LGBTQ elders struggle with health care, housing and isolation

Gene Dinah misses his late husband, Robert Malsberry, every day. He misses Malsberry’s cooking, his love for gardening, the way he fixed things around the house and the way he made him feel special and protected.

“He was just great,” Dinah said of Malsberry, who died in 2019. “I couldn’t have had a better partner.”

The memories of the 46 years the men had together are all around him.Malsberry is in the paintings he bought to decorate their home in Fort Lauderdale, Florida. He is in the medals he received for his service with the Air Force. Heis in the photos from a lifetime together.

“Oh, this is one of my favorite pictures,” Dinah said as he held a photo of himself and his husband standing in front of lush green shrubs at their home. “That’s our rock garden.”

Gene Dinah, left, and his husband, Robert Malsberry.Courtesy Gene Dinah

Picking up another photo, he said, “That’s my husband in our dining room in our house in Victoria Park with Cleo, our Persian cat.”

Robert Malsberry with Cleo, the cat he shared with Gene Dinah.Courtesy Gene Dinah

“Oh, this is a good picture,” he continued. “This is my husband when he was an Air Force lieutenant after graduating college.”

Robert Malsberry when he was an Air Force lieutenant.Courtesy Gene Dinah

They had no children, so when Malsberry was diagnosed with leukemia and later dementia, Dinah became his full-time caregiver. “I took care of him as best I could,” he said.

Malsberry died in 2019, four years after the couple got married in 2015, following that year's landmark same-sex marriage ruling by the Supreme Court.

“My husband was very happy when we got married,” Dinah said. “I didn’t know how he was going to take it. I really didn’t, because he’d been in the closet, you know, for all those years.”

Dinah was destroyed after Malsberry died. “My whole life was him,” he said.

While taking care of his sick husband, Dinah did not think about his own elder years. Now, at 76, he is one of many LGBTQ elders who have no surviving relatives who can take care of them.

LGBTQ older adults are four times less likely to be parents than older heterosexual adults, and twice as likely to grow old single and living alone, according to SAGE, a national group that offers services and advocacy for LGBTQ adults 50 and older.

The challenges LGBTQ elders face overlap with an aging U.S. population. According to the U.S. Census, the population aged 65 or over grew to an unprecedented 55.8 million, or 16.8% of the total population, in 2020. The number of people in the U.S. that are 65 or older is projected to increase by 47% by 2050.

An older population exacerbates workforce shortages in senior living facilities and health care institutions, and while this affects many older Americans, LGBTQ elders face unique challenges when compared to their heterosexual counterparts.

In a report published in 2018, SAGE found LGBTQ elders are far more likely than their heterosexual peers “to have faced discrimination, social stigma and the effects of prejudice.” They are therefore, the report found, more likely “to face poverty and homelessness, and to have poor physical and mental health.”

Caregiving

Since LGBTQ people are less likely to have children, more than half (54%) of LGBTQ elders receive care from their partner and nearly a quarter (24%) receive care from a friend, according to SAGE. More than 20% of older LGBTQ adults have provided care to friends, compared to just 6% of their heterosexual counterparts.

Mitchell Zahn, a coordinator for SAGE in South Florida, said that in heterosexual family units, caregiving tends to have a vertical model, in which the child takes care of their parents.

“But in the gay community, since so many do not have a family, caregiving tends to be with friends, a more horizontal model,” Zahn said. “However, when you age, your friends tend to be older as well and have their own health needs, so our health support is failing as well because we don’t have that intergenerational aspect.”

Photographs of Gene Dinah and his husband, Robert Malsberry, throughout the years.Courtesy Gene Dinah

Dinah is a vivid example of the horizontal model of caregiving. For the four years during which Dinah was his husband’s sole caregiver, he arranged all of his medical appointments, found him the doctors he needed, took care of him through medical procedures, cooked for him, took care of the house and got him all the medical supplies he needed. After his husband died, Dinah had no one to help him with his own health care.

“I didn’t see a doctor or a dentist for four years while I was his caretaker,” he said. “When it was all over, I started going to the doctor, and I found out I had prostate cancer.”

Dinah went through six weeks of radiation treatments by himself.

Health care

Discrimination in health care and the fear of such discrimination are major factors that lead to health disparities for LGBTQ elders, according to research. In its 2018 report, for example, SAGE found approximately 20% of LGBTQ people avoid medical care out of fear of discrimination.

Zahn, the SAGE coordinator, said that because many LGBTQ elders grew up in a time when discrimination was more widespread and intense, they tend to fear government and health care institutions.

“People have experienced housing evictions, not having their partners recognized in health care institutions,” Zahn said. “So as a result, many are closeted when seeking services through traditional institutions.”

Zahn said LGBTQ elders may feel judged for who they are, so they may not share everything about their medical history with their doctors, which could lead to misdiagnosis and overall poor health outcomes.

The challenges of aging are even greater for transgender elders and even more for trans immigrants and trans people of color.

More than 20% of transgender people report that a doctor or other health care provider used harsh or abusive language while treating them, according to SAGE, while 50% of trans people reported having to teach medical providers about transgender care.

Morgan Mayfaire, 65, is the executive director of TransSOCIAL, an organization that aims to create a more inclusive community for transgender people. As a trans man, he said, he has experienced prejudice when visiting medical providers.

“When they look at your records, they’re going to see in your list of medications that you’re either taking estradiol or you’re taking testosterone,” Mayfaire said. “The question then is, ‘Why?’ The minute you tell them that it’s because you’re trans, you can see the bias in their face.”

Mayfaire helps train a variety of institutions, including those focused on health care, about best practices when caring for older trans people.He said very few medical professionals have gone through sensitivity training, and those that have, typically don’t train their new hires.

Andrea Montanez said it's "scary to be an elder as a transgender person."Courtesy Andrea Montanez

Florida is one of the states that has recently passed legislation seeking to restrict transgender rights, including a law signed by Gov. Ron DeSantis that made it harder for transgenders adults to access gender-affirming care. That law is now on hold after a federal district court ruled it unconstitutional, but Mayfaire said the effects are palpable.

“A lot of the providers that we had before have either left the state and moved somewhere else, or are reluctant to reopen those services,” Mayfaire said.

Andrea Montanez, a trans field organizer in Orlando with the National LGBTQ Task Force, said, “It’s scary to be an elder as a transgender person, to be honest.”

Montanez, 58, said a doctor who had given her great treatment for years suddenly turned curt, cold and distant after she transitioned.

She also suspects her apartment lease was not renewed because she told her landlord she had transitioned.

Housing 

Mayfaire said housing is another big obstacle for LGBTQ elders.

Half the LGBTQ population live in states with no laws prohibiting housing discrimination against them, and 48% of LGBTQ couples experience adverse treatment when seeking senior housing, according to SAGE.

“There are very few retirement communities for LGBTQ folks to begin with,” Mayfaire said. He added that even at retirement communities that are accepting of gays and lesbians, “it’s very rare” that they accept trans people.

He said he has heard of LGBTQ elders who end up having to go back into the closet in order to be accepted in some retirement communities.

“It’s a little bit more difficult when you’re trans and you’ve transitioned,” Mayfaire said. “How do you backtrack on that and how do you deal with that emotionally and mentally?”

Isolation 

Nearly 60% of LGBTQ older adults report feeling a lack of companionship and over 50% reported feeling isolated from others, according to SAGE.

That isolation can really impact the mental health of LGBTQ elders, many of whom faced the brunt of discrimination and were the pioneers of the movement for LGBTQ rights.

To combat that loneliness, SAGE matches elders with “friendly visitors”: volunteers who donate their time to accompany an LGBTQ elder.

Volunteers sometimes share a meal with an elder, tell stories, watch movies, play board games or just simply talk. Some volunteers check in with their elders with a simple text message or a call.

“I’ve seen some real magic happen between volunteers and participants, some incredible relationships that have formed,” Zahn said.

Craig Rosenblatt is one of SAGE’s volunteers. Sitting next to Dinah on a recent Friday afternoon, Rosenblatt said he volunteers in part to pay homage to and learn from his LGBTQ elders.

“You’ve had experiences that I have not had with bigotry. Where there were a lot of things that I was able to do that you were not able to do, and there’s a lot of things that I was not able to do that people can do today,” Rosenblatt told Dinah.

Last Christmas, a SAGE volunteer helped Gene Dinah put up his Christmas tree. Courtesy Gene Dinah

After his husband died, Dinah said, he was so consumed by grief that he couldn’t manage to put up his Christmas tree for several holiday seasons.

“I just didn’t feel like doing anything for the holidays,” he said. “Grief is a funny thing. It saps your energy.”

Last Christmas, however, that changed, thanks to another SAGE volunteer.

“He got our Christmas tree out, got it working and plugged it in and everything, and that meant everything to me,” Dinah recalled. “The passage of time is a good thing. I know I feel much better now than I did in the beginning.”

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Andrés González

Andrés González is a senior producer with MSNBC.