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Growing Diversity and Uncounted Groups

Growing Diversity and Uncounted Groups

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Growing Diversity and Uncounted Groups

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  1. Growing Diversity and Uncounted Groups Mark Brennan-ing, phd Senior research scientist Brookdale center for healthy aging, Hunter college, cuny Panel presentation at the 2019 M. Powell Lawton Conference and Award Ceremony Philadelphia, PA, May 2, 2019

  2. The Problem How can providers meet the needs of older adults if we don’t know who they are, what they’re like, and what kind of services they need to age in the best way possible?

  3. Case study: sexual Minority and gender diverse older adults • Sexual minority and gender diverse older adults, sometimes referred to as LGBTQ (lesbian, gay, bisexual, transgender, & queer), represent an example of a population that is often hidden and invisible to providers. Why? • We lack good population-based data on these older adults to inform policy and programming. • Many are reluctant to “out” themselves in heterosexual and cisgender environments that they perceive as being unaccepting or non-friendly. • “We don’t discriminate against LGBTQ adults, we just don’t have any here.”

  4. Background • More than 39 Million Americans are age 65 or older. • Estimates of the LGBT Older Adult Population: • 2010: Between 1.6 and 2.4 million • 2030: As many as 7 million • Same-sex couples live in ~93% of all U. S. counties.

  5. The data problem • We don’t know how many older Sexual Minority and Gender Diverse (SMGD) older adults live in our communities – NO accurate data from the U.S. Census! • Plans were in place to include questions on sexual orientation and gender identity (SOGI) in the 2020 Census. • In 2016, the U.S. Department of Labor added SOGI questions to an employment survey to test their feasibility and acceptability. • Test worked will, although some SMGD adults did not like the restrictive categories (there are many ways people describe themselves) • However, 2020 Census questions proposed by the current administration do not include SOGI questions. • People will only be counted as sexual minorities if they are in a same-sex relationship and cohabitating. • This leaves out singles • Bisexuals will not be counted unless they are in a same-sex relationship • We will have no idea about people who are transgender or gender diverse

  6. Other National Data Sources • The National Health Interview Survey (NHIS) currently collects sexual orientation, but not gender identity, information. • Due to the size of the SOGD sample, it usefulness is limited (i.e., @ 3%) • The NHIS cannot tell us the size of the SOGD population • The National Survey of Older Americans Act Participants • Purpose is to provide data for the Administration for Community Living/Administration on Aging on older adults receiving services through Title III Older Americans Act Programs. • Current administration pulled SOGI question from the current version. • After considerable pushback and advocacy, sexual orientation questions were restored, but questions on gender identity were not.

  7. What are some alternatives? • State-based Initiatives: • In 2013, the New York State Office for the Aging expanded its data collection to include SOGI data in order to address health disparities in the senior service system. • In 2015, California mandated the collection of SOGI data by state agencies, including aging. • Pennsylvania – not yet. Currently evaluating how to ask SOGI questions. • National Health, Aging, and Sexuality/Gender Study (Karen Fredriksen-Goldsen et al., University of Washington). • First federally-funded longitudinal national project designed to better understand the aging, health, and well-being of LGBTQ midlife and older adults and their families. • Over 2,400 LGBTQ adults ranging in age from 50 to over 100 • Collaboration with 17 community agencies serving LGBTQ older adults in every census division throughout the U.S. 

  8. What do we know about SMGD Older Adults?

  9. A Lifetime of Discrimination • To understand LGBT Aging, it is important to consider the life course of these older adults and the impact of stigma and discrimination. • Fredriksen-Goldsen et al. (2011) report that 82% of their sample of LGBT older adults reported being victimized at least onec, while nearly two-thirds (64%) reported being victimized at least 3 time in their lives. • Verbal assault was the most frequently reported type of victimization Source: Fredriksen-Goldsen, K. I., Kim, H.-J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., Goldsen, J., Petry, H. (2011). The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults. Seattle: Institute for Multigenerational Health.

  10. Health Needs and Disparities • Older LGBT adults may have different health needs when compared with their heterosexual counterparts. • Such differences can affect the need for community-based services and supports in this population. • LGBT individuals report poorer health than the general population (Wallace, Cochran, Durazo, & Ford 2011) • Higher disability rates have also been reported; one study found 47% of older LGBT adults having at least one disability (Fredriksen-Goldsen et al., 2011; Wallace et al., 2011).

  11. E.G.s of LGBT Health Disparities • 55% of all new HIV infections occur among gay and bisexual men, and 17% occur among people age 50 and older. • Older lesbians have higher rates of obesity compared to heterosexual women which negatively affects health by increasing the risk for diabetes, cardiac disease, and certain cancers • LGBT adults are more likely to smoke cigarettes compared to Heterosexual & Cisgender adults.

  12. Social Care and Older LGBT Adults • The social care network is considered to be a vital component of helping people to age independently and maintain quality of life. • Social care includes the broad-based system of informal social network resources (i.e., family and friends) and the network of community-based formal services (e.g., senior centers, home health care) (Cantor & Brennan, 2000).

  13. A Social Care Crisis? • As aging LGBT adults increasingly require social care, their informal social networks are a cause for concern. • Research finds that LGBT older adults typically do not have the robust informal social resources that characterize heterosexuals (Shippy, Cantor, & Brennan, 2004). • Among community-dwelling older adults 43% report a spouse while 77% have at least one living child (Cantor, Brennan, & Shippy, 2004). • Among older LGBT adults, approximately 40% have a partner/spouse and only 20-25% report at least one living child (Cantor, Brennan, & Shippy, 2004; Fredriksen-Goldsen et al., 2011).

  14. Compensatory Social Care • The Hierarchical Compensatory Theory of social supports (Cantor & Mayer, 1978), posits that when older people need assistance, they turn first to close family members such as spouses or children. • If these individuals are not available, they will then turn to more distant relatives, then friends and neighbors, and lastly to formal community-based supports. • Formal services are increasingly accessed when informal caregivers are unable to meet the needs of the older adults (Cantor & Brennan, 2000).

  15. Hierarchical Compensatory Model Older LGBT adults are likely to utilize formal services given their health needs and lack of family supports as they grow older.

  16. The Problem! • A history of discrimination leaves many LGBT older adults with a general distrust of mainstream institutions that many heterosexuals assume are in place to help them. • This leaves us with two questions: • How adequate are the social care resources of LGBT adults as they grow older? • What is the experience of older LGBT adults in accessing government and community-based services in terms of access and unmet needs?

  17. Methods • Data were obtained in 2010 and 2011 from a convenience sample of older LGBT adults recruited through the Center on Halsted (COH), a LGBT community center in Chicago. • Two-hundred thirty-three participants were recruited resulting in 210 usable surveys. • The survey instrument was self-administered, and took on average 45 to 60 minutes to complete. • Approved by the Copernicus Group IRB. • Examination of Social Care data used quantitative and qualitative findings in a mixed-methods approach

  18. Functional Social Network Members (i.e., weekly phone and/or monthly face-to-face contact)a * p < .05, ** p < .01, *** p < .001 a Cantor & Brennan, 2000

  19. Service Needs in Past Year * p < .05, ** p < .01

  20. Qualitative findings

  21. Housing • Housing costs and quality are always an issue in large urban centers like Chicago: • [73-year old man] “Right now I need subsidized housing. My apartment had a fire and right now I’m kind of homeless and staying with friends.” • [50-year old man] “I’m unemployed and homeless… every time I try for assistance… I get turned down.” • Many expressed a need for senior/supportive housing, especially a gay-friendly or LGBT-focused facility: • [56-year man] “Senior housing in Boystown {a gay neighborhood in Chicago} exclusive to us.” • [57-year old woman] “Out gay or lesbian retirement communities... “

  22. Employment Services • A number of individuals expressed the need for employment counseling: • [50-year old man] “I could really benefit from job counselors or advisors.” • Some reported that they had been looking for work but were not successful: • [55-year old transgender woman] “[I] filled out on-line or paper job application – still waiting for response to get an interview. I’m sure of my qualifications.”

  23. Socialization • Socialization was the most frequently reported service need in the quantitative survey for LGBT older adults (51%). While the bar scene has been a social staple for the LGBT community, a common remark by the older respondents in the current sample was a need for venues outside of this domain: • Reflecting the ageism in the LGBT community, one 67-year old man told us, “I feel lonely and isolated a lot of the time (partly internalized ageism). I don’t know where to go to meet other gay men my own age in a healthy setting, not bar, etc.” • Many lesbian and bisexual women related the difficulties they had on the social scene as they got older: [50 year-old woman] “Lesbians have limited social environments after age 50. Bar scene, limited at best, is for younger women. Fundraisers are too costly ($300 for date and me to go to Lesbian Community Care Project). Social events give 50+ women chance to meet other women, reconnect with friends, etc.”

  24. Summary • Relatively low involvement with family indicates that older LGBT adults will turn to community-based formal services for needed assistance. • Many older LGBT adults are struggling financially as evidenced by needs for assistance with housing and employment. • Socialization needs are high in this community and are exacerbated by ageism.

  25. Implications • What are some other hidden groups in your community that might need your services?

  26. Thank you! Mark Brennan-Ing, PhD Senior Research Scientist Brookdale Center for Healthy Aging, Hunter College, CUNY New York, NY