By Anne Mironchik, MS, CCC-SLP
Speech-Language Pathologist
LSVT LOUD Certified Therapist
Pennsylvania – Lehigh Valley

It’s been over 50 years since police raided a popular gay bar in NYC. Raids at the time typically included beating and arresting patrons. This treatment was routine for the 1960s until one particular night on June 28, 1969, known as “The Stonewall Uprising.” Stonewall resulted in a rebellion and a series of demonstrations prompted by the rallying cry, “Why don’t you guys do something?” In reality, by the 1960s, LGBTQ+ people had already begun doing many things—and helped advance the causes for gay rights throughout their lifetime. 

Since Stonewall, they have taken extraordinary steps that have brought us from riots to gay marriage to openly gay public servants holding public office. With many individuals from this era well into retirement, is the healthcare system ready to serve this population? What education and experience do we need to address the needs of the LGBTQ+ community fully? 

Let’s start by looking at the history of gay rights to help us understand its impact on overcoming the challenges of receiving quality health care, how gay rights overlap with civil rights and women’s rights, and how best to move forward in serving older adults in the LGBTQ+ community.

Understanding the Experiences of the LGBTQ+ Community

When studying the gay rights movement in America, researchers often refer to Stonewall as the event that propelled gay rights activism to a national level. The Stonewall Inn was a gay and lesbian bar in the New York City neighborhood of Greenwich Village and was frequently raided by police. At the time, laws were in effect that prohibited sex between gay men. Before we continue with the history, stop and think about the healthcare implications of that. Suppose you were gay at the time and had reproductive health issues or any health issues for that matter. How terrifying would it have been to seek medical attention for your problem if your intimate life was deemed illegal? 

By the end of the 1960s, Stonewall’s patrons were emboldened, partly because of the civil rights movement, to seek justice for what they believed was their right to live their lives peacefully. By addressing social, legal, economic, and healthcare inequities, gay rights advocates began to improve how the world perceived and treated people who expressed an orientation other than heterosexuality.

Once activists in cities like New York City and San Francisco began advocating for the rights of gay people to be treated fairly, there was a remarkable trajectory for more acceptance in the general population. The timeline for acceptance is varied and complex. Still, part of the acceptance among the wider heterosexual population is that gay individuals are members of our families, owners of the business we patronize, and our fellow worshipers. They are embedded in every community across the entire country. 

This personal contact helped the general population more widely accept and eventually support gay rights. In 2003 the Supreme Court struck down state laws against consensual, same-sex relations. Yet despite (some) individuals believing that gender discrimination laws are unconstitutional, and despite the number of Americans who think that homosexuality should not be a criminal offense (dropping from 56 percent in 1986 to 18 percent in 2021), 12 states still have such laws on their books. 

Strangely, gay rights are not always all-inclusive, and we still see today how embracing the rights of “TQ+” lags behind that of LGB. The efforts to improve LGBTQ+ rights continue, including the need for clinicians in our field to advocate and educate for improved healthcare for all our non-heterosexual patients.

Gay, trans, and non-binary patients choose their providers very carefully. They often rely on word-of-mouth and advocacy organizations or trusted colleagues to suggest a provider. As noted in the LGBTEI, community members want and need providers with more than just good intentions. They want what any patient wants: providers who are “experienced, competent, safe, welcoming, and culturally sensitive.” 

Finding those providers is difficult enough when you’re young and can travel easily to get to your appointments. It becomes even more difficult for older adults who have difficulty traveling or live in areas where they feel uncomfortable or unsafe discussing their health background with new providers.

How Can Senior Living Communities Best Care for LGBTQ+ Residents?

As clinicians, what must we do to educate ourselves and gain the experience required to serve this population? The answer to this question can be surprising to clinicians who haven’t had the opportunity to work with patients in the LGBTQ+ community. Here is what some experts say about creating a welcoming environment for treating and healing our LGBTQ+ patients.

• Become an educated provider.
• Use inclusive terms consistently in all printed and online material.
• Use the name of the patient they use for themselves.
• Post information prominently about inclusive practices in your facility.
• Participate in LGBTQ+ events and celebrations in your community.
• List your services in the resources used by LGBTQ+ patients.

Connecting with others different from our own culture and experiences in peaceful, supportive ways can help bridge differences and create a welcoming environment. While we address the needs of treating people in the gay community, it does not erase the need to continue to address the needs of treating the elderly in other groups of people who experience barriers to quality rehab care.  

We have all seen, read about, and understand the implicit bias toward older adults of color, women, and the poor or uninsured. It reminds us that treating people from diverse backgrounds or combinations of backgrounds ultimately means we must treat each patient as an individual. 

LGBTQ+ Resources for Rehabilitation Healthcare Providers

Creating a safe space for older adults in the LGBTQ+ community takes effort from clinicians and senior living community staff. While this article seeks to give you a good starting point, there are plenty of additional resources you can explore. Here are some places to start:

• LGBT Elder Initiative 
• SAGE
• National Resource Center for the Aging 
• A Practical Guide To Creating Welcoming Agencies 
• Eastern PA Trans Equity Project
• Speech-Language Pathologists’ Knowledge and Attitudes Regarding Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Populations
• Knowledge, Training, and Attitudes of Students and Speech-Language Pathologists About Providing Communication Services to Individuals Who Are Transgender
• Interview from Advocate: This Trans Elder Is Changing Lives With Her “Ministry of Presence”