This episode explores homophobia in elder care, featuring the LGBT Aging Project founder, Dale Mitchell. We also meet Rebekah Levitt, Executive Director of Rogerson House, who brought LGBT sensitivity training to her staff. And we hear from Laura Barr, who shares her own concerns about homophobia in institutional care.
This episode explores homophobia in elder care, and features several people, including Dale Mitchell from Ethos and the LGBT Aging Project; Rebekah Levit, the Executive Director of Rogerson House, who brought in training via the LBGT Aging Project to sensitize her staff to issues facing LGBT elders; and Laura Barr, who reflects on her concerns about how Jean may be treated as a lesbian living in a long-term care institution.
The Shape of Care, Ep. 5: Aging for LGBTQ folks
Dale We consider institutions, nursing homes, to be what we call ‘institutional closets.’ And the experience of most out LGBTs when they go into institutions is to go back into the closet.
Mindy: That’s Dale Mitchell. Dale’s the CEO of a large, Boston-based nonprofit called Ethos. It’s one of 26 organizations in Massachusetts that are equivalent to one-stop shopping for elder services. Like home care, nutrition services, counseling and case management. These services are designed to help elders live independently in their homes. Ethos also serves a specific segment of the aging population: lesbian, gay, bisexual and transgender elders. Fifteen years ago, Dale created the LGBT Aging Project. It’s one of the few programs in the country that serves LGBT elders.
Dale If you scratch the surface of any older LGBT, you’ll hear the same thing. ‘I’m really scared about what’s going to happen to me if I’m alone and I can’t take care of myself.’
Mindy: This is The Shape of Care, a podcast that explores the world of caregiving. I’m Mindy Fried, the host and creator of this podcast. In this series, we look at who does the caregiving in the US, and why we should care about this work. In the last episode, we met a woman named Laura Barr, and we learned about her wife Jean, who has Alzheimer’s Disease. Jean was living at a dementia facility in Boston called Rogerson House. And Laura had some concerns.
Jean Jean's the only lesbian there. I don't think there are any gay men there. And you know we're very demonstrative with each other. And I don't know what the effect of that is. I don't know if the caregivers there feel uncomfortable with that and in any way affects. I don't even want to, it sounds like I’m making that accusation which I’m not. I just think the possibility exists.
Rebekah I did have a conversation with Laura at one point, we were just talking through some situations, and she said, you know, she just wanted to make sure that there was no backlash.
Mindy: Rebecca Levitt is the Executive Director of Rogerson House. She says several of their residents are LGBT. And she understands where Laura’s coming from.
Rebekah: She didn't necessarily express that there was anything in particular, or that she felt it. But, there are cultural differences in our staff and there are religious differences in our staff and that's enough to make sort of anyone nervous, I think, who's part of the LGBTQ community.
Mindy: We heard from Dale Mitchell at the beginning of this episode. Dale became CEO of Ethos about 25 years ago. He was an experienced administrator in the nonprofit world, but he was new to elder services. Dale’s been out since he was 18, and he’s been very active in the gay rights movement throughout the years. I asked him why he started the LGBT Aging Project.
Dale Once I kind of got further along in my arc of understanding what aging services were and how comprehensive and how really impressive they were in terms of their scope and their ability to actually keep people at home, I started wondering what would this service be like for me as an out gay man? What would it be like for me to be unable to be fully independent and need the help of a professional stranger, coming into my home and then I started to get a knot in the pit of my stomach and I became concerned that this system, which is so beneficial for so many people, is a scary option for LGBTs. I think most of us of a certain age have had very bad experiences with mainstream helping professionals and that would include the social workers and the direct care workers who are involved in helping the aged as they become more frail and more homebound.
Mindy: Dale became painfully aware of some of the problems LGBT elders face in institutions, like being mistreated by staff and being bullied by other residents.
Dale You are very, very vulnerable, if you are an out LGBT in an institution you are by definition, without the physical or the emotional resources to defend yourself.
Mindy: Now, as head of Ethos, Dale felt he could do something about this.
Dale I decided that I was going to use the very limited power and resources that I have to try to create a vehicle for expressing the concerns and issues of older LGBTs.
Mindy: The LGBT Aging Project sponsors a number of programs, including community meals for seniors, bereavement groups, and caregiving support groups. When LGBT elders need in-home services, the Project tries to match them with home care workers who are LGBT-friendly.
Dale I don't think there's any other agency that has grappled with this quite to the extent that we have. We have case managers who are assigned to deal with clients of a particular culture or language, so we have Haitian speaking case managers, we have Spanish speaking, we have Korean speaking etc. We also have recently designated a case manager who is LGBT competent, so that he or she would be able to deal with the unique concerns and needs of LGBT elders. [20:51]
Mindy: Ethos also hosts events for LGBT seniors. Including monthly luncheons and dinners, health and wellness education programs - and an annual senior pride luncheon that draws nearly 300 people. Last year, as people were leaving this gathering, an 88-year-old man slowly walked up to Dale, leaning heavily on his two canes. He thanked Dale for the services he was receiving from Ethos.
Dale Specifically, the services that he receives from his LGBT friendly case manager, singled her out by name and along with him was this younger gay man. You don't want to ask questions, you know, about what's going on, but then he eventually pointed to this young man, Eric, who he identified as a volunteer that Ethos had matched him up with. This is an out gay man who was previously very isolated, was very afraid of having people come into his home, very reluctant to open himself up to the notion of receiving a volunteer companion.
Mindy: These two men - one very young, the other very old - connected.
Dale You know, we just promised LGBT friendliness, but this is a gay man and you could just see the relationship, the warmth that existed between this very old, very frail man and this very young, very vibrant younger gay man and it was very heartwarming, very heartwarming.
Mindy: The volunteer program serves around 800 elders in Boston. Volunteers bring people to appointments; help them shop; and they visit them in their homes to keep them company. Dale says Ethos is highly regarded for its LGBT programming, even though that’s just a small part of what they do. He considers this a compliment and a challenge.
Dale looking forward I'm looking forward to the day when we're not distinguishable at all in terms of what we do for LGBT elders that all of our other sister agencies are doing the same.
Mindy: Despite the success of the program, there has been some pushback.
Dale resistance Certainly among elders there was resistance and there continues to be resistance. Homophobia is a particularly strong phenomenon among older adults. Homophobia seems to increase with age, for some strange reason. But among my colleagues, there wasn't a hostility certainly, but there was bafflement. What are you? We've never heard about older gay people. What are you talking about? And it was only through the work of the LGBT Aging Project and really a conscious consciousness-raising effort that the system eventually turned around.
Mindy: Ethos is in a Boston neighborhood with a large gay and lesbian community, and home to several prominent LGBTQ rights activists. But even in that community, Dale can point to LGBT elders living in public housing who have been harassed by their neighbors.
Dale Not every resident of senior housing is going to be homophobic and certainly the lack of action on the part of providers is not necessarily an indication of homophobia, but what we are contending, is that to make your organization LGBT friendly requires conscious steps and a process that you have to invest time and leadership into. To simply say we treat everyone equally, which is what the common reaction is, we don't treat people separately, is to really avoid the very real situations that elders face in terms of their daily lives and their fears and their experiences, their historical experiences.
Mindy: The majority of the care workforce is comprised of immigrants. Dale says that some come from cultures that have deeply entrenched homophobic attitudes. And he’s concerned that these attitudes might affect how workers treat their clients. This prompted Dale to create a successful training program for direct care workers.
Dale We have worked with a couple of our venders to create what we call Lavender Brigades which is a coterie of direct care workers who have been trained specifically to deal with an LGBT clientele.
Mindy: To Dale’s delight, all the participants, including some folks he thought would be resistant, embraced the training. Rebekah Levitt, from Rogerson House, knew first hand about the LGBT Aging Project. It was her field placement when she was getting a Master’s degree in Social Work. And a couple of years after she graduated, she was hired as Rogerson’s Executive Director. Rebekah decided to bring the training program to Rogerson for her staff.
Rebekah And whether staff have an issue or not I don't know at the time. But that's something that I want to address just in case it is there.
Mindy: Making the decision to bring the training to Rogerson wasn’t easy. Rebecca did it after a conversation with one of the trainers, Lisa. And it involved some personal risk.
Rebekah private personIt’s interesting, I think I generally I'm a very private person and so I don't really know, sort of, what my staff do or don't know and it was a conversation that Lisa and I had in terms of bringing the training, that I think one of the biggest concerns sometimes is that you’re kind of champion your own cause, and I think this is a really important training to bring in. But I was very aware that this could be my project. But like I said, you know, I'm not fully out with my staff. I will be now if they listen to this podcast.
Mindy: Ultimately, Rebecca’s belief in the need for staff training outweighed her concern about how staff might think about her sexual orientation. She wanted the training to help staff understand what LGBT seniors experience as a marginalized group. And that they would value the importance of treating all clients with respect.
Rebekah The biggest piece, too, is knowing that most of the seniors would not necessarily be so forthcoming and so having to think about making sure that we just naturally are being open and affirming and comfortable for LGBT seniors because they wouldn't necessarily be coming, as Dale would say, you know, with their rainbow flags and boa’s through the door.
Mindy: Rebekah wasn’t sure how the training would go over with her staff. She was relieved to hear their response.
Rebekah They were all really excited about this and thought it was an amazing idea and thought the training was really great.
Mindy: The person who spearheaded the training, Dale Mitchell of Ethos, takes pride in what it has accomplished. But it’s hard to maintain progress. Because of the high level of turnover among direct care staff.
Dale The infrastructure shreds very quickly, but it's probably the biggest issue right now facing the home care program and home care providers in terms of adequately serving LGBT older adults.
Mindy: The other problem is that the training program costs too much for his organization to maintain. So Ethos is partnering with about a dozen organizations to share the cost of a new initiative. Their goal is to train the elder care workforce on a more consistent basis. Dale believes that everyone who works with elders should experience this kind of training. So he’s supporting a bill in the Massachusetts Legislature that would do two things: mandate that all providers who receive state funds complete sexual orientation and gender identity training. And improve access to services for lesbian, gay, bisexual and transgender elders.
Dale I feel like it would be the culmination of a decade and a half of work around this issue to move this from the realm of the good guys and gals to the realm of official policy: that homophobia against vulnerable elders is not to be tolerated. And the state will affirmatively demand that in exchange for the taxpayer dollars that are going to those providers, that they open themselves up to a new attitude around LGBT elders. And attitudes do change. I mean, we all know this it's as we've all experienced this in our lives once you come out to somebody they've never known an out gay person. You know, sometimes they'll walk away from you, but most of the time though like their attitudes will start to peel away and eventually they'll get to an accepting place. We've seen that socially, historically and I think it could happen in institutions, as well.
Mindy: I had a chance to follow up with Laura Barr after her wife, Jean, had moved from Rogerson House into a skilled nursing facility. Jean’s Alzheimer’s Disease had progressed to the point where she needed more intensive care. I wanted to know if Laura had concerns about homophobia in Jean’s new institution.
Laura There have been some people that have been just really friendly and nice and some people who aren't, you know. It's just sort of how it is, at that those places, I think. And, also, of course, I always wonder is it homophobia, you know. I feel much less out there than I did at Rogerson.
Mindy: And sometimes people ask Laura about their relationship.
Laura: Because they’re like ‘is she your sister?’ You know, everybody wants to know who she is, or her roommate who I hope has vision problems calls her my daughter. I try really hard not to be offended by that. But you know that people are curious about our relationship, I think. And it doesn't really feel that welcoming in terms of being out. So what do you say to them? I say she’s my life partner, my life partner. And, you know, whether that means anything to them or not they don't really seem to respond that much like kissing her hello and kissing her goodbye, I still do it but kind of maybe on her cheek and not on our lips. You know, sort of that kind of thing just the subtle ways that you adjust. [16:36]
Mindy: Dale Mitchell remains optimistic that attitudes can change among people working in elder care. And he’s in it for the long haul.
Dale We have to remain vigilant, we have to remain strong and we have to remain proud and say this is a fight to the finish for all of us, it's who we are, we can’t give up.
Mindy: I’ve learned that being dependent on other people can make us feel more vulnerable. Independence is valued in our culture. And when we do need help, it’s important that the people who care for us treat us with respect and without prejudice. And that they acknowledge and accept us for all of who we are and who we’ve been, not just someone who is old or frail or ill. That includes recognizing our sexual orientation, our gender identity, our cultural backgrounds, the roles we’ve played in our families and our work, and the things we’re proud of having accomplished over the years.
Mindy: Do you have a caregiving story to share? A question about navigating the care system? We’d love to hear from you. Our phone number is: 6-1-7-600-87-90, that’s 6-1-7-6-0-0-8-7-9-0 or e-mail us: at contact@shape-of-care-podcast-dot-org.
You can learn more about this series: connect with us on Facebook, Twitter and Instagram @the-shape-of-care. You can find out more about the people we’ve interviewed, read The Shape of Care Blog and see lots of caregiving resources at the-shape-of-care-dot-org. This project has been a labor of love, with the support of friends and family. If you like what you’re hearing, please support The Shape of Care financially at the-shape-of-care-dot-org.
That’s it for this episode. The Shape of Care is produced at Whiskey Lane Productions in West Roxbury, Massachusetts. Helen Barrington is Executive Producer, mix engineer is James Donahue and our assistant producer is Alex Birch. Special thanks to podcast advisor, Lisa Mullins. Sarah Wasko created our logo, Kate Krosschell developed the marketing plan and Maggie Taylor is our marketing consultant. Our theme music is “Break Out” written by Josh Rosen, that’s him on piano, with Stan Strickland on sax and percussion. Other music in this episode is by Blue Dot Sessions. I’m your host and the co-producer of this podcast, Mindy Fried. Next week is our final episode. Elder care expert, Karen Wasserman will respond to your questions and comments. See you then.
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