Lesbians’ difficulty Accessing Quality Health
Care is a Problem for Many Older Lesbians
By Beth Kling
“What do you expect at your age?” is not a question
that anyone wants to hear from a doctor. Yet it’s not uncommon
for elders to get this response when seeking care from their physicians.
Add homophobia and sexism to this kind of overt ageism and you
get a serious barrier to health care access — a problem faced
by many older lesbians at a time in their lives when the need for
high quality medical care is profound and growing.
The current generation of older lesbians, especially those in
their seventies, eighties, and nineties, came of age at a time
of intense social discrimination against gays and lesbians. Until
1973, homosexuality was designated a psychiatric illness by the
medical establishment, and for decades it was commonly regarded
as sinful and even criminal by society at large. Some lesbians
have spent a lifetime avoiding medical care in order to protect
themselves from discrimination, stigmatization, and even hospitalization.
Despite the gains made in recent years, their fears may be so ingrained
that many may continue to avoid medical care into old age, until
their health deteriorates to such a degree that the need for treatment
becomes acute. Others who may have kept their sexuality a secret
from their physicians throughout their lives may continue to do
so into old age, making it potentially difficult for providers
to offer accurate diagnoses, sound advice, and good care.
it isn’t only residual fear from lifelong homophobic
experiences that blocks older lesbians from accessing quality health
care. LGBT people continue to face intolerance, hostility, and
outright discrimination at the hands of some health care practitioners.
Although a greater number of LGBT-sensitive doctors are practicing
around the country, it may be challenging for many older lesbians
to find and visit these physicians. Access to the Internet may
be necessary to locate LGBT-friendly doctors, and visiting these
physicians may require traveling outside of a client’s neighborhood.
For some older lesbians, lack of access to online resources and
mobility challenges may leave them to seek care in less than accepting
environments or opt for no treatment at all. For many, information
on LGBT-friendly physicians comes from networking in the lesbian
and gay community. Older lesbians who are not out — and do
not, therefore, have any contact with this community — will
again be at a disadvantage.
lesbians share the experiences of all older people in dealing
physicians who may see their increasingly complex health
challenges and need for potentially conflicting treatment regimens
as a “problem” that isn’t worth spending time
to try to solve. As a result of this fatalistic approach to the
care of older people, some physicians offer a less than adequate
service to their older patients, leaving some elders to live with
untreated medical problems.
Society’s tendency to see older people, particularly older
women, as less than whole persons, may also have a damaging effect
on medical care for older lesbians. If doctors see older women
as asexual beings (a prevalent misconception in society), they
may fail to diagnose sexually transmitted diseases (despite the
increase in HIV/AIDS diagnoses in the over 50 population) or to
provide information important to quality of life and sexual fulfillment.
Also, the inclination to equate women’s sexual health with
reproductive health reinforces a largely heterosexual and youth-based
approach to women’s care.
Issues around accessing appropriate and complete care for older
lesbians may intensify when infirmity or illness pushes some women
into nursing homes. Depending on the sensitivity of nursing home
staff and the presence of LGBT-affirmative policies in the facility
(which until recent years have been virtually nonexistent), older
lesbians may face unchecked homophobia from fellow residents or
even staff. This situation potentially puts older lesbians in danger,
and causes some women to return to the closet, worsening the isolation
and alienation they may already feel being away from home and family.
As baby boomers get closer to retirement age and service providers
mobilize to meet the needs of this substantial group, the barriers
to accessing quality health care for many older lesbians may diminish,
but not without good advocacy programs and awareness raising. SAGE
(Services and Advocacy for GLBT Elders, a New York-based social
service and advocacy organization), has developed a curriculum
to educate and sensitize practitioners in social service agencies
and long-term care facilities about the needs of LGBT elders across
the country. This is a first step, but more needs to be done. Good
healthcare for older lesbians (and for older gays, bisexuals, and
trans people) must become a part of the national policy agenda
“What do you expect at your age?” should be a question
with a viable answer — and the answer should include high-quality,
sensitive and professional health care that meets the unique needs
of older people without prejudice. Older lesbians should expect,
and demand, no less.