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#ActivitiesStrong 18

Join Robert Espinoza, Executive Vice President of Policy at PHI and Rev. Beth Long-Higgins, VP of Engagement and Director of the Ruth Frost Parker Center for Abundant Aging at United Church Homes for a discussion aimed to reflect, address, and attract diverse population preferences in senior living communities.

As many LGBTQ+ older adults have lived a lifetime of challenges and discrimination, which often persist as they enter the long-term care system, there are great opportunities for senior living leaders to consider unmet expectations from these individuals. Providers are increasingly tapping into these unmet demands by addressing barriers to promote equitable, person-centered resident engagement. Learn how your community can create safe and inclusive environments for LGBTQ+ individuals that draw on their wisdom, allow them to participate in the community, and receive the support they need as they age to finally build true person-centered care.



Today’s webinar is about building real communities with engagement from LGBTQ plus older adults. And we are really excited to have both Robert Espinoza and Rev. Beth Long Higgins as our featured speakers. As I said earlier, my name is Meaghan McMahon and I am the director of strategic development here at Link Senior. And I am very proud to be the co-producer of the Activities Strong virtual event series alongside Charles deVilmorin CEO and co-founder of Linked Senior. As many of you know, our team believes in a world where people of all ages are respected and valued, and that is why we started our old people are cool initiative back in 2017 at the same time. We also believe that activity and life enrichment professionals are incredible and that you are the industry’s unsung heroes, which is why we created the Activities Strong initiative two years ago, to acknowledge, educate, and empower each of you.


And we are also very excited to be working with so many forward-thinking communities across the United States and Canada, and look forward to welcoming more communities on board in the weeks and months ahead. And every day we are working to enhance life in senior living communities by building simple and evidence-based solutions to bring person-centered care experiences to older adults and their care partners. Our technology focuses on engagement, connection, and celebration of individuality. In 2018, we did partner with the responsive group in Toronto and Western Oregon University to research our impact on resident engagement with funding from the center for aging and brain health innovation and results from this study showed that our technology increased cognitive functioning and social engagement for residents and decreased aggression in antipsychotic medication use. So, as I mentioned here is the agenda for today. I just want to remind you to type any questions you have for our speakers today into the Q and a section of the webinar room.


And if you want to engage in the chat section today, please just remember to select ‘everyone’ so that we can all see your messages. And a quick reminder, these are the objectives for today’s webinar. So this is what you will take away from the webinar after the presentation from our speakers today. And it is now my pleasure to introduce first Robert Espinoza, Executive Vice President of Policy at PHI, and Reverend Beth Long Higgins, vice president of engagement and director at the Ruth Frost Parker center for abundant aging at United church homes. So with that, I’m going to stop sharing my screen and hand it over to Robert.

Robert Espinoza

Thank you, Megan and good afternoon or good morning everyone. It’s good to see a really healthy and sizeable audience on today’s webinar. It’s exciting to see that, especially during pride month. I am going to take just a quick minute to share my screen. So bear with me while I do that. Again my name is Robert Espinoza and I’m the Executive Vice President of policy at PHI. For those of you who are not familiar with PHI, we are a national organization. That’s focused on strengthening the direct care workforce and by direct care workers, I mean home care workers and nursing assistants who support older adults and people with disabilities in a vast range of long-term care settings. I’m also on the faculty of Linked Senior. And a lot of my knowledge on LGBT aging actually comes from a prior position to PHI, which was the Senior Director of Public Policy and Communications at Sage, which is a national organization.

Robert Espinoza 14:19


That’s focused on improving the lives of LGBTQ plus older adults. And I ran their advocacy and their public education work. So I’m really excited for today’s webinar and for the ability to share some knowledge and some ideas about what it means to really engage a growing and diverse population of LGBTQ plus older adults. I’m going to start by just sharing the agenda for our hour together. I’m going to share just a few key terms, some definitions as level setting for today’s conversation. I will then share a variety of ideas or statistics that describe the realities of LGBTQ plus older adults. Again, one of the objectives is really to better understand who is this population and what are some of the challenges and opportunities that are facing this demographic. Beth will be sharing a historical timeline to give you a sense of what an older adult who’s LGBT today might have lived through over the decades and how that has affected who they are today.

Robert Espinoza 05:31

As well as some provider interventions, and she and I will both going to share that part of the presentation. And then we’ll open it up to a Q and A, we really want to hear people’s questions and their ideas as well. So with that started, let me just describe a few key terms. By LGBTQ, we mean a few different identities that are captured in that term. LGBTQ plus means lesbian, gay, bisexual, transgender, queer and others. That’s the plus. And the plus can sometimes include categories like pansexual, gender, asexual, and so much more. It really speaks, I think, to the evolution of our movement and our populations that we’re working with. I remember I came out of the closet in 1997 and the first thing I did was go to a Barnes and Noble, in Boulder, Colorado. And at the time there was a gay and lesbian section, and that was, you know, 1997, twenty-some years ago.

Robert Espinoza 06:34

That tells us how much, I think we’ve come to an understanding that we are talking about a much more diverse population of sexual orientations and gender identities. And that’s part of the reality, I think, of meaningfully engaging this population in our settings. The second term is older adults and we mean older adults to mean a variety of definitions. I think sometimes the definition can mean people aged 15 and older depending on whether it’s a policy, or a living environment or just a way of describing older adults in rapport. I mean, we’re talking about an older population and in that sense and the data that I’ll be sharing today, I’m specifically referencing older adults that are age 50 and older. This is in contrast to terms like seniors or other terms that sometimes don’t resonate as much, I think, with older adults.

Robert Espinoza 07:27

But of course that is a debate, I think in terms of terminology and then long term care or long term services and supports is about the range of settings in which older adults and people with disabilities receive a variety of supports and services. And this can happen in the home and in the community or HCBS, it can happen in a vast range of residential care settings, like assisted living, and it can happen in nursing homes. And I think I think today is really focused in the residential care settings. But many of us know that older adults and LGBTQ older adults are of course delivering in a variety of settings based on choice and based on need. So I want to share just a few different ideas that hopefully together will really paint a good picture of who LGBTQ plus people are, older adults are.

Robert Espinoza 08:22

And some of the challenges that they continue to face in various aspects of life. I want to share with a start with the statistic that shows that there are at least 2.4 million LGBTQ plus adults aged, this should say 50 and older in the United States. And what’s important here are a few things. I use the word at least because unfortunately, LGBTQ people are not counted in the US census. So we don’t really have a reliable national estimate on the number of LGBTQ people. What we often do in this field is we rely on independent studies or some kinds of modeling and other methods to arrive at estimates, usually based on the percentage of people who identify as LGBTQ plus and different research studies, for example, to then estimate how many might there be nationally. And this is a statistic that’s quoted in a few different resources including a report from the Williams Institute, which is a think tank based at UCLA that has done quite a bit of research on LGBTQ people.

Robert Espinoza 09:29

What’s important here is that as with the rest of the population, this is a demographic that will more than double by 2030. And so it is a sizeable workforce, this is sizable population, that’s existing in our society, and that’s becoming increasingly more common in long-term care settings. We often say, and Beth and I were speaking about this in preparation for the webinar that we should just assume that there is at least one LGBTQ plus person in any setting in which we live or work. And often more than that. If we don’t know that there’s a person it might have to do with the fact that they simply haven’t shared that information for whatever reason, but this is I think a level setting point in terms of the size of this population. The second point that I want to make is that LGBTQ older adults and much of the research show that they face high rates of poverty and economic insecurity.

Robert Espinoza 10:26

And I think Beth is going to show us several timeline moments that describe why that’s the case, but just to share a few statistics. One study shows that one in three LGBTQ, older adult 65 and older is at, or below the federal poverty line. And that’s compared to one in four in the general population. So 33% versus 25%, that’s a sizable disparity. When you look at LGBTQ older adults that are age 80 and older, which is the oldest of the population, that’s percentage goes up to 40% of people. And I think anybody who studied poverty or dealt with poverty in older adult populations know that it’s often those olderthe oldest of older populations that often face kind of the highest rates of challenges including poverty. And so it’s something to, I think, make sure that we bring into the conversation that older adults is not a monolith, that there are generational differences and LGBTQ plus is not a monolith.

Robert Espinoza 11:30

There are differences based on race and gender and gender identity and so much more. It’s also important to note that part of the reason that we see these high rates of poverty and economic insecurity among LGBTQ older adults, is that they faced a lifetime of discrimination and inequities in areas such as earnings, employments, and a chance to build savings. In fact, before 2015, which is when marriage equality became national law or federal law, same-sex couples were denied the same benefits under programs like social security and Medicaid, for example, the spousal impoverishment protections, for example, that further impoverished same sex, older couples. And of course in all of this research, what you often find is that it’s transgender people, people of color and people with disabilities among other groups who face the worst economic outcomes. So again, this is not a monolith and there are disparities even within disparities.

Robert Espinoza 12:34

If you are living a life in poverty, you’re also more likely to rely on public assistance and supports, not just from the public safety net, but also from aging services providers. Many people know this, but public assistance programs differ by state in terms of the funding level and the eligibility requirements. Some states can be generous. Some states cannot be generous and they’re often under constant attack at the political level. And yet for poor people, especially poor low income people who are LGBTQ plus, like those programs are essential to determining whether they can make it through the day. And I used to work at Sage where we ran a senior center that provided a lot of senior supports and aging services for older adults. And what we saw is that a lot of people relied on those aging services like meals as one example not just for food and nutrition, but sometimes for socialization and communities.

Robert Espinoza 13:32

So there’s something about kind of a disproportionate reliance on these programs that is relevant for us to consider. Because of all of this, of course, LGBTQ older adults have serious fears about their retirement security. Retirement is expensive for anyone. And I think when you look at the broader research, what you see is that most people actually have not saved enough if at all, for their retirement. But if you faced a lifetime of discrimination in earnings and employment, in savings, and you continue to face discrimination with legal and social programs that are meant to support you in terms of retirement planning, you’re not going to have much of a safety net when you reach retirement age. In fact, you may not even be able to retire. And many older adults often are working way past their retirement age just to survive or to help their loved ones.

Robert Espinoza 14:29

The research has also shown that LGBTQ plus older adults, they’re more likely to live alone and they’re less likely to have significant others or children. What this means is that in so many instances around the country, it’s often family caregivers who provide that kind of unpaid support to people who need care at any point in their lives. And yet if that biological family caregiving unit is not there and it’s assumed that it’s there, but it’s not there for LGBTQ plus older adults, it means that they might be more likely to be isolated and lonely. And I’ll talk about that in a second. And they made it more likely to go without the support that they need. It also means that many LGBTQ older adults often rely on families of choice or kinship networks and friends and community members to offer this care.

Robert Espinoza 15:22

And yet, so much of public policy is family first and is often written to support biological family members like spouses or siblings and not those families of choice. And so that’s another way in which LGBTQ older adults might be left out of the public safety net and the long-term care system so to speak. All of this, the discrimination, the isolation, the challenges in daily life and the political life ultimately impacts people’s health. Oftentimes we see that many LGBTQ people at any age will avoid or delay healthcare because they fear discrimination in those settings from doctors, from nurses and others in hospitals. They often conceal their sexual orientation and, or their gender identity status which can of course affect the type and the quality of care that they receive in both health and social settings.

Robert Espinoza 16:22

What I’m talking, what it means is that this leads to health disparities related to physical and mental health. It leads off into higher disability rates at a younger age and to a higher rates of chronic diseases, such as the ones that are listed on this slide, like diabetes, asthma, heart disease, HIV cancer, and so much more. As I mentioned earlier a lot of this research also shows that these disparities are even worse for transgender and gender non-Binary older adults. And they’re worse for people living with and aging with HIV. Also there’s research that shows that there’s a higher risk for health behaviors that may lead to poor health outcomes among LGBTQ people, including smoking and excessive alcohol abuses, just two examples. What we see often is that many LGBTQ older adults are entering long term care settings, whether it’s an assisted living setting a nursing home or a home, or within their private home, somebody’s entering their private homes prematurely because they don’t have that family caregiving support or they have, higher rates of health, chronic health conditions and disability rates.

Robert Espinoza 17:40

But that they’re also experiencing high rates or risk of social isolation and loneliness. A few years ago, I had the privilege of advising a report that came out from the national academy of sciences, engineering and medicine on social isolation and loneliness among older adults. And what was telling in that report is that too often, isolation and loneliness are treated as social concerns when in fact they should be treated as medical concerns, because if they go untreated at any age they can be deadly. And the report found that across the spectrum, but of course it focused on older adults and it showed that LGBTQ older adults were also at greater risk because of notions like discrimination, because of a different family support context, because they’re more likely to live alone, because of higher health conditions and so much more. And because the long-term care settings that are meant to support them and provide socialization sometimes are simply unwelcoming at best and discriminatory at worse.

Robert Espinoza 18:43

We also see that they face discrimination in a few different arenas. They face discrimination in housing again in long-term care and under the law, and I’ll talk about that a little bit more in a second, what we know is that from many studies, LGBTQ plus older adults report high rates of physical and verbal abuse. And that can have an incredible effect on a person’s mental health, which can then affect their physical health. We also know that discrimination can be implicit and difficult to pinpoint and address, and it can be explicit. Although if the state or locality doesn’t have non-discrimination protection, that’s also difficult to protect. A few years ago when I was at Sage, I remember we worked with a research team that was studying LGB older adults who were searching retirement housing.

Robert Espinoza 19:34

And what they found is that LGB older adults were being shown fewer housing options and were being offered higher pricing than their peers, they’re essentially heterosexual peers searching for the same housing. So they are facing discrimination even as they search for housing, not to mention in other aspects of our lives. And of course, housing it should be said, is a crisis for everyone across ages. And for all older adults, it’s incredibly expensive to afford rent and mortgages. And there’s lots of ways in which discrimination and inequities show up in that system. We also know that many LGBTQ older adults reside in parts of the country without adequate anti-discrimination protections. There is no federal protection that would provide full protection based on sexual orientation or gender non-gender discriminate, gender identity. This is why so many people advocate for the Equality Act, which would provide exactly that.

Robert Espinoza 20:34

And without that, what we know is that there are 29 states that do not have full non-discrimination protections for LGBTQ plus people. This is also a country that is becoming increasingly hostile to LGBTQ people. In 2021, one researcher showed that nearly 400 anti LGBTQ bills were introduced in states and localities around the country. And already in 2022, about 300 bills have been introduced. And many of them are specifically targeting transgender people. But of course the breadth and how they’re written have impacts on the full community. The final point I’ll make before I hand over to Beth is that the federal government as a whole has historically underfunded aging services that are specific to older LGBTQ older adults. And what we know, and I think many of you can attest to this is that the largest funding vehicle in this country for aging services is the Older Americans Act.

Robert Espinoza 21:43

And that’s often based on vulnerable populations and populations of what are called greatest social need. And for years LGBTQ people were not considered a population of greatest social need, even despite what I just mentioned. This was corrected thankfully a few years ago, thanks to the advocacy of many organizations. But it still means that the aging network nationally, those state units on aging, those area agencies on aging, and so much more, one are underfunded in general. And I think people can attest to that, but there’re specifically underfunded when it comes to offering targeted supports for LGBTQ people. Supports that might help them deal with discrimination claims, or maybe friendly visitors if they don’t have family supports, or all those kinds of offerings that those aging network entities offer. So without that funding, I think it becomes difficult for many other types of providers, like people on the phone today to really offer the kind of wraparound support that their residents need and that they often deserve to really promote engagement. With that, I’m going to hand it over to my colleague Beth.

Rev. Beth Long Higgins 22:57

Hi, I’m Beth Long Higgins, as you were told earlier today. And I am joining you from central Ohio. I work for United church homes and we have over 80 communities in 15 states. But our headquarters, our corporate offices are here in the middle of the state of Ohio, which is one of those states that lacks the protections, some of the protections that Robert was talking about. Our organization for 10 years now has been committed to doing what we need to do to learn and grow along the way. To be sure that we are serving the LGBTQ community in the best way possible. Because we know in all 88 counties in Ohio there are LGBT older individuals presiding in those counties and they are aging just as are the rest of us.

Rev. Beth Long Higgins 23:52

So I am an ally and it is privileged to advocate and to help be with you today. And I do so in honor of my great-aunt Gertz and her partner, Annie Doris. So my introduction to the LGBTQ community before I even knew what that community was, was through these two women who were in their late sixties. So we, yes, we need to treat everyone equally, but it’s also extremely important for all of us to understand a bit of the historical context, which our residents and older adults today have lived because that’s going to help give some context to some of the pieces that Robert was talking about a little bit earlier. So just keep in mind an 85-year-old resident that you may work with, and I’m going to do the timeline based on their lifetime.

Rev. Beth Long Higgins 24:51

So they would’ve been born in 1937 from birth to about junior high. Would’ve been during world war II and there there’s some common themes in here. It’s important for us to be aware of what was happening in the military as well as, as legally and, and in the social context. So when they were younger the military prohibited gays and lesbians from serving, and if you were already serving and it was discovered that you were gay or lesbian, you would’ve been committed to a military hospital. There were often targets of violence and homosexuality was considered to be a violent crime and was put into the same category as rape and child molestation. So think about those individuals that, you know, perhaps hopefully, you know, who are LGBTQ, who have shared their own life story. In my, from my experience, most individuals knew that from a very young age.

Rev. Beth Long Higgins 25:50

So as they were coming into their own self-awareness of, of who they were attracted to, or understanding their own gender, the cultural cues were telling them that the, what they thought they were experiencing or feeling would have been considered a crime. Also during WWII, LGBT individuals were put into concentration camps between 10 and 15,000 of them were killed. And this is actually where the pink triangle comes from. The sign comes from the Memorial and Matt house on concentration camp. And it says struck dead hushed up the homosexual victims of Nazi-ism. So there were not many positive messages about being LGBT. Patriotism was denied. They were victims and they were considered criminals by the larger context. So over the next decade from 1950 to 1960, when these individuals would’ve been in college or possibly themselves entering military service, this is what was happening in the larger context.

Rev. Beth Long Higgins 26:58

President Eisenhower called for the dismissal of all LGBT individuals from government surface. And that was in place until Don’t Ask Don’t Tell in 1993 almost 40 years of military service. The American Psychiatric Association considered homosexuality is a psychological disorder. And, but they also knew and perhaps had heard that Christine Jorgenson became the first widely publicized person to undergo sex reassignment surgery in Europe andcame back to the us. She ended up being somewhat of a celebrity. And that was not at all very comfortable for her, but it did perhaps lay some seeds of possibilities or at least curiosity to individuals. So they could have lost their jobs. They were considered to be mentally ill, and there were very few rays of hope. So in the next decade, from 1960 to 1970, our 85 year old individual, would’ve been between the ages of 23 and 33.

Rev. Beth Long Higgins:

Robert go ahead and advance the slide there. And this is the decade of the Stonewall Stonewall riots, the three days of rioting in New York City. And this is really when the gay civil rights movement begins. That was in New York City on the west coast, the bay activist Alliance formed to secure the basic human rights and freedom for all for all gay people. So that was happening on both coasts. What’s really interesting is this is the period of time that the National Organization for Women Now was being formed. And they intentionally sought to exclude lesbians because they didn’t want the stigma related to what it meant to be a lesbian, to be associated for all women. And so even as equal rights within the movement, the were, were civil rights were being championed. Other organizations that were also seeking civil rights were excluding members of this community.

Rev. Beth Long Higgins 29:08

Internationally, there’s an illustration thereof Castro as well. So you have both the civil rights movement, which was beginning, LGBT civil rights movement was beginning. They were being excluded from other parts of society and they still were considered to be criminals. 


So from 1970 to 1980 in the next decade, when our 85-year-old would’ve been between 33 and 43 years old the first gay pride marches happened on the anniversary of the Stonewall Riots. And those the first gay pride was not at all what we see even in small towns around America today. But it was this need to be publicly. And to say this is who we are. The US Supreme court refused to hear a case of a teacher who was fired for lesbian during this decade, making it a legal reason to fire teachers. And my great auntie Gert and Aunt Doris, both were teachers.

Rev. Beth Long Higgins 30:10

And I have a better understanding of how they had to keep quiet who they, their authenticity of who they were for fear of losing their jobs. The picture that you have there is of a teacher in Cincinnati. This legal reason continues to be used against teachers today. I think she’s officially been fired in Cincinnati, Ohio because she was outed as a lesbian woman. 80% of Oregon doctors report refusal to treat a known homosexual during this decade during a survey that was taken. So if we want to consider why older adults today may have some advanced medical issues why they may be reluctant to seek medical care or enter into anything at all related to the healthcare community, consider the fact that throughout their lifetime they have not even perhaps been able to be open and honest with doctors, their medical professionals.


Rev. Beth Long Higgins 31:15

The good note is that the American Psychiatric Association determined that homosexuality was not a psychiatric disorder, but it was still considered to be a mental disorder. So they have a lack of legal protections. They’re rejected by medical institutions and personnel. And even though it’s not a psychiatric disorder, it’s still a mental disorder and still not accepted. In the next decade when up to when our current 85 year old, would’ve been up to 53 from 80 to 90, finally in 1987 at the end of that decade is when the American Psychiatric Association removed homosexuality from the list of mental disorders and recognized that sexual orientation and expression occur naturally, and it’s not necessarily, it’s not a free world choice at all. So it’s also at the decade when the first aids cases are reported. And we’ll get more into that a little bit here in the next decade. But it’s also Martina Ava’s female lover publicly sits in her box at Wilmington and the French open.


Rev. Beth Long Higgins 32:25

So the good news is it’s beginning to be recognized by some psychiatrists that we’re not talking about a Freewill choice. It’s also a decade when we begin this epidemic, which at the time meant almost certain death. And there is a growing public awareness for good and for ill. Not everyone appreciated Martinez’ lover being in that box, but she was taking the courage and more people were taking the courage to be more public. So in the next decade up until the turn of the century, our residents would’ve been 53 to 63 years old. The good news is that there’s hope for living with HIV before it advances to aids. Congress. However, passes the act bidding, federal recognition of state-approved, same sex marriages. In 93, we come back to the fact that Don’t Ask, Don’t tell.

Rev. Beth Long Higgins 33:25

So if you’re gay or lesbian and you’re in the military, you were automatically put into a military hospital or not allowed to serve in the military, but if, if you just don’t let people know it’s okay. And in 1998, many of us remember Matthew Shepherd being killed in the brutal attack in Laramie Wyoming, which was a very public, and fortunately it got a lot of coverage helping to bring to awareness that individuals who are out, people know about their sexual orientation and gender identity are often victim or can be victim to physical harm and to even death. And another illustration is Brandon Tina, a transgender man who is raped and killed when his birth gender is revealed by police to his male friends. The turn of the century then up until the time when our 85 year old resident, about 73 years old during this decade, Vermont is the first state to offer same sex couples civil unions and the same rights as heterosexual couple. In the United Kingdom allows transgender people to change their gender on their birth certificates.

Rev. Beth Long Higgins 34:44

This is, this is a very significant act. And in the United States some states allow this and some states still do not allow this. And in Iran again, this is a global issue, and in Iran two gay gay male teenagers are executed by the government because it was found out that they were being gay. So twinges of hope but still very easily fall victim to, to violence and to death. So in 2010 to 2020 in the last 10 years, finally in 2011, we have the repeal of don’t ask don’t tell which allows LGB members ro military service while being open about their sexual identity. Trans individuals that still continues to be a little bit trickier. And the military aren’t completely accepted. In 2013 we have the fact that spouse and family benefits in military were extended to same-sex partners.

Rev. Beth Long Higgins 35:47

In 2016, there is the ban on transgender military service. And in 2021 trans individuals can enlist and serve. So there’s this back and forth, and it’s not that the LGBTQ community all gets the same thing at the same time. And kind of back and forth and little bits here and there. And finally, 2015, this is wrong here, Robert marriage equality is passed by the Supreme court. In the past two years of this decade in Ohio. Unfortunately Ohio law now allows doctors or medical personnel to deny treatment based on moral grounds. And this is specifically targeted for individuals who don’t want to treat LGBTQ individuals. In 2022 this year, Florida’s, Don’t Say Gay bill restricts the education of LGBTQ topics with children. And we can talk about many other states, Missouri Texas, you know the states that you live in. Under the Biden administration.

Rev. Beth Long Higgins 36:56

Some things to note are that there are new actions to support the mental health of transgender children. But as we also know, these are actively state by state being challenged. The Biden administration has sought to remove barriers that transgender people face assessing critical government services and has tried to improve the visibility of transgender people in our nationals nation’s data. If we don’t count the individuals, it doesn’t matter that then the data can be used to say then that they don’t exist. And it is really important in our sense census data and in even in the data that we take within our communities to figure out how it is that we’re collecting data, to be able to show that LGBTQ individuals are intermixws and to then be able to monitor and understand how to better serve their needs and what they’re experiencing.

Rev. Beth Long Higgins 37:52

So Robert and I got to first met because we both serve on the advisory committee that has been pulled together by the human rights campaign foundation, Sage Robert’s former employer in developing the long term care quality index. So for those who are unaware that HRC, the human rights campaign foundation has a series of indices in which organizations can take a survey, answer questions, and then based on the results of their questions they, they receive information or, certification about how LGBT welcoming inclusive supportive they are. So there’s a healthcare equality index. So if you want to know what hospital in your community might not discriminate against you, but might actually have policy in place to protect you. You can check out the healthcare equality index. There’s one for corporations and, other groups. This is the first time that we’ve taken a look to put together a long-term care equality index called the LEI. Robert, I’ll let you do the next slide here and talk a little bit more about the LEI.

Robert Espinoza 39:09

Thank you, Beth. So absolutely. So the Lei is really an opportunity to for Sage and the human rights campaign to work closely with residential care settings to take a closer look at the ways in which their policies, their protocols, their practices are LGBTQ welcoming. And I think it’s developed a range of criteria it’s developed a set of tools to really help employers in those settings assess that. And then of course provide that information to the human rights campaign and Sage, so that they can compile that information in a way that gives us a better national picture of the extent to which residential care environments are supporting LGBTQ older adults. It’s actually based on an index that human rights campaign developed years ago called the corporate quality index, where they worked with an incentivized corporations like Walmarts and many, many others to become more LGBTQ friendly through a wide range of practices and policies and grant-making even. So I think that there is a way in which I think this is a nice way to offer the framework to make it optional. And then to work really closely with employers and providers to understand what does it take to create a welcoming environment for LGBTQ older adults?

Rev. Beth Long Higgins 40:39

So a part of the LEI questions have to do with education. And I mentioned 10 years ago, United Church Homes declared itself to be open and affirming and aligned with the denomination. The United Church of Christ with which we are affiliated. And immediately we brought in folks from Sage because they are national organization to help do training from the board on down to our professional carecare providers. But that was in 2012. And by 2015, I had come on staff and realized that we hadn’t done anything since then we know that their staff turnover, and then we needed to provide a way for there to be ongoing training for staff. And so we were able to be one of the first organizations, the fourth multisite organization to be exact, to participate in Sage care. And this is the web-based or in person or web-based training credentials through Sage.

Rev. Beth Long Higgins 41:42

And you get a level based on the percentage of your employees who have completed the training. We try to do this every year, I believe last year because of the pandemic, we were unable to do that, but are picking that up again this year. And it’s not only for our organization as a multi-site, but all of our communities, particularly where we have healthcare participate in the Sage care training. We also do affordable housing and even our managers and service coordinators participate. There is a session specifically for housing individuals with Sage care. There are other organizations more locally in your communities could, which could provide the education for the Lei. You don’t have to do Sage care but I’m not paid by, by Sage. This is not a commercial that they endorse. But as a provider who uses Sage care, I can’t tell you how invaluable this has been.

Rev. Beth Long Higgins 42:39

When you have staff then who are attuned to the language that needs to be used, to the sensitivities that need to be provided. I have to say that our level of care for our residents who are LGBTQ have increased significantly. The other piece to add about this is since we’ve begun this process, have not taken in significant numbers of older LGBT individuals as residents, but here’s, what’s going to get your HR directors, the number of LGBTQ staff who have joined our communities is significant. and we actually are in the process of collecting the data so we can share just exactly what that has meant for us. And it’s not just individuals who identify as being LGBTQ, but it’s individuals who want to work in an environment that is inclusive to this community, who also have found us as an employer work for us. So education is a significant piece of the LEI and together Sage as an organization, advocacy, service and services for LGBTQ older adults and the, the national resource center on LGBTQ plus aging are have some resources available for you and, and the website is there. If you’d like more information to, to help in your own education process or to  share with others in your community. And Robert, I know you’ve had a lot more experience with the National Resource Center also.

Robert Espinoza 44:13

I have. And so I would just add to Beth’s point that the national resource center on LGBTQ plus aging actually was established in 2010 with a federal grant from the US Department of Health and Human services. And many of you probably know this, but the federal government has a long history of establishing national resource centers on critical topics like Alzheimer’s and dementia. LGBT aging is another one. There are many, I think there are nearly 30 resource centers. And what they typically do is they offer training to specific audiences. They offer technical assistance on questions related to that topic, and they produce educational resources for at least through the national resource center on LGBT aging for LGBT organizations, for long-term care providers and also resources for older adults themselves. And so I would highly encourage people to visit the website because there’s a pretty robust online library of multi-med resources on LGBT aging that are aimed at those three sets of audiences that I just described, and it continues to evolve and become, I think, even more preeminent in the field.

Robert Espinoza 45:41

I think that the presentation piece and then I think open to question and, and I’m sharing so we can each other.

Meaghan 25:56

Beth excellent. Beth, Robert, thank you so much. And the questions are pouring in. So I’m going to jump, jump in here and start with, from Michelle. Are there organized programs to bring youth and older adults in the LGBTQ plus community together, like mentor support multi-generationally?

Rev. Beth Long Higgins 46:07

I don’t know of any specifically on a national basis. I do know of one program through Sage, which is called Sage Table, and I don’t know if they’ve been doing this during the pandemic or not. Originally they kind of targeted a week where they encouraged folks to invite, to come together around tables to have conversations. But that would be a wonderful way to do intergenerational contact as well. And I do believe strongly that helping older adults to be mentors for younger individuals would be extremely valuable for both individuals and in both generations. I don’t know Robert, if you’re aware of.

Robert Espinoza 46:50

Yes, I was going to say Sage Table as well. The one point that I would add is that we often think of intergenerational as the two ends of the age spectrum, the older adults and the younger people. But in fact, what people often find is that there’s a lot of opportunities for intergenerational work where the generations are actually much closer in age. So people in their sixties with people in their forties might make more sense. Or people in their fifties with people in their late twenties, for example. And oftentimes those programs are more at the local level. So definitely connecting with LGBT community centers or other kinds of organizations. Yep.

Meaghan 47:30

Excellent. Thank you so much. And the next question we have here is does the LEI apply for Canada, or would you by chance know of similar work being done in Canada?

Robert Espinoza 47:40

It does not apply to Canada. I think right now the focus is on us. It’s potentially, I mean, I think that would be a good question for the two host organizations, to what extent do they want it to go globally? I personally have contacts in Canada, but I don’t know of a similar project like that in Canada, but that could be just my lack of awareness. So maybe we can share some resources after the, the webinar.


So from Ann, many residents are learning that they have an LGBTQ plus grandchild. Is there an education resource you can recommend to help them learn more and how to support their grandchild?

Rev. Beth Long Higgins 48:18

Absolutely. And that is one of the things that we’ve seen. I kind of call it the outing of the parents and the grandparents in our communities because they know that our communities are openthey feel freer to talk about all of their children and all of their grandchildren. And we’ve had several poignant stories of residents coming to our staff to say, “I saw that rainbow, what does that mean?” And they really know what it means, but that starts the question. And there was one particular woman who started the conversation that way with our chaplain. And then she said, “I have a grandchild who is transitioning. I don’t know what that means. Can you educate me? Because I want to make sure that I love my grandchild no matter what.” And so the chaplain then kind of led this resident through training to understand what it meant to be transgender and how to talk to their grandchild about it. And because of some of these stories that I’ve shared with folks at Sage, Sage and the national resource LGBTQ resource center has just published a book for grandparents about how to talk to our grand, your grandchildren and kind of does some of that basic information. I was trying to pull it up real quick and I was, I’m not able to and have a conversation here, but that’s another link I can get to you, Megan, that you can share with individuals.


Thank you, Beth. Absolutely. And we’ll throw up your contact information in a moment here. Once we wrap up the question, so people can email you directly just really quick Elizabeth would like to know she missed it. What does the Sage initials stand for? We can say that again.

Rev. Beth Long Higgins

It used to stand for something, but they don’t use that anymore. <Laugh> Robert. I don’t know if you know some more of the history..


Robert Espinoza 50:04

Yeah. So it has a long history. You know, it’s almost a, I think it’s from the early eighties, late seventies, actually late seventies. And I think it used to be, I actually don’t know if it stood for anything. I think Sage was understood as like the word that meant as you get older, you become wiser, et cetera. And it used to be called Services and Advocacy for GLBT elders. And then it evolved as terminology evolved, but I’m not sure it was ever an acronym. I could verify that, but, well, I’m sorry. It was an acronym. It was, yeah, it was, it was Services and Advocacy and then the GLBT elders. So yeah. Yeah, I misspoke.


Perfect. Thank you. Thank you both. We have another question from Michelle. So what do you think are the pros and cons on collecting sexual orientation information on new residents and staff occupancy or hire and what are best practices to collecting this kind of information?

Robert Espinoza 51:03:

Yeah maybe I’ll take that information. So national resource center does have resource guides on what it means to kind of ethically and appropriately collect sexual orientation, gender identity in clinical settings. And there are other GT groups that have done the same for hospitals and other settings. And they pretty much list out similar items of advice. It’s about protecting people’s privacy. It’s about using the right questions. It’s about making sure that you’re providing kind of a safe space where people can, can produce that information and assurances of how the data will be used. So I would really just go to one of those guys and it can offer a point, kind of a step by step approach. The pros and cons is a good question. I mean, the arguments that I think the public health field make is that when we collect information on sexual orientation and gender identity, similar to information on gender or race or immigration status and other stuff, it helps clinicians and other social professionals better understand the complex realities of their work, of kind of the clientele and potentially deliver better supports, right?


Robert Espinoza 52:17

So we understanding that somebody is LGBTQ plus, and having gone through this training, you might be more attuned to the kinds of barriers that you’ve facing and you’ve been facing your whole lives. It’s also a way to be able to report information on disparities. Is our health is our health and for resources being equally accessed by everyone in the community, or any other kind of outcome data, if you’re trying to better understand a health intervention at that level. The cons or some concerns that need to be kept in mind, is that if it’s not done properly, it could inadvertently out people. And if there aren’t precautions to keep the persons safe, if that information gets revealed. Let’s say it’s asked in a public space and somebody else finds out and outs them and some member of the community, et cetera, like that could be damaging in other ways, right. So, but the best practice guide speak to those concerns. Yeah.

Rev. Beth Long Higgins 53:14

Yeah. And I just want to for mention that for organizations that use the PELI, the personal preferences for everyday living instrument, that’s an evidence-based piece that that’s often used. Rabbi Erica Steelman has been working with the folks at Penn State who originally put together the PELI, and I’ve been privileged to be on the advisory committee for that process. We are in the process of going through that, that entire survey to make sure that it is worded in a way that would be inclusive of LGBTQ folks because the previous edition, the one that’s out there right now, isn’t quite as sensitive as it needs to be. So that is another resource that’s coming and they’re in the process of doing the research right now.

Meaghan 54:03

Excellent. I dropped the link to the PELI website there in the chat box for anyone that’s interested in learning more. And I think to wrap up the Q and A here, I would just be curious, Beth and Robert, if you could each share what gives you hope that we’re moving in the right direction when it comes to better serving or LGBTQ plus older adult residents in our communities?

Rev. Beth Long Higgins

What gives me hope is how engaged our employees are. They, know from the get go that if you cannot provide care to the community, as well as everyone else, this is not a place for you to work. And in having a workforce that is educated and attuned, we are providing better care and there are increasing number of safe places for folks to be there authentic selves through their entire lifespan.

Robert Espinoza 54:55:

Yeah, those are, are great reasons. I would add that. I remember when I was at Sage and we were first testing the training on LGBT cultural competence. What we found was that the benefits were not just for the LGBT older adult resident. They were for staff and frankly, they were for everyone because. When you made healthcare workers and others, more aware of how diverse and challenged a population is on sexual orientation and gender identity, it brought up questions about race and immigration status and economics and all of that. And so I do think that looking more closely at one population that is already diverse helps you better understand the full diversity of your entire clientele.

Meaghan 55:39

Thank you so much. So Robert and Beth, I just can’t think of a better way to continue celebrating pride month, year than with this webinar. And I’m sure you’ve seen in the chat, people are just thrilled with what they’ve learned today in your presentation, and it’s information that we can use, not just during pride month, but during every day in our work and in our interactions with the LGBTQ plus older adults in our lives. So before I jump into the final announcements here, I just want to say one final. Thank you. And we appreciate your time today. And with that, I’ll just go ahead and share my screen.

Rev. Beth Long Higgins 56:14

Can I just interject one thing while you pulling up the screen? We didn’t mention this andd Robert will get in trouble if we don’t. The LEI is brand new and it will officially be opening for the very first time to  be able to take the surveys between August and November of this year. So if your organization would like to participate in the Long Term Care Quality index, I invite you to, to go LEI website to, to look up the LEI and take the survey. It’s a way to get kind of free consultation as you do an assessment of your organization and they, the things that aren’t as strong as they need to be, they give you best practices and you know exactly where you need to work within your organization. I realized we didn’t put that plug in.


Yeah. And is it okay to say that if folks have questions on that, Beth, they could use your email here and Robert you as well?


Yes, absolutely. Yeah.


Excellent. And if people have any links, senior-specific questions, I’ve put the contact information for Charles on this slide as well. And we’ve posted the PDF of the presentation today in the chat box. And so just a few last minute announcements. Robert and Beth were kind enough to partner with us on this co-branded material here at Tipsheet on the topic that you learned about today. So we hope you’ll download that. I did put the link for that in the chat box. We are in June. So our virtual summit is quickly approaching. So if you haven’t registered for that already, please be sure to do that. You can earn up to six free CEU credits for that. And we’ll be talking about how to enable the social prescription this year as our topic. And to get people excited about this year’s event, we’re also doing a senior living’s got talent competition. So get your submissions in by June 10th, if you haven’t already. And also we are doing bingo. So the bingo game will end at after the final session at the summit so we hope you’ll download your bingo card and get to work on that in the weeks ahead. And with that, I would just like to thank everyone. I’ll stop my share and put the CEU survey link in the chat box now. And Robert, Beth, thank you again. Have a great afternoon.


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