LGBT Elders & Health

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.

Yet 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.

Older lesbians share the experiences of all older people in dealing with some 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 on aging.

“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.

Beth Kling

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