Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Clinical Practice with Older LGBT Clients: Overcoming Lifelong Stigma Through Strength and Resilience

This article provides an overview of the unique challenges and strengths of the older lesbian, gay, bisexual, and transgender (LGBT) population and the theories and evidence-based interventions that can be used to work with them in a clinical setting. Two case studies will be used to highlight potential issues in clinical social work and provide guidance for intervention with LGBT older adults. The article concludes with a summary and implications for clinical social work practice.     

Lesbian and gay men’s perceptions of their local area agency on aging

This article reviews data from a qualitative study of lesbians and gay men about engagement with their local Area Agency on Aging (AAA). Findings include lack of knowledge about the local AAA, feelings of exclusion, and the need for better outreach. It is important that AAAs engage their local lesbian, gay, bisexual, and transgender (LGBT) elders, as data show they are at higher risk for aging alone and can often harbor mistrust of formal services due to lifetimes of discrimination. Suggestions on where AAAs can find training and resources on reaching out to the LGBT older adult community and implications for the profession of social work are provided.     

Characteristics of LGBT caregivers of older adults: Results from the national Caregiving in the U.S. 2015 survey

Using data from the Caregiving in the U.S. 2015 national survey, we compared characteristics of lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT caregivers of older adults and explored predictors of caregiver strain. LGBT caregivers were younger, more racially/ethnically diverse, and less frequently a spouse/partner compared with their heterosexual counterparts. LGBT caregivers more frequently reported helping with medical nursing tasks and reported higher levels of financial strain. While LGBT identity was not an independent predictor of greater strain, characteristics more frequently reported by LGBT caregivers were, for instance, helping with medical nursing tasks. In addition, LGBT individuals who were children of the older adult were more likely to report higher levels of emotional strain than other relationship types.     

“Family” Support for Family Violence: Exploring Community Support Systems for Lesbian and Bisexual Women Who Have Experienced Abuse

ABSTRACT

“Family” is a euphemistic term that lesbian, gay, bisexual, and transgender (LGBT) people use among ourselves to designate membership in lesbian, gay, bisexual, and transgender communities. Ironically, this “family” may be the most sought, yet least successful, support for dealing with the intimate partner violence that occurs within LGBT families. This study of 11 lesbian and bisexual women's experiences seeking support revealed several tiers of unmet needs within the LGBT community. They rarely used services in the general community, although these services are often the focus of both criticism and efforts to build support systems for LGBT victim/survivors. A model presents the different stages and potential sources of support.     

Older lesbians' experiences with home care: Varying levels of disclosure and discrimination

ABSTRACT

There is considerable evidence that lesbian, gay, bisexual and transgender (LGBT) older adults have experienced barriers to health care access and have profound fears about how they will be treated in the long-term care system, but the specific experiences of older lesbians have received less attention. Most older adults needing long-term services and supports (LTSS) prefer to remain at home, and this is true for lesbians as well. This article reports on a national, qualitative study of the experiences of 20 older lesbians (age 65 and older) with home care workers. The experiences of six informal partner caregivers with home care services are also included. Emergent themes regarding level of disclosure, experiences with homophobia, evaluation of care received, and thoughts about ideal LTSS are described. Most study participants did not disclose their sexual orientation to their home care workers. A significant minority experienced homophobia, but nearly all ultimately found workers who provided good care with which they were comfortable. Their visions of ideal LTSS included greater affordability and particular qualities that were important for home care workers to possess, such as competence, caring and acceptance. Practice and policy implications are outlined including careful recruitment, training and supervision of home care workers to foster lesbian-sensitive care, but also improved wages and work conditions in order to maintain a quality home care workforce.     

“What About the Rest of Us?” An Overview of LGBT Poverty Issues and a Call to Action

In this article, I argue that, despite the myth of gay affluence, existing research is conclusive enough to claim that lesbian, gay, bisexual, and transgender (LGBT) adults are overall less financially secure than their heterosexual, cisgendered counterparts. I demonstrate that LGBT poverty is a broad social issue that can no longer be viewed as affecting only specific subpopulations of LGBT communities. I argue that the social work profession and the LGBT movement need to recognize LGBT poverty as a social issue. I then present a call to action for social work practitioners, researchers and LGBT organizations.     

Psychotherapy with Lesbian,Gay, Bisexual,and Transgender Older Adults

A small literature has addressed psychotherapy with lesbian, gay, bisexual, and transgender (LGBT) samples over the past two decades. Older adults have also been investigated in a growing number of psychotherapy research studies. However, psychotherapy specifically with LGBT older adults has not received adequate investigation. This review relies on converging lines of research to provide an integrated discussion of evidence-based psychological treatments (EBTs) with current research and clinical observations in the field of gerontology and suggests ways in which these topics can inform psychotherapy practice with LGBT older adults. We summarize current research on aging in several areas of practical interest to psychotherapists seeking to apply EBTs in their work with LGBT older adults. These areas include: adult development, coping, stigmatization, social context, and the effects of cohort membership. The results of these studies belie stereotypes regarding both the aging process, in general, and more specifically LGBT older adulthood, with significant implications for the practice of psychotherapy. EBTs are adaptable to a variety of issues encountered in later life by LGBT older adults, and these modifications to therapeutic technique are addressed throughout.     

Lift Every Voice: Voices of African-American Lesbian Elders

Old lesbians of African descent have experienced racism, heterosexism, homophobia, and ageism. This article explores the topics of aging, ageism, heterosexism, and minority stress among older African-American lesbians. The narratives and subsequent analysis offer significant contributions to the dialogue regarding Black aging lesbians in the aging and lesbian, gay, bisexual, and transgender (LGBT) communities generally and in the African-American and African-American lesbian communities specifically.     

The model standards project: creating inclusive systems for LGBT youth in out-of-home care

This article describes the Model Standards Project (MSP), a collaboration of Legal Services for Children and the National Center for Lesbian Rights. The MSP developed a set of model professional standards governing the care of lesbian, gay, bisexual and transgender (LGBT) youth in out-of-home care. This article provides an overview of the experiences of LGBT youth in state custody, drawing from existing research, as well as the actual experiences of youth who participated in the project or spoke with project staff. It will describe existing professional standards applicable to child welfare and juvenile justice systems, and the need for standards specifically focused on serving LGBT youth. The article concludes with recommendations for implementation of the standards in local jurisdictions.     

Lesbian,Gay, Bisexual,and Transgender Communities’ Readiness for Intimate Partner Violence Prevention

Efforts to address intimate partner violence (IPV) in lesbian, gay, bisexual, and transgender (LGBT) communities often rely on identifying what service providers can do to better reach and serve these populations. However, assessing a community's readiness in response to the issue of IPV in LGBT communities locates the issue where outcry is most likely to occur. Utilizing the Community Readiness Model in lesbian, gay, bisexual, and transgender communities in two rural and two urban communities, this study revealed a low level of community readiness to address IPV. Only vague awareness of IPV exists in these sexual orientation, gender identity, and geographic communities. The study suggests specific next steps tailored to raise LGBT communities’ readiness to address IPV from within their own communities, starting at the current low level.     

Belonging and Acceptance: Examining the Correlates of Sociopolitical Involvement Among Bisexual and Lesbian Latinas

This article employs a national sample of almost 400 bisexual and lesbian Latinas to examine the impact of community-level support/comfort, as well as the importance of sexual orientation and racial identity, on sociopolitical involvement. Results indicate that feelings of connectedness to the lesbian, gay, bisexual, and transgender (LGBT) community are the most important predictor of sociopolitical involvement within both LGBT and people of color (POC) communities. While comfort within the LGBT community had no impact on LGBT sociopolitical involvement, it had a negative impact on POC sociopolitical involvement.     

Planning for the Residential Needs of Lesbian,Gay, Bisexual,and Transgender Older Adults

Lesbian, gay, bisexual, and transgender (LGBT) older adults experience housing-related barriers. Previous research has described residential challenges experienced by this population, but few studies have examined implementation of housing solutions. This exploratory study conducted 7 semistructured phone interviews with program directors and/or development managers from initiatives offering residential services to LGBT older adults. Qualitative analysis identified themes that characterize the implementation of housing solutions. Study results suggest that future residential solutions for LGBT older adults should consider housing in relation to other aging-related barriers and frame solutions that promote collaboration among community actors (e.g., residential and service providers).     

Types of LGBT Microaggressions in Counselor Education Programs

Although previous research has identified common types of lesbian, gay, bisexual, transgender (LGBT) microaggressions, there is a lack of research that describes the specific experiences of LGBT students in counselor education programs. This study examined the microaggression experiences of 12 LGBT students in such programs. Data analysis revealed several thematic microaggression types. Implications for counselor educators are discussed.     

Virginity Definitions and Meaning Among the LGBT Community

The literature on lesbian, gay, bisexual, and transgender (LGBT) virginity is almost nonexistent. Thus this exploratory study was completed to understand virginity in the LGBT community. The research questions asked members of two LGBT student groups to define virginity, discuss its meaning, and share experiences. Data were collected from two focus groups and six individual follow-up interviews and were analyzed. Results indicate that there is a range of virginity definitions, there is little discussion of the topic, and that “coming out” is a more important rite of passage than virginity among these LGBT community members. Future research needs are discussed.     

Examining Cohort Differences and Resilience among the Aging LGBT Community: Implications for Education and Practice among an Expansively Diverse Population

The aging lesbian, gay, bisexual, and transgender (LGBT) community continues to grow considerably while often being faced with unique and unmet needs separate from younger LGBT cohorts or their non-LGBT counterparts. This article explores some of the differences in attitudes among generational cohort groups regarding coming out decisions; sexual risk and safety; the impact of evolving policies within systems and society; as well as the demonstrated strengths and resiliencies of the aging LGBT community. Implications and suggestions for education, training, and best practices among this expansive and diverse population are considered as well as continued research in the field of LGBT aging.     

LG(BT) Families and Counting

Counting and understanding lesbian and gay families have gained attention over the last decade in popular culture, policy, and academic research. Contentious debates on family values and same‐sex marriage, increasing rates of social tolerance for homosexuality, and a greater general academic attention on issues of sexual orientation have partially spurred this attention in demographic analysis of lesbian and gay families. It is becoming increasingly clear that sexual orientation and gender identity have an effect on demographic processes and life outcomes. Although not perfect, practically speaking, drawing on nationally representative survey data has allowed us to illuminate the presence of same‐sex families and their children. These findings have an iterative relationship with social change, public policy, and increasing tolerance for diversity. This article reviews the recent demographic contributions related to lesbian, gay, bisexual, and transgender (LGBT) families. Due to research concentrations, the content of this article not only mostly addresses what is known about gay and lesbian families but also offers future directions to fill research voids including a call for greater attention to and visibility for families with bisexual and transgender members.     

Substance Abuse in Lesbian,Gay, Bisexual,and Transgender Communities

Abstract

This article calls attention to the lack of knowledge concerning alcohol and other drug (AOD) use in lesbian, gay, bisexual, and transgender populations. Twenty-five Internet Web sites related to the LGBT substance use are reviewed.     

An Examination of School Counselors’ Competency Working with Lesbian,Gay and Bisexual and Transgender (LGBT) Students

This study aims to investigate school counselors’ competency level in working with lesbian, gay, bisexual, transgender (LGBT) youth. Using a sample of 125 school counselors who are currently practicing in schools, this study found school counselors perceived themselves with very low competency levels. Spearman's rho correlation results indicated that only three demographic variables were significantly correlated with school counselors’ self-perceived competency level: sexual orientation, whether having received any postmasters trainings and geographic regions. Counselors identifying as nonheterosexual, those who received postmasters trainings or workshops, and those who reside in the West tend to have a higher self-perceived competency working with youth identifying as LGBT.