Addressing the Needs of LGBT Older Adults in San Francisco: Recommendations for the Future

Introduction In 2012 the San Francisco Board of Supervisors established a time limited LGBT Aging Policy Task Force to explore the health and wellness issues facing San Francisco’s LGBT older adults and to provide the Board with actionable policy and program recommendations by the end of 2013. The Task Force commissioned this community survey after a review of available City data on San Francisco’s lesbian, gay, bisexual, and transgender (LGBT) older adults revealed little information on LGBT older adults in general and for LGBT seniors of color in particular.

Outreach efforts for this survey focused on previously underrepresented groups (including racial and ethnic communities, bisexuals, transgender adults, non-English speakers, and those living in SRO’s or experiencing homelessness).

This report is a follow-up of LGBT Older Adults in San Francisco: Health, Risks, and Resilience - Findings from Caring and Aging with Pride, which was released in January, 2013, and provided an initial snapshot of 295 LGBT older adults living in San Francisco who participated in the national research project, Caring and Aging with Pride.

Understanding the needs of older LGBT adults is critical in light of the aging and increasingly diverse population. Projections based on the 2010 census suggest that the one in five in San Francisco will be 65 or older by 2060, nearly doubling from the current 109,517, to 177,963 (U.S. Census Bureau, 2013a). San Francisco is undergoing a dramatic racial, ethnic, and aging demographic shift; 40% of older adults in San Francisco were non-Hispanic white in 2010 while only 26% will be non-Hispanic white in 2060.

LGBT adults are also part of this increasing diversity; their numbers are projected to double to 3 million nationally by 2050 (Auldridge & Espinoza, 2013). Indeed, population-based research suggests that there are likely 18,000 to 20,000 LGBT adults aged 60-years old or older living in San Francisco, based on estimates that among City residents aged 60 and older, 11.1% to 12.4% identify as LGBT (Jensen, 2012).

Despite this increasing diversity, a great deal is still unknown about the health and aging needs of LGBT older adults (Institute of Medicine, 2011), which is a serious shortcoming in health disparities research (Centers for Disease Control and Prevention, 2011a). Accumulating research leaves little doubt – LGBT older adults experience significant health disparities (Fredriksen-Goldsen, Cook-Daniels, et al., 2013; Fredriksen-Goldsen, Kim, Barkan, Muraco, & Hoy-Ellis, 2013; Valanis et al., 2000; Wallace, Cochran, Durazo, & Ford, 2011). Health disparities are differences in population health that result from social, economic, and environmental marginalization (U.S. Department of Health and Human Services, 2010).

Although population-based research on LGBT older adults is limited, important findings are emerging.

A recent study by Fredriksen-Goldsen, Kim, and colleagues (2013) compared lesbian, gay, and bisexual (LGB) adults aged 50 and older to their heterosexual peers. LGB older adults had higher rates of disability and frequent mental distress. They were also less likely to be partnered or married. Legal marriage is no panacea for the challenges that face sexual minorities, but there is evidence that it provides health and mental health benefits (Buffie, 2011; Center for American Progress, 2012; Gay and Lesbian Medical Association, 2008; Herdt & Kertzner, 2006; Herek, 2006, 2007; Rendall, Weden, Favreault, & Waldron, 2011). Although some of this "benefit" is undoubtedly economic in nature, accruing from the more than 1,100 rights, benefits, and privileges extended through federally-recognized marriage (General Accounting Office & Office of the General Counsel, 1997), there is also strong evidence in support of the social and 7