Authored by Sasha Buchert, Senior Attorney, and Karen Loewy, Senior Counsel and Seniors Strategist.
As most everyone understands by now, the overall infection and mortality rates of COVID-19 increase with age and when there is an underlying health condition. There is an estimated mortality rate for older Americans of approximately 15%.
While there is no census data available, existing research estimates there are approximately 2.4 million LGBT adults over 50 in the U.S. While they are already at greater risk for the virus based on age, a lifetime of discrimination means a higher likelihood of underlying health conditions. Many have endured years of social repression and condemnation and have struggled against widespread prejudice and harassment in employment, housing, health care, relationship recognition, public accommodations, and more. This has led to long term negative economic and health outcomes that place them at serious risk of developing illnesses related to COVID-19. This is especially true for older transgender adults, as more than 1 in 5 transgender people already report having a chronic health care condition.
A lifetime of trauma stressors can also encourage unhealthy coping mechanisms that eventually lead to underlying conditions. For example, LGBT older adults are at risk for COVID-19 because they are more likely to smoke as a coping behavior, making them much more susceptible to respiratory viruses.
The effect of discrimination and harassment on the vulnerability of LGBT older adults to COVID-19 is clear.
Other challenges faced by LGBT seniors make navigating life in the COVID-19 era more complicated, too. While older adults across the country have struggled with social isolation even before the pandemic, those who are LGBT are also more likely to lack an extended family network they can turn to for support. On top of this, many physical spaces — like LGBT community centers — that serve these populations have recently been closed as non-essential. This extreme social distancing further negatively impacts health and wellbeing.
High percentages of older LGBT adults report a wide array of discrimination in health care settings. Many are provided inferior care; subjected to harsh language, physically rough or abusive treatment, and unwanted physical contact. Some are simply denied care. Health care providers have refused to recognize their families, including children, partners, or spouses, much less their chosen family. This discrimination is compounded for older transgender adults, and for LGBT people and people living with HIV.
Many LGBT older adults face a difficult decision when planning how to respond if they begin to develop symptoms that indicate they have COVID-19. Some may be hesitant to rely upon mainstream providers based on prior experiences. Almost 15% of LGBT people who experienced discrimination on the basis of their sexual orientation or gender identity postponed medical care. This reluctance to seek care is a matter of life and death during a pandemic, and demonstrates why it is critical to eliminate discrimination and harassment in health care settings. There must be trust between a patient and their provider for health care to be effective.
The well-grounded fear of discrimination LGBT older adults experience has been exacerbated by the nonstop attacks from the Trump administration, which has tried to undercut or eliminate vital protections against health care discrimination and invite health care providers to seek exemptions from those protections to impose their religious beliefs upon vulnerable patients.
Thankfully, those efforts have failed and laws remain in place to protect LGBT older adults and people living with HIV who may have to engage with the health care system. Federal law — including the Affordable Care Act, the Americans With Disabilities Act, and the Rehabilitation Act — continues to bar discrimination against LGBT people and people living with HIV in health care. The Federal Nursing Home Reform Act also sets a baseline of protections in long-term care settings that apply to LGBT older adults. Additionally, nearly half of states prohibit discrimination in public accommodations, and many have patient bills of rights and state licensing requirements for health care facilities that include nondiscrimination provisions.
Older LGBT adults have demonstrated their resilience and strength throughout our history, but the LGBT community needs to stand beside them in this difficult moment and make sure they have the resources they need to survive the pandemic. Their struggle paved the way for the rights and protections we enjoy today, and we stand on their shoulders. It is critical that we acknowledge their unique vulnerabilities to this virus and stand alongside them in this fight.
Please read through the following resources and take a moment to reach out to the LGBT older adults in your life to check in and share this with them. Anxiety-inducing information is permeating the news cycle and social media. A call, text, or email can be deeply healing to many who are isolated
Resources for LGBT Older Adults
CHECKLIST: What does this mean to be free from discrimination?
☑ It means you can’t be refused treatment or given inferior treatment because you are LGBT or living with HIV, and people’s sexual orientation, transgender status, or HIV status can’t be inappropriately considered in assessments about who gets access to lifesaving care.
☑ You have the right to be addressed by the name and pronouns you use.
☑ You have the right to be housed and to use facilities consistent with who you are
☑ It also means having control over who gets to visit you.
CHECKLIST: What should you do if you experience discrimination?
☑ Please contact Lambda Legal immediately if you are an older adult or you know of an older adult who has experienced discrimination because of their sexual orientation or gender identity or because they are living with HIV: call 1-866-542-8336 or go to our website at https://www.lambdalegal.org/helpdesk.
☑ Advocate for yourself. Calmly, but firmly tell the person who is discriminating against you that it is both wrong and unlawful for them to discriminate against you.
☑ Report each incident to the appropriate staff. If necessary, ask to speak to a supervisor. Contact the hospital’s Ombudsman.
☑ Take notes—write down what happened, where, when, and who was there. If you can, ask for names of the bad actors and anyone else who observed it. Contact information is helpful.
☑ Get copies of anything the discriminator has put in writing—letters, emails, medical records.
☑ File a complaint. The legal protections are enforced in a wide variety of ways. Filing complaints with agencies that oversee and enforce the laws or with licensing authorities.
CHECKLIST: What should you do to be prepared in case you need to seek medical care?
☑ Put documents in place to make sure your wishes will be respected. Consult Lambda Legal’s checklist for advance planning: https://www.lambdalegal.org/sites/default/files/final_pp_ttp-2014-10_are-you-prepared.pdf. This is part of Lambda Legal’s Tools for Life and Financial Planning: https://www.lambdalegal.org/publications/take-the-power.
☑ Contact Lambda Legal’s Help Desk for information and attorney referrals. Call 1-866-542-8336 or go to our website at https://www.lambdalegal.org/helpdesk.
Further Resources
From Lambda Legal:
- Know Your Rights: Wallet Card For LGBT Older Adults and Older Adults Living with HIV: https://www.lambdalegal.org/publications/know-your-rights-wallet-card.
- Know Your Rights as a Nursing Home Resident: https://www.lambdalegal.org/publications/fs_nursing-home-residents-rights.
- FAQ: Housing Rights of LGBT Seniors: https://www.lambdalegal.org/blog/housing-rights-of-seniors.
- Employment Discrimination and LGBT Seniors: https://www.lambdalegal.org/publications/employment-discrimination-and-lgbt-seniors.
- Transgender Rights Toolkit: A Legal Guide For Trans People and Their Advocates: https://www.lambdalegal.org/publications/trt_trans-aging-were-still-here.
- Results from Lambda Legal’s When Health Care Isn’t Caring Study: LGBT Older Adults and Older Adults Living with HIV: https://www.lambdalegal.org/sites/default/files/publications/downloads/whcic-insert_lgbt-older-adults-and-older-adults-living-with-hiv.pdf.
From Partners:
- If you or an LGBT older adult you know believes they have been exposed to COVID-19 and develop a fever and symptoms, such as a cough or difficulty breathing, call your healthcare provider for medical advice.
- Contact the SAGE LGBT Elder Hotline at 877-360-LGBT (5428). The Hotline is available 24 hours a day, 7 days a week, in English and Spanish, with translation in 180 languages. Another option is the GBLT National Senior Hotline: 888.234.7243 https://www.glbthotline.org/senior.html.
- Check out the Advocacy & Services for LGBT Elders Fact Sheet: https://www.sageusa.org/coronavirus/.
- Most recent recommendations from the Center for Disease Control: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html.
- Tips and Resources from the National Resource Center on LGBT Aging: https://www.lgbtagingcenter.org/resources/resource.cfm?r=990.
- List of establishments offering designated high-risk shopper hours: https://www.sageusa.org/protecting-high-risk-shoppers-2/.
- Contact your local area on aging to access resources such as delivered meals or transportation: https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx.
- Although many LGBT-oriented health centers have requested that people call before entering, many of them continue to provide services in cities such as New York City (Callen Lorde), Washington DC (Whitman-Walker), Los Angeles (LGBT Center), Philadelphia (Mazzoni Center), Chicago (Howard Brown), and other parts of the country.
- National Center for Transgender Equality Fact sheet for Trans Elders: https://transequality.org/covid19.
- If you need food assistance, contact your Area Agency on Aging and register for home delivered meals (commonly referred to as Meals on Wheels). You can search for your AAA here: https://eldercare.acl.gov/Public/Index.aspx or call 1-800-677-1116.
- Ensure you have designated a person of your choice to make medical decisions for you in case you become unable to make decisions for yourself: https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives/.
