Exploring the Issues Faced by LGBT Elders Part II: LGBT Elders and Elder Abuse

This blog post was written by Meagan McKinstry, a second year law student from Northeastern University School of Law and an Equal Justice Works Elder Justice Americorps law student who worked with the Elder Abuse Prevention Project this Summer.  This is the second post in a two-part series written by Meagan and focusing on LGBT elders. 

Despite efforts to raise awareness about the existence, nature, and prevalence of elder abuse, there continues to be a shortage of data on the topic. Naturally, this means there is a lack of data on elder abuse as experienced by LGBT elders. However, even without numbers, the lived experiences of LGBT elders in the past and present inform us that they deal with not only the standard forms of elder abuse – physical or mental abuse, financial exploitation, fraud, and neglect, to name a few – but also unique forms of abuse that non-LGBT elders do not encounter. These LGBT-specific forms of abuse occur both in and out of long term care facilities.

LGBT Elder Abuse in Long Term Care Facilities

37% of LGBT respondents reported that they had been physically or verbally harassed while living in or visiting someone living in long term care. [1]  There are many other ways that LGBT elders experience abuse while in long term care, including forced isolation, neglect, and disrespect for personal identity. There are at least two ways that care facilities impose isolation on LGBT elders. First, LGBT elders are sometimes denied visitors [2], which limits their ability to receive outside support and combat the loneliness that LGBT elders are already more susceptible to. Second, if a same-sex couple lives in the same facility, they may be forced to live in separate rooms instead of being permitted to live as a couple. [2] This obviously separates the elder from a key pillar of love and social support, and it (as well as the denial of visitors) contributes to an atmosphere where LGBT elders who remain closeted are afraid to come out, which means they must suffer alone in the knowledge that they are neither accepted nor welcome.  Neglect is another form of abuse that LGBT elders in long-term care may experience. This takes place in the form of denying LGBT elders personal care services due to anti-LGBT prejudice. [2] Depending on which services are withheld, the elder’s health could be jeopardized. For example, facility employees who are reluctant to bathe an elderly transgender person because of that person’s anatomy. Another form of abuse occurs in facilities where transgender women are forced to live with men, and vice versa. [2]. Trans folks do not choose their gender any more than other people do, and they should be allowed to live in conditions that honor who they truly are. Disrespect of personal identity in these situations is a form of abuse.

LGBT-Specific Elder Abuse

Most of the examples of abuse discussed above connect to the elder’s sexuality or gender identity in some way. The same is true in this next section, except the abuses are not specific to long-term care. They could be perpetrated by all categories of abusers (family, friends, strangers, etc.) and affect LGBT elders in all sorts of living situations. Many of the abuses involve an abuser using the person’s sexuality to their advantage. For example, they might threaten to “out” the elder (i.e. reveal the elder’s sexual orientation or gender identity against their wishes) if the elder seeks help or doesn’t do what the abuser wants. [3] Alternatively, the abuser may invoke societal discrimination and negative attitudes toward LGBT people to convince the elder that they can’t expect to be treated any better than the abuser treats them. [3]  LGBT elders are in some ways more vulnerable to elder abuse than their straight counterparts. Since they are less likely to be married [4], their money and property is less likely to be protected by marriage and community property laws, making it easier for an abusive partner to take control of the elder’s finances [3]. LGBT elders are also more likely to fear being alone [4], which creates the opportunity for the abuser to take advantage of that fear and use it to dissuade the elder from seeking help. [3] Estrangement from biological family additionally makes the elder easier to isolate, thereby keeping them from accessing alternative resources. [3]

What Can Be Done

Increased awareness, education, and cultural competency are critical to reducing the bias and discrimination that underlies much of the abuse LGBT elders face, particularly in long-term care facilities. There is a lot of work to be done, but with continued efforts, advocates can eliminate the differences between the treatment of LGBT and non-LGBT elders, as well as ensure greater protection from abuse for all elders.

Sources:                                                                           

[1] http://www.lgbtmap.org/file/Older-Adults-Religious-Exemptions.pdf

[2] https://issuu.com/lgbtagingcenter/docs/researchbrief_lgbt_elders

[3] https://issuu.com/lgbtagingcenter/docs/self-help_elderabuse_guide

[4] http://www.lgbtmap.org/file/understanding-issues-facing-lgbt-older-adults.pdf

 

 

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Exploring Issues Faced by LGBT Elders – Part I: Barriers to Successful Aging

This blog post was written by Meagan McKinstry, a second year law student from Northeastern University School of Law and an Equal Justice Works Elder Justice Americorps law student who worked with the Elder Abuse Prevention Project this Summer

This is the first post in a three-part series written by Meagan and focusing on LGBT elders. Parts two and three will discuss religious exemption laws and LGBT-specific elder abuse issues

 Lesbian, Gay, Bisexual, and Transgender (LGBT) older adults confront particular challenges that may prevent successful aging. There are three key elements to successful aging:  financial security, good health and health care, and social support and community engagement. [1] Multiple barriers, discussed below, prevent many LGBT older adults from achieving these important goals.

Financial Security

LGBT older adults have an increased risk of poverty due to the history of discrimination against them. [2] 32% of all LGBT elders age 50+ live at or below 200% of the Federal Poverty Line (FPL), compared to 25% of non-LGBT-elders. [2] [3] The proportions are even higher for LGBT elders who are over age 80 (40%), African American or Hispanic (40%), bisexual men (47%), bisexual women (48%), and transgender elders (48%). [2] [3] Employment discrimination is one explanation for this. For instance, 51% of transgender women report not being hired because of their gender identity.  Employment discrimination contributes to lower earning power, which can result in lower Social Security payments. Additionally, LGBT elders whose partners died before marriage equality was legalized may not be able to access various spousal benefits. The effect of this is that 42% of LGBT elders are very or extremely concerned they will outlive their retirement savings, compared to just 25% of non-LGBT elders. [2]

 LGBT elders may also encounter housing discrimination. There is already a shortage of affordable housing for elders in general, so when discrimination is factored in, LGBT elders are in considerable danger of being denied housing, evicted, overcharged, or otherwise mistreated. Unfortunately, 50% of the LGBT population in the U.S. lives in states with no law prohibiting housing discrimination on the basis of sexual orientation or gender identity. In one study, half of older same-sex couples applying for housing in 10 states experienced overt discrimination.  An LGBT older adult’s race also plays a role; 1 in 4 LGBT elders of color have experienced housing discrimination based on race. [2] All of this places LGBT elders at greater risk of housing insecurity and homelessness.

Good Health and Health Care

As members of a marginalized community, LGBT elders may experience minority stress, which results from exposure to discrimination and can impact both physical and mental health.  In fact, 44% of transgender elders worry that their relationships with healthcare providers would be adversely affected if they were to come out.  The same is true for 34% of Hispanic LGBT elders and 23% of black LGBT elders, compared to 16% of white LGBT elders.  On top of that, LGBT older adults also encounter barriers within the health care system that prevent them from accessing competent care. For example, LGBT veterans discharged from the military under the Don’t Ask, Don’t Tell policy may be ineligible for veterans’ benefits, including health care. [2]

Social Support and Community Engagement

While many elders either are alone or fear becoming so, LGBT older adults are especially vulnerable. Sadly, LGBT elders are more likely to be afraid of dying alone, especially in places where LGBT people have fewer rights. [2] They are twice as likely as non-LGBT elders to live alone [4], and are “more likely to be single, childless, and estranged from their biological family.” [1] Those who lack connection to their biological family may have selected a “chosen family” made up of close friends, but chosen families are less reliable than biological families for several reasons. First, chosen family members are often the same age as the elder, so their physical and/or mental condition may limit their ability to provide care and support. [2] The lack of legal relationship between LGBT elders and their chosen family also means that chosen family members are not entitled to take time off from work to assist with care. Similarly, chosen family may not have the legal right to share health insurance plans with the elder, or to make medical decisions for them. [2] Therefore, even if LGBT elders have people close to them, they still may lack the support they need, which leaves them vulnerable to abuse and exploitation. 

Breaking Down the Barriers

While LGBT elders have some disadvantages when it comes to successful aging, there are things that can be done to address the problems. Several organizations are already making efforts to create change, but a lot more work is needed to close the gap between LGBT elders and their straight counterparts. The following list of action items is adapted from a guide [2] created by the Movement Advancement Project and the National Resource Center on LGBT Aging:

Financial Security

  • Legislatures should pass anti-discrimination employment and housing protections.
  • Elder housing facilities should adopt explicit non-discrimination policies.

Health and Health Care

  • Medical service providers should receive cultural competency training.
  • Congress should pass a law that makes LGBT veterans discharged under the Don’t Ask, Don’t Tell Policy eligible for veterans’ benefits.

Social Support and Community Engagement

  • The Older Americans Act should recognize LGBT people as a population of “greatest social need.”
  • Elder community centers and LGBT community centers should create supportive spaces for LGBT elders.
  • The US Department of Health and Human Services should designate LGBT elders as an underserved population.

Additionally, there are a number of organizations that strive to provide the support that LGBT elders all too often lack. Here are some of them:

 

[1] http://www.lgbtmap.org/policy-and-issue-analysis/lgbt-older-adults

[2] http://www.lgbtmap.org/file/understanding-issues-facing-lgbt-older-adults.pdf

[3] http://www.lgbtmap.org/file/A%20Closer%20Look%20Bisexual%20Older%20Adults%20FINAL.pdf

[4] http://www.lgbtmap.org/LGBT-Older-Adults-Social-Isolation

[5] http://www.lgbtmap.org/bisexual-older-adults

 

 

 

Preventing Elder Abuse Through Mahjong

This post was written by Annika Olson, a second year law student at Boston College Law School who worked as a legal intern with the Elder Abuse Prevention Project of Greater Boston Legal Services this Summer

With adults aged 65 and older expected to grow to over 20% of the U.S. population by 2030, it is important to bring attention to the needs of older adults.[1] Baby boomers are more educated with more work experience than previous generations, which should increase their lifetime earnings and economic security as they age.  However, baby boomers also had fewer children and high divorce rates, meaning more elders may live alone in old age without the financial and social support of a spouse or child. In Boston, there will be an estimated 130,000 seniors by the year 2030, up from 88,000 in 2010.[2]

As people age, there are many reasons why social interactions with others decrease. That is why many researchers and health organizations support Activity Theory, which emphasizes the continuation of participation in all kinds of activities to improve the well-being of older adults in later life and achieve successful aging. One such activity senior centers have used to encourage participation is mahjong. Mahjong is a game of skill played by four people with domino-like tiles. Anneliese Heinz, an assistant professor at University of Texas, Dallas, has found that both Jewish American and Chinese American communities were built around mahjong during the 20th century. Heinz remarks that mahjong requires cooperation and strategy between players, creating an ideal forum for interaction between people. Mahjong is making a comeback and is gaining in popularity with older adults, who now have the free time to learn the game.

Playing mahjong requires attention control, alertness, quick information processing, and visual-motor coordination. Three aspects of hand-eye coordination are used in the game: reaction time, speed of movement, and accuracy. Mental quickness and retention of memory can help prevent elder abuse. The tile game is thought to slow down the effects of dementia, a condition that unfortunately leaves many elders particularly susceptible to abuse. Additionally, mahjong has been shown to indirectly improve psychological well-being through social interaction.[3] Low social support is a large contributing cause of elder abuse and a consistent meeting of four mahjong players would help to combat that.

Mahjong is a simple way to minimize the susceptibility of elder abuse, but an effective one, as it touches on social support and both physical and mental wellness. The cost to play is relatively small for the benefits the game provides. Many senior centers in the greater Boston area offer organized mahjong group play. Below are a variety of senior centers and the meeting times for mahjong:

-Rockland Senior Center: Friday at 10am

-Hingham Senior Center: Tuesday at 1pm and Friday at 10am

Brookline Senior Center: Monday and Thursday from 12:30-3pm

-Newton Senior Center: Monday at 2:30pm

*If your senior center doesn’t offer it, share the benefits with them.

*Mahjong can also be spelled mah jongg, majong, mah-jongg

[1]As compared to 13% in 2010. Ortman, Jennifer, Velkoff, Victoria and Hogan, Howard. An Aging Nation: The Older Population in the United States. May 2014. https://www.census.gov/prod/2014pubs/p25-1140.pdf

[2] Donahue projections are prepared by the UMass Donahue Institute (http://pep.donahue-institute.org/) MAPC projections are prepared by the Metropolitan Area Planning Council (MAPC), an organization based in Boston. MAPC-high projections assume stronger population growth and are recommended by MAPC for use by municipalities

[3] Cheng ST, Chan AC, Yu EC. An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia. Int J Geriatr Psychiatry, 2006, 21: 611–617.

Chinese Elder Outreach: How Cultural Barriers Affect Elder Abuse

This blog post was written by Antonio Gonzalez, a second year law student at Boston College Law School and an Equal Justice Works Elder Justice AmeriCorps law student who worked with the Elder Abuse Prevention Project of Greater Boston Legal Services this Summer

On June 27th, 2018, the Elder Justice Team at Greater Boston Legal Services conducted an Elder Abuse Prevention Outreach at Wollaston Senior Center in Quincy. Our goal was to raise awareness in the Chinese elder community about types of elder abuse, discuss specific cultural barriers to assistance, encourage reporting, and provide effective ways of getting help. The Asian American Service Association Inc. (AASA) established the Wollaston Senior Center as one program to help serve the needs of Asian Americans in the Quincy area. The Center and the staff there have created a welcoming and safe environment to talk about these difficult issues.

“The Wollaston Senior Center is open Monday through Friday, in the morning. The Center provides a broad variety programs that include Qi-Gon classes, English classes, Chinese nutritional meals, social services, interpretation and translation assistance, field trips, Chinese movies, games, blood pressure testing, festive celebrations and parties, video and literature library and educational seminars. The existence and services of Wollaston Senior Center provide seniors with a consistent and welcoming place to turn to for their services and needs.”[1]

The elders that attended the outreach presentation were attentive and engaged. They signaled that they were familiar with the subject matter by their own experiences or the experiences of friends in similar situations. At the conclusion of the presentation, there were several questions about seeking assistance and what may be considered elder abuse (such as a lack of respect). In particular, there were several elders with concerns about racism in public housing and assisted living facilities including accounts of other residents yelling and berating Chinese elders in particular, and instances of neglect of Chinese elders by caretakers at assisted living facilities. These anecdotes reveal another form of abuse that these elders are vulnerable to, as fear of retaliation and language barriers can make it difficult for Chinese elders to speak up.

The difficulties these elders face highlight the importance of programs such as the Asian Outreach Unit and Elder Abuse Prevention Project at Greater Boston Legal Services, as well as the Wollaston Senior Center. Elder abuse prevention outreaches and multidisciplinary teams address barriers that immigrants and minorities face through engagement with the local community and creating culturally appropriate educational resources, improving access to healthcare, and legal advocacy.  In addition to these resources, Chinese elders can also reach out to Local Adult Protective Services units (https://www.mass.gov/report-elder-abuse) and The Massachusetts Elder Abuse Hotline (800-922-2275).

[1] http://www.wlchurch.org/community/aasa.asp

Caring Community Leaders Celebrate World Elder Abuse Awareness Day

In honor of World Elder Abuse Awareness Day, the 2018 Summer Elder Justice Team at Greater Boston Legal Services participated in an event by the Cambridge Elder Abuse Prevention Coalition, which featured True Story Theater. True Story Theater is a local nonprofit organization that features a group of highly talented, improv actors. “Our mission is to promote social healing through theatre.  We perform and teach an embodied theatre of empathy, respect and creativity. Volunteers from the audience are encouraged to share what is important in their lives. On the spot, the actors then portray the heart of what they heard using music, movement, and dialogue.”[1]The presentation provided an emotional outlet for elders, their loved ones, and providers to come together and discuss how elder abuse and the opioid epidemic correlate. People from the audience shared how the opioid crisis affected their loved ones and changed people. Some people shared personal stories of grief and loss, while others shared emotions such as hopeful stories of recovery, and the importance of the surrounding community.Interns.jpg

The Correlation between the Opioid Epidemic and Elder Abuse

Opioid misuse is not always an intentional act. Prescriptions such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine,[2] and many others are recommended for pain after surgery. Opioids are highly addictive due to their powerful force to relieve physical pain and psychological effect of euphoria. Persons with opioid addiction often undergo dramatic changes in their personality and become unable to handle their finances. The children and grandchildren who misuse opioids then become financially dependent on their parents and grandparents or financially exploit their loved ones. The addiction takes over and often creates a multitude of problems, such as a housing eviction due to illegal activity on the premises or staying in the elder’s apartment in violation of the lease.

There is Hope

Organizations such as the Cambridge Elder Abuse Prevention Coalition, Greater Boston Legal Services, Somerville Cambridge Elder Protective Services, and many more are standing together in an effort to provide public awareness of these issues, information on how to properly use and dispose of opioids, and more importantly, resources for those who are affected by its harmful effects. This week, Attorney General Maura Healey initiated a lawsuit against Purdue Pharma for allegedly misleading doctors and Massachusetts residents about the risks of opioids like OxyContin, and profited from its deception. The Cambridge initiative is a prime example of what happens when people begin to care about the elders in their community, and the surrounding issues. Helen Keller stated, “Alone we can do so little; together we can do so much.” The key to elder abuse prevention is awareness, and a community that cares to take action.

[1] https://truestorytheater.com/

[2] https://www.drugabuse.gov/drugs-abuse/opioids

June Is Elder Abuse Awareness Month – Cambridge Plans a Creative Response

The Cambridge Elder Abuse Prevention Coalition, which the Elder Abuse Prevention Project helped found, is co-chaired by the authors of this article, Susan Pacheco, the Executive Director of the Cambridge Council on Aging, and Norah Al-Wetaid, a Senior Protective Services Caseworker, at Somerville-Cambridge Elder Services.

Many in the elder services field have long known that elder abuse is a common issue that often goes unreported. However, some new data is helping illustrate how widespread this problem is in the Bay State .In a recent WBGH story, the Executive Office of Elder Affairs reported 9,800 confirmed cases of elder abuse in 2017– an increase of nearly 40 percent since 2015.  A couple of key factors were cited to explain that growth. First, there was some optimism that efforts to raise awareness about the many forms of elder abuse are leading to more incidents being reported. But Massachusetts Secretary of the Executive Office of Elder Affairs Alice Bonner cited the rapidly growing population of older adults as a factor, adding that financial exploitation—often by family members—is a growing problem.

Roughly ten percent of older adults experience some form of elder abuse, which can be physical, emotional, sexual, or financial. Self-neglect is another, often overlooked, form of elder abuse. It’s an issue that affects individuals regardless of income level, culture, gender, race or sexual orientation.  Despite progress being made with raising awareness and increasing reports, most elder abuse goes unreported-we’ve heard everything from one in 14 incidents being reported to one in 24. Given the prevalence of elder abuse, it is critically important to recognize common warning signs:

  • Unexplained injuries or financial loss
  • Isolation
  • Verbal abuse or threats
  • Changes in mood or behavior
  • Rapid decline in health of unexplained weight loss
  • Neglected care needs
  • Hesitation to speak openly

June is Elder Abuse Awareness Month, and for the third straight year Somerville-Cambridge Elder Services (SCES) and the Cambridge Council on Aging are partnering to distribute information on recognizing elder abuse and purple ribbons, which are a symbol of this cause. As part of Elder Abuse Awareness Month, the Cambridge Council on Aging, SCES, and Cambridge Elder Abuse Prevention Coalition are exploring how opioid misuse increasingly contributes to elder abuse, with a free event at the Cambridge Senior Center (806 Mass Ave.) on Thursday, June 14 from 12:30 to 3 p.m.

Titled “Promoting Elder Wellness in Your Community”, the event will feature a mini-resource fair and light refreshments at 12:30, followed by performances of common scenarios by True Story Theatre. Attendees are also invited to bring any expired or unused medications as part of a drug take back facilitated by the Cambridge Police and Public Health Departments.

Finally, if you are concerned about an older adult and have reason to believe they are being abused, call the Statewide Elder Abuse Hotline at 1-800-922-2275. All calls are confidential, and are referred to local Adult Protective Services, which can investigate and determine the best course of action to alleviate risk.

Awareness and knowing how to counter elder abuse are the key first steps to mitigating this silent epidemic. Please join us in that goal for Elder Abuse Awareness Month and beyond.

For more information about the Promoting Elder Wellness in Your Community event, contact Pacheco at 617-349-6220 or spacheco@cambridgema.gov. The event is free, but preregistration is requested.   

The Cambridge Council on Aging and Somerville-Cambridge Elder Services will distribute purple ribbons this June to raise awareness about elder abuse. June is Elder Abuse Awareness Month.

 

 

Meals on Wheels = Elder Abuse Prevention

A recent article in the Boston Globe highlights the crucial role that the Meals on Wheels program plays in the lives of millions of older adults across the country who are food insecure and isolated.  Sadly, food insecurity and social isolation are widespread problems that can have devastating affects on older adults.  One of the crucial services available to older adults nationally is the Meals on Wheels program.  Meals on Wheels provides healthy food to people who experience hunger due to poverty, social isolation, immobility, or illness.  In addition to delivering food, Meals on Wheels volunteers also offer companionship and another set of trained eyes on a person’s home life.  For some people, the volunteer is the only person they see or talk to all day.  This “emotional nourishment” provided by volunteers such as Vito LaMura, the volunteer from Minuteman Senior Services featured in the Globe article, is why the Meals on Wheels program is such an invaluable asset in combating food insecurity, social isolation, and elder abuse.   

About Meals on Wheels America

 Meals on Wheels America is the leadership organization supporting the more than 5,000 community-based programs across the country that are dedicated to addressing senior isolation and hunger. This network serves virtually every community in America and, along with more than two million staff and volunteers, delivers the nutritious meals, friendly visits and safety checks that enable America’s seniors to live nourished lives with independence and dignity. By providing funding, leadership, education, research and advocacy support, Meals on Wheels America empowers its local member programs to strengthen their communities, one senior at a time. For more information,visit http://www.mealsonwheelsamerica.org