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LGBTQ elder care facilities open nationwide, but discrimination persists

Advocates say seniors face challenges despite groundbreaking advances

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The Ariadne Getty Foundation Senior Housing facility opened this week in Los Angeles. (Blade file photo)

Marsha Wetzel, an out lesbian, shared her life with her partner of 30 years, Judith Kahn, at the coupleā€™s home in Illinois until Kahn died in 2013 of colon cancer.

As is the case with some same-sex couples who never married, Kahnā€™s family took legal possession of the coupleā€™s home several years later, forcing Wetzel, who suffered from severe arthritis, to move into the Glen St. Andrew Living Community, a retirement and assisted living facility in Niles, Ill.

According to a lawsuit filed on her behalf in 2016 by the LGBTQ litigation group Lambda Legal, when word got out that Wetzel was a lesbian after she disclosed her sexual orientation to a fellow resident, she was called homophobic slurs, spat on, and assaulted on several occasions by other residents of the facility. The lawsuit, which later resulted in a court ruling in Wetzelā€™s favor, charged that officials at the Glen St. Andrew facility illegally failed to take action to prevent Wetzel from being subjected to abuse and threats by fellow residents and retaliated against her when she complained.

Lambda Legal announced one year ago, on Nov. 20, 2020, that Wetzel passed away at the age of 73 of natural causes after a landmark 2018 appeals court ruling in her favor affirmed that residential facilities such as the one in which she lived are legally responsible for the safety of tenant residents.

ā€œMarsha spent the rest of her days in a senior living community where she was out and affirmed,ā€ said Lambda Legal attorney Karen Loewy, who represented Wetzel in the lawsuit.

Advocates for LGBTQ seniors were hopeful that the 2018 U.S. Court of Appeals for the Seventh Circuit ruling in the Wetzel case would speed up the gradual but steady advances in the rights of LGBTQ elders in long-term care facilities and in society in general.

A short time later, the New York City-based national LGBTQ elder advocacy group SAGE expanded its programs providing cultural competency training for the nationā€™s long-term care residential facilities. And in some cities, including New York, Los Angeles, and San Francisco, LGBTQ specific retirement and long-term care facilities began to open to provide LGBTQ elders with a wide range of ā€œwrap aroundā€ services in addition to a safe place to live.

But LGBTQ elder advocates were taken aback in October of this year when news surfaced that transgender U.S. Army veteran Lisa Oakley, 68, was denied placement in more than two-dozen long-term care facilities in Colorado in 2020 and earlier this year.

ā€œWhen they found out I was transgender, a lot of the facilities didnā€™t want me,ā€ Oakley told USA Today. ā€œA lot of transgender people, Iā€™m sure, face the same thing,ā€ she said. ā€œWeā€™re humans, just like everybody else.ā€ 

Oakley told other media outlets her ordeal in trying to gain admission to a residential care facility began in October 2020, when she became unable to care for herself due to complications from diabetes. Her first choice was a facility in her hometown in rural Craig, Colo., where she had lived for the previous 25 years. She believes that facility turned her down because of her gender identity.

A social worker who assisted in Oakleyā€™s applications for long-term care facilities said the facility in Craig said Oakley would have to be placed in a private room, which was at the time unavailable, ā€œbecause she still has her ā€˜boy partsā€™ and cannot be placed with a womanā€ in a shared room. 

Many other Colorado facilities to which Oakley applied for admission, according to social worker Cori Martin-Crawford, cited the COVID pandemic as the reason for not accepting new residents. But as COVID related restrictions began to subside, other facilities continued to deny Oakley admission.

With Martin-Crawfordā€™s help, Oakley finally found a facility that is LGBTQ supportive in Grand Junction, Colo., which is nearly three hours away from her hometown of Craig, where she had hoped to remain.

LGBTQ activists expressed concern that the discrimination that Oakley faced took place in the state of Colorado, which has a state law that bans discrimination based on sexual orientation and gender identity. Experts familiar with long-term care facilities for older adults have said many private elder care facilities can get around state LGBTQ nondiscrimination laws by claiming other reasons for turning down an LGBTQ person.

Michael Adams, the CEO of SAGE, told the Blade that the wide range of programs and initiatives put in place by SAGE and other groups advocating for LGBTQ elders in recent years have resulted in significant changes in support of LGBTQ seniors.

ā€œIt is the case now that in almost all states there are one or more elder care facilities that have been trained through our SAGECare program,ā€ Adams said. ā€œBut itā€™s nowhere near what it needs to be,ā€ he said. ā€œIt needs to be that there are welcoming elder care facilities in every single community in this countryā€ for LGBTQ elders.

Adams was referring to the SAGE program started recently called SAGECare that arranges for employees and other officials at elder care facilities throughout the country to receive LGBTQ competency training. The facilities that participate in the program are designated “SAGECare credentialed,ā€ and are included in SAGE database lists available to LGBTQ elders looking for a safe facility in which to reside.

SAGE spokesperson Christina Da Costa provided the Blade with data showing there have been 136,975 professionals trained at a total of 617 SAGECare credentialed organizations nationwide. Out of 617 organizations, 172 are residential communities. Also, out of the total of 617 are 167 Area Agencies on Aging, Aging and Disability Resource Centers, Senior Centers, and senior Ombudsman offices.

Da Costa said 278 of the credentialed entities that have received the SAGECare training throughout the country are ā€œother aging focused nonprofit and for-profit businesses.ā€

According to SAGE, there are 12 SAGECare credentialed elder care facilities or service providers operating in the D.C. metropolitan area, with two located in D.C. One of the D.C. facilities is Ingleside at Rock Creek, located in Northwest D.C., which is a residential facility. The other is Options for Senior America, a company that provides in-home care services for seniors, including seniors living in D.C.

A SAGE list of the D.C.-area SAGECare credentialed facilities shows that three are in Rockville, Md.; two are in Gaithersburg, Md.; and one each are in Bethesda, Md.; Arlington, Va.; and Alexandria, Va. The list shows that one of them that provides services to elders in the D.C. area is based in North Carolina.

SAGE has a separate list of the 15 elder care residential facilities in the U.S. created specifically to serve LGBTQ residents. 

None are in D.C., Maryland, or Virginia. However, SAGE says it has been working in cooperation with Maryā€™s House for Older Adults, a D.C.-based LGBTQ organization that advocates for LGBTQ seniors and is in the process of opening LGBTQ elder residential facilities in D.C. and others in the surrounding suburbs.

Maryā€™s House founder and CEO Dr. Imani Woody couldnā€™t immediately be reached to determine when the organization expects to open its first residential facility. 

While a residential LGBTQ elder facility has yet to open in the D.C. area, activists note that in addition to Maryā€™s House, services and amenities for LGBTQ elders in the area are currently being provided by the D.C. Center for the LGBT Community and Whitman-Walker Health, the LGBTQ supportive health center, which also has a legal services branch.

Adams of SAGE said the Los Angeles LGBTQ Center opened the nationā€™s first LGBTQ elder residential facility over eight years ago called Triangle Square. He said the L.A. Center opened a second LGBTQ elder residential facility a short time later. And this week, the L.A. Center announced it has opened a third LGBTQ elder residential facility in Hollywood that is part of a larger ā€œintergenerational campusā€ that will bring together LGBTQ seniors and LGBTQ youth. 

SAGE, meanwhile, operates two LGBTQ elder long-term care residential facilities in New York City, one in Brooklyn called the Stonewall House and one in the Bronx called Pride House. 

The other U.S. cities with LGBTQ elder residential facilities include: Philadelphia, Minneapolis, Chicago, Cleveland, San Francisco (which has two such facilities), San Diego, Houston, Fort Lauderdale, and Islip, N.Y.

Adams said the LGBTQ elder residential facilities range in size, with the largest ā€“ New Yorkā€™s Stonewall House ā€“ having 143 apartments that can accommodate 200 residents. He said others vary from 40 or 50 residential units to 120.

Advocates for LGBTQ elders point to what they consider another important breakthrough for LGBTQ elders this year in the release of a joint SAGE-Human Rights Campaign Long-Term Care Equality Index report for 2021. Adams said the report is the first of what could become an annual report and rating and scorecard for long-term care elder residential facilities and other elder facilities. 

The 2021 report includes a self-reporting assessment of elder care facilities that the facilities themselves completed through a questionnaire in which many disclosed they have LGBTQ nondiscrimination policies for elders around admission to the facility and for practices by staff for those residing in their facilities.

The report includes a chart showing that 158 elder care facilities in 31 states responded positively to the outreach to them by organizers of the Long-Term Care Equality Index.

ā€œWe are thrilled to be working with SAGE and to be working with the Human Rights Campaign who are developing the Long-Term Care Equality Index,ā€ said Nii-Quartelai Quartey, who serves as senior adviser and LGBTQ liaison for the American Association of Retired Persons or AARP.

ā€œThere is a great deal of work that weā€™re doing in the area of LGBTQ older adults nationwide,ā€ Quartey told the Blade. ā€œAnd AARP has been engaged with the LGBTQ community nationwide for many years now,ā€ he said.

ā€œIn recent years, weā€™ve turned up the volume in working more closely with organizations like SAGE and Lambda Legal and the Victory Fund Institute, the Center for Black Equity, the National Queer Asian Pacific Islander Alliance, and the Hispanic Federation.ā€

According to Quartey, a recent AARP study of LGBTQ elders called Maintaining Dignity shows that longstanding concerns of discrimination remain despite the many advances in support for LGBTQ seniors in recent years.

He said a survey that was part of the study found that 67 percent of the LGBTQ elders who responded, ā€œwere concerned about neglect in a long-term care setting.ā€ Over 60 percent feared verbal or physical harassment in a long-term care setting and over half ā€œfelt forced to hide or deny their identityā€ as an LGBTQ person, Quartey said.

Another recent survey of LGBTQ elders conducted by SAGE asking them how they feel about the use of the word ā€œqueerā€ in descriptions of LGBTQ people yielded findings that came as a surprise to some, according to Adams. A large majority of those surveyed from across the country said they are ā€œcomfortable at this point using that word and reclaiming that word, which is different from what we had heard historically,ā€ Adams said.

He said in response to those findings SAGE will now as an organization gradually shift to using the term LGBTQ instead of its past practice of using LGBT.

Although Congress has yet to pass the Equality Act, last year under the Trump Administration, Congress acted in a rare bipartisan way to approve the required five-year reauthorization of the U.S. Older Americans Act with new language supportive of LGBTQ older adults. President Trump signed the legislation.

The language includes a mandate for outreach to and reporting about services provided to LGBTQ older adults in federally funded programs. It also opens the way for LGBTQ older adults to be designated in a category of ā€œgreatest social need.ā€ Under that category, older adults receive a higher priority in the allocation of resources by the federal government.

ā€œWeā€™ve come a long way, but we still have a way to go to get over the finish line,ā€ said the AARPā€™s Quartey. ā€œAnd aside from passing legislation federally and on the state and local level, we absolutely need to continue the hard work of changing hearts and minds,ā€ he said.

Longtime gay activist and writer Brian McNaught, whose latest book, ā€œOn Being Gay and Gray ā€“ Our Stories, Gifts, and the Meaning of Our Lives,ā€ was just released, says his own very informal survey of LGBTQ elders found there is a need for intimacy that may be too controversial for the establishment LGBTQ elder groups.

ā€œIā€™m a SAGE volunteer and the 81-year-old man with whom I was working after his husband of 47 years died, said after his grieving process, ā€˜I want to be hugged and kissed. Does that make me a bad person?ā€™ā€

McNaught told the Blade he assured the man those feelings do not make him a bad person. McNaught said the manā€™s comment prompted him to conduct further research, in which he found that some gay male elders in the Fort Lauderdale, Fla., area who often need assisted living support would like to patronize gay bathhouses or seek the services of an escort agency. He said he determined that any LGBTQ elder group providing such services would trigger ā€œa huge uproar of protestsā€ and most likely a loss of funding.

ā€œWe donā€™t want to talk about sexuality and aging,ā€ McNaught said.

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The White House

USCIS announces it now only recognizes ‘two biological sexes’

Immigration agency announced it has implemented Trump executive order

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An American flag flies in front of a privately-run U.S. Immigration and Customs Enforcement detention center in the Southeast U.S. on July 31, 2020. U.S. Citizenship and Immigration Services has announced it now only recognizes "two biological genders, male and female." (Washington Blade photo by Yariel ValdƩs GonzƔlez)

U.S. Citizenship and Immigration Services on Wednesday announced it now only “recognizes two biological sexes, male and female.”

A press release notes this change to its policies is “consistent with” the “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” executive order that President Donald Trump signed shortly after he took office for the second time on Jan. 20.

ā€œThere are only two sexes ā€” male and female,ā€ said DHS spokesperson Tricia McLaughlin in a statement. “President Trump promised the American people a revolution of common sense, and that includes making sure that the policy of the U.S. government agrees with simple biological reality.”

“Proper management of our immigration system is a matter of national security, not a place to promote and coddle an ideology that permanently harms children and robs real women of their dignity, safety, and well-being,ā€ she added.

The press release notes USCIS “considers a personā€™s sex as that which is generally evidenced on the birth certificate issued at or nearest to the time of birth.”

“If the birth certificate issued at or nearest to the time of birth indicates a sex other than male or female, USCIS will base the determination of sex on secondary evidence,” it reads.

The USCIS Policy Manuel defines “secondary evidence” as “evidence that may demonstrate a fact is more likely than not true, but the evidence does not derive from a primary, authoritative source.”

“Records maintained by religious or faith-based organizations showing that a person was divorced at a certain time are an example of secondary evidence of the divorce,” it says.

USCIS in its press release notes it “will not deny benefits solely because the benefit requestor did not properly indicate his or her sex.”

ā€œThis is a cruel and unnecessary policy that puts transgender, nonbinary, and intersex immigrants in danger,” said Immigration Equality Law and Policy Director Bridget Crawford on Wednesday. “The U.S. government is now forcing people to carry identity documents that do not reflect who they are, opening them up to increased discrimination, harassment, and violence. This policy does not just impact individuals ā€” it affects their ability to travel, work, access healthcare, and live their lives authentically.” Ā 

“By denying trans people the right to self-select their gender, the government is making it harder for them to exist safely and with dignity,” added Crawford. “This is not about ā€˜common senseā€™ā€”it is about erasing an entire community from the legal landscape. Transgender, nonbinary, and intersex people have always existed, and they deserve to have their identities fully recognized and respected. We will continue to fight for the rights of our clients and for the reversal of this discriminatory policy.ā€Ā 

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Federal Government

Mass HHS layoffs include HIV/AIDS prevention, policy teams

Democratic states sue over cuts

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HHS Secretary Robert F. Kennedy Jr. (Washington Blade photo by Michael Key)

Tuesday began a series of mass layoffs targeting staff, departments, and whole agencies within the U.S. Department of Health and Human Services under Secretary Robert F. Kennedy Jr., who reportedly plans to cut a total of 10,000 jobs.

On the chopping block, according to reports this week, is the Office of Infectious Disease and HIV/AIDS Policy. A fact sheet explaining on the restructuring says “a new Administration for a Healthy America (AHA) will consolidate the OASH, HRSA, SAMHSA, ATSDR, and NIOSH, so as to more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans.”

The document indicates that “Divisions of AHA include Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce, with support of the U.S. Surgeon General and Policy team.”

“Today, the Trump administration eliminated the staff of several CDC HIV prevention offices, including entire offices conducting public health communication campaigns, modeling and behavioral surveillance, capacity building, and non-lab research,” said a press release Tuesday by the HIV + Hepatitis Policy Institute.

The organization also noted the “reassignments” of Jonathan Mermin, director of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, and Jeanne Marrazzo, director of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases. Both were moved to the Indian Health Service.

ā€œIn a matter of just a couple days, we are losing our nationā€™s ability to prevent HIV,” said HIV + Hepatitis Policy Institute Executive Director Carl Schmid. “The expertise of the staff, along with their decades of leadership, has now been destroyed and cannot be replaced. We will feel the impacts of these decisions for years to come and it will certainly, sadly, translate into an increase in new HIV infections and higher medical costs.”

The group added, “We are still learning the full extent of the staff cuts and do not know how the administrationā€™s announced reorganization of HHS will impact all HIV treatment, prevention, and research programs, including President Trumpā€™s Ending the HIV Epidemic initiative,” but “At the moment, it seems that we are in the middle of a hurricane and just waiting for the next shoe to drop.”

A group of 500 HIV advocates announced a rally planned for Wednesday morning at 8 a.m., at the U.S. Capitol lawn across from the Cannon House Office Building, which aims to urge Congress to help stop the cuts at HHS.

“Over 500 advocates will rally on Capitol Hill and meet with members of Congress and Hill staff to advocate for maintaining a strong HIV response and detail the potential impact of cuts to and reorganization of HIV prevention and treatment programs,” the groups wrote.

The press release continued, “HHS has stated that it is seeking to cut 10,000 employees, among them 2,400 CDC employees, many doing critical HIV work. It also seeks to merge HIV treatment programming into a new agency raising concerns about maintaining resources for and achieving the outstanding outcomes of the Ryan White HIV/AIDS Program.”

On Tuesday a group of Democratic governors and attorneys general from 23 states and D.C. filed a lawsuit against HHS and Kennedy seeking a temporary restraining order and injunctive relief to halt the funding cuts.

U.S. Centers for Disease Control and Prevention withdrew approximately $11.4 billion in funding for state and community health departments during the COVID-19 pandemic response, along with $1 billion to the Substance Abuse and Mental Health Services Administration.

ā€œSlashing this funding now will reverse our progress on the opioid crisis, throw our mental health systems into chaos, and leave hospitals struggling to care for patients,ā€ New York Attorney General Letitia James said.  

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State Department

Former US envoy for global LGBTQ, intersex rights slams Trump

Former President Joe Biden appointed Jessica Stern in 2021

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Jessica Stern, the former special U.S. envoy for the promotion of LGBTQ and intersex rights abroad, center, speaks outside the U.N. Security Council on March 20, 2023 (Washington Blade photo by Michael K. Lavers)

Jessica Stern, the former special U.S. envoy for the promotion of LGBTQ and intersex rights, says the work that she and her colleagues did under the Biden-Harris administration is “being systematically dismantled.”

“As the person who was responsible for leading U.S. foreign policy on LGBTQI+ issues, it’s been very difficult for the past two months to see that work being systematically dismantled,” she told the Washington Blade on March 19 during a telephone interview.

Stern was the executive director of Outright International, a global LGBTQ and intersex advocacy group, when then-President Joe Biden appointed her in June 2021.

The promotion of LGBTQ and intersex rights was a cornerstone of the Biden-Harris administration’s overall foreign policy. These efforts specifically included the decriminalization of consensual same-sex sexual relations and marriage equality efforts in countries where activists said they were possible through the legislative or judicial processes.

The Trump-Vance administration’s decision to freeze most U.S. foreign aid spending for at least 90 days has had a devastating impact on the global LGBTQ and intersex rights movement. President Donald Trump’s executive order that bans the State Department from issuing passports with “X” gender markers has prompted Germany and several other European countries to issue travel advisories for transgender and nonbinary people who are planning to visit the U.S.

Stern said the Trump-Vance administration “has studied the anti-LGBTQI strategies of other countries and basically imported the worst ideas from around the world: The most violent, the most dehumanizing, the most targeting strategies.” Stern added these policies have emboldened Hungarian Prime Minister Viktor OrbĆ”n, Russian President Vladimir Putin, Argentine President Javier Milei and other anti-LGBTQ heads of state.

“It’s one thing when a small country that has limited global reach implements anti-LGBTQI laws and policies. It’s another thing when one of the world’s superpowers does so,” Stern told the Blade. “There’s no question that the U.S.’s regression on LGBTQI rights is actually going to accelerate backlash against LGBTQI people around the world.”

“We provide political legitimacy to those ideas, but also we’re forging new alliances and coalitions, and we’re pushing these ideas on other countries,” she added. “So, it’s not a passive action. The U.S. government currently is actively funding and disseminating anti-LGBTQI hatred around the world.”

Former State Department colleagues ‘afraid every day’

The Trump-Vance administration in a Feb. 3 statement that defended its efforts to dismantle the U.S. Agency for International Development noted examples of the organization’s “waste and abuse” included $2 million for “sex changes and ‘LGBT activism'” in Guatemala and $1.5 million to “advance diversity, equity and inclusion in Serbia’s workplaces and business communities.” Secretary of State Marco Rubio last month said 83 percent of USAID contracts have been cancelled, and the remaining will “now be administered more effectively under the State Department.”

Rubio after the Trump-Vance administration froze nearly all U.S. foreign aid spending issued a waiver that allowed the President’s Emergency Plan for AIDS Relief and other “life-saving humanitarian assistance” programs to continue to operate.

The Blade has previouslyĀ reportedĀ PEPFAR-funded programs in Kenya, South Africa, and elsewhere have suspended services and even shut down because of a lack of U.S. funding. UNAIDS Executive Director Winnie Byanyima on March 24 said 6.3 million more people around the world will die of AIDS-related complications over the next four years if the U.S. does not fully restore its foreign assistance.

Stern said her former State Department colleagues are “afraid every day.”

“They never know, ‘Am I going to be fired today?’ “Am I going to be put on administrative leave?’,” she said. “I cannot even imagine what it’s like to go to work every day.”

Stern told the Blade her former colleagues tell her that “there’s not a lot of foreign policy work happening because there’s so much disruption being caused by DOGE (the Department of Government Efficiency).”

“Entire departments have been decimated,” she said, noting one of them has lost 60 people. “It’s almost inconceivable to figure out how to restructure your work when your resources have been decimated.”

Jessica Stern speaks at an LGBTQ+ Victory Institute co-organized conference in Mexico City on July 20, 2023. (Washington Blade photo by Michael K. Lavers)

Stern described herself as “an eternal optimist” when the Blade asked whether she thinks the U.S. can ever stand for LGBTQ and intersex rights abroad.

“You have to believe in human rights,” she said.

Stern said former Secretary of State Antony Blinken as “an ally on LGBTQI issues.” Stern also said many of her now former State Department colleagues thanked her and her team for their work before they left government.

“There’s so much compassion from straight and cisgendered allies, from career officials, people that are not human rights experts or specialists, people that don’t focus on the well-being of LGBTQI people, but people that care very much about the United States standing for its values, the rule of law, equality for all, and this notion that it is in our national interest to ensure that there is safety, prosperity, and well-being for people around the world,” she said.

“The situation we find ourselves in will not last forever,” added Stern. “What we have to do is figure out how to hold the line right now, and how to organize for the future.”

She stressed ways to “hold the line” include litigation, protests, letters-to-the-editor, demanding accountability from lawmakers.

“There’s so much to do,” said Stern.

Then-Secretary of State Antony Blinken speaks at a World AIDS Day event hosted by the Business Council for International Understanding on Dec. 2, 2022. (Screen capture via U.S. Department of State YouTube)

Stern is currently teaching at Columbia University’s School of International and Public Affairs, and is writing about her experience as the “first-ever human rights expert to be the special U.S. envoy for LGBTQI rights.” Stern also told the Blade that she is working to launch a new organization.

“I love being an activist again,” she said. “If there was ever a time when activists are needed, it’s now.”

“I am really proud to have rejoined the resistance,” added Stern.

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