about how you want to live at this stage of your life?

Michael Adams: Yeah, it's been interesting for me coming into this age. I'm now 61, and I joke that I have the kind of job that the older I get, the more qualified I am for the job.

So one thing I would say is that it's really interesting to me to be the head of this organization as somebody in my sixties, right, versus somebody in my forties, because the work of SAGE is much more immediately personal to me than it was when I was younger.

And as I think about what it means to get older for me and get older as a gay man, I don't know why, but for some reason, I often find myself thinking about back when I was in my twenties. I was in my twenties during the worst of the AIDS epidemic, living in San Francisco at the time. And it was for a lot of us, for me and my friends, we wondered if we would get old. I think many of us thought we would never get old. Just because it was so dangerous and so unknown, and if we got AIDS–and that seemed like inevitable at some point that we all would–there was no way to survive that. And so it's not an overstatement to say that me and my friends and people of my generation had to fight to get old, right?

We had to fight to win that right to get old. And now, as I am aging, and I am in my 60s, I feel a lot of gratitude for the fact that I'm here, that I have the opportunity to live the life of an older person, an aging person, and I look forward to that. There are challenges because of the work I do with SAGE, but I also see a lot of opportunities and new chapters in life. One of the many benefits of being at SAGE is watching the people 10, 20, and 30 years older than me and seeing how they're leaning into those opportunities.

And it's pretty exciting, you know, and so I'm excited about that for me and my husband.

Robert Espinoza: When you look at your bio, it's clear that you've had an expansive and storied career in LGBTQ+ rights dating back to the 1990s, if not earlier, working for the ACLU and Lambda Legal. Can you share a specific case or story from that time that captures what it meant to live as an LGBTQ person in those years?

Michael Adams: Yeah, I had the opportunity to work on quite a number of cases during my times with the ACLU and Lambda Legal, and there was one that jumps out at me and actually in a tragic way.

I represented a man in Mississippi. It's okay to say his name because it was a public case back then. His name was David Weigand, and he had been married for a number of years. He and his wife divorced, and they had a son. His wife remarried, and his ex-wife had primary custody of their boy, and David had visitation, mostly in the summer, etc. But he was able to spend a good amount of time with the son and maintain a relationship.

And then, sadly, his ex-wife's third husband was abusive, was very physically abusive, and had substance abuse problems. And so it was a very violent household. The boy was witnessing his mom being beaten up by his stepdad, was being physically threatened by his stepdad, and was forced to call 911 repeatedly on his stepdad. He was in a very, very dangerous situation.

And so, in those circumstances, David moved the boy to come and live with him because of the really dangerous situation in the house. Recognizing that, of course, their son should maintain a relationship with both parents, but that the household he was in was just literally physically dangerous.

And that case went all the way up to the Mississippi Supreme Court in a series of horrific decisions by the Court of Appeals in the state and eventually by the Mississippi Supreme Court that didn't care what the specifics were about, the circumstances. It didn't care about the fact that the boy was in danger.

They cared about only one thing: the fact that the father was gay. And the fact that the father was gay meant that according to six of the nine members of that court, by definition, his household was not fit for the boy to stay in any ongoing way. And so that boy was kept in this highly dangerous situation.

And I've never forgotten about that case. That would never, ever have been the result of a case like that if it were not for David's sexual orientation, and it's indicative of the circumstances, certainly, that gay and lesbian parents faced back then. But that was just indicative of the larger challenge in society at the time, where LGBTQ people were just really thought of as second-class citizens and barely human beings in many contexts.

Robert Espinoza: This is the story that haunts me to this day. Several years ago, a former colleague told me about an older gay man who had just moved into a nursing home in St. Louis. His adult children lived outside of Missouri and had never approved of their father's sexuality and gay life partner. So, they forcibly removed him from the nursing home to another state, effectively ending his relationship with his partner.

Same-sex marriage wasn't legal then. And vicious acts against nursing home residents, unfortunately, go unresolved all the time for various reasons. But imagine being that father dragged against his will to another state by his own family. Or imagine being the partner left behind in Missouri. Where would you turn?

Thankfully, with all of these terrible stories, there are people like Michael and organizations like SAGE that are fighting to make the world a better place for LGBTQ+ older adults. So I asked Michael: What are you most proud of at SAGE?

Michael Adams: I'm most proud of the level of visibility and celebration that we've been able to bring and support for older folks in our community.

I remember when I first joined SAGE, what I heard over and over and over again from elders in our community, elders coming to SAGE, is that we're invisible. Nobody sees us. SAGE's tagline is "We refuse to be invisible," and it was [created] a refutation of the notion that nobody cared and nobody saw elders in our community.

And back just a couple of years into my time at SAGE, we did a public awareness campaign, an advertising campaign on subways and buses in New York City that was nothing more than beautiful images of queer elders. Just to make the point that we're here, right? Our elders are here, visible, and living beautiful lives that people should be paying attention to, which was radical at that time. Because older folks in our community were so invisible. And almost 20 years later, while there's still a lot of work to do, there's a tremendously greater amount of visibility and awareness about elders and LGBTQ communities.

And then, looking beyond the community, I think more and more so, we're seeing attention in the larger aging and eldercare space being paid to LGBTQ+ older folks.

Robert Espinoza: I want to ask you one final question. If a younger LGBTQ person were to ask you, What is it like to reach older age? What would you tell them?

Michael Adams: I would say, first of all, and I referenced this earlier, that it's a gift. It's a gift that none of us should assume we're going to have. And so it's something to be cherished. It's something to be cherished–to have the opportunity to get old. And that even though there are a lot of wonderful, incredibly fun things about being young, and I loved so much about what I experienced as a young, gay man, there's also a lot of amazing things about being older.

I have a level of peace and self-awareness in my life at the age of 61 that was nowhere in sight for me when I was a younger person, and I wouldn't trade either for the other. I mean, I loved my younger years, but I love these years, as well. So I would say cherish the opportunity, work for it, do what it takes, and keep yourself healthy so you can get old. And then when you get here, there's going to be a lot to look forward to and a lot to experience.

Robert Espinoza: Even though I've been politically active since college, my own ageism prevented me from even thinking about the needs of older people until I was in my early 30s. In 2009, I came across a press release describing a federal grant awarded to SAGE to establish the country's first-ever National Resource Center on LGBT aging. The center aimed to train aging providers across the country about this population and many other goals.

At the time, I was beginning to grow concerned about how my sister and I would support our parents as they entered their 70s and their 80s. I was soon connected to Michael Adams, SAGE's CEO, and a few months later, he hired me to lead the organization's national policy advocacy and education arm.

I remember Googling "LGBTQ" and "older" then and finding very little content. The LGBTQ aging field had remarkable thinkers and advocates, but their work was often localized, siloed from one another, and grossly underresourced. While researchers had produced some early, pathbreaking ideas for government reform and industry change, they had yet to be activated at the scale necessary to affect millions.

Fast forward to the present, and the landscape looks much different. Even though LGBTQ older adults continue to deal with immense pressures, as described in this episode, this field now has a vast network of thinkers and advocates shaping various dimensions of the health and long-term care industries.

Journalists, policymakers, and entertainment professionals grapple with this issue like never before. And it's less frightening, perhaps even exciting, for many older LGBTQ people to imagine their later years.0

I often think about the greater meaning of the LGBTQ older adult experience and what it can teach our broader culture and democracy. And it boils down to this. Looking closely at the themes underpinning this population, you might see your aspirations and fears, regardless of how you identify. The need to feel safe in our homes and communities. The ability to thrive financially and in good health. The desire for affirmation and love. The mountains of challenges and rivers of strength that aging incurs for most of us.

And the bias codified in our laws and institutions, in our everyday thinking, because too many people refuse to see one another's humanity. Or they are afraid of what it might reveal about themselves.

The truth is that when we make life more fruitful for older LGBTQ people and remove all their barriers in this pursuit, we ultimately improve aging for everyone. Consider how a nurse who has been trained to understand the histories of queer people might also become more sensitive to the cultural identities of other elders. Or how a health clinic that offers quality care to transgender older adults might, in turn, improve its reproductive care and geriatrics expertise along the way.

A transformed, long-term care system that creates the freedom to be who we are and what we desire until our final years is a system in which all of us will flourish.

Thank you to my guest, Michael Adams, and to you, the listeners. If you enjoyed this episode of A Question of Care, please share it on your social channels and stay tuned for future episodes.This podcast was produced by me, Robert Espinoza, in partnership with Modry Media. Please make sure to rate and review the podcast wherever you're listening.