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ACL has long
been committed to ensuring that LGBTQI+ older
adults receive the services and supports they need and
deserve. We know that making this vision a reality requires
intentional and ongoing work by people at all levels of the
aging services network. As LGBTQI+ Pride Month comes to a
close, we wanted to hear from Maine and Oregon, two states
that have committed to this work.
We spoke to:
- Debbie McCuin, Program
Analyst, Community Services and Supports Unit, Oregon
Department of Human Services; and
- James Moorhead, Aging
Services Manager, Office of Aging and Disability
Services (OADS), Maine Department of Health and Human
Services.
In the Q&A below, they
discuss why it is important to listen to LGBTQI+ older
adults, outreach strategies, the changes they have seen in
their states, and their advice for other states looking to
make their aging services more equitable.
Why
was it important for your state to directly engage LGBTQI+
older adults?
Moorhead:
The current cohort of LGBTQI+ older adults, especially
those ages 85+, have experienced discrimination at each
stage of their lives. They grew up during the Lavender
Scare, had to fight for their rights, were
expelled from higher education, were told they were
mentally ill by the American Psychiatric Association until
1973, were barred from military service, were fired by
employers, survived the height of the AIDS epidemic, were
denied marriage equality until 2015, and more.
Now they are too often facing discrimination when accessing
needed long-term care both in the community and in
facilities. As such, the state of Maine prioritizes
community input on how aging services and programs are
delivered across the state to reduce barriers, such as fear
of discrimination.
McCuin:
Many LGBTQI+ older adults (a community which also includes
asexual and two spirit indigenous people) have experienced
lifelong challenges and discrimination resulting in fewer
resources and supports to meet their needs. Governmental
entities have historically perpetuated these inequities
through policies such as the denial of spousal survivor
benefits or by creating an unwelcoming environment that
makes it risky for individuals to disclose their sexual
orientation or gender identity when accessing services.
Where there hasn’t been explicit discrimination, there has
often been a history of benign neglect, particularly in
recognizing and acknowledging the unique needs of this
population and providing services that are welcoming and
appropriate.
Community advocates have long been raising concerns about
disparities, discrimination, invisibility, and lack of
data. As Oregon is committed to the provision of services
and supports to all older adults, addressing these equity
issues, in partnership with community, is long overdue.
What
strategies did your agency use to ensure that the voices of
LGBTQI+ older adults would be heard?
McCuin:
Building relationship and trust are critical. Some
strategies to promote and hear LGBTQI+ voices include:
- Including LGBTQI+ older adult
community members on project advisory committees,
public boards, and commissions;
- Hosting community listening
sessions;
- Inviting community members to
participate in leadership recruitment and hiring;
- Dedicating staff time to liaise
with community groups and serve on their committees;
and
- Sponsoring LGBTQI+ conferences
Community inclusion,
partnerships, and outreach are key strategies, and a good
example of this is the recruitment and involvement of
LGBTQI+ older adults on the Oregon LGBTQ+ Older Adult
Survey Advisory Committee.
Moorhead:
More data is needed on LGBTQI+ older adults in Maine. To
begin collecting such data, Maine included questions about
sexual orientation and gender identity in its statewide
needs assessment for the State Plan on Aging.
But we know that simply asking questions on a survey would
not accurately capture the unique service needs of LGBTQI+
older adults. To amplify their voices using qualitative
data, OADS partnered with the Maine Health Access
Foundation to host a series of focus groups of older adults
in target populations that included LGBTQI+ older adults.
How
did you recruit participants for surveys or focus groups of
LGBTQI+ older adults? Do you have any tips or best
practices to share?
Moorhead:
Partnerships are EVERYTHING! LGBTQI+ community
organizations have the skills to effectively communicate
with LGBTQI+ people and have well-established outreach
methods such as mailing lists, websites, and social media.
Partnering with SAGE Maine,
with support from Maine Health Access Foundation, directly
increased participation of LGBTQI+ older adults in Maine’s
State Plan on Aging needs assessment. SAGE Maine shared the
survey that was open to all family care partners and
recruited focus group participants.
Additionally, we used recommended
survey questions about sexual orientation and gender
identity developed by the National Resource Center on LGBT
Aging.
McCuin:
To reach a population with an inherent distrust of
government, we believe it is critical to have information
shared by trusted partners. With our partners, we spent a
great deal of time developing LGBTQI+ community outreach
contacts who could help encourage community members to take
our survey.
We also translated outreach materials into 10 languages. We
shared many shelf-ready samples of communication that
organizations could use, such as sample blurbs, flyers,
letters to the editor, and social media posts.
When we were recruiting participants for the Oregon
LGBTQ+ Older Adult Survey, some key methods
included social and print media, announcements at public
meetings, and emails and other communications by the agency
and our community partners. The response was phenomenal:
over 1,400 people took the survey. We attribute this
success to the efforts of our community partners in
reaching their networks.
How
has your state’s approach to serving LGBTQI+ older adults
changed? What are you doing differently?
McCuin:
Oregon’s Office of Aging & People with Disabilities has
a new willingness to truly see the LGBTQI+ population and
to view this population as one that requires—and
deserves—visibility, support, and resources specific to
their needs and strengths.
The agency has evolved in its thinking, engagement,
prioritization, and funding of equity—including around
sexual orientation and gender identity. Equity is now our
agency’s “north star,” guiding all our work, internally and
externally. There is support for staff to engage more fully
with community groups in order to build foundational
relationships and trust, and there is increased internal
training.
The office has committed to acting through examination of
programs, policies, rules, and services and has committed
resources to this end. It has committed resources to, and
completed a community needs survey of, LGBTQI+ older
adults; raised statewide awareness of those needs; and is
actively engaging community groups to address concerns. In
addition, the LGBTQI+ population is also specifically
called out as a target population with “greatest social
need” in the Area Agency on Aging Area Plans and in the
Service Equity Focus Area of the current State Plan on
Aging. There is a real commitment to partnerships and
action that has tremendous potential to effect change.
Moorhead:
The desire to improve services and programs for LGBTQI+
older adults was already there among Maine’s Area Agencies
on Aging and service providers. They want to get it right
and they are looking for statewide leadership in this area.
Governor Janet Mills and her administration have
consistently supported LGBTQI-inclusive policies. Maine’s
2020-2024 State Plan on Aging was designed, for the first
time in Maine’s history, using an inclusive process that
incorporated historically underserved populations,
including LGBTQI+ older adults. Importantly, Maine also is
building better data collection methods on sexual
orientation and gender identity in our statewide database
to document the needs of LGBTQI+ older adults.
The Office of Aging and Disability Services purchased
LGBTQI+ cultural humility training through SAGECare offered
by the National Resource Center for LGBT Aging for over 450
staff at both the state and local levels of Maine’s aging
network. The next phase of this training is expanding to
direct care workers in long-term care.
The pandemic relief funding also afforded Maine unique
opportunities to strengthen relationships with SAGE Maine
(a program of Equality Maine and an affiliate of SAGE USA)
to ensure inclusive vaccine outreach to LGBTQI+ older
adults statewide and reduce social isolation throughout the
pandemic.
What
advice would you give other states looking to make their
aging services more responsive to the needs of LGBTQI+
older adults?
McCuin:
There is no substitute for being present, for listening and
acknowledging past issues, and for genuinely, respectfully
engaging communities to advance positive change.
This requires more than a token effort; states should be
willing to invest ongoing staff time and resources.
Externally, states must put in the energy to build
trust and then take real, meaningful actions based on the
community input they receive. Internally, agencies must
fully commit to training and to policy, practice, and
program change.
Moorhead:
Designing and implementing inclusive aging services and
programs is an iterative, ongoing process. The quick, easy
solutions do not lead to measurable population-level
results. You have to commit to the process and not expect
overnight results.
The best advice I have is from Strengthen
Your State and Local Aging Plan: A Practical Guide for
Expanding the Inclusion of LGBT Older Adults:
- Educate staff of agencies and
service providers about the needs of LGBT older
adults.
- Develop partnerships with
community-based LGBT organizations.
- Invite LGBT community stakeholders
to provide input.
- Identify the needs of older LGBT
adults through new or existing needs assessments and
data.
- Review existing programs and
services for LGBT-inclusion.
- Design LGBT-inclusive plans on
aging with input from key stakeholders.>
- Measure program success.
- Continue planning for
LGBT-inclusive services and programs.
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