Older LGBTQ adults fear going back “in the closet” upon entering assisted living

When Ann Francis and her partner approached their 80s, their list of medical needs grew longer. But they don't have children, the circle of friends in their community that they relied on for care was also aging and they had their own medical problems to tend to. 

So when Francis and her partner started looking around for assisted living facilities near their home in Lansing, Michigan, they were disappointed they did not find one in which, as a lesbian couple, they felt welcomed. Once, someone told her they accepted LGBTQ residents, but they "could not guarantee" the other residents would be understanding, she told Salon in a phone interview.

"That was sobering," Francis said. "We did not feel assured that if we had to go into assisted living or a nursing home that we would be respected, that we would be able to be together or that we would even have access to one another."

Eventually, they found a community 200 miles away in Oberlin, Ohio that they felt comfortable in. But that meant leaving behind the supportive community they had built over the past 40 years in Michigan.

"We would have stayed in Michigan — we loved our community back in Michigan and we worked really hard to form an LGBTQ community that was supportive," Francis said. "But when we aged, it became increasingly clear to us because of our circumstances that we would not get the support we needed to have a good experience in our senior years."

Francis is not alone. In a survey conducted by AARP New York and SAGE, one-third of older adults surveyed in New York said they feared having to "re-closet" themselves when seeking senior housing. Another report found half of older same-sex couples faced discrimination when applying for housing. 

The needs of older individuals can become invisible in decision-making as they age, partly due to ageism and ableism. While the LGBTQ community has visibility today, over 500 anti-LGBTQ bills have been introduced in state legislatures this year alone, and the community is still victim to outsized rates of violence. 

Many older LGBTQ individuals who came out in the '60s or '70s have faced threats or violence in their past or had to hide their sexuality for decades, said Dan Stewart, associate director of the Aging Equality Project with the Human Rights Campaign. Having to hide their sexuality not only dredges those feelings up but adds another layer of invisibility to a population that is already often overlooked.

"A lot of these elders have lived in the closet for many decades and now, if they are out, are faced with the concern of, 'If I go into long-term care services or access home and community-based services [will they] help support me as I age?'" Stewart told Salon in a phone interview.

Francis grew up in a Catholic home in Florida in the 1950s and didn't come out until her 30s. She worked as a teacher, but without LGBTQ protections in place, she faced discrimination and left the profession to work in an automotive factory in Michigan for the next 20 years. As a peace activist, Francis spent decades fighting for civil rights and the climate movement and helped build a community supportive of women, the LGBTQ community, and people of color in her area in Lansing, Michigan over the course of 40 years.

At her new home in Ohio, Francis is building that support system up again. 

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"We had a lot of hope also because of the welcoming nature of this community," Francis said. "We have an LGBTQ group here and we've grown that, we've worked together to make that happen right here in the community."

Although Francis feels safe in her assisted living facility, she doesn't feel as comfortable in the wider community beyond its borders, especially as legislation was proposed in Ohio that would let parents opt out of "sexuality content" in school and prevent doctors from providing gender-affirming care this year.

"We've had a lot of pride activities and we made a point of being out in the community and out supporting pride events," Francis said. "Do we feel safe? I would say no, you don't feel safe. … I've grown up in very unsafe places. We don't forget how unsafe it can be and is."

A host of factors make the need for inclusive housing for LGBTQ individuals more pressing. The LGBTQ community is twice as likely to be single and live alone than other communities. This population also has higher rates of certain chronic health conditions and is less likely to access preventative health services. 

"When we think about this population getting to an age when they may need assistance in the home or perhaps they need to move into a more supportive environment, they're bringing with them these generational experiences of health systems and government systems not seeing them," Stewart said. "And if they do, it's a danger to them — being fired or being denied service — and that's the reality we see today, unfortunately."

Being in the closet — or not being able to be one's true self — can be a source of toxic stress and exacerbate existing illness in itself, said Sherrill Wayland, the director of National Education Initiatives, including the National Resource Center on LGBT Aging, at Sage. On the other hand, older adults have been shown to be resilient, with more social connectedness tied to a better quality of life.

"During a time in life when we may be having to leave our homes and move to our new home where we don't know our neighbors, where we're more dependent on others for support if we are not able to be our true self, that can cause depression, anxiety and a whole host of potential mental health and other health-related conditions," Wayland told Salon in a phone interview. "It's really important for people to feel safe and comfortable when they're having to go into long-term care communities."

To implement inclusive policies in assisted living facilities, Wayland and Stewart lead the Long-Term Care Equality Index, a program that trains a network of long-term care communities across the country.

"It's going beyond raising a rainbow flag or changing your logo during Pride month," Wayland said. "It's actually living that commitment to LGBTQ equity."

Although it's not a comprehensive list of LGBTQ-accepting assisted living facilities, 200 communities across 34 states, including Francis' community in Ohio, have formalized inclusive policies since 2015. Other LGBTQ-specific assisted living facilities, like the Stonewall House in New York, are popping up across the country. Still, just 18% of long-term care communities across the country have policies to protect residents based on their sexual orientation and gender identity.

"When we talk about LGBTQ inclusion, it's not just the fact that someone can come in and see, 'Oh, I'm represented,'" Stewart said. "It really is a matter of taking a deep breath and sighing, like, 'Okay, I am safe.' That's something we all need and deserve, especially if we are needing to access services when we are very sick or we need long-term support like in a skilled nursing community."