Protecting Our LGBT Seniors in Long-Term Care Facilities

Co-authored by Daniel Redman

LGBT seniors blazed the trail for our community. They stood their ground at Stonewall and Compton's Cafeteria and kept our community alive during the height of the HIV/AIDS epidemic. They laid the groundwork for so many of our recent successes.

Our LGBT senior population is growing. In San Francisco we estimate that we currently have 18,000 to 20,000 LGBT residents aged 60 and older. This number is expected to double by 2050. For our seniors today and tomorrow we must act now to address their needs.

Today the San Francisco Board of Supervisors will vote on groundbreaking legislation protecting LGBT seniors who are living in long-term care facilities, whether nursing homes, assisted-living facilities, or other similar housing. This legislation, which prohibits discrimination based on sexual orientation, gender identity or expression, and HIV status, is long overdue and serves as a model for the rest of the country.

While LGBT seniors face many of the same challenges that all seniors face, they also face specific and unique challenges that haven't been adequately addressed. They are less likely to have adult children to help care for them and advocate for them, and they are more likely to live far from their biological family and be estranged from their family. Many are aging with HIV, with the unique challenges presented by the disease, and many lost a significant part of their social network during the HIV epidemic. LGBT seniors are a particularly vulnerable population due to lifelong experiences of marginalization that place them at greater risk of isolation, homelessness, poverty, and premature institutionalization.

Tragically, too many LGBT seniors who have been out and proud for many years face discrimination, lack of understanding, and outright hostility in long-term care facilities. A 2011 report published by the National Senior Citizens Law Center showed that nearly 90 percent of LGBT seniors were afraid to be out in a care facility. Nearly half had personally faced discrimination in a facility or knew someone who had.

Some LGBT seniors go back in the closet upon entering a facility. Others are separated from their partners. Others are treated in highly disrespectful ways. LGBT advocates report having seen cases where facilities forced butch lesbians to dress in stereotypical feminine attire or refused to respect a transgender senior's gender identity. Others face bullying by fellow residents or staff. And even where staff members want to do the right thing, they often lack the protocols and training to address the needs of LGBT seniors.

In 2012 we formed the LGBT Aging Policy Task Force in San Francisco to study the needs of LGBT seniors and make policy recommendations to the Board of Supervisors. After 18 months of intensive work, the Task Force made a series of recommendations. One of the most significant recommendations was legislation to address the needs of LGBT seniors living in long-term care facilities.

It is already illegal under existing California law to discriminate against LGBT seniors in long-term care facilities, but the prohibition is general in nature, with little specific guidance about what actually constitutes discrimination. San Francisco's ordinance tackles that problem head-on and fleshes out what long-term care facilities need to do in order to create a safe and nondiscriminatory environment for our LGBT seniors. The law also provides remedies for those who encounter discrimination.

The ordinance, among other things:

  • Requires facilities to designate an LGBT liaison to undergo appropriate periodic training.

  • Requires facilities to respect residents' wishes to be addressed by the pronoun of their choice.
  • Allows requests by two residents to share a room and forbids involuntary room reassignment as a result of one resident complaining about another resident's sexual orientation or gender identity.
  • Requires access to appropriate medical care specific to an LGBT resident's needs.
  • Requires that residents be allowed to use restrooms available to other residents of the same gender identity.
  • Provides aggrieved persons with the right to seek investigation and mediation by our Human Rights Commission.
  • Creates a private right of action and civil penalties for violations.
  • This law is common sense. It gives facilities the clarification they need to provide excellent care to all their residents regardless of sexual orientation, gender identity, gender expression, or HIV status.

    Today's LGBT seniors are the people who built this community and built this movement. They fought for the freedoms we enjoy today. This first-in-the-nation law helps ensure that some of our most vulnerable LGBT seniors and people with disabilities receive care in peace and dignity.

    Scott Wiener is a member of the San Francisco Board of Supervisors, representing the Castro, among other neighborhoods. Supervisor Wiener co-authored the long-term care anti-discrimination ordinance.

    Daniel Redman is an attorney in San Francisco. He served as the chair of the legal committee of the San Francisco LGBT Aging Policy Task Force.