A recently published study from the University of Minnesota, the third in a decennial series first undertaken in 2002, is an essential and fascinating look at the needs of LGBTQ+ older Americans, including the wave of Baby Boomers now entering retirement and the Silent Generation that preceded them.
The Minnesota 2022 LGBTQ Aging Needs Assessment Report surveyed hundreds of LGBTQ+ older adults in the state to gain insight into the community’s experiences with services, caregiving, discrimination, employment, chosen family, and other metrics describing their lives.
The results, according to the report’s authors, indicate that “we’ve come a long way, but have much further to go” in addressing the harmful disparities between LGBTQ+ older adults and their straight peers.
While remarkable strides have been made since the report’s first iteration at the turn of the millennium, “health disparities still are fairly rampant,” says the study’s principal investigator, Rajean Moone. “They actually are pretty close to what you see nationally.”
LGBTQ Nation spoke with Moone to learn about the progress the studies have recorded and where they indicate room for improvement.
In February, Moone, 44, was holed up in his home office as a blizzard descended over the Midwest. “I think we’re supposed to get like 18 to 20 inches. So life per usual in Minnesota.” Also, per usual: the out researcher working from home, where 80% of university staff have been most school days since the start of the pandemic.
I asked Moone what he thought was the most significant change in three reports over 20 years. He said the most dramatic shift was in attitudes around LGBTQ+-affirming care.
“In 2002, the study showed only nine percent of LGBTQ respondents were confident that they would receive sensitive care” at places like doctors’ offices, clinics and hospitals, Moone says. “In 2012, that number doubled to 18 percent — keeping in mind that that’s still 82% of the population surveyed that weren’t sure if they would receive safe services. But in 2022, we had 85 percent that felt confident that they would receive sensitive care. That is absolutely striking.”
Moone cites several factors accounting for the positive change. “There has been, I would say, a greater sophistication amongst consumers in looking for LGBTQ-welcoming providers. So while things like visual cues are very important, in the latest wave of the study, it was interesting to see that there were sort of deeper cues, like hiring LGBTQ staff, and the use of pronouns in intake questionnaires. It’s a deeper sense of sophistication, that you just can’t slap a rainbow flag up on your front door — which is an important visual cue, we shouldn’t downplay that — but you have to do more than just that.”
Respondents are reacting to a real improvement in LGBTQ+ sensitivity training in the state, says Moone, who served as executive director of Training to Serve, a nonprofit organization created to train service providers in the unique needs of LGBTQ+ older adults. According to Moone, that group incorporated results from the 2012 report in training to address issues “like how you conduct intake assessments. What does your environment look like? Do you have non-discrimination clauses?”
The dramatic shift in positive sentiment was also influenced by current events in 2012 and 2022. “In 2012, Minnesota was battling a constitutional amendment to define marriage between one man and one woman,” explains Moone, “so there was a sort of hypersensitivity to LGBTQ people really being oppressed based on this legislation. ‘How is my neighbor gonna vote? How would my provider vote? Are the people around me going to basically enshrine discrimination in our Constitution?’”
Minnesota Amendment One, the initiative that would have effectively outlawed same-sex unions, was defeated in 2013. The U.S. Supreme Court ruling in Obergefell V. Hodges recognized the right to same-sex marriage two years later.
“The second context around this number,” says Moone, “is we did data collection during the pandemic. And so the people that we were able to reach really are people that are frankly, connected to broader networks. We weren’t able, for example, to go to more of the isolated communities, because the survey was online and not done in person. So we also have to temper that, because some of the people that respond to this obviously tend to be more socially connected to be able to receive the survey in the first place.”
I asked Moone about some of the data points that distinguish LGBTQ+ older adults from their straight peers. “In the study, I saw that volunteerism is one positive example. What are some of the others that stand out?”
“What’s interesting is we often do focus on negative disparities, but disparity isn’t a negative or a positive word, right? So you can also have positive disparities. Sounds counterintuitive, but you pointed one out,” says Moone.
Moone explains his researchers were able to compare results from their study with those from a similar survey of straight older Minnesotans, which revealed LGBTQ+ older Minnesotans were nearly twice as likely to volunteer as their straight counterparts.
“They’re also more likely to have completed a health care directive.” That high completion rate was a matter of necessity for partners in long term-term relationships, says Moone.
A health care directive, or “living will” as it’s called in some states, is “essentially a document that helps care providers determine who’s there to make decisions about a person if they were to become incapacitated. And that actually is just the nature of the fact that marriage was not universal. So you weren’t guaranteed those rights,” Moone says. “Your health care directive could guarantee those rights to your partner.”
Moone notes that there are over 500 rights associated with marriage in Minnesota, from assets’ forfeiture to Medicaid benefits, a fact documented by the local 515 Project. “The health care directive was one of those tools that could help fill that gap” before marriage equality would grant those 515 rights to LGBTQ+ couples.
Compared to their straight peers and despite marriage equality, LGBTQ+ older Americans are still less likely to be married, the survey data revealed. “They’re less likely to be married and more likely to live alone,” says Moone. They’re also less likely to have children.
In the broader population, “over 90% of care to vulnerable and older adults in Minnesota is provided informally and unpaid by friends and family members,” Moone says. “The number one provider of care is a spouse, and the second provider of care is an adult daughter.”
“Now, if you don’t have a spouse, or you don’t have an adult daughter, or an adult daughter-in-law, or an adult son, you’re less likely to have those informal supports that can help you age in-community, and you may be more likely at risk for things like institutionalization and going into a nursing home,” explains Moone.
“If you compound that with the fact that your experience with the healthcare system for most of your life was that you were a ‘medical diagnosis,’ then you arrive at what I call the LGBTQ aging paradox: You’re more likely to need formal services, but you’re less likely to access them because of internalized fear of how you’re going to be treated.”
Sensitivity training is one tool that gets at that endemic problem.
“The whole point of Training to Serve was to attempt to break down that second part of the paradox. How do we decrease that fear? We can’t increase the fact that you don’t have kids, right? You’re not married. That’s not something that we can control. But what we can try and control is training service providers” to deliver a more welcoming and affirming healthcare experience.
Training to Serve has educated over 15,000 providers in sensitive care for LGBTQ+ older adults, an approach welcomed across the political spectrum, says Moone.
“I’ve trained many conservative organizations myself,” he says, including a Catholic-based nursing home chain. “Being invited to a Catholic institution to do a training on LGBTQ aging is pretty significant.”
That training leads to building relationships among all segments of older adults.
“Once you break down those fears, people realize that they have common experiences: love, loss, family,” Moone says. “These are universal experiences of aging. That regardless of whether you are LGBTQ or heterosexual cisgender, you still experience them. Finding those common themes builds community.”
“We now have nursing homes in Minnesota that hang out rainbow flags during Pride month, and they have Pride celebrations, you know? Pretty amazing.”