By Loree
Cook-Daniels , Transgender Aging Network
_____________________________________________________
Introduction
When most people think about Lesbians and Gay men, they think about
sexuality. After all, it's sexuality -- sexual behavior -- that
distinguishes heterosexuals from homosexuals. And since our culture
says sexuality is an intensely private activity (particularly for
the generations who are currently elders), discussion of Lesbian
and Gay male elder issues can seem inappropriate and/or unnecessary,
particularly when our goal is to intervene in cases of elder abuse
that may have nothing to do with sex.
However, the equation of homosexuality exclusively with sexuality
does Lesbian and Gay male elders a very grave disservice. It erases
two key components of Gay life that have everything to do with how
well these elders are served by aging providers in general and by
adult protective services in particular: their relationships, and
their social, psychological, and legal environment. This article
seeks to outline how being a Lesbian, Gay male, or Bisexual(1)
elder may impact on that elder's need for -- and willingness to
accept assistance from -- adult protective services. It will also
discuss some strategies adult protective workers may want to adopt
to ease these elders' fears.
Lesbian and Gay male elders have been called an "invisible"
population (Cruikshank, 1991). If they are invisible, then transgendered
elders have been inconceivable. Many adult protective services workers
do not even realize such elders exist. This article therefore also
explores transgender issues and identity vis-a-vis elder abuse and
adult protective services.
Unfortunately, due in large measure to our society's still-pervasive
social prejudice against and ignorance about sexual orientation
and gender minorities, there have been few studies of this population
of elders, and virtually no one has examined how this population's
culture affects its experience with elder abuse. This paper is thus
only a beginning, speculative venture into this realm. It is based
primarily on my personal knowledge of Lesbian and Gay male elders
and younger transgendered persons and on my discussions with social
workers serving older Lesbians and Gay men and with domestic violence
specialists serving older women or Lesbians, Gay men, and transgendered
persons.
Sexual Orientation and Gender Identity
It's often said that Americans are obsessed with sex. Unfortunately,
that obsession has not translated into accurate and complete information
about sexuality and gender. Therefore, before we can begin discussing
elder abuse in relationship to this population, we need to define
who they are.
Sexual Orientation
Sexual orientation refers to whether someone is sexually and/or
emotionally attracted to: someone of the same gender (Lesbian, Gay
male, Gay or Homosexual [both referring to either men or women]);
someone of the opposite gender (heterosexual or "straight");
or both (bisexual). It's impossible to determine how many people
are Lesbian or Gay, since social prejudices dictate that many people
will lie about this aspect of their identity. Those who have estimated
percentages have produced numbers everywhere from 2% of the population
to 20%, with 5-10% being the most popular estimates (Buxton, 1994).
Gender Identity
Gender identity refers to whether you perceive yourself to be male,
female, both, or neither. Most of the time people who perceive themselves
to be male are born with male genitalia, and those who perceive
themselves to be female are born with genitalia labelled female.
The exceptions are transgendered persons, who will be discussed
in more detail below. There are nocredible estimates of how many
Americans are transgendered.
The Intersection of Gender Identity and Sexual Orientation Sexual
orientation and gender identity are wholly separate characteristics,
like age and race. Most Lesbians feel fully female and most Gay
men never question their maleness. Transgendered individuals may
be heterosexual, homosexual, bisexual, or asexual. Lesbians, Gay
men, and transgendered persons are found in every racial and cultural
group. Therefore, it's possible for an individual elder to face
abuse and prejudice based on her age, her race, her gender identity,
and her sexual orientation. While such multiple-jeopardy situations
are not uncommon, this paper will focus only (and separately) on
how Lesbian or Gay sexual orientation and transgendered identity
intersect with elder abuse issues.
The Social, Psychological, and Legal Environment of Lesbian and
Gay Male Elders
Homophobia
For the generations of Lesbians and Gay men who are now elders,
the larger social environment in which they've existed can be summed
up in one word: homophobic. Homophobia is fear of and/or hatred
toward homosexuals. When those who are now elders were growing up,
discovering their sexuality, forming relationships, and making a
living, homosexuality was viewed as criminal, sinful, and sick.
Those known to be homosexual were often fired from jobs, thrown
out of their apartments, kicked out of the military, disowned by
their families, and beaten by strangers. Businesses known to cater
to Gay men and Lesbians were frequent targets of police harassment.
Gay men and Lesbians who were working class and/or adopted manners
of dress deemed that of the "opposite" sex were particularly
brutalized (Marcus, 1992). Lesbian and Gay relationships were (indeed,
in most ways still are) completely denied the rights and recognition
routinely granted heterosexual marriages.
A few brave Lesbians and Gay men confronted the larger society's
disparagement (Marcus, 1992), but most learned that in order to
survive, they must hide their identities and relationships. Indeed
the stigma of being Gay or Lesbian is so great for these generations
of elders that many of them refuse to label themselves as such.
"We identify simply as two women living together in a primary
relationship," said one 75-year-old who had been partnered
for 41 years (Johnson, 1991, p. 26). Adelman (1991, p. 30) interviewed
another elder who said, "I never wanted to identify with a
lesbian group. I just like being with women."
Social condemnation of people who have relationships or sex with
persons of their own gender is so strong that even those who do
not identify themselves as Gay or Lesbian, those who do not associate
with other known Gays or Lesbians, and those who "come out"
(realize they are Gay) late in life nevertheless adopt many of the
same protective behaviors and social adaptations as those who have
long labelled themselves Gay.
Some of these adaptations are helpful. Some researchers believe,
for instance, that Lesbians and Gay men may actually adapt to aging
better than some of their heterosexual peers because they've learned
to build close networks of friends and have a greater range of daily
living skills due to their rejection of social gender task proscriptions
(Friend, 1991).
Unfortunately, some of these adaptations make older Gay men and
Lesbians morevulnerable to abuse, neglect, and exploitation. And
none of the adaptations spares Lesbian and Gay male elders from
the abuse all elders are vulnerable to, or from the threat of homophobic
abuse.
Abuse of Lesbian and Gay Male Elders
Homophobic Abuse
The stories abound. One researcher discussed an older resident
of a nursing home whom staff refused to bathe because they didn't
want to touch "the Lesbian" (Raphael, 1997). A social
worker reported a case where the home care assistant threatened
to "out"(2) her
older Gay male client if he reported her negligent care (Roosen,
personal communication, May 12, 1997). Older Lesbians and Gay men
who choose not to or do not succeed at hiding all traces of their
sexual orientation are also subject to street harassment and violence
(Visano, 1991).
Domestic Violence
Homophobia also plays a part in domestic violence within Lesbian
and Gay couples. A therapist who works with Gay male batterers reports
that "the majority...[of the men referred to him] have manifested
a negative self- concept related to being homosexual, as well as
negative feelings about who they are as a person." (Byrne,
1996, p. 110) Homophobia is often used as a tool of batterers, who
threaten to out their lovers to family or employers (Elliott, 1996).
Fear of Authorities
Most importantly, however, homophobia serves to keep victims from
seeking help. Such a move (particularly if the abuser is a lover)
might require outing oneself and facing possible hostility from
the very people who are supposed to help. If seeking help involves
-- or might involve -- the police, Lesbians and Gay men are especially
likely to demur, because being Gay is still illegal(3)
in many states and because virtually every older Lesbian and Gay
man knows of instances of police brutality against homosexuals (Marcus,
1992).
Legal Barriers
Legal discrimination against Lesbian and Gay male couples makes
it harder for elders to afford to leave an abusive relationship.
Whereas a heterosexual wife usually has access -- albeit sometimes
hard-to-obtain access -- to her husband's pension and (in community
property states) to half of the couple's assets regardless of whose
name is on the title or account, Lesbians and Gay men have no such
rights. An older Gay man who does not have sufficient pension income
of his own has no right to a portion of his lover's, and an older
Lesbian whose abusive partner put all their assets in her name (a
scenario that is fairly common among couples with an abusive, controlling
partner) will lose everything she has worked for her whole life
if she leaves.
Self-Neglect by Lesbian and Gay Male Elders
Every state that includes self-neglect in its definition of elder
abuse reports that self- neglect makes up a large proportion of
the elder abuse problem (Tatara, 1994). In fact, one study (Duke,
1990) found that self- neglect made up 79% of substantiated elder
abuse cases. Judging from the experiences of Ruth Morales and George
Roosen, caseworkers for San Francisco's Gay and Lesbian Outreach
to Elders, it seems possible that Lesbians and Gay men make up more
than their "fair share" of this population. They have
several reasons why they believe this is so (personal communication,
May 12, 1997).
Internalized Homophobia
All Lesbians and Gay men must struggle to define themselves as
worthy and decent human beings in the face of social prejudice that
says they are emphatically not worthy and decent (Adelman, 1991).
Some never successfully achieve a positive self-definition. Others,
facing increasing disabilities, the deaths of lovers and friends,
and other drains on their emotional strength, may find their psychological
defenses against homophobia disintegrating as they age. Elders who
have internalized homophobia come to believe that they are not worthy
and respectable people and consequently deserve loneliness, ill
health, and poor living conditions. Lacking self- esteem, these
elders may be unable to ask for help, and unwilling to accept any
help that is offered.
A History of Hiding
The current generations of Lesbian and Gay male elders almost invariably
have histories of protecting themselves from social prejudice by
hiding who they are. Some contracted heterosexual marriages or took
opposite-sex friends to work-related social events. Others "simply"
pretended to be single or lied about their hobbies and interests.
Many turned down jobs and other opportunities that threatened their
efforts to appear heterosexual. Roosen believes that some Lesbian
and Gay male elders have so routinely taken extraordinary measures
to protect their privacy that the prospect of allowing someone into
their homes to provide personal care is unthinkable.
The Value of Independence
Ironically, one of the most adaptive consequences of learning to
deal with societal homophobia -- cultivating the skills and attitudes
to sustain independence -- can end up being counter-productive when
an elder becomes frail. Because so many Gay men and Lesbians are
disowned by family members who learn of their homosexuality and
because they are legally deprived of rights to their partners' earnings
and pensions, Lesbians and Gay men tend to highly value self-reliance.
Older Lesbians, in particular, often take pride in their ability
to be self- supporting. Unfortunately, this independent streak can
make accepting help in old age anathema. Consequently, some Lesbian
and Gay male elders, Morales believes, simply vastly prefer self-
neglect to "becoming dependent."
Fear of Encountering Homophobia
Finally, Lesbian and Gay male elders may end up self-neglecting
in order to protect themselves from others' homophobia. Isolation
is widely viewed as one of the primary risk factors for elder abuse
and neglect (Wolf, 1996). Unfortunately, the services set up to
connect isolated older people with others are shunned by many Lesbians
and Gay men. Morales and Roosen report that many of their clients
refuse to attend senior centers or nutrition sites or move into
senior housing because they have "nothing in common" with
heterosexual peers, whose conversations often include discussions
of grandchildren(4) and
spouses. They also tend to refuse home care services, fearing that
a worker might realize they are Gay and become abusive or try to
blackmail them.
Transgendered Elders
Definitions
It is highly unlikely an adult protective services worker will
ever encounter an elder who calls him- or herself "transgendered."
This term is relatively new, and its definition is contested. However,
it is a useful umbrella term for several types of gender-related
identities.
Transsexual. A transsexual
is a person assumed to be female at birth who now lives full- time
as a male (female-to-male or FTM), or a person assumed to be male
at birth who now lives full-time as a female (male-to-female or
MTF). Transsexuals may be post-operative, which means they have
had one or more surgeries to alter their primary and/or secondary
sex characteristics. They may be pre-operative, in that they intend
to have one or more surgeries in the future. And they may be non-operative,
which means they do not intend to have any gender-related surgeries.
Although most transsexuals take hormones to help their bodies visually
conform to their gender identity, some do not. Legally, transsexuals
may have changed all, some, or none of their identity papers to
reflect their "new" gender and (if appropriate) name.
Cross-dresser or transvestite.
A cross-dresser or transvestite is a person who dresses part- time
or full-time in clothing his or her culture deems as "belonging"
to the "opposite" gender. Some people cross-dress as part
of a performance, and may be called drag queens or drag kings.
Intersexed (intersexual) or hermaphrodite.
Intersexuals (formerly known as hermaphrodites) are persons born
with genitals that are not clearly "male" or "female,"
or do not look like "typical" genitals.
Transgender(ed).
This term is a catch-all for all of the above and for people who
feel they cross or blur gender lines, are both female and male or
neither. "Butch" Lesbians and "effeminate" Gay
men are sometimes included in this category.
Non-congruent Bodies
What nearly all transgendered elders have in common is a body that
does not "match" their clothing, presentation, and/or
identity. Transsexual genital surgeries only began in the 1940s
and 1950s, are extremely expensive and seldom covered by insurance,
and -- especially in the case of female-to-male transsexuals --
have often produced less-than-satisfactory results. Therefore, even
transsexual elders are likely to have genitals and (perhaps) other
physical features that are not congruent with their sense of who
they are. That means transgendered elders will tend to be extremely
reluctant to use services -- even emergency medical care -- that
require disrobing.
Transphobia
Social prejudice against transgendered persons (transphobia) is,
in many cases, even more intense than that directed against Lesbians
and Gay men. Surveys of transgendered persons consistently show
an extremely high rate of violent victimization, including higher-than-average
rates of street violence and of childhood violence perpetuated by
parents and caregivers (Bowen, 1996; Courvant, 1997; Wilchins, 1997).
Transgendered persons face prejudice from family members, employers(5),
the general public, and "helping professionals."
Law enforcement. Like Lesbians and Gay men, transgendered persons
generally avoid contact with the police. Transgendered persons have
often been the victims of police brutality and negligence, and many
stories circulate about what happens in jail when a transgendered
person is placed in a sex-segregated group cell.
Health care professionals. Transgendered persons are also subject
to health care provider ignorance and prejudice. Even those who
specialize in treating transgendered persons often require them
to lie and hide. For decades these doctors and therapists required
transsexuals to divorce loving spouses, move to new states, and
fabricate whole new "life histories" in order to qualify
for hormones and surgery. Even today, some surgeons refuse to operate
on transsexuals who reveal facts like having borne or sired children.
Health care providers who do not specialize in treating transgendered
persons are, for the most part, completely ignorant about their
health care needs and concerns (Morton, Lewis, Hans and Green, 1997).
Effects of transphobia. Because they face similar social prejudices
and degradations, it is likely that transgendered elders face the
same elevated risks of elder abuse and self-neglect as their Lesbian
and Gay male peers. They may frequently internalize the prejudice
against them and come to believe that they are not worthy of decent
treatment. Greg Merrill, Director of Client Services at the Community
United Against Violence, reports that transgendered victims of domestic
violence are the least likely to leave an abusive lover, since they
often believe their abuser's taunts that no one else will ever love
and accept them as they are (personal communication, June 17, 1997).
Like Lesbian and Gay elders, transgendered elders may frequently
refuse services. They, too, will be exceptionally protective of
their privacy. Because of past negative experiences, they may be
particularly resistant to dealing with health care professionals,
law enforcement, and agencies that may question their legal identity.
Implications for Adult Protective Services
Adult protective services workers, no matter how skilled and caring,
cannot begin to negate or compensate for the violence and prejudice
Lesbian, Gay male, and transgendered elders face. What they can
do is try to be more aware of the perhaps-hidden realities of clients'
lives, and be more skilled at addressing clients' fears and needs.
Identifying Lesbian and Gay Male Elders
Adult protective services workers do not have to positively identify
who among their caseload is Gay in order to properly serve them.
Indeed, many Lesbian and Gay male elders would feel distinctly uncomfortable
if they felt they were "read" (identified as Gay), and
some might deny it if asked. One Gay social worker even recommends
not coming out to a suspected Lesbian or Gay male elder if you yourself
are Gay, as it puts the elder in the uncomfortable position of feeling
pressure to also self-disclose (Roosen, personal communication,
May 12, 1997).
Recognize Relationships
Instead, be aware that not all couples are heterosexual. If there
is evidence an elder lives with another adult, gently probe as to
the nature and length of the relationship. Echo the elder's language.
Is this "friend" or "roommate" someone the elder
can count on for care? For financial assistance? If there appears
to be a partnership of some sort, you need not determine whether
it's sexual. Simply begin asking the type of questions you would
ask a married couple rather than the type of questions you'd ask
about a neighbor.
Be Aware of Legal Realities
At the same time, if the client appears to have a same-sex partner,
be aware of the lack of legal protections and assumptions these
couples have. If the client and partner want the partner to have
something as simple as hospital visiting privileges or something
as complex as an inheritance, special legal documents may have to
be drafted. Even then, the couple may need help getting such documents
honored: one lawyer who specializes in elder law and Lesbian and
Gay issues reports that a nursing home refused to honor the Power
of Attorney he drew up for the Gay lover of a resident (private
conversations held at Joint Conference on Law and Aging, 1994).
Listen Especially Carefully
It was easy for the social workers who work with Lesbian and Gay
elders to recite instances where adult protective services workers
made situations worse. In one case, an older Gay man was moved out
of a "dangerous" neighborhood to "nice senior housing."
All of this man's friends and social contacts were young Gay male
hustlers who abandoned him once he moved out of their neighborhood
and into a "secure" building, effectively isolating him
among people with whom he had nothing in common (Roosen, personal
communication, May 12, 1997).
Similarly, what may look to an outsider like an exploitative relationship
may, in fact, be quite an acceptable exchange to the people involved.
Many older Gay men, in particular, couple with much younger men
(Steinman, 1991; Visano, 1991). In one instance reported by Roosen,
an older Gay man took in a much younger, Gay addict living with
AIDS. The younger man was abusive and exploitative, but after his
death the older man reported that he was prouder of having helped
that young man than of almost anything else he'd ever done.
Find Respectful Service Providers
Just as an elder from a racial minority culture needs to have service
providers who are respectful of her beliefs and practices, Lesbian,
Gay male, and transgendered elders need providers who will treat
them respectfully. If you suspect an older client is Lesbian, Gay,
or transgendered, make sure you find or train service providers
who will not denigrate them. In the case of transgendered elders,
it is crucial for everyone who comes into contact with the elder
to always address them by the name and pronoun they use, regardless
of that elder's genitals or legal identification.
Connect with the Client
One of the interesting findings of Bozinovski's study of self-neglecting
elders (1996) is that many of these elders were strongly identified
with their past professions. This seems a fruitful rapport-building
area to explore with suspected Lesbian and Gay elders, as these
elders often invested a lot in their professional lives (Johnson,
1991). Further rapport can be developed by addressing "friends"
or "roommates" as one would a spouse, and by noticing
and asking about personal effects such as pictures (just don't assume
the young man in a picture is the client's son!). If it will work
in smoothly, talk about the variety of persons your agency serves.
Connect the Client to the Community
If you get any indication that a client is willing to talk about
being Lesbian, Gay, or transgendered, be prepared to assist her
or him in locating appropriate resources. Although there are very
few programs specifically for Lesbian and Gay elders and none for
transgendered elders, there are more and more "Gay retiree"
groups, and hundreds of communities have Gay-oriented churches or
social groups and/or transgender support groups. The pastors of
such churches or leaders of such groups may be willing to arrange
for an informal friendly visitor if the elder is homebound. A list
of such resources is included below.
Conclusion
Given how much prejudice and violence Lesbian, Gay male, and transgendered
elders face, there can be no question that any given APS caseload
will include such elders. These clients are likely to be more resistant
than other clients to accepting services, due to their fears of
being victimized or ridiculed again and of losing especially-valued
independence and privacy. When APS workers become more aware of
the existence and circumstances of Lesbian, Gay male, and transgendered
elders, they should be better able to build rapport with these clients
and assist them in getting the services and assistance they need.
References
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A study of later-life gay men and lesbians. In J. A. Lee (Ed.),
Gay midlife and maturity (pp. 7-32). New York: the Haworth Press.
Bowen, G. (1996). Violence and health survey. (Available from American
Boyz, 212A S. Bridge St, # 131, Elkton, MD 21922-1118)
Bozinovski, S.D. (1996, November). Self-neglect among elders: A
struggle for self- continuity. Paper presented at conference of
the National Association of Adult Protective Services Administrators,
Austin, TX.
Buxton, A.P. (1994). The other side of the closet: The coming-out
crisis for straight spouses and families (revised edition). New
York: John Wiley & Sons, Inc.
Byrne, D. (1996). Clinical models for the treatment of gay male
perpetrators of domestic violence. In C. M. Renzetti & C. H.
Miley (Eds.), Violence in gay and lesbian domestic partnerships
(pp. 107-116). New York: Harrington Park Press.
Courvant, D. (1997). Domestic violence and the sex- or gender-variant
survivor. (Available from the Survivor Project, P.O. Box 40664,
Portland, OR 97204-0664).
Cruikshank, M. (1991). Lavender and gray: A brief survey of lesbian
and gay aging studies. In J. A. Lee (Ed.), Gay midlife and maturity
(pp. 77-87). New York: The Haworth Press.
Duke, J. (1996). Study found 79% of adult protective services cases
were self-neglect. Aging, 367, 42-43.
Elliott, P. (1996). Shattering the illusions: Same-sex domestic
violence. In C. M. Renzetti & C. H. Miley (Eds.), Violence in
gay and lesbian domestic partnerships (pp. 1-8). New York: Harrington
Park Press.
Flynn, E. & Choe, C. (1996, June 26). Down by law. San Francisco
Bay Guardian.
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successful aging. In J. A. Lee (Ed.), Gay midlife and maturity (pp.
99-118). New York: The Haworth Press.
Johnson, S.E. (1990). Staying power: Long term lesbian couples.
Tallahassee, Florida: The Naiad Press.
Marcus, E. (1992). Making history: The struggle for gay and lesbian
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Morton, S., Lewis, Y., Hans, A., & Green, J. (1997). FTM 101
-- The invisible transsexual. (Available from FTM International,
Inc., 1360 Mission Street, Suite 200, San Francisco, CA 94103)
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at a conference of the National Center on Elder Abuse, Long Beach,
CA.
Steinman, R. (1991). Social exchanges between older and younger
gay male partners. In J. A. Lee (Ed.), Gay midlife and maturity
(pp. 179-206). New York: The Haworth Press.
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(Booklet). Washington, D.C.: The National Center on Elder Abuse.
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Notes
1. Bisexual elders have simultaneous relationships
with both men and women, "serially monogamous" relationships
with both men and women, or self-define as bisexual because of a
personal philosophy. A bisexual identity or reality is unlikely
to increase an elder's risk of elder abuse except when he or she
is (or is perceived to be) in a same-sex relationship. They are
therefore considered Lesbian or Gay male for the purposes of this
paper. The one area in which bisexual elders may be differentially
subject to abuse is in cases where a bisexual elder's heterosexual
spouse does not know about same-gender affairs. These elders are
uniquely vulnerable to exploitation and blackmail by lovers or others
who threaten to tell the spouse. Heterosexually married bisexual
men who seek "anonymous" male sexual partners also risk
violence from those they approach.
2. "To out" means to publicly reveal
the homosexuality of someone who is trying to keep that information
private.
3. In 22 states, engaging in consensual homosexual
sex is still a criminal act, punishable up to life imprisonment
(Flynn and Choe, 1997).
4. Lesbian and Gay elders may have grandchildren,
as well, but talk of one family relationship frequently leads into
talk of other family relationships, making even this topic potentially
dangerous.
5. Only a very few jurisdictions (and all of those
only recently) outlaw employment discrimination against transgendered
persons.
_____________________________________________________
[Note: An earlier version of this article was published
in:
Journal of Elder Abuse and Neglect,
The Haworth Maltreatment & Trauma Press, Vol. 9, No. 2, 1997;
pp. 35-49.]
Copyright © 2002 Loree
Cook-Daniels.
