SAGE: Advocacy & Services for LGBT Elders
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Cultural Competence

Research suggests that LGBT older adults are less likely than their heterosexual peers to access aging services and to reach out to providers, senior centers, meal programs and other entitlement programs because they fear discrimination or harassment if their sexual orientations or gender identities become known.

Our experience shows that many LGBT older adults access aging service agencies but choose to remain closeted about their sexual orientations or gender identities, often referring to partners, significant others or loved ones as a "friend," "roommate," or "sibling." In some instances, an LGBT elder might only seek assistance for emergency care, which can be costly to his/her health and to the health care system. In the face of these challenges, a growing number of aging and health providers are seeking training on LGBT cultural competence that equips their staff with the skills to engage this at-risk population.

Key Facts

The effects of a lifetime of stigma and discrimination can put many LGBT older adults at a greater risk for physical and mental distress, social isolation, depression and anxiety, poverty, chronic illness, delayed care-seeking, poor nutrition and premature mortality—according to the literature on these topics. Further, the fear of encountering an unwelcoming health care provider can lead many LGBT elders to delay seeking necessary care or make them reluctant to disclose their sexual orientations or gender identities to health care providers, which can compromise their patient care plans.

This overarching fear of aging and health providers might be heightened among transgender older adults. In a 2011 study conducted by the National Gay and Lesbian Task Force and the National Center for Transgender Equality, 50 percent of respondents reported having to teach their medical providers about transgender care. Additionally, when they were sick or injured, 28 percent of respondents reported that they postponed medical care to avoid discrimination. Read more about the issues facing transgender elders.

LGBT cultural competence training creates more inclusive environments for all elders, including LGBT older people—yet it's offered by few aging providers. A recent nationwide study of area agencies on aging found that agencies whose staff had received some form of LGBT training were twice as likely to receive a request to help an LGB individual and three times as likely to receive a request to help a transgender older adult. Additionally, more than half of the agencies have offered or funded staff training about LGBT aging, yet only one agency is providing services and outreach targeted to the LGBT community and only two agencies had received a request to assist an LGBT older person in the previous year.

Even providers who know that they engage LGBT clients report not knowing how to effectively serve these elders in a culturally competent way. For example, research shows that very few agencies and professionals that serve elders have received any training on LGBT cultural competence. In contrast, an evaluation of the National Resource Center on LGBT Aging's original LGBT cultural competence training program found an increase in skills and knowledge on LGBT aging issues among mainstream aging providers.

SAGE’s Work

A premier, evidence-based LGBT cultural competence training from SAGE. Established in 2010 through a federal grant from the U.S. Department of Health and Human Services, SAGE's National Resource Center on LGBT Aging offers training nationwide on the various issues affecting LGBT older people. The center also maintains a unique online clearinghouse of educational resources on LGBT aging. Learn more about this historic resource.

To learn more about SAGE's work on cultural competence please contact Hilary Meyer, Director, SAGE's National Resource Center on LGBT Aging, at 212-741-2247 or at

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