A recently completed study of the needs of GLBT seniors was the topic at a Thursday, Feb. 19 meeting held at The Center. The San Diego County LGBT Senior Healthcare Needs Assessment, funded by The California Endowment and Alliance Healthcare Foundation, is the first in-depth look at the county’s GLBT senior issues and healthcare needs. The study focused on social and emotional health as it relates to physical health, concerns about being “out” in a mainstream retirement community, rights regarding retirement and pension funds, social security discrimination due to legally unrecognized partnerships and specific cultural needs that are not formally addressed by medical and care facilities. All survey respondents who participated in the study, which began in August 2001, were 50 years or older.

According to figures gathered by the San Diego Association of Governments, one in six San Diego County residents are 65 or older, and in another 25 years, that number will jump to one in four.

“We’re reaching a point where the Stonewall generation are getting older and retiring,” said Jim Zians, project director of the needs assessment. “This is the first group that is really ‘out’. This is a different time period in our country’s history and LGBT history, and things are different now.”

The town hall meeting focused on the reasons the needs assessment is so important and civil rights issues that affect seniors, as well as looking at the goals that were laid out by the National Gay and Lesbian Task Force and the conclusions drawn from the survey – what characterizes GLBT seniors and what the survey conductors found in terms of health and social concerns.

Civil rights issues were paramount to the discussion, establishing where discrimination actually occurs in social security, pension and retirement plans, Medi-Cal and Medicaid. “For instance, with spousal benefits and things like that, LGBT families don’t qualify,” Zians said. “I think of them as being discriminated against. I don’t know if the outside world does necessarily, but I think as a community it is discrimination. Our relationships aren’t recognized. In terms of retirement plans, if you have a legal marriage, different rules apply. [Also,] in terms of if a spouse passes away, and with rollovers of pension plans instead of treating it as income.”

The comprehensive 59-page study explores a broad cross-section of daily life, including employment, financial income, legal assistance for financial planning and preparation of wills, home ownership and mortgage, living situations and future outlook, varying degrees of “outness” among family, friends and society at large, the stereotype of mental decline, drugs and alcohol, men’s and women’s sexual health, general happiness and social support. It also looks at problems common among all seniors, such as financial and retirement problems (among women in particular), problems with ageism and social discrimination, the inability to obtain adequate transportation, housing services and nutrition, and intergenerational isolation with caregivers.

The survey found, however, that there are marked differences for GLBT seniors in some areas. Social discomfort in mainstream senior groups and what the study referred to as the “twice-hidden” group – those who experience ageism and sexual orientation discrimination – are culturally specific problems that frequently go underserved.

“If you interview some seniors, you will hear stories of going back in the closet as they get older, when they have to go to government organizations for services and different mainstream providers for retirement,” Zians said. “We’re hoping that this project begins the process to change that. We’re a consumer group in our community, and we’re not asking for people to be nice to us or to do the right thing, we’re really asking to be treated like a consumer group – we have our needs, we have our culture and we have our families and relationships.”

One intriguing find was that GLBT seniors who were open about their sexual orientation to their healthcare providers scored higher on assessments of their mental health, social activity and overall life satisfaction than those who did not disclose their sexual orientation. For the same reason, these respondents were also more likely to have had a recent physical exam, and were more likely to feel that their providers cared about them.

“We also asked questions like, ‘In the next five years, how much do you feel that you can rely on the LGBT community for services you may need?’” Zians said. “It showed that we were deficient in that area. People didn’t feel overwhelmingly that they could rely on the LGBT community.”

Though a majority said they felt connected to the GLBT community, three-quarters of the respondents wanted more GLBT-oriented services; a project, Zians said, that The Center has already pledged to be a part of.

“This is a topic that needs to interest all of us,” said Delores Jacobs, executive director of The Center, in a press release. “Just as we care for our youth, we need to ensure that the needs and concerns of our LGBT seniors are more fully addressed.”

“I think it’s really good community planning to get empirical data – objective data – through a needs assessment as a beginning point in helping to plan a continuum of services,” Zians said. “You take the data and you organize it in a way so people can use it.”

The needs assessment concluded with 11 recommendations to address and improve upon GLBT seniors’ specific social service and healthcare needs.

“The whole reason to have objective data is so that people have information to use to make decisions, instead of just making decisions based on what you think we need,” Zians said. “For instance, immediately when people think of senior issues they think of nursing homes and retirement facilities. Only about five percent of the population ever ends up in a facility like that. Very often communities will put resources into areas where perhaps the money could be better spent by expanding capacity with an organization that already does that kind of work and focusing on things that are more reasonable.”

One of the study’s top recommendations was to form a planning group that would organize the proposals into appropriate services, then obtain funding to implement them in target communities. Another was to create educational resource materials and initiate training for providers throughout the county, so that GLBT seniors can have their needs addressed in mainstream healthcare and social service organizations. Using the information from the needs assessment, the California Endowment has already funded an organization called Elderhelp to start this community planning process.

The San Diego County LGBT Senior Healthcare Needs Assessment is one in a long line of funding priorities for the Alliance Healthcare Foundation, a nonprofit founded in 1988 to assist medically under-served groups by researching issues and writing grants to help get them the care that they need.

“Some of the staff at the Alliance Healthcare Foundation, who focus on health issues for target populations around the community, are very interested in health issues for the LGBT community,” Zians said, addressing how the idea for the needs assessment developed. “They funded the Rubberboyz grant [a safe-sex campaign] back in 1997 as well as the Lesbian Health Project and capacity-building grants at The Center, and they also funded the social marketing campaign on methamphetamines for Stepping Stone. Someone [at Alliance] who works on senior issues saw an overlap between a deficit in LGBT senior healthcare and some of the other senior issues that they were working on. So we have some friends in the funding and healthcare community.”

Zians said the Human Dignity Foundation is already looking into establishing a GLBT retirement community in the area, similar to those starting up in Arizona and northern California. “I think that is where we are next, regarding the planning process,” he said. “As the committee comes together, they may want to reach out to some of the developers or some of the retirement communities that are already in existence.”

He also pointed out that the needs assessment was written with a built-in literature review section to help with future grant writing for such projects. “Since we know so little about LGBT seniors and there isn’t a lot of research, we had to go exploring ourselves. As I was putting the lit review together I thought maybe we should just integrate the lit review into the report so that when people use it to write a grant a lot of the resources and references are right here.”

For a copy of the San Diego County LGBT Senior Healthcare Needs Assessment, contact Jim Zians at (619) 543-5086 or jzians@ucsd.edu.