LGBT Advocates Disappointed Rules for Community Care Fail to Protect LGBT Seniors

January 23, 2014

The undersigned LGBT organizations are deeply disappointed that the Department of Health and Human Services (HHS) has announced it will not add explicit nondiscrimination protections for LGBT and other consumers to Medicaid’s Home- and Community-Based Services (HCBS) program. Our organizations along with the National Senior Citizens Law Center, have urged HHS over the past three years to adopt these protections to ensure low-income older adults and people with disabilities can receive needed services and supports without fear of refusal, harassment, or other discrimination because of who they are. The protections were not included in a final rule issued last week to strengthen standards for the long-running program.

HHS seemingly based its decision to reject these LGBT protections, which have been included in other HHS programs, on the notion that general nondiscrimination protections already exist. Despite being made aware of the critical need for explicit LGBT consumer protections, as well as protections on the basis of religion, marital status, and source of payment, HHS simply stated in a new HCBS regulation that these protections were “not necessary.”

HHS’s surprising statement that protections for LGBT seniors are “not necessary” is contradicted by reports from the Institute of Medicine and the Agency for Healthcare Research and Quality, which have found that discrimination against LGBT people in health settings is widespread. A survey of providers, LGBT consumers, and family members conducted with the National Senior Citizens Law Center found that most believed anti-LGBT discrimination was a problem in long-term care settings and many had witnessed discrimination. Failure to include explicit protections undermines efforts prevent anti-LGBT discrimination in home- and community-based care.

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Senator Bennet Introduces LGBT Elder Americans Act

September 28, 2012

Last week, Senator Michael Bennet (D-CO) introduced the LGBT Elder Americans Act of 2012. If passed, this bill would increase federal supports to millions of lesbian, gay, bisexual and transgender (LGBT) older people through the Older Americans Act (OAA), which is the “major vehicle” for promoting the delivery of social and nutrition services to older Americans and their caregivers.

Among the bill’s proposals for the OAA is an amendment that would designate LGBT elders as a group in “greatest social need,” which is currently defined as need caused by non-economic factors, such as physical and mental disabilities, language barriers, and cultural, social, or geographic isolation, including isolation caused by racial or ethnic status. This designation would drive funding of LGBT elder programs and services, including greater inclusion of LGBT elders in general aging program design, deliver and outreach. It would also require cultural competency training of staff and agencies and service providers and incentivize organizations to adopt nondiscrimination policies and training. Finally, it would necessitate data collection on LGBT elders to better understand their needs and appropriately tailor services.

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Re-Cap: Trans Issues at the Aging in America Conference

April 6, 2012

I was pleased to be able to attend and present last week at Aging in America, the nation’s largest multi-disciplinary conference on aging issues, which this year was held in the nation’s capital. I attended a number of great sessions on topics such as cultural competence in aging services, the experiences of transgender people at mid-life, improving responses to issues of intimacy and sexuality in long-term care settings, and how the Affordable Care Act benefits multicultural elders. There was an incredible track of LGBT aging programming at this year’s conference, with more than a dozen LGBT-focused workshops.

I was privileged to join Karen Fredriksen-Golden of the University of Washington School of Social Work and Loree Cook-Daniels of FORGE Transgender Aging Network for a panel on what some of the most recent transgender survey research can tell us about trans older adults. In addition to the National Transgender Discrimination Survey, we discussed the recent Aging and Health Report on LGBT older adults, surveys by FORGE on sexuality and sexual violence among older adults, and research documented in the new book The Lives of Transgender People.

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Transgender Older Adults Featured in First-Ever LGBT Aging Publication

November 17, 2011

In a groundbreaking LGBT-themed issue of Public Policy & Aging Report, a publication of the National Academy on an Aging Society, NCTE Policy Counsel Harper Jean Tobin outlines the policy agenda of transgender older adults. From accessing healthcare to the mistreatment of transgender older adults in long-term care facilities, Tobin reviews the issues that diminish the quality of life for a growing segment of the transgender community. The introduction of Tobin’s entry called, “Improving the Lives of Transgender Older Adults,” reads:

[L]ittle is known about the growing population of older transgender people and their needs (Institute of Medicine, 2011). Some older transgender women and men transitioned from one gender to another at a time when trans people were invisible, legal rights were nonexistent, and doctors recommended starting a new life and avoiding other trans people. Others come out and transition later in life, and may face the loss of existing sources of social and financial support. Trans people are commonly challenged and mistreated in all kinds of settings over what name they go by, how they dress, which restroom they use, and whether their ID matches their gender identity.

Tobin’s research is part of NCTE’s expanding federal aging agenda, which includes advocating for full Medicare coverage of transition related care, collaborating with SAGE on a Transgender Aging Advocacy Initiative, and working to improve cultural competency in aging services and long-term care through the Department of Health and Human Services.

Read the full publication here.

Read the press release from SAGE here.


Medicare Has You Covered

August 15, 2011

As part of NCTE’s federal aging policy agenda, we are releasing this guide on navigating Medicare for transgender beneficiaries. Transgender people often face confusion around what is covered in their Medicare benefits, both for transition-related care and for routine preventive care.

This guide makes clear that Medicare does cover:

1) Routine preventive care regardless of gender markers, and

2) Medically necessary hormone therapy.

Medicare has instituted a special billing code to end denials of coverage based on apparent gender discrepancies. Now doctors and hospitals can use this code to override Medicare’s computer systems to ignore gender discrepancies on a person’s record. Unfortunately, Medicare still does not cover medically necessary sex reassignment surgery.

This document goes into detail about what is covered, appealing denials of coverage, and reporting instances of disrespect, discrimination and harassment related to your gender identity or transgender status.

Read the full guide below.

View this document on Scribd

What Happens When We Get Older?

July 15, 2011

As the US population ages, ensuring that our society adequately supports us all as we get older becomes more important than ever. Researchers and advocates have recently turned increased attention to LGBT aging issues, highlighting discrimination against LGBT elders in long-term care facilities and in federal programs such as Medicare and Medicaid. However, there has been little research, discussion or advocacy on transgender older adults. Indeed, the recent Institute of Medicine report on LGBT health identified transgender aging as a major gap in existing health-related research. And the amount that has been written about transgender aging in any field makes for a very short reading list. While many challenges and issues are common to LGBT older adults, we know there are also issues that are particularly important for transgender older adults.

To this end, NCTE and SAGE (Services and Advocacy for GLBT Elders) are collaborating on the Transgender Aging Advocacy Initiative with the goal of developing an agenda for meeting the public policy needs transgender older adults. By consulting with community leaders, health care providers and policy experts from around the country, we hope to identify achievable policy goals at the state and national level that would materially benefit transgender people as they age, and enable them to live in good health, safety, dignity and independence in their later years. We are examining issues such as long-term care, veteran’s services, economic security, access to transition-related care, aging research, area agencies on aging, and building cultural competence for health care providers.

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Caring and Aging with Pride

August 12, 2010

NCTE has been working in recent months with SAGE and the National LGBT Aging Roundtable to bring greater attention to the needs and vulnerabilities of transgender, lesbian, gay and bisexual older adults. One of the great challenges in advancing equity for this population is the paucity of data. Now there is an opportunity for you to help fill that gap.

FORGE and the Institute for Multigenerational Health at them University of Washington are collaborating on the Caring and Aging with Pride project to better under stand the needs of LGBT people over 50. They are conducting what could be a major survey, and we strongly encourage transgender people over 50 to participate. You can complete the Caring and Aging with Pride survey online or by mail. Your participation helps ensure that this project produces valuable data on transgender older adults that can be used to advance policy, training and education. The project is also conducting a raffle for a $500 Visa gift certificate, and you can enter this raffle online whether or not you choose to complete the survey questionnaire.


NCTE Talks to Hill Staffers about Trans Aging

April 22, 2010

Today I was privileged to speak to Congressional staffers and aging advocates about the challenges facing transgender older adults. In conjunction with the National LGBT Aging Roundtable, SAGE (Services and Advocacy for GLBT Elders) and the National Gay & Lesbian Task Force presented a briefing this morning at which I shared the podium with Laurie Young of the Task Force, Hope Barrett of Chicago’s Howard Brown Health Clinic, and SAGE’s John Johnson.

Like transgender people of all ages, trans older adults face social stigma and discrimination in the workplace and when seeking housing, health care and social services, and suffer serious health disparities. In the NCTE/NGLTF National Transgender Discrimination Survey, 30% of adults over 60 reported having lost a job because they were transgender. Trans older adults are also more likely to live on their own, tend to have fewer social supports, and are vulnerable to elder abuse. They face systemic inequities, such as the frequent exclusion of medically necessary care under Medicare, and use of gender markers on Medicare cards that out people when they seek basic care.

One problem that we focused on in the briefing is discrimination in long-term care. Whether in nursing homes, assisted living facilities, or other community- or home-based care services, trans people frequently encounter discrimination by the very people providing them essential and often intimate care. In a recent survey of  LGBT long-term care recipients, providers and caregivers, conducted by the National Senior Citizens Law Center along with NCTE and others, we heard stories of trans people being referred to by the wrong name and pronouns, of staff mocking trans residents’ bodies, of trans people being outed to other residents or staff, and even of staff refusing to perform basic care for trans people, or barring them for social activities and from dining with other residents. Federal and state laws exist to prohibit this kind of ill treatment of any older person, but oversight and enforcement are weak. Long-term care providers and other aging service providers (along with all health-care providers) are badly in need of training and education on working with transgender people.

NCTE looks forward to working with the National LGBT Aging Roundtable and with Congress and federal agencies to address these disparities and ensure that transgender older adults receive the care and services they need without discrimination.


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