HRC Issue Brief: Aging

The Problem

As they enter their later years, lesbian, gay, bisexual, and transgender (LGBT) older adults and their families are forced to navigate unique, complex barriers, often without the traditional support systems many seniors take for granted. Discrimination in housing, employment, and healthcare has made many LGBT older adults vulnerable to an increased risk for social isolation and higher poverty rates. The lack of relationship recognition, continued harassment by peers and healthcare providers, and the impact of lifelong discrimination silences many LGBT older adults and their families.

Marriage Discrimination Particularly Harms Older Adults

The lack of formal relationship recognition leaves many LGBT older couples struggling to make ends meet as they plan for their later years and end of life. Older couples can create decision making documents including wills, but in most states these wills can be contested by blood relatives. For older couples not out to their families or the community, the surviving partner often has little standing to protect his or her interest in property. This is particularly common among couples who have lived most of their adult lives with psychiatric and legal authorities characterizing them as mentally ill and criminals.

Denial of Federal Benefits Increases LGBT Older Adults’ Risk of Poverty

The federal government recognizes that the loss of a partner can be devastating, both emotionally and financially and has created programs to assist surviving spouses. However, the Defense of Marriage Act (DOMA) denies surviving same-sex spouses these critical benefits. For example, most spouses pay into Social Security with the expectation that their surviving spouse will receive this benefit and in turn, will be able to maintain a shared home and continue to provide for their children; DOMA denies surviving same-sex spouses this security.

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In addition, same-sex couples lack access to protections under Medicaid that prevent a healthy spouse from losing a family home and basic assets to survive on when his or her spouse enters nursing or other long-term care. While the Department of Health and Human Services (HHS) has made clear that states can extend these protections to same-sex couples, the vast majority of them do not.

LGBT Older Adults Experience Discrimination in Long-Term Care

Many LGBT older adults rely on peer groups as their support system and for caregiving. These peer groups are often unable to fully meet the healthcare needs of each member as the group ages together.  This results in a disproportionate number of LGBT older adults relying on long-term and assisted living facilities for care, and in many of these facilities, members of our community experience discrimination by caregivers, nurses, and other patients.

This discrimination can take many forms including bullying and harassment, as well as failure to provide necessary daily care like bathing. Some long-term care facilities have failed to recognize transgender residents’ gender identity, often refusing to use a correct name or respect a resident’s gender expression through clothing or grooming. This harassment and discrimination too often leads to depression, failure to thrive, and suicide among LGBT older adults in long-term care facilities.

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What has the Obama administration done to address the needs of LGBT older adults?

  • The Department of Health and Human Services awarded a $900,000 grant for the creation of a national resource center on LGBT aging issues to Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE).  For more information on the resource center visit:
  • The Office of Personnel Management expanded eligibility for long-term care coverage to same-sex partners.
  • The Centers for Medicare and Medicaid published guidance confirming the authority of states to extend protection from “spousal impoverishment” to same-sex domestic partners under Medicaid.
  • The Department of Health and Human Services issued regulations requiring all hospitals receiving Medicaid and Medicare to prohibit discrimination in visitation against LGBT people.

How is HRC working on aging in the LGBT community?

  • HRC continues to work with the Department of Health and Human Services Administration on Aging (AoA) to ensure that LGBT older adults nationwide have equal access to AoA funded programs.
  • HRC is participating in the development of cultural competency training materials for long-term care facility managers and employees with the Centers for Medicare and Medicaid (CMS).
  • HRC continues to support the reauthorization of the Older Americans Act and is working to include language that would improve the lives of LGBT older adults, such as designating LGBT older adults as a vulnerable population with the greatest social need.


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