Aging in Place in the LGBTQ+ Community

Like the majority of older adults in the U.S., LGBTQ+ older adults (LGBTQ+ OA) OA prefer to age in place. Beyond a mere preference, however, LGBTQ+ OA also fear discrimination, harassment, and physical abuse in nursing homes and assisted living facilities. Eighty percent of LGBTQ+ older Americans do not feel safe being out about their orientation in long-term care facilities.

What Is Aging in Place?

Aging in place is the ability to live safely and independently in your own home as you age.

Older adults receive support from their loved ones, family members, chosen family, home care services, and other support services to complete homeowner responsibilities and the activities of daily living.

Support for Aging in Place

As a rule, older people require more assistance with daily tasks as they approach advanced age, such as bathing, meal preparation, and household maintenance.

To ensure their ability to remain in their homes and communities, LGBTQ+OA and their caregivers should contact their local Area Administration on Aging (AoA), which provides support to older adults for a variety of home care and other services, including:

  • Household chores
  • Home modification and repairs
  • Personal care
  • Home health care
  • Respite care
  • Transportation assistance
  • Meal delivery
  • Social and educational activities
  • Legal help and elder rights education
  • Caregiver resources

Preparing for Aging in Place: Advance Planning

Ensuring the ability to age in place requires careful advance planning; LGBTQ+ OA should develop cohesive elder care plans to document their preferences for LGBTQ+ affirming service providers, caregivers, health care and visitation directives, power(s) of attorney, guardianship, estate planning, and long-term care decisions.

If you have Medicare, you may qualify for certain home healthcare services to ensure you can continue living at home, but you will likely eventually need to either pay for Long-Term Care insurance or spend down your assets to qualify for Medicaid in order to cover the long-term cost.

Barriers to Aging in Place

As trailblazers for LGBTQ+ civil rights and long-time survivors of homophobia and transphobia, LGBTQ+ OA are less likely to reach out to health providers and aging providers services like senior centers and meal programs designed to support aging in place, because they fear discrimination and harassment.

This is especially true for transgender older adults, who often postpone essential health care due to a lifetime of experiencing ignorance, prejudice, discrimination, hostility, and even violence. A lifetime of these experiences means they expect such treatment in the very places designed to support their successful aging.

According to the Long-Term Care Equality Index, a recent study found that 76% of LGBTQ+ OA reported concern about maintaining adequate social support to rely on as they age. LGBTQ+ OA face higher rates of disability, chronic disease, and social isolation. This is especially true for black, indigenous, or people of color (BIPOC), for whom the intersection of racism, homophobia, and transphobia lead to the most severe health outcomes, making it challenging to remain safely at home as their age-related needs increase.

Further, many parts of the country do not support aging in place due to eroding infrastructure and inadequate public transportation. Those factors, combined with anti-LGBTQ+ bias in health care settings and senior community centers, contribute to higher rates of loneliness and social isolation for LGBTQ+ OA and create additional hurdles to aging in place.

The Accessory Dwelling Unit: A Creative Way to Age in Place

The accessory dwelling unit (ADU) provides LGBTQ+ OA one creative housing option to age in place. An ADU is a small apartment attached to or on the same property as a main house. Also called “carriage houses," “in-law suites," “granny flats," “casitas," or “guest cottages," ADUs can be stand-alone structures or connected to the primary house (like a garage or basement apartment).

The average ADU measures 1,000 square feet or less. It includes a separate entrance from the main house, a bathroom, and a small kitchen. An increasing number of states and cities, including the District of Columbia, now have laws promoting ADU construction, reducing zoning requirements, simplifying the permitting process, and easing neighborhood parking restrictions.

How to Make a Home Accessible for Aging in Place

To make aging in place possible for older adults, renovations might be necessary, including adding:

  • Ramps
  • Grab bars and handrails
  • Medical/fall alert systems
  • Wider doorways
  • Lower sinks
  • Walk-in shower/tub or transfer bench
  • Lifts

You can find home modification resources through the government's Elder Care Locator.

Should You or Your Loved One Age in Place?

Aging in place is a decision only you and your loved ones can make. There are, however, many factors to consider such as: 

  • Do you have the support services necessary to age in place? 
  • Is your home accessible? 
  • Do you have the right systems in place for emergencies such as falls? 
  • Are there mental health or dementia concerns? 
  • Are there other options available such as a retirement community or senior living facility that caters to LGBTQ+ OA individuals? 

Discuss these questions with a trusted loved one.

Important: If you are considering aging in place because you have experienced abuse, discrimination, or harassment (such as in an assisted living facility or nursing home, or by a caregiver), consider talking to an attorney to hold the caregivers/facility accountable and prevent the same abuse from happening to someone else.

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