Arthur “Artie” Fuller came out rather late in life, he says. At 52. His best friend, Clark McKinley, was already out in ’52. In 1952, that is.

Fuller and McKinley have lots of stories to tell. And they take their time doing it. In fact, both might consider it a fine art.

Fuller, 73, is a Southern California native and McKinley, 72, moved here after serving his country in World War II.

“I guess you could say that was before blue states and red states,” McKinley says.

“Hell, that was before Alaska and Hawaii were even states,” Fuller jokes.

“Yeah, I guess I came out even before Hawaii and Alaska,” McKinley finishes.

It’s hard not to get the feeling that these two have used this banter to entertain listeners before.

According to the San Diego Association of Governments, there are more than 350,000 seniors age 65 and older living in San Diego County. And Baby Boomers are about to add to that number dramatically.

The AARP (American Association of Retired Persons) estimates that by 2030, seniors will account for one in five Americans. Locally, by 2030, one in four residents will be age 65 or older. Most census experts agree that GLBT seniors account for nearly 10 percent of the general senior population.

What that means for the GLBT community in San Diego is that in a very short period of time, for every four persons seeking services from the local GLBT community, one will be a senior.

And few experts believe the community is prepared.

Brad Winn has worked with GLBT seniors for the last 20 years of his practice as a therapist in California.

“The issues that face seniors today, and in particular [GLBT] seniors, are huge,” Winn says. “We are talking about a dramatic shift in the makeup of our community.

Rachel Merrill is post-doctorate in sociology at the University of California at Berkeley and has been working on a thesis covering the shifting demographics of the GLBT community.

“Most social trends stay a few steps ahead of the actual demographic shifts,” Merrill says. “There are always small steps made just before a large shift happens. We’re not seeing that with our graying LGBT culture. We still worship youth. We still focus our dollars on gay men and meth. I think when the rubber hits the road, it’s going to be a total wipeout.”

One of the largest issues facing the growing population of GLBT seniors is health care.

Renee Nashtut is the care coordinator for ElderHelp’s Aging as Ourselves program. Aging as Ourselves is a community-based collaboration providing a safe and caring network of health, legal and social services to GLBT seniors in San Diego County.

“We are on the verge of the changing demographics, with a growing number of LGBT seniors,” Nashtut says. “And there is an increasing degree of need for this population in terms of health care. The health care community is not prepared to embrace this population. And that’s a problem.”

And as far as she can tell, the culture shock that the health care community is going to go through is like nothing it has seen before.

Specifically, Nashtut says, are the various heterosexual assumptions that are inherent in the current health care system. For example, the presumptions that everyone has the same social support system, such as children who can assist as potential caregivers, can be a concern, as well as women’s issues as they relate to many lesbian seniors, such as nulliparity, never bearing children, or simple assumptions when it comes to gender.

Each of these, when taken in isolation, makes for a small number of the population. But when viewed collectively, the case for a more aware – and less heterosexist – health care system is powerful.

Just ask Peter Valle. Valle recently fell in his home and was placed in a nursing home while he recovered from surgery. Valle, 71, says his stay was riddled with unnecessary stressors.

“From the moment I arrived at the facility it was a silent living hell,” Valle recalls. “They asked me about my children, my wife and grandchildren. I just looked at them blankly. I had never come out to my doctors before and now it came back to haunt me.”

Valle is not alone in being closeted to health care providers. In fact, studies primarily show that nearly a quarter of GLBT seniors have never come out to their health care provider. And only 50 percent of GLBT seniors feel health care providers are competent when it comes to issues of sexual orientation.

But Valle isn’t convinced having been out would have helped him much. After all, if he had one more nurse tell him how wonderful it was that his “buddy” was coming to visit him, he was going to “throw the walker at the woman!”

Valle’s buddy is his partner of 17 years, Frank Mitchell. Mitchell and Valle have mutual power of attorney and are registered with the state as domestic partners.

“I just had the feeling that if I were to introduce Frank to everyone as my domestic partner, they would have just thought, ‘Oh, that’s a nice gay man,’ and never even understood what the legal and medical implications are,” Valle says.

Vincent Meyer, 65, had other reasons for not coming out to his doctor.

“How do you ask your doctor for Viagra and explain it’s so that you can have a healthy sexual experience with another man?” says Meyer, who actually switched physicians in order to get Viagra. “I just couldn’t ask my current physician. He knew I was gay, and that was OK because men my age are often single, having lost their wives or whatnot. But being actively gay, that was somehow different. It was somehow a shameful thing.”

Meyer considered getting Viagra over the Internet or from Mexico and keeping his regular physician.

“But then I worried about what would happen if I had a medical issue and someone wasn’t aware of the chemicals in my body that would effect their treatment,” Meyer recalls. “The trade-off, then, is that I no longer have a doctor who knows to check things like prostate cancer and such from the perspective of a gay male.”

Janice Beckman considers herself a “radical feminist and militant lesbian, but only deep down inside.”

Beckman, 82, met Valle when Valle was recovering from his surgery.

“I thought to myself, ‘Oh, here’s a friend of Dorothy’s,’” Beckman jokes. “And so I went up and struck up a conversation with Peter. And suddenly, it was the talk of the [nursing] home. ‘Janice has met a man! Looks like it’s not too late for Janice to settle down and get married.’ No offense to Peter, but not since I left my husband in 1952 have I ‘met a man.’ While it was sort of funny, it was also kind of sad, all the assumptions people were making. It was like having to hide [my sexual orientation] all over again. And, my dear, I am too old for that.”

Particularly disturbing are studies in lesbian senior health care. And coming out to a physician is critical in getting the right medical care.

Aside from nulliparity, lesbian seniors often have used oral contraceptives far less, thus changing the discussion of hormones. Statistics are showing that lesbian women are less likely to have been screened for ovarian and endometrial cancers, as they are less likely to have seen these specialists than their heterosexual counterparts. And statistics show that lesbians are twice as likely as heterosexual women to be, or have been, heavy smokers.

In an April ElderHelp report on GLBT senior health issues, it was reported that 40 percent of all GLBT seniors came out after the age of 40. Eleven percent of GLBT seniors have never come out. The study also indicates that, like Beckman, more than 50 percent of lesbian seniors had been married. So while their histories show a heterosexual marriage, their true history often remains hidden.

Winn says nursing homes and assisted-living facilities are severely lacking in their cultural awareness around GLBT issues. And while places like Fountain Grove Lodge in Santa Rosa, a GLBT retirement assisted-living community, are starting to crop up more and more, there are economic constraints that will prevent the vast majority of the GLBT community from ever getting to experience that luxury.

“Places like Fountain Grove and Palms [of Manasota, Fla.] are great models for what assisted living for LGBT seniors should be,” Winn argues. “But the reality is that without the financial structures that often come with conventional marriage and family, most of our [GLBT] seniors will end up in local facilities. It is imperative that all facilities have a cultural awareness of LGBT issues, not just those built for LGBT seniors.”

According to Winn, this means reflecting same-sex relationships in the images that the facility uses. GLBT symbols such as the Pride flag, the lambda sign or the pink triangle should be displayed. Intake forms should address issues that are specific to GLBT seniors. Nurses and doctors should be more aware of medical issues as they relate specifically to GLBT seniors.

“We’re not talking about a radical agenda,” Winn says. “We’re talking about making sure every individual is valued and cared for in a way that we expect they should be. We’re talking about dignity and quality of life.”

And while the face of the GLBT community is changing with regard to a growing number of gay men and lesbian women adopting, conventional family support is missing in a significant percentage of our GLBT senior community.

One of the most disturbing trends is in the area of HIV. More than a quarter (28 percent) of HIV/AIDS patients in the United States are older than 50. By 2015, that number will increase to more than half. Since 1991, AIDS cases among individuals over the age of 50 have increased 22 percent. One in seven new cases of HIV is a person over 50. Black seniors are 10 to 15 times more likely than their white counterparts to be infected.

“One of the challenges in people 50 and older is the mistaken belief that they’re not at risk,” Robert S. Jannsen, M.D. and director of the Centers for Disease Control and Prevention’s division of HIV/AIDS prevention, told members of the Senate Committee on Aging.

In fact, the CDC indicates a 500-percent increase in HIV cases in those over 50, from 16,000 in 1995 to 90,000 in 2003.

And while the increase in new cases is predominantly in heterosexuals, there has been an increase in gay male seniors.

“What’s happening is that men who have lived through the initial AIDS crisis and have reached the age of 60 or 65 are starting to view themselves as invincible,” Winn explains. “And as these men have greater access to sexual enhancement medication … they have greater access to sexual experiences.”

Gary Rice is 61 and says he has sex on a weekly basis.

“Have you ever been on Adam4Adam?” Rice says. “I would guarantee you that on any given night there are 50 to a hundred guys over 55 cruising. And you would think it would be hard for an old man like me, wrinkles, fat and all, to meet someone. Not at all, not at all. You just have to know how to market yourself and where to look.”

And does Rice use protection?

“You bet I do,” he says. “But for every guy like me I bet there are 10 or 15 who don’t. I’ve had several of my friends seroconvert over the last few years. Here they survived the AIDS crisis of the ’80s only to head into their 80s HIV positive.”

Jonathan T. (last name withheld by request) is one of Rice’s friends who seroconverted after having unprotected sex with other men. He is 68.

“I heard a guy say the other day, ‘Well, I may be HIV positive, but at least I’ve lived to be old enough to retire,’” Jonathan says. “I guess the way he sees it, if he had caught AIDS back in the day, he wouldn’t have lived this long, so catching it now is OK since he’s older than he would have been the other way and at least he doesn’t have to face his parents. I can’t see it that way. I screwed up.”

There is genuine sadness in Jonathan’s voice. “The way I see it,” he says, “I may have just cost me my golden years.”

Winn explains that the invincibility attitude combines with two other primary factors: a lack of HIV awareness due to generational issues and reluctance on the part of seniors to talk to health care providers about their sexual activity.

Diagnosis can also be an issue. Oftentimes, Winn says, early indications of HIV, such as weight loss, decreased mental faculties and fatigue, can be mistaken for Parkinson’s, Alzheimer’s or respiratory diseases. If a patient is reluctant to discuss their sexual behavior, and the health care provider sees first and foremost an elderly person, conclusions that are contrary to optimal health care will result, Winn says.

With lesbian seniors, HIV continues to be a concern because studies have shown that an estimated 20 percent of all self-identified lesbians are sexually active with men.

From a sociological standpoint, there are two ways that can break this cycle, Merrill argues.

“Either the doctors have to start asking the right questions,” she says. “Or the patient has to be more forthcoming with the information. From a strictly sociological and psychological perspective, there is a power issue that is going to have to be overcome for the patient to take the initiative. In our society, patients are rushed through HMOs, and we are given less than 10 minutes to explain our concerns. We are at the mercy of these individuals whom our society deems as upper class from a power perspective. It’s very hard for many people to understand that their body and their well-being are of more importance to themselves than any other person.”

And if you think nothing is being done, think again, Nashtut says.

“We’ve received a grant for a million dollars over four years to create awareness campaigns and change around LGBT seniors and HIV,” she explains. “It’s the largest grant of its kind. It will most definitely make a difference.”

What Merrill and Winn are arguing for is something called culturally responsive care. It’s a term that, simply put, means “physical and behavioral health care services that are sensitive to the needs and health status of different groups.”

The American Nurses Association has been turning its focus away from ethnocentric approaches and toward more specific cultural issues.

In a statement from the ANA, the organization explains the shift.

“Knowledge of cultural diversity is vital at all levels of nursing practice. Ethnocentric approaches to nursing practice are ineffective in meeting health and nursing needs of diverse cultural groups of clients. Knowledge about cultures and their impact on interactions with health care is essential for nurses, whether they are practicing in a clinical setting, education, research or administration. Cultural diversity addresses racial and ethnic differences….” However, “these concepts or features of the human experience are not synonymous.”

Specific to GLBT seniors, Winn explains, the shift needs to focus on how GLBT groups – collectively and individually as gay, lesbian, bisexual or transgender – understand life processes.

“Health care providers need to be prepared to understand how lesbian women view menopause differently than heterosexual women,” Winn says. “It’s fundamentally different. In general, I believe there is less a connection with the loss of reproductive ability and more of a connection with midlife crises. ”

Likewise, he says, is the way gay men define health and illness.

“Oftentimes, the way gay men define wellness and how they go about maintaining it is radically different than the way straight men do,” Winn says.

Most importantly, though, he says, is that health care providers need to be understanding of they way the GLBT community cares for members of its own community.

“We must understand that quite often LGBT seniors simply do not have the direct familial and generational support system built into their care,” Winn explains. “While our system is set up, for example, for many outpatient procedures – ‘Do you have someone who can come get you as you’ll be unable to operate a vehicle until the anesthetics wear off?’ – we might not have those support systems there. Our system’s heterosexist assumptions have to be replaced with a more culturally responsive and responsible care.”

One of the key areas of focus for GLBT seniors is on social outlets. S.A.G.E. (Seniors Active in a Gay Environment) is “an organization committed to fostering a greater understanding of aging and to meeting the unique needs of seniors” that has been in San Diego for 26 years.

Tom Kirkman is the executive director of the S.A.G.E. Center, located at 3138 Fifth Ave. in Hillcrest, which has been open since 1992.

“I think senior gay organizations are so important,” Kirkman argues. “Unlike seniors in general, like our parents, as they got older, their peers may have passed away, but they still had the support of children, grandchildren and extended families that way. A lot of times, LGBT seniors come into a different situation: Their peers pass away, sure, and they may even lose a partner, but there is not greater family support.”

And that, says Kirkman, is exactly what S.A.G.E. and other organizations in San Diego do – provide a social support network for GLBT seniors.

“The emphasis is on ‘active,’” Kirkman explains. “Many of our members are still working. Many volunteer at a variety of theater programs like the Diversionary and The Old Globe. Some are part of the RSVP [Retired Senior Volunteer Program] with the police. Many are volunteers in the community, like with AIDS Walk or Pride. Many of our members have a need to stay involved.”

Other groups in San Diego, like S.O.L. (Slightly Older Lesbians), are focused on bringing seniors together for meaningful discussions – and change.

S.O.L. meets every Friday at The Center from 7:30 to 9:00 p.m., and provides a discussion space for lesbian seniors.

Beckman wishes she had known about these organizations.

“When I think of all the times I spent wondering who I could ask for help, what I could do in a certain situation, that’s a lot of time and energy spent unnecessarily,” Beckman avers. “I suppose on a positive note, if these opportunities grow for generations to come, maybe there will be fewer people who find themselves fending for themselves.”

Kirkman explains that like S.O.L. and other senior groups, S.A.G.E. is not just a social club.

“It’s true that we provide opportunities for socialization through membership programs and activities,” he says. “But we also find ways to help those in the senior community. One recent example is a guy who lost his partner. He was living alone and had not really left his house for a year. It was horrible. So we sent one of our members over to see if he could help out, you know. Sort of check in and see if there was anything the member could do.”

S.A.G.E. is also partnering with other organizations in the community to provide resources for GLBT seniors.

As part of the Aging as Ourselves project, S.A.G.E. is working with the LGBT Resource Center on the University of California San Diego’s campus to identify volunteers who will be trained to provide culturally appropriate, non-medical, in-home support services to GLBT seniors. Support will include friendly visitors, transportation, grocery shopping, home repair and gardening, assisting the senior with organizing their finances and pet care.

The first training is scheduled for Nov. 5 from 9:00 a.m. to 12:00 noon at the S.A.G.E. Center.

One of the issues seniors face, in fact, is the shrinking circle of social outlets as they age.

“When we are young, we are exposed to such a broad range of social institutions,” Merrill explains. “In primary school we are brought into buildings where there are hundreds of other members of our peer group. In college we are brought together in an institution where there are often thousands, if not tens of thousands, of our peers. As we age, the number of individuals to whom we are exposed shrink dramatically. We might work in a company where there are a hundred or fewer people that we would interact with in any given year.”

When a person retires or leaves the workforce, that number drops even further.

“Once a person leaves the workforce, we no longer provide them with spaces to meet others,” Merrill explains. “This seems reasonable at first glance because, traditionally, once a person is done working, their lives are complete. They would spend the next few years living out the remainder of their lives. The issue, though, is we now have people leaving the workforce at 60 or 65 and living to be 90 or 95 years old. How do they meet people when all their former support networks are gone?”

Ultimately, Merrill says, seniors are reduced to private-room assisted-living facilities.

“The ultimate reduction in our social institutions in terms of numbers,” she says, “is when we move seniors to a facility that has 50 or 100 people in it but place them in private rooms with a television set. They are reduced to interacting with three aides – one for every shift – and an occasional Tuesday bingo group. Something has to change. We have to create communities for these individuals to interact, to meet, to socialize. Age should not determine quality – or quantity – of dignified life.”

Rice is interested in more than just a Tuesday bingo group.

“The way I see it, [George] Washington was 57 when he was sworn in as president,” Rice explains. “With the relative life expectancy, that’s what? Like, 95 years old in today’s age. And [Benjamin] Franklin lived into his 80s, serving as postmaster general and the head of the Supreme Court. And that was in the 18th century. I have every intention of continuing my life in a forward direction. No stops, no breaks. Maybe a speed bump here or there.”