Listening to LGBTQI+ Older Adults: How Maine and Oregon are Making Aging Services More Inclusive

June 30, 2022

ACL has long been committed to ensuring that LGBTQI+ older adults receive the services and supports they need and deserve. We know that making this vision a reality requires intentional and ongoing work by people at all levels of the aging services network. As LGBTQI+ Pride Month comes to a close, we wanted to hear from Maine and Oregon, two states that have committed to this work.

We spoke to:

  • Debbie McCuin, Program Analyst, Community Services and Supports Unit, Oregon Department of Human Services; and
  • James Moorhead, Aging Services Manager, Office of Aging and Disability Services (OADS), Maine Department of Health and Human Services.

In the Q&A below, they discuss why it is important to listen to LGBTQI+ older adults, outreach strategies, the changes they have seen in their states, and their advice for other states looking to make their aging services more equitable.

Why was it important for your state to directly engage LGBTQI+ older adults?

Moorhead: The current cohort of LGBTQI+ older adults, especially those ages 85+, have experienced discrimination at each stage of their lives. They grew up during the Lavender Scare, had to fight for their rights, were expelled from higher education, were told they were mentally ill by the American Psychiatric Association until 1973, were barred from military service, were fired by employers, survived the height of the AIDS epidemic, were denied marriage equality until 2015, and more.

Now they are too often facing discrimination when accessing needed long-term care both in the community and in facilities. As such, the state of Maine prioritizes community input on how aging services and programs are delivered across the state to reduce barriers, such as fear of discrimination.

McCuin: Many LGBTQI+ older adults (a community which also includes asexual and two spirit indigenous people) have experienced lifelong challenges and discrimination resulting in fewer resources and supports to meet their needs. Governmental entities have historically perpetuated these inequities through policies such as the denial of spousal survivor benefits or by creating an unwelcoming environment that makes it risky for individuals to disclose their sexual orientation or gender identity when accessing services. Where there hasn’t been explicit discrimination, there has often been a history of benign neglect, particularly in recognizing and acknowledging the unique needs of this population and providing services that are welcoming and appropriate.

Community advocates have long been raising concerns about disparities, discrimination, invisibility, and lack of data. As Oregon is committed to the provision of services and supports to all older adults, addressing these equity issues, in partnership with community, is long overdue.

What strategies did your agency use to ensure that the voices of LGBTQI+ older adults would be heard?

McCuin: Building relationship and trust are critical. Some strategies to promote and hear LGBTQI+ voices include:

  • Including LGBTQI+ older adult community members on project advisory committees, public boards, and commissions;
  • Hosting community listening sessions;
  • Inviting community members to participate in leadership recruitment and hiring;
  • Dedicating staff time to liaise with community groups and serve on their committees; and
  • Sponsoring LGBTQI+ conferences

Community inclusion, partnerships, and outreach are key strategies, and a good example of this is the recruitment and involvement of LGBTQI+ older adults on the Oregon LGBTQ+ Older Adult Survey Advisory Committee.

Moorhead: More data is needed on LGBTQI+ older adults in Maine. To begin collecting such data, Maine included questions about sexual orientation and gender identity in its statewide needs assessment for the State Plan on Aging.

But we know that simply asking questions on a survey would not accurately capture the unique service needs of LGBTQI+ older adults. To amplify their voices using qualitative data, OADS partnered with the Maine Health Access Foundation to host a series of focus groups of older adults in target populations that included LGBTQI+ older adults.

How did you recruit participants for surveys or focus groups of LGBTQI+ older adults? Do you have any tips or best practices to share?

Moorhead: Partnerships are EVERYTHING! LGBTQI+ community organizations have the skills to effectively communicate with LGBTQI+ people and have well-established outreach methods such as mailing lists, websites, and social media. Partnering with SAGE Maine, with support from Maine Health Access Foundation, directly increased participation of LGBTQI+ older adults in Maine’s State Plan on Aging needs assessment. SAGE Maine shared the survey that was open to all family care partners and recruited focus group participants.

Additionally, we used recommended survey questions about sexual orientation and gender identity developed by the National Resource Center on LGBT Aging.

McCuin: To reach a population with an inherent distrust of government, we believe it is critical to have information shared by trusted partners. With our partners, we spent a great deal of time developing LGBTQI+ community outreach contacts who could help encourage community members to take our survey.

We also translated outreach materials into 10 languages. We shared many shelf-ready samples of communication that organizations could use, such as sample blurbs, flyers, letters to the editor, and social media posts.

When we were recruiting participants for the Oregon LGBTQ+ Older Adult Survey, some key methods included social and print media, announcements at public meetings, and emails and other communications by the agency and our community partners. The response was phenomenal: over 1,400 people took the survey. We attribute this success to the efforts of our community partners in reaching their networks. 

How has your state’s approach to serving LGBTQI+ older adults changed? What are you doing differently?

McCuin: Oregon’s Office of Aging & People with Disabilities has a new willingness to truly see the LGBTQI+ population and to view this population as one that requires—and deserves—visibility, support, and resources specific to their needs and strengths.

The agency has evolved in its thinking, engagement, prioritization, and funding of equity—including around sexual orientation and gender identity. Equity is now our agency’s “north star,” guiding all our work, internally and externally. There is support for staff to engage more fully with community groups in order to build foundational relationships and trust, and there is increased internal training.

The office has committed to acting through examination of programs, policies, rules, and services and has committed resources to this end. It has committed resources to, and completed a community needs survey of, LGBTQI+ older adults; raised statewide awareness of those needs; and is actively engaging community groups to address concerns. In addition, the LGBTQI+ population is also specifically called out as a target population with “greatest social need” in the Area Agency on Aging Area Plans and in the Service Equity Focus Area of the current State Plan on Aging. There is a real commitment to partnerships and action that has tremendous potential to effect change.

Moorhead: The desire to improve services and programs for LGBTQI+ older adults was already there among Maine’s Area Agencies on Aging and service providers. They want to get it right and they are looking for statewide leadership in this area.

Governor Janet Mills and her administration have consistently supported LGBTQI-inclusive policies. Maine’s 2020-2024 State Plan on Aging was designed, for the first time in Maine’s history, using an inclusive process that incorporated historically underserved populations, including LGBTQI+ older adults. Importantly, Maine also is building better data collection methods on sexual orientation and gender identity in our statewide database to document the needs of LGBTQI+ older adults.

The Office of Aging and Disability Services purchased LGBTQI+ cultural humility training through SAGECare offered by the National Resource Center for LGBT Aging for over 450 staff at both the state and local levels of Maine’s aging network. The next phase of this training is expanding to direct care workers in long-term care.

The pandemic relief funding also afforded Maine unique opportunities to strengthen relationships with SAGE Maine (a program of Equality Maine and an affiliate of SAGE USA) to ensure inclusive vaccine outreach to LGBTQI+ older adults statewide and reduce social isolation throughout the pandemic.

What advice would you give other states looking to make their aging services more responsive to the needs of LGBTQI+ older adults?

McCuin: There is no substitute for being present, for listening and acknowledging past issues, and for genuinely, respectfully engaging communities to advance positive change.

This requires more than a token effort; states should be willing to invest ongoing staff time and resources. Externally, states must put in the energy  to build trust and then take real, meaningful actions based on the community input they receive. Internally, agencies must fully commit to training and to policy, practice, and program change.

Moorhead: Designing and implementing inclusive aging services and programs is an iterative, ongoing process. The quick, easy solutions do not lead to measurable population-level results. You have to commit to the process and not expect overnight results.

The best advice I have is from Strengthen Your State and Local Aging Plan: A Practical Guide for Expanding the Inclusion of LGBT Older Adults:

  1. Educate staff of agencies and service providers about the needs of LGBT older adults.
  2. Develop partnerships with community-based LGBT organizations.
  3. Invite LGBT community stakeholders to provide input.
  4. Identify the needs of older LGBT adults through new or existing needs assessments and data.
  5. Review existing programs and services for LGBT-inclusion.
  6. Design LGBT-inclusive plans on aging with input from key stakeholders.>
  7. Measure program success.
  8. Continue planning for LGBT-inclusive services and programs.

Last modified on 06/30/2022


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