Being out, old and rural

LGBTQ+ seniors face challenges living in the country

Posted 5/15/19

I grew up listening to stories about my colorful family: about Uncle Christian Wilhelm who went to Russia with Napoleon, great-great-great grandpa who fought in the American Civil War, my aunt Norma …

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Being out, old and rural

LGBTQ+ seniors face challenges living in the country


I grew up listening to stories about my colorful family: about Uncle Christian Wilhelm who went to Russia with Napoleon, great-great-great grandpa who fought in the American Civil War, my aunt Norma who made tiny toys and danced under the moon.

Dad was quiet about his cousin Ed, and it was my mom who explained why. Cousin Ed was gay, had a lifetime partner named Harmon. As Mom put it, “Ed and Harmon were in love, and they had to live in San Francisco to be safe.”

Ed passed away a few years ago, in his 80s, Harmon a few years before him, and they had a long, happy life together. But their experience—a supportive, safe community with people to help them in their later years—is not typical. And it’s especially not typical of LGBTQ seniors in rural areas.

In a cultural landscape where teens come out on Instagram and movie superheroes are gay, it may be hard to imagine a world where one’s sexual preferences had to be kept secret, where hate crimes might be ignored.  But that is how today’s seniors grew up, and that world was, for them, not safe but normal.

“When we talk about the Stonewall generation, this is a population that grew up when their existence was criminalized,” said Aaron Tax, director of advocacy for SAGE-USA in Washington, D.C.  The organization is the oldest U.S. nonprofit focused on improving the lives of LGBTQ seniors.

Decades ago, to be LGBTQ was to be mentally ill. Those in that community could not show love publicly for someone of the same gender. They could not raise children. They could not be “out” and get jobs. Couples had no legally binding relationship, so healthcare decisions could not be made by one partner for the other. When AIDS decimated the community, people watched their loved ones die and were told the disease was their fault.

“One needs to look back at their coming-of-age stories,” Tax said, “to understand why they carry with them a fear of discrimination and stigma.”

So LGBTQ people took refuge in secrecy: the famous closet. Instead of a partner or spouse, they lived with a friend, Tax said, and they kept very, very quiet about their lives.

Coping mechanisms in the past kept them safe. But now they cause problems too.

In general, LGBTQ seniors face the same challenges as other seniors, but the difficulties are more far-reaching. For those in rural areas, the difficulties are magnified.

“Social isolation: LGBT[Q] seniors are twice as likely to be single,” Tax said. Perhaps a partner died, or a relationship came to an end. But they are more likely to be childless too and, sometimes, without extended family. And isolation “has repercussions in terms of mental health and physical health.”

Isolation in the country means that you’re managing without the social supports that urban LGBTQ people take for granted, according to a SAGE report, Fighting Isolation to Support Rural LGBTQ Elders ( And physically, distance and lack of public transportation means it’s hard to meet others if you can’t drive.

LGBTQ seniors, particularly women, also have higher rates of poverty, Tax said. “Same-sex female couples create challenges: smaller lifetime earnings, smaller social security checks, no survivor benefits.” And as with heteronormative couples, women live longer and have to get by longer on those smaller checks.

“There’s a lack of access to social services and supports,” Tax said, pointing out that the senior population learned to be wary of a medical profession that had told them they were mentally ill. “They’re less likely to access services because of a fear of discrimination and stigma.”

Again, the lack of public transportation adds to the problem in rural areas. And even though society seems less homophobic, people may worry that one’s neighbors might not be that progressive. The SAGE report found that rural elders were less “out” than urban residents. This means that even if programs exist, people may not feel comfortable signing up.

Back in the closet

Tax said, survivors of “the first generation [who] ‘out’ but now in a long-term-care setting or [with] a home caregiver,” might feel vulnerable, so they hide their preferences. For trans seniors, he added, that’s not an option.

“When [LGBTQ seniors] enter long-term care, they don’t know if they’re entering a safe space,” explained Toni Maeck from the Hudson Valley LGBTQ Community Center, at a presentation to the Sullivan County Long Term Care Council in March.

Higher rates of poor health

“It’s a combination of circumstances,” Tax said. In 1973, for example, the American Psychiatric Association decided that being gay was not a mental illness, but the community was still cautious about what they told medical personnel, which led to inadequate care.

Staff in institutions or in home health may be uncomfortable looking after someone who is gay or transgender. “It’s a matter of training and it requires leadership in these institutions,” said Maeck, “to continue to hold themselves and staff accountable, to make changes and implement what is learned... after the session is done.” The problem is so significant that if it’s not addressed, “LGBTQ seniors could get care that is totally inappropriate.”

And there is HIV/AIDS. First, there was the trauma of watching a generation of friends and loved ones die.

Now, with treatment available, “more than half of people living with HIV are over 50,” Tax said. The UK charity AVERT points out that we are just now starting to see the effects of long-term use of HIV drugs on the human body, and how HIV status affects an older person. How do the drugs act in the older body? Which medications do they interact badly with? Doctors need to be aware of potential problems, and ask about them.

Marriage is yet another concern for elders. “For a lot of the aging population, they may not have been able to enter into a legally binding relationship,” Maeck said, so they have lifetime partners for whom they cannot make legal and medical decisions. And when seniors do think about marrying, Tax said, “they need to check into means testing... wills and financing have been figured out in a way that didn’t take marriage into account. People need to talk to a legal expert.” How will social security be affected? Pensions? These are questions that need answering before an LGBTQ senior couple marries.

Seeking solutions

For all seniors, but especially LGBTQ seniors and even more so those in rural areas, finding community is critical, Tax said. But in rural areas, that community can be harder to find.

“There’s good news,” he said. “Senators Casey, Murkowski and Bennet have sponsored the Inclusive Aging Act, which authorizes grants to help LGBT[Q] seniors age gracefully.” It builds on the Older Americans Act, but focuses on the LGBTQ population. A SAGE statement notes that the bill would “issue funding opportunities that would support older LGBT[Q] people—including a rural outreach grant program to connect rural LGBT[Q] older people with services and supports—and promote the adoption of policies across federal programs to help address the specific needs of LGBT[Q] elders.”

Outreach programs are a great start, but rural LGBTQ seniors need to find community—sometimes, they must create it. There’s a danger too in making it a group of peers, SAGE’s report said. You might find yourself “the last person standing,” as friends upon whom you rely age and die. The soultion is to bring younger people into the community, but how do you do that? How do you make sure home-health aides are comfortable caring for a trans person or someone with a same-sex partner?

SAGE acknowledges this and offers training and resources on its website, Tax  said. New York City’s Friendly Visitor Program can be replicated. Some places have experimented with phone trees (including landlines) as a way of keeping in touch with seniors in areas without broadband or cellphone access. Toni Maeck suggested ways for social services to phrase questions and learn the proper pronouns when working with an LGBTQ senior.  “Using the correct name and pronoun is one of the most important ways to show respect for their identity,” she said.

There are challenges ahead, of course. But there is hope, too. As Sen. Lisa Murkowski (R-AK), co-sponsor of the Inclusive Aging Act, pointed out, “It’s important that we promote the inclusion of all seniors, and work to increase access to care and services for their overall health and well-being.”

For more information, visit SAGE NYC at, the Hudson Valley LGBTQ Community Center in Kingston, NY at and the NEPA Rainbow Alliance at


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