Social work practice with LGBT seniors.

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Social Work Practice With LGBT Seniors a

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Steve Gratwick , Lila J. Jihanian , Ian W. Holloway , Marisol b

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Sanchez & Kathleen Sullivan a

Los Angeles Gay & Lesbian Center, Los Angeles, California, USA

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Department of Social Welfare, University of California, Los Angeles, Los Angeles, California, USA Accepted author version posted online: 10 Mar 2014.Published online: 24 Sep 2014.

Click for updates To cite this article: Steve Gratwick, Lila J. Jihanian, Ian W. Holloway, Marisol Sanchez & Kathleen Sullivan (2014) Social Work Practice With LGBT Seniors, Journal of Gerontological Social Work, 57:8, 889-907, DOI: 10.1080/01634372.2014.885475 To link to this article: http://dx.doi.org/10.1080/01634372.2014.885475

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Journal of Gerontological Social Work, 57:889–907, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0163-4372 print/1540-4048 online DOI: 10.1080/01634372.2014.885475

Practice Forum


Social Work Practice With LGBT Seniors STEVE GRATWICK Los Angeles Gay & Lesbian Center, Los Angeles, California, USA

LILA J. JIHANIAN, IAN W. HOLLOWAY, and MARISOL SANCHEZ Department of Social Welfare, University of California, Los Angeles, Los Angeles, California, USA

KATHLEEN SULLIVAN Los Angeles Gay & Lesbian Center, Los Angeles, California, USA

The Los Angeles Gay & Lesbian Center began providing services to LGBT seniors in 2008. Since then, the Center’s seniors program has grown to over 3,300 clients. It provides a variety of enrichment and support services with the overarching goal of empowering seniors to successfully age in place. This article outlines the service delivery program of the Center’s Seniors Services Department and describes its successes and challenges in meeting the needs of diverse LGBT seniors. It offers future directions for social work practice, policy, and research with LGBT older adults. KEYWORDS LGBT aging, seniors services, LGBT

Scholars estimate that by the year 2030 there will be between two and six million lesbian, gay, bisexual, and transgender (LGBT) people ages 65 and older living in the United States (Cahill, South, & Spade, 2000; FredriksenGoldsen & Muraco, 2010). This is a population of particular interest for social workers and other health professionals, because LGBT older adults are at disproportionate risk for physical disability, psychological distress, and lower Received 31 March 2013; revised 16 January 2014; accepted 16 January 2014. Address correspondence to Ian W. Holloway, Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, 3250 Public Affairs Building, Box 951656, Los Angeles, CA 90095-1656, USA. E-mail: [email protected] 889


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health status than their heterosexual counterparts (Fredriksen-Goldsen et al., 2011; Wallace, Cochran, Durazo, & Ford, 2011). However, LGBT older adults appear to be underrepresented in aging service programs, either because they are not utilizing these services or are not identified as LGBT within service contexts. Qualitative studies point to wariness about using mainstream aging services among LGBT older adults and their caregivers (Brotman et al., 2007; Brotman, Ryan, & Cormier, 2003; Orel, 2004). A recent report on national survey data suggests underutilization of aging services by LGBT older adults. Among those surveyed, only 28% of LGBT older adults accessed aging services, despite the availability of mainstream aging services in many communities (Fredriksen-Goldsen et al., 2011). We could not locate a comparable statistic for non-LGBT older adults, and the assertion is not that LGBT seniors are accessing services at lower rates than other older adults. Rather, we include this statistic because FredriksenGoldsen et al. also found that 47% of older LGBT respondents experienced disability, 53% reported loneliness, and 31% indicated depression, suggesting that need surpasses service use. In Los Angeles, the figure is even lower, as demonstrated by a recent survey conducted by the Department of Aging where only 4% of LGBT seniors reported ever using publicly funded senior centers (City of Los Angeles Department of Aging, 2012). The purpose of this practice forum article is to describe a successful LGBT seniors program and practices that will help other communities and aging professionals better serve this vulnerable population. Details are specific to LGBT seniors, but the issues and concepts may be relevant to social work practice with other marginalized older adults. Two factors appear to contribute to LGBT older adults not being recognized by providers in aging services: nondisclosure of sexual minority status by LGBT older adults and lack of data collection on sexual minority status by service providers. Various authors have reported that when LGBT older adults use aging services, they may not disclose their sexual orientation or gender identity to service providers (Altman, 1999; Brotman et al., 2003; de Vries, 2006; Orel, 2004; Stein, Beckerman, & Sherman, 2010). Reluctance to disclose their LGBT identity can stem from seniors’ past experiences of discrimination with institutions and industries, including healthcare, and also from fear that they may receive substandard care due to perceived homophobia among agency service providers. Moreover, service providers do not collect data during assessments that would assist them in identifying LGBT elders and their unique concerns (Altman, 1999; Connolly, 1996; Knochel, Croghan, Moone, & Quam, 2012). Consequently, much of the literature on the aging experiences of the LGBT community highlights the invisibility of this aging population (Altman, 1999; Brown, 2009; Connolly, 1996; Morrow, 2001; Orel, 2004; Persson, 2009). LGBT older adults may choose not to access mainstream health and social services or not disclose their LGBT identity to providers for a variety


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of reasons, including anticipated discrimination in contexts that are hostile or insensitive to the needs of LGBT people (Hughes, 2007; Morrow, 2001). For example, Brotman and colleagues (2003) found that historical experiences of discrimination in health and social services informed current distrust of such services among lesbian and gay older adults. Fear of homophobiabased victimization was reported to be associated with lesbian and gay elders’ decisions to not access services (Brotman et al., 2003). In a more recent study, Brotman et al. (2007) found that caregivers of LGBT older adults’ anticipation of discrimination (often based on past experiences of discrimination) mediated willingness to access services for themselves and the elders for whom they cared. These data demonstrate the importance of the social context or social environment. Life-span theorists have made a link at both the individual and collective level between the importance of the social environment and well-being and successful aging (Baltes & Carstensen, 1999; Helliwell & Putnam, 2004). This article is descriptive of a particular program for LGBT seniors and their allies; however, as is detailed in the following, it provides further evidence of the importance of theories such as Socioemotional Selectivity Theory (Sullivan, 2011).

IMPACT OF THE SOCIAL ENVIRONMENT A growing body of literature suggests that LGBT older adults are quite justified in their concerns about discrimination by health and social service providers (Brotman et al., 2007; Fredriksen-Goldsen et al., 2011; Hash, 2006; Hughes, 2007; National Senior Citizens Law Center [NSCLC] et al., 2011; Orel, 2004). Fredriksen-Goldsen et al. (2011) found that many LGBT older adults have been denied healthcare services or provided with substandard care due to their LGBT identities, with transgender elders considerably more likely to have these experiences. Participants in a study of LGBT older adults in longterm care settings reported having experienced or witnessed staff engaging in verbal harassment of LGBT clients, denial of admission, nonobservance of a partner or spouse’s power of attorney, and refusal to honor transgender clients’ preferred gender pronouns or names (NSCLC et al., 2011). Even when providers of aging services express willingness to become more responsive to the needs of LGBT older adults, there is evidence that they do not take sufficient action. In a recent study that included half of the Area Agencies on Aging (AAAs) across the United States, Knochel et al. (2012) found that most AAAs were willing to provide relevant staff training; however, fewer than 8% offered targeted services for LGBT older adults and under 13% provided outreach to these elders. Interestingly, AAAs cited lack of available training and funding for training to explain the discrepancy between their openness to providing training and action toward this end (Knochel et al., 2012).


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Theory offers guidance in explaining and responding to the forgoing problems. Helliwell and Putnam (2004) discussed social capital as the concept that social networks have worth for people. They found that social capital and theoretically related variables, such as trust of social networks, were associated with happiness and life satisfaction directly and through their effects on health. Socioemotional Selectivity Theory (SST) builds on the idea that social networks have value. A basic tenet is that perception of time affects how people regulate their social environment and that people who perceive their time as finite (e.g., older adults) choose to spend their time optimizing relationships that are the most emotionally fulfilling (Carstensen, Isaacowitz, & Charles, 1999). From this perspective, older adults are expected to contract their social networks by forgoing relationships that are peripheral or likely to produce negative affect (Baltes & Carstensen, 1999). These social context theories suggest that LGBT older adults may not use or disclose in services because they do not trust the social environment in which services are delivered or do not perceive potential relationships in these contexts to be emotionally supportive or fulfilling. Accordingly, Sullivan (2011) found that an LGBT-accepting social environment played a major role in LGBT seniors’ decisions to enter LGBT senior housing and their sense of safety to increase their social networks. Although these seniors expanded, rather than contracted, their social networks, their pursuits of new relationships in this context were based on expectations that the relationships presented a relatively high likelihood of providing emotional support and satisfaction. The need for service providers to be clearly supportive of LGBT people and for services that can strengthen and expand supportive social networks is indicated. To reduce health disparities among LGBT older adults, culturally sensitive programs and services that are tailored to the unique needs of this population must be developed and implemented. However, social workers have few effective examples of older adult programs that have been successful in engaging LGBT seniors. As is described in the following, the Center’s Seniors Services Department responds to this need with a three-pronged service approach that includes opportunities for socialization, supportive case management services, and trainings to help other service providers develop affirmative, supportive practice with older LGBT clients. In this article, we describe the service delivery program of the L.A. Gay & Lesbian Center’s Seniors Services Department, highlight the successes and challenges of this program, and provide insights for future directions for social work practice, policy, and research with LGBT older adults.

THE CENTER According to Gallup surveys from June to December 2012, about 4% of people in California identify as LGBT (Gates & Newport, 2013). Based on

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Cahill et al.’s (2000) estimate that 3–8% of the population is LGBT and the 2010 US Census figures for Los Angeles County, there are between 294,558 and 785,488 LGBT people in Los Angeles County. Founded in 1971, the Los Angeles Gay & Lesbian Center (the Center) is the largest LGBT community center in the world. The Center services include a full health clinic, mental health clinic, legal services, seniors services, youth shelter and services, substance abuse programs, and community cultural arts.

THE CENTER’S SENIORS SERVICES DEPARTMENT The Center’s Seniors Services Department was created in 2008 to meet the needs of the growing senior population. The department provides supportive services for LGBT people and their straight allies ages 50 and older. Approximately, 3,300 clients are enrolled in the Seniors Services Department, which has roughly 1,100 client visits each month. Table 1 presents findings from City of Los Angeles Department of Aging needs assessment data collected in late 2011 and early 2012. This survey was the first time the city had ever included LGBT seniors in the needs assessment, and LGBT TABLE 1 Needs Assessment Survey of Los Angeles Residents Age 62 and Older (N = 407) Variable Age ranges 50–64 65–74 75 and older Gender Male Female Transgender Currently employed Yes No Living alone Yes No Relationship status Single Partnered Race/Ethnicity Black (not Hispanic) White (not Hispanic) Hispanic Asian/Pacific Islander Multiracial

% 33% 42% 25% 64% 35% 1% 31% 69% 66% 34% 70% 30% 4% 79% 7% 4% 6%

Source. City of Los Angeles Department of Aging (2012).


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respondents total 16% of all those surveyed. The survey was made up of two populations of LGBT seniors, those active at the Center and those who live at Triangle Square, a senior citizen apartment building with a high LGBT population. Findings confirmed high rates of isolation, poverty, and disability; however, because of the convenience sample the findings are not generalizable. The Center’s Seniors Services Department strives to enrich the lives of LGBT people 50 years of age and older. The strategy is to provide direct services to clients and leverage social service resources of other agencies. All services are delivered with the goal of aging in place for all Center clients (i.e., helping LGBT seniors to remain comfortably and happily in their existing homes, whenever possible). Additionally, consistent with SST, isolation reduction is imperative. Loneliness and a lack of belonging or connection to others increase the likelihood of death for those 65 and older by 45% (Perissinotto, Cenzer, & Covinsky, 2012). Thus, the Center aims to provide a supportive social context in which LGBT older adults can access necessary services in a supportive environment and facilitate connections between LGBT older adults and their peers.

SERVICE DELIVERY PROGRAM The service delivery program of the Center’s Seniors Services Department takes a three-pronged approach, which includes (a) activities; (b) case management; and (c) cultural competency trainings (Figure 1). Activities include classes, support groups, enrichment workshops, meals, field trips, and entertainment. Case management provides assistance with housing, medical, Los Angeles Gay and Lesbian Center Senior Services Program

Socialization Activities -Shared meals

Case Management -Behavioral management

Cultural Safe Spaces Training -History

-Computer classes, including social media

-Housing assistance

-Barriers to service

-Food insecurity

-Fall prevention classes (e.g., Tai Chi, dance, chair yoga and stretching)

-Referrals to socialization

-Challenges or differences in aging

-End of life planning

-Trauma informed service

-Storytelling and writing classes

-Mental health referrals

-Practical steps to create safe space

-Art expression

-Legal resources

-Theater performance classes

FIGURE 1 Los Angeles Gay and Lesbian Center service delivery program.


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mental health, employment, benefits, food referrals, and other quality of life needs. Cultural competency trainings are conducted to train and inform service providers on the issues essential to senior LGBT welfare. Health care professionals, housing organizations, government agencies, and businesses are all eligible to receive cultural sensitivity trainings. Once these organizations receive training from the Center’s Seniors Services Department, they are eligible to receive referrals from the Center. In this way, the service delivery program seeks to enrich the lives of LGBT older adults while expanding the supportive social context for these elders.

Activities Each month, 80 different activities are available for seniors to participate in, such as enrichment, creative expression, educational, entertainment, and socialization activities. These include instruction with computer skills, tai chi, yoga, acting, writing, and studio art. Local theater and music are staples of the program and popular with the senior community. A mixture of gender specific meals on and off site and a co-ed monthly dinner, provide affordable healthy nutrition and regular socialization opportunities. All enrichment programming has a clinical purpose guided by SST: providing a safe, accepting, and community space for LGBT seniors affords them the opportunity to establish social connections and create new or stronger social support networks (Sullivan, 2011).

Case Management Case management and support groups are also central to the Center’s Seniors Services. In addition to staff members, masters of social work (MSW) interns are available to support clients. Most case managers are bilingual and provide case management in various languages (i.e., English, Spanish, Japanese, French). Approximately 55 clients come at least once each month for case management services, with the majority of requests focusing on affordable housing, mental health, legal, and food resources. Although Seniors Services has a solid database of referrals appropriate for LGBT seniors in the Los Angeles area, demand frequently outpaces availability. There are eight support groups for seniors: two for women, two for men, one for Latino/Latina seniors, one for seniors experiencing grief and loss, one for caregivers, and one for LGBT residents in the San Fernando Valley (an urban area to the north of the city of Los Angeles). All support groups are at or close to capacity, with an average of 10–12 participants each. Demand for case management services and support groups reflects the importance of an LGBT-affirmative social environment and LGBT seniors’ willingness to access services in a supportive social context.

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Cultural Competency Trainings The Center’s Seniors Services Department has trained over 2,000 providers in senior LGBT care and services since launching its “Creating Safe Spaces for LGBT Seniors” program 2 years ago. These trainings vary from 2 to 5 hr, depending on the trainees, and provide clear and accessible information on issues that affect LGBT people as they age and how to create safe space for LGBT seniors. Receiving this information in trainings with open discussion and a training video, providers are better prepared to effectively support LGBT seniors with care and respect. Research shows that LGBT seniors are less likely to seek medical and support services unless they know they can present genuinely and openly as themselves to providers (Brotman, Ryan, Jalbert, & Rowe, 2002; Gabrielson, 2011). This is consistent with SST’s claim that older people may not pursue relationships that are not likely to be emotionally supportive or gratifying. The Center trainings have expanded into central and northern California through a partnership the Center has established with the Academy for Professional Excellence. This partnership has increased the reach of the Center trainings to all professional Aging Protective Service and professional aging staff in the State of California. As mentioned previously, referrals from the Center to other resources are contingent upon those organizations undergoing the Center’s cultural sensitivity training.

SUCCESSES The Center’s Seniors Services Department has had a number of successes, which include successful collaborations with area schools of social work, increasing public awareness about LGBT senior issues, training professional aging workers, and establishing Comunidad Latina, an LGBT social group for Latina/Latino seniors, to name a few. Exemplifying these results, consider Norman (pseudonym). Norman is an 88-year-old gay WWII veteran who arrived at the Center 3 years ago. Norman presented as depressed, impoverished, and emotionally distant after the death of his life partner. Case management referred Norman to the Center’s mental health department to relieve his depression, and he was referred to the Seniors Services Department as a way to decrease his social isolation. Today, Norman is a changed man. Social support programming has substantially increased his social network; the Center’s partnering and training at the local Veterans Administration (VA) led him to apply for his VA benefits, and case management has helped him acquire those benefits. Norman received an increase in his monthly salary from $800 a month prior to VA benefits to $3,200 after. He was literally pulled from poverty by the Center’s work with the VA. Shockingly, the Center found that 22% of their clients are veterans, and only 4% receive the benefits they earned (Los Angeles Gay & Lesbian Center,



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2013). Additionally, Norman is assured that all referrals he receives are for culturally competent providers based on the Department’s cultural sensitivity trainings. Since welcoming MSW student interns 3 years ago, Seniors Services now includes students from each of the major degree programs in the Los Angeles area including the University of California, Los Angeles (UCLA); the University of Southern California; California State University, Northridge; and California State University, Los Angeles. Assisting the department in all areas of programming, case management, and cultural competency trainings, the contributions of bright, dynamic, and bilingual interns have vastly enhanced the provision of services to LGBT seniors in Los Angeles. Additionally, participants repeatedly comment on how they enjoy the regular intergenerational opportunities these interns provide. It is anticipated that the inclusion of MSW interns will increase the local social work community’s capacity to establish trusting relationships with LGBT seniors and to advance the well-being of LGBT seniors by helping them expand their social networks. Increasing public awareness about LGBT senior issues has come through the cultural competency trainings offered by the Center. Through interaction with service organizations and individuals who work with LGBT seniors, the Seniors Services Department has brought attention to the stigma and discrimination that can be faced by LGBT seniors in service agencies. Through ongoing case management sessions, the Center’s Seniors Services Department solicits regular feedback from its seniors about their experiences with referral agencies in order to document when issues arise in the community and offer additional support to the agency from which the complaint arose. It also works to ensure that referral agencies have the most up-to-date information regarding optimal service delivery for LGBT seniors. As hypothesized by SST, local assisted living communities that have completed the cultural competency trainings actively welcome LGBT seniors, which has resulted in a more supportive social environment, increased service use, and disclosure of sexual orientation and gender expression among LGBT seniors. As a service agency in the largest city on the west coast, the Center is constantly seeking ways to reach the many cultural and linguistic communities of LGBT seniors throughout Los Angeles. With Latinos now comprising the largest segment of the population in Los Angeles, Seniors Services launched Comunidad Latina, a social and cultural support program for LGBT Latinas and Latinos age 50+. Since its inception 2 years ago, the group has grown to host monthly social gatherings, workshops on health and legal issues, and an annual Cinco de Mayo fiesta. Bilingual and monolingual Spanish language case management requests have tripled during this time period, as well. Comunidad Latina participants anecdotally report that although there are other opportunities to engage with community members who may share religious, health (e.g., HIV), and cultural affinities, there

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are limited opportunities specifically for LGBT Latino/Latina seniors in any of these areas. The slow but steady growth in the program’s attendance indicates that the Center is meeting an important need for this growing community of elders in Los Angeles.


CHALLENGES Despite its successes, the Center’s Seniors Services Department faces numerous challenges. These are documented to provide insights to other providers working with this population. As mentioned, one major challenge in outreach to LGBT seniors stems from the fact that these individuals are closeted within their communities. To address this reality, all departmental mailings are sent in plain envelopes with “Seniors Services” listed as the sender. Thus, the cost of working with this group can be higher than the general population of seniors. In addition, some clients have experienced discrimination and harassment in their previous interactions with social service providers. This past trauma must be considered when working with LGBT clients. Creating safe space is critical to both their comfort level and willingness to share helpful information with case managers and social workers. A trauma-informed model of service provision espoused by the Seniors Services Department can help providers create a non-threatening space. Ageism in the LGBT community is another major obstacle to optimal service delivery with LGBT seniors. Already pervasive throughout general American culture, a predominant youth focus also remains a powerful challenge for the LGBT community as its members age. Whether impacted by a perception of health and the HIV/AIDS epidemic, or the reality of a culture that has yet to fully realize and enjoy its position in society, a disproportionate emphasis on youthful looks, especially in Los Angeles, can lead to a reduced sense of self-worth or relevance for many LGBT seniors. Some LGBT older adults are true pioneers, as they are the first generations to ever age openly as LGBT people and have few, if any, examples of how to navigate and define later stages of life, which some never thought they would reach. The Center’s recognition that this challenge exists, even internally, led to action. Intergenerational programming has existed at the Center for several years and begun to bridge the gap between younger and older generations. The Senior/Youth Photo Project, periodic dinners, and volunteer programs at the Center all provide opportunities for intergenerational interaction and the development of genuine understanding and appreciation where there was little to none previously. There is still much room for progress, not the least of which can stem from LGBT seniors themselves, as they acquire a more confident, flexible, and empowered view of their rightful place in the natural lifecycle.



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Another major challenge to the successful implementation of the Center’s senior programming arises from Los Angeles’ unique urban environment, which is geographically dispersed. Because many clients of the Center travel great distances to participate in programming, transportation is a key concern for both case management clients and clients of the social programs. The Center is located in Hollywood, and transportation can be a barrier to accessing services for the racial/ethnic minority LGBT elders who reside in the San Fernando Valley and South Los Angeles. Long commutes by bus and transportation safety are major concerns for these older adults. Although it is not possible to include specialized services for the myriad cultural and language communities, Seniors Services has identified opportunities to encourage participation among members of more groups. Multilingual members of the Seniors Services Department are key to current efforts to develop pilot support groups and programs toward this end. The goal is to create increasingly representative and sustainable social service opportunities for the greater LGBT senior community that exists in 21st century Los Angeles.

IMPLICATIONS FOR SOCIAL WORK PRACTICE Theoretically-Driven Practice Theoretically-driven service models are crucial to effective service provision. In the case of the Center’s Seniors Services Program, SST provides a framework for understanding how LGBT seniors make decisions about accessing and sharing information in service environments, which informs development and implementation of services. For example, the guidance of SST extends to assessment procedures at the Center. If (as SST suggests) perception of the social context and, specifically, the likelihood of emotionally supportive relationships inform seniors’ willingness to participate in relationships with service providers, inclusive assessment procedures are a critical step in engaging LGBT seniors. Past research identifies intake forms and interviewing skills as important to inclusion and assessment of LGBT people, particularly those who may not disclose their sexual orientation in service contexts (Dutton, Koenig, & Fennie, 2008; Israel, Gorcheva, Burnes, & Wather, 2008; Landers, Mimiaga, & Krinsky, 2010; Lee & Quam, 2013). Israel and colleagues (2008) found that LGBT clients felt unsafe, uncomfortable, and disrespected in unhelpful therapy situations with intake forms that assumed heterosexuality and when service providers did not use transgender clients’ preferred names. Based on SST and Seniors Services’ theoreticallyconsistent experiences, language of and categories within intake forms and psychosocial assessments reflect LGBT inclusion through use of terms such as partnered, gender (with options for transgender people), and HIV/AIDS status. Thus, SST helps to both frame the service access problem and to

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suggest a solution. Social workers can enhance their abilities to respond to LGBT seniors in a coherent way by adopting service models that are grounded in theory.


Confronting Ageism As described in the Challenges section, the Center has confronted the rift between younger and older LGBT clients. In addition to offering intergenerational programming, the Seniors Services Department has undertaken efforts to integrate seniors into the culture of the Center by providing linkages to other departments (e.g., mental health, legal, and youth departments). Addressing ageism is also a part of the Creating Safe Spaces training. Based on increasing intergenerational contact and the heightened integration of LGBT seniors into the client community of the Center, it is clear that ageism and isolation of LGBT seniors from the larger LGBT community must be addressed on several fronts. Social workers can spearhead intergenerational programs, facilitate communication between people of diverse ages to advance supportive and understanding relationships, and provide training on combating ageism to service providers within and outside of their agencies. Fostering positive relationships with younger people is yet another way to expand LGBT seniors’ social networks, thus promoting their well-being and successful aging.

Reducing Isolation of LGBT Seniors With Mobility Barriers To address transportation problems in a service area that is geographically dispersed, it is necessary to develop ways to reach very isolated seniors. In the coming years, the Center’s Seniors Services Department seeks to implement home-based services and home visiting for its clients. Other social service organizations seeking to serve LGBT seniors should consider developing strategies for reaching those with mobility issues for several reasons. LGBT seniors are more likely to live alone than their heterosexual counterparts (Fredriksen-Goldsen et al., 2011; Wallace et al., 2011). This, along with compelling evidence of the prevalence of disability and various health disparities among LGBT older adults (Fredriksen-Goldsen et al., 2011; Wallace, et al., 2011), may mean that many LGBT seniors are frail and remain in their homes, missing critical services that they need. Home visits can help mitigate this reality and bring care and support to these isolated and vulnerable seniors. Efforts to help isolated LGBT seniors expand their social networks are especially critical given the links between belonging to social networks and life satisfaction (Helliwell & Putnam, 2004) and mortality (Perissinotto et al., 2012). The Center believes that this is particularly important in an urban landscape like Los Angeles, which is geographically vast. Although



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the Center offers comprehensive services, the majority of these are located in the Hollywood and West Hollywood areas, leaving large expanses of southern Los Angeles and the San Fernando Valley geographically isolated from the Center services. Other social service organizations seeking to provide services to LGBT seniors should take into account clustering of these individuals in urban areas and also the complex mobility needs of LGBT seniors. Another way that the Center hopes to address mobility issues for LGBT seniors is by implementing technology in service delivery, such as the use of online social support groups and remote access to gain information about Seniors Services and referrals. Recent research points to the possible effectiveness of using technology to serve older adults remotely (Botella et al., 2009; Irvine, Gelatt, Seeley, Macfarlane, & Gau, 2013; Savolainen, Hanson, Magnusson, & Gustavsson, 2008). Pilot investigations of Internetbased health and social service interventions have shown promise in areas such as increasing positive moods (Botella et al., 2009), reducing isolation/ loneliness (Savolainen et al., 2008), and increasing physical activity (Irvine et al., 2013) among older users. For example, a start-up organization has emerged in Los Angeles County that allows users to join online groups for the purpose of receiving support from those with similar concerns and exchanging information related to health and wellness (www.celsyalife.com). It also provides online health management tools. At least one other senior service agency in Los Angeles County has started a group on this social networking site, suggesting the potential for it to be a supportive resource for seniors served by the Center in the future.

IMPLICATIONS FOR SOCIAL WORK POLICY Equality for LGBT Older Adults in Aging Services The Center has conducted its Creating Safe Spaces training throughout the state of California, despite lack of enforcement mechanisms in laws that advance equality for LGBT older adults. AB 2920, the Older Californians Equality and Protection Act, ensures that the California Department of Aging includes programming for LGBT seniors as part of its services. SB 1729, the LGBT Senior Care Training, requires licensed health professionals who have constant interaction with seniors in nursing homes and senior care facilities to receive training to better understand how to foster an environment that is free from discrimination based on sexual orientation and gender identity. Unfortunately, neither of these laws have enforcement provisions, so compliance is essentially voluntary. If, as theory suggests, LGBT seniors’ well-being is related to supportive social networks (Helliwell & Putnam, 2004), it is essential that providers of aging services have the capacity to facilitate trusting and emotionally helpful relationships with LGBT seniors. Social workers

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should advocate for policies that address equality for LGBT older adults and work to ensure that there are enforcement stipulations in place.


Funding to Meet Expanded Demand for Services The current demand that the Center experiences for senior services (e.g., support groups at capacity and requests for referrals that outpace availability), along with anticipation of increased demand in the future, also suggests political action. The aging of the baby boomers has implications for demand for services. This cohort is expected to contribute to the expansion of the number of LGBT seniors to between two and six million by 2030 (Cahill et al., 2000; Fredriksen-Goldsen & Muraco, 2010). Particularly because the major studies that documented health disparities among LGBT seniors (Fredriksen-Goldsen et al., 2011; Wallace et al., 2011) included baby boomers, it is clear that need for services will be relevant to future LGBT seniors. In this, it can be reasonably surmised that demand for targeted services will grow with the dramatic increase in older adults. Policy is needed to support the development and infrastructure of new and expanded services to meet this need.

Equality for LGBT Seniors to Address Poverty High demand that the Seniors Services Department receives for referrals to services such as affordable housing and food resources necessitates attention to how the current policy context places LGBT seniors at risk of poverty. At the Federal level, policy has denied benefits under various programs to older partners in same sex relationships (Cahill et al., 2000; LGBT Movement Advancement Project [MAP] & Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders [SAGE], 2010). Until it was overturned in June 2013, the Defense of Marriage Act (DOMA) barred the extension of Social Security spousal, survivor, and death benefits to married same sex couples. Because of this, Social Security discrimination has been a serious financial detriment for LGBT seniors, as Social Security is the primary source of income for many older adults, and partners in same-sex relationships have been denied sustaining benefits that their heterosexual counterparts enjoy (Cahill et al., 2000; MAP & SAGE, 2010). Although the elimination of DOMA allows married same-sex couples to collect these benefits, committed, unmarried same-sex partners are still excluded, and most states do not allow same-sex couples to marry. Lack of access to Social Security benefits can result in financial catastrophe for LGBT seniors (MAP & SAGE, 2010). Without the advantage of survivor benefits, especially, LGBT seniors may be at risk of eviction, chronic stress, and further isolation, all when simultaneously dealing with the grief of a lost partner. The Center’s Seniors Services


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case managers have helped seniors establish a safety net when these financial catastrophes arise. However, comprehensive reform of Social Security and exclusionary state marriage laws are needed to meet the needs of LGBT seniors who are in committed same sex partnerships. Social workers have a responsibility to engage in advocacy work to realize social justice for LGBT seniors.


IMPLICATIONS FOR SOCIAL WORK RESEARCH Research Relationships and Federal Grants The National Institutes of Health, in response to the 2011 Institute of Medicine report, issued requests for proposals to increase the knowledge base regarding the health and well-being of LGBT people. Although this is a significant step in increasing available funds to address LGBT health disparities, other grant opportunities that are specifically tailored for LGBT seniors are needed. Demand for services continues to grow and will likely further expand as baby boomers, a group more likely to be out of the closet and demanding of services, age (Sullivan, 2011). Service grants from the Administration on Aging may be one way to meet the service need of this population. The Center Seniors Services was, in fact, a recipient of one such grant from 2009 to 2012 (the Aging in Place Initiative) and was able to successfully expand services and programming for LGBT seniors because of it. This 3-year federal grant allowed Seniors Services to hire a full-time case manager, increase enrichment programming, and launch the ongoing cultural sensitivity trainings for provider agencies and businesses. This unprecedented funding provided a solid foundation for growth and expansion, from which Seniors Services continues to build upon to this day. Community-based agencies that wish to initiate and expand services for LGBT older adults should be aware of these funding opportunities and may wish to cultivate partnerships with social work researchers in academic institutions to apply for federal funding to better understand the needs of LGBT seniors and implement programs that effectively meet those needs.

Development of Tested Service Models In developing the Seniors Services programs, the Center did not have the benefit of tested service models for LGBT seniors. As of this writing, we could find only two empirical evaluations of staff trainings or community dialogues aimed at improving services to LGBT seniors in the social work literature (Anetzberger, Ishler, Mostade, & Blair, 2004; Landers et al., 2010) and one that pertained to training healthcare professionals (Gendron et al., 2013). To create a broad evidence base for best practices in serving LGBT seniors, social work researchers must continue to partner with community


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agencies to evaluate the programs and services that are currently being offered. Toward this end, in the coming year, the LGBT Seniors Services program will be partnering with researchers from UCLA to develop a formal evaluation of the cultural sensitivity trainings that are offered by the Center’s Seniors Services. Although we have anecdotal evidence, and a limited number of studies provide empirical evidence (Anetzberger et al., 2004; Gendron et al., 2013; Landers et al., 2010) that such training programs are effective in increasing knowledge about issues facing LGBT older adults and changing negative attitudes about this population, this collaboration between the Center and UCLA will seek to solicit qualitative and quantitative data from service providers who undergo the training so that it may be strengthened and ultimately translate into better outcomes for LGBT seniors.

Collecting Data on LGBT Seniors The Center’s experience creating services for LGBT seniors who live in a large urban area and face mobility barriers points to research priorities. Although we know that LGBT seniors who access the Seniors Services Department come from throughout LA County, we currently have no information on the number of LGBT seniors living in Los Angeles and the percentage who may not be reached by our efforts. In Los Angeles, much remains to be known about the geographic dispersion of LGBT seniors, which is of primary importance when considering placement of service delivery centers and formulation of in-home supportive services. Moreover, lack of data on the numbers of LGBT older adults (de Vries, 2006; Simone & Appelbaum, 2011) is one of the problems currently faced by the research community, which makes it difficult to advocate for research funding to study this population. Social work researchers who focus on older adult populations can play a key role in further documenting the needs of LGBT older adults by collecting data on gender identity and sexual orientation.

CONCLUSION Despite developments in the past decade toward full legal and civil rights inclusion for LGBT community members in North America and beyond, LGBT seniors remain an underserved population. A paucity of specific or inclusive services and programs exists to support this community throughout the aging process. With high rates of isolation, poverty, disability, and mental health diagnoses, when compared to their heterosexual counterparts, LGBT seniors remain a vulnerable population. The social work profession can play a valuable role in reversing this reality through compassionate service delivery, advocacy for equal representation under the law, and development of


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evidence-based interventions. It is our hope that this description of the Center’s successes and challenges in meeting the needs of LGBT older adults will expand the knowledge base about this important population and encourage senior service agencies to develop theoretically-driven, culturally congruent programs for LGBT older adults.


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