This article was downloaded by: [University of Western Ontario] On: 10 February 2015, At: 09:25 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Homosexuality Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjhm20
Friends, Family, and Caregiving Among Midlife and Older Lesbian, Gay, Bisexual, and Transgender Adults a
b
Catherine F. Croghan MS MPH RN , Rajean P. Moone PhD & Andrea M. Olson PhD
c
a
Croghan Consulting , Roseville , Minnesota , USA
b
Greater Twin Cities United Way , Minneapolis , Minnesota , USA
c
Click for updates
Psychology Department , St. Catherine University , St. Paul , Minnesota , USA Accepted author version posted online: 28 Aug 2013.Published online: 07 Dec 2013.
To cite this article: Catherine F. Croghan MS MPH RN , Rajean P. Moone PhD & Andrea M. Olson PhD (2014) Friends, Family, and Caregiving Among Midlife and Older Lesbian, Gay, Bisexual, and Transgender Adults, Journal of Homosexuality, 61:1, 79-102, DOI: 10.1080/00918369.2013.835238 To link to this article: http://dx.doi.org/10.1080/00918369.2013.835238
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Homosexuality, 61:79–102, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0091-8369 print/1540-3602 online DOI: 10.1080/00918369.2013.835238
Friends, Family, and Caregiving Among Midlife and Older Lesbian, Gay, Bisexual, and Transgender Adults
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
CATHERINE F. CROGHAN, MS, MPH, RN Croghan Consulting, Roseville, Minnesota, USA
RAJEAN P. MOONE, PhD Greater Twin Cities United Way, Minneapolis, Minnesota, USA
ANDREA M. OLSON, PhD Psychology Department, St. Catherine University, St. Paul, Minnesota, USA
The study examines the frequency and nature of the informal caregiving experience for midlife and older lesbian, gay, bisexual, or transgender (LGBT) adults. Responses from a Twin Cities Metropolitan Area LGBT aging needs assessment survey were analyzed for social supports, current caregiving activity and availability of a caregiver. The majority of respondents identified a primary caregiver who was not a legal relation; and compared to the general population were (a) less likely to have traditional sources of caregiver support and (b) more likely to be serving as a caregiver and caring for someone to whom they were not legally related. Implications of the findings for enhancing resources to more fully support the 10% of caregivers that are caring for non-kin are discussed. KEYWORDS aging, caregiver, homosexual, LGBT, non-kin
Although only 5% of older adults reside in a skilled nursing facility or nursing home (Hillier & Barrow, 2010), placement in a nursing home remains one of the primary fears of the American public. Having a family caregiver is a key indicator for remaining in your home and in your community (Miller & Weissert, 2000; Spillman & Long, 2009). Family caregiving, in contrast to Address correspondence to Catherine F. Croghan, Croghan Consulting, 1961 Midland Hills Rd., Roseville, MN 55113, USA. E-mail: [email protected] 79
80
C. F. Croghan et al.
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
formal caregiving, is the unpaid assistance of any relative, partner, friend or neighbor who provides a broad range of assistance for an older adult or an adult with chronic or disabling conditions (AARP, 2011). In 2009 an estimated 61.6 million U.S. family caregivers provided care valued at $450 billion. This unpaid care is a central feature of the overall United States long-term social services and health care plan for maintaining the fast-growing population of older adults in the community. As a result, there is considerable interest in development of policies, programs and services that will sustain caregivers in their critical roles. What does this mean for lesbian, gay, bisexual, or transgender (LGBT) caregivers?
FAMILY FACTORS Family caregiving for older adults is primarily a female activity, with 85% done by wives, and adult daughters and daughter-in-laws (National Alliance for Caregiving & AARP, 2011) and usually follows a hierarchical pattern with assistance sought first from spouses followed by adult children, other relatives and finally neighbors and friends (Shanas, 1980). This order reflects traditional family patterns and is less appropriate for LGBT older adults (Barker, Herdt, & de Vries, 2006) who are less likely to have children and partners than the larger population (Adelman, Gurevich, de Vries, & Blando, 2006; Beeler, Rawls, Herdt, & Cohler, 1999; Cantor, Brennan, & Shippy, 2004; Croghan, Mertens, Yoakam, & Edwards, 2003; de Vries, 2006; Fredriksen, 1999; Grossman, d’Augelli, & Hershberger, 2000; MetLife, 2010) and who cannot marry a same-sex partner in most States (National Gay and Lesbian Task Force, 2012). Further, some LGBT adults lack the support of extended biological families due to the stresses or estrangement associated with the coming out process (Cantor et al., 2004; de Vries & Hoctel, 2006; Witten, 2009). Due to a lack of biological and legal family to provide support, many older LGBT individuals will rely on friends to sustain them in the community. A common feature of LGBT culture is the "chosen family" which comprises people with whom you feel close and consider family even though they are not biologically or legally related to you (MetLife, 2010). The MetLife study of LGBT baby boomers found 64% reported having a family of choice.
SERVICE PROVIDER READINESS TO WORK WITH LGBT CLIENTS These families of choice often form the caregiving networks that support LGBT older adults in the community (de Vries, 2011). However, LGBT care recipients and caregivers may find a service provider network that is ill
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
LGBT Friends, Family, and Caregiving
81
prepared to meet their needs. A 2010 national survey of Area Agencies on Aging (AAAs; Knochel, Croghan, Moone, & Quam, 2012) found < 13% of AAAs conducted outreach to the LGBT community, < 8% reported LGBT targeted services and about one-third had staff trained in LGBT aging issues. Sixty percent did not believe there was a need to address issues specific to LGBT people, and while approximately three-fourths believed LGBT people would be welcomed by local senior service providers, the balance did not believe they would be welcomed or were unsure of a positive welcome. A national survey of nursing home social service directors found only 24% had received at least 1 hr of training about homophobia in the previous five years (Bell, Bern-Klug, Kramer, & Saunders, 2010). At major national conferences of aging service providers, opportunities for education on LGBT aging has also been minimal (Moone & Cagle, 2011). Multiple local and regional studies suggest only a minority of providers are prepared to work with LGBT clients (Knochel, Quam, & Croghan, 2011; Logie et al., 2008; Willingin, Salvador, & Kanan, 2006).
NON-KIN CAREGIVING The overall lack of service provider readiness to work with LGBT clients may be exacerbated by the high rate of non-kin caregiving in the LGBT community. Approximately ten percent of U.S. caregiving is provided by someone not legally related to the care receiver (Barker, 2002). This rate is considerably higher for the LGBT community due to non-heteronormative family structures. Fredriksen-Goldsen et al. (2011) reported 27% of LGBT adults 50 and older were serving as caregivers. This included 35% providing care to a partner or spouse, 32% caring for a friend and 7% caring for some other non-related persons such as a neighbor. The MetLife (2010) study of LGBT baby boomers found 21% serving as caregivers of whom 34% caring for a partner or spouse, 21% caring for a friend and 6% caring for a neighbor or someone else. Caregiving can have a number of negative effects on the caregiver including their financial position, retirement security, social relations, careers, and physical and emotional health (AARP, 2011). The associated high levels of caregiver stress result in poor outcomes for both the caregiver and care receiver and are strong predictors of nursing home placement (Spillman & Long, 2009). Non-kin caregivers and their care recipients experience added stress due to the limited support resources available to them. Although the National Family Caregiver Support Act provides for assistance to all primary caregiver regardless of relationship, many federal and state laws and policies are reserved for caregivers caring for someone to whom they are legally related. These include coverage under the Family Medical Leave Act,
82
C. F. Croghan et al.
equivalent Medicaid spend-downs, Social leave (Fredriksen-Goldsen & Hoy-Ellis, durable powers of attorney for health cuted to ensure that wishes of non-kin honored.
Security benefits and bereavement 2007). Legal documents such as care and wills need to be execaregivers and care receivers are
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
FEAR OF ACCESSING SERVICES In addition to interacting with a service provider network that may not be ready to work with them, LGBT caregivers may be reluctant to seek services or disclose their LGBT identities when seeking services due to fear of receiving poor quality services or being denied services. Multiple surveys in Australia, Canada and the United States suggest LGBT adults do not believe they will be welcomed or receive high quality services when accessing aging services if their sexual orientation or gender identity were known (Brotman, Ryan, & Cormier, 2003; Croghan et al., 2003; de Vries, 2006; Hughes, 2009). This anticipation of discrimination may result from personal experiences or those shared by their personal network (Brotman et al., 2007). In addition to LGBT clients not being confident of a welcoming service provider environment, non-LGBT specific survey respondents have indicated they too are unsure that LGBT individuals will receive appropriate care. Jackson, Johnson, and Roberts (2008) reported the majority of both heterosexual and LGB survey participants believed long-term care residents and staff would discriminate based on sexual orientation. A 2007 survey of AAA service providers in Minneapolis–St. Paul found 38% believed lesbian and gay older adults would not be welcomed at local senior centers (Knochel et al., 2011).
RELUCTANCE TO DISCLOSE Delivery of quality services to LGBT caregivers may also be hindered by the reluctance of LGBT clients to disclose their sexual orientation or gender identity due to fear of discrimination when seeking social and health services. de Vries’s (2006) review of multiple U.S. and Canadian LGBT community surveys showed up to 24% did not disclose their sexual orientation to service providers, or rarely discussed it. The Caring and Aging with Pride Project (Fredriksen-Goldsen et al., 2011) found 11% of LGBT respondents had not told their primary physician about their sexual orientation or gender identity. A national survey of transgender individuals found 28% of respondents had postponed health care due to fears of discrimination (Grant, Mottet, & Tanis, 2010). Cantor et al. (2004) studying LGBT caregivers in New York City report 50% did not disclose sexual orientation to service providers.
LGBT Friends, Family, and Caregiving
83
Disclosure of sexual orientation to a medical provider has been shown to be positively linked to regular health care use (Steele, Tinmouth, & Lu, 2006). The failure to disclose makes LGBT people invisible to service providers (Brotman et al., 2003; Clark, Landers, Linde, & Sperber, 2001; Fredriksen-Goldsen et al., 2011; Jackson et al., 2008) and, therefore, limits their ability to deliver appropriate services and medical care specific to the client.
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
PURPOSE AND RATIONALE Even with previous studies detailing trends in LGBT caregiving, much is still unknown about the diversity of the LGBT caregiving experience. This study sheds additional light on the frequency and nature of caregiving within the LGBT community at midlife and older ages. The data used in this study were derived from a 2012 Twin Cities Metropolitan Statistical Area (MSA; U.S. Census Bureau, 2012) LGBT aging needs assessment survey that was intended to generate information for use in local planning (Croghan, Moone, & Olson, 2012). Responses from individuals 48 years old (the youngest baby boomers) and older were included in this study.
METHOD Participants A total of 792 people responded to the survey and ranged in age from 18 to 85 years old. Of those, 242 (31%) were younger than 48 and were, thus, excluded for the purposes of this study. Of the remaining 551 respondents, 56 participants were excluded if they reported a zip code outside of the Twin Cities MSA, or if they reported they were both cisgender1 and heterosexual. The final sample consisted of 495 participants. Three in ten respondents (29.7%; n = 147) were 48 to 54 years old, 45.5% (n = 225) were between the ages of 55 and 64 years old, 20.4% (n = 101) were 65 to 74 years of age, and 4.4% (n = 22) were 75 and older (see Table 1). Nine percent (n = 45) were bisexual, 46.7% (n = 231) were lesbians, 38.7% (n = 191) were gay men, and 5.3% (n = 26) were queer/other. Nine in 10 (90.1%) were cisgender, including 247 women and 199 men. Approximately 10% were transgender, including 31 women, 16 men, and 2 non-male/female identified individuals. The sample was predominantly White, non-Latino (93.2%), and most participants had a Bachelor of Arts/Bachelor of Science or more formal education (80.8%). Less than one-third were retired (29%). Less than 1 in 10 (7.5%) reported household incomes under $20,000, and more than one-fourth (26.5%) reported a household income of $100,000 or more.
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TABLE 1 Sample Demographics
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
Variable Gender identity Transgender woman Transgender man Transgender other Cisgender woman Cisgender man Sexual orientation Gay man Lesbian Bisexual woman Bisexual man Queer/other Heterosexual Age 48–54 years 55–64 years 65–74 years >74 years Relationship status Single Partnered/married Widowed Education
Journal of Homosexuality Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjhm20
Friends, Family, and Caregiving Among Midlife and Older Lesbian, Gay, Bisexual, and Transgender Adults a
b
Catherine F. Croghan MS MPH RN , Rajean P. Moone PhD & Andrea M. Olson PhD
c
a
Croghan Consulting , Roseville , Minnesota , USA
b
Greater Twin Cities United Way , Minneapolis , Minnesota , USA
c
Click for updates
Psychology Department , St. Catherine University , St. Paul , Minnesota , USA Accepted author version posted online: 28 Aug 2013.Published online: 07 Dec 2013.
To cite this article: Catherine F. Croghan MS MPH RN , Rajean P. Moone PhD & Andrea M. Olson PhD (2014) Friends, Family, and Caregiving Among Midlife and Older Lesbian, Gay, Bisexual, and Transgender Adults, Journal of Homosexuality, 61:1, 79-102, DOI: 10.1080/00918369.2013.835238 To link to this article: http://dx.doi.org/10.1080/00918369.2013.835238
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Homosexuality, 61:79–102, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0091-8369 print/1540-3602 online DOI: 10.1080/00918369.2013.835238
Friends, Family, and Caregiving Among Midlife and Older Lesbian, Gay, Bisexual, and Transgender Adults
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
CATHERINE F. CROGHAN, MS, MPH, RN Croghan Consulting, Roseville, Minnesota, USA
RAJEAN P. MOONE, PhD Greater Twin Cities United Way, Minneapolis, Minnesota, USA
ANDREA M. OLSON, PhD Psychology Department, St. Catherine University, St. Paul, Minnesota, USA
The study examines the frequency and nature of the informal caregiving experience for midlife and older lesbian, gay, bisexual, or transgender (LGBT) adults. Responses from a Twin Cities Metropolitan Area LGBT aging needs assessment survey were analyzed for social supports, current caregiving activity and availability of a caregiver. The majority of respondents identified a primary caregiver who was not a legal relation; and compared to the general population were (a) less likely to have traditional sources of caregiver support and (b) more likely to be serving as a caregiver and caring for someone to whom they were not legally related. Implications of the findings for enhancing resources to more fully support the 10% of caregivers that are caring for non-kin are discussed. KEYWORDS aging, caregiver, homosexual, LGBT, non-kin
Although only 5% of older adults reside in a skilled nursing facility or nursing home (Hillier & Barrow, 2010), placement in a nursing home remains one of the primary fears of the American public. Having a family caregiver is a key indicator for remaining in your home and in your community (Miller & Weissert, 2000; Spillman & Long, 2009). Family caregiving, in contrast to Address correspondence to Catherine F. Croghan, Croghan Consulting, 1961 Midland Hills Rd., Roseville, MN 55113, USA. E-mail: [email protected] 79
80
C. F. Croghan et al.
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
formal caregiving, is the unpaid assistance of any relative, partner, friend or neighbor who provides a broad range of assistance for an older adult or an adult with chronic or disabling conditions (AARP, 2011). In 2009 an estimated 61.6 million U.S. family caregivers provided care valued at $450 billion. This unpaid care is a central feature of the overall United States long-term social services and health care plan for maintaining the fast-growing population of older adults in the community. As a result, there is considerable interest in development of policies, programs and services that will sustain caregivers in their critical roles. What does this mean for lesbian, gay, bisexual, or transgender (LGBT) caregivers?
FAMILY FACTORS Family caregiving for older adults is primarily a female activity, with 85% done by wives, and adult daughters and daughter-in-laws (National Alliance for Caregiving & AARP, 2011) and usually follows a hierarchical pattern with assistance sought first from spouses followed by adult children, other relatives and finally neighbors and friends (Shanas, 1980). This order reflects traditional family patterns and is less appropriate for LGBT older adults (Barker, Herdt, & de Vries, 2006) who are less likely to have children and partners than the larger population (Adelman, Gurevich, de Vries, & Blando, 2006; Beeler, Rawls, Herdt, & Cohler, 1999; Cantor, Brennan, & Shippy, 2004; Croghan, Mertens, Yoakam, & Edwards, 2003; de Vries, 2006; Fredriksen, 1999; Grossman, d’Augelli, & Hershberger, 2000; MetLife, 2010) and who cannot marry a same-sex partner in most States (National Gay and Lesbian Task Force, 2012). Further, some LGBT adults lack the support of extended biological families due to the stresses or estrangement associated with the coming out process (Cantor et al., 2004; de Vries & Hoctel, 2006; Witten, 2009). Due to a lack of biological and legal family to provide support, many older LGBT individuals will rely on friends to sustain them in the community. A common feature of LGBT culture is the "chosen family" which comprises people with whom you feel close and consider family even though they are not biologically or legally related to you (MetLife, 2010). The MetLife study of LGBT baby boomers found 64% reported having a family of choice.
SERVICE PROVIDER READINESS TO WORK WITH LGBT CLIENTS These families of choice often form the caregiving networks that support LGBT older adults in the community (de Vries, 2011). However, LGBT care recipients and caregivers may find a service provider network that is ill
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
LGBT Friends, Family, and Caregiving
81
prepared to meet their needs. A 2010 national survey of Area Agencies on Aging (AAAs; Knochel, Croghan, Moone, & Quam, 2012) found < 13% of AAAs conducted outreach to the LGBT community, < 8% reported LGBT targeted services and about one-third had staff trained in LGBT aging issues. Sixty percent did not believe there was a need to address issues specific to LGBT people, and while approximately three-fourths believed LGBT people would be welcomed by local senior service providers, the balance did not believe they would be welcomed or were unsure of a positive welcome. A national survey of nursing home social service directors found only 24% had received at least 1 hr of training about homophobia in the previous five years (Bell, Bern-Klug, Kramer, & Saunders, 2010). At major national conferences of aging service providers, opportunities for education on LGBT aging has also been minimal (Moone & Cagle, 2011). Multiple local and regional studies suggest only a minority of providers are prepared to work with LGBT clients (Knochel, Quam, & Croghan, 2011; Logie et al., 2008; Willingin, Salvador, & Kanan, 2006).
NON-KIN CAREGIVING The overall lack of service provider readiness to work with LGBT clients may be exacerbated by the high rate of non-kin caregiving in the LGBT community. Approximately ten percent of U.S. caregiving is provided by someone not legally related to the care receiver (Barker, 2002). This rate is considerably higher for the LGBT community due to non-heteronormative family structures. Fredriksen-Goldsen et al. (2011) reported 27% of LGBT adults 50 and older were serving as caregivers. This included 35% providing care to a partner or spouse, 32% caring for a friend and 7% caring for some other non-related persons such as a neighbor. The MetLife (2010) study of LGBT baby boomers found 21% serving as caregivers of whom 34% caring for a partner or spouse, 21% caring for a friend and 6% caring for a neighbor or someone else. Caregiving can have a number of negative effects on the caregiver including their financial position, retirement security, social relations, careers, and physical and emotional health (AARP, 2011). The associated high levels of caregiver stress result in poor outcomes for both the caregiver and care receiver and are strong predictors of nursing home placement (Spillman & Long, 2009). Non-kin caregivers and their care recipients experience added stress due to the limited support resources available to them. Although the National Family Caregiver Support Act provides for assistance to all primary caregiver regardless of relationship, many federal and state laws and policies are reserved for caregivers caring for someone to whom they are legally related. These include coverage under the Family Medical Leave Act,
82
C. F. Croghan et al.
equivalent Medicaid spend-downs, Social leave (Fredriksen-Goldsen & Hoy-Ellis, durable powers of attorney for health cuted to ensure that wishes of non-kin honored.
Security benefits and bereavement 2007). Legal documents such as care and wills need to be execaregivers and care receivers are
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
FEAR OF ACCESSING SERVICES In addition to interacting with a service provider network that may not be ready to work with them, LGBT caregivers may be reluctant to seek services or disclose their LGBT identities when seeking services due to fear of receiving poor quality services or being denied services. Multiple surveys in Australia, Canada and the United States suggest LGBT adults do not believe they will be welcomed or receive high quality services when accessing aging services if their sexual orientation or gender identity were known (Brotman, Ryan, & Cormier, 2003; Croghan et al., 2003; de Vries, 2006; Hughes, 2009). This anticipation of discrimination may result from personal experiences or those shared by their personal network (Brotman et al., 2007). In addition to LGBT clients not being confident of a welcoming service provider environment, non-LGBT specific survey respondents have indicated they too are unsure that LGBT individuals will receive appropriate care. Jackson, Johnson, and Roberts (2008) reported the majority of both heterosexual and LGB survey participants believed long-term care residents and staff would discriminate based on sexual orientation. A 2007 survey of AAA service providers in Minneapolis–St. Paul found 38% believed lesbian and gay older adults would not be welcomed at local senior centers (Knochel et al., 2011).
RELUCTANCE TO DISCLOSE Delivery of quality services to LGBT caregivers may also be hindered by the reluctance of LGBT clients to disclose their sexual orientation or gender identity due to fear of discrimination when seeking social and health services. de Vries’s (2006) review of multiple U.S. and Canadian LGBT community surveys showed up to 24% did not disclose their sexual orientation to service providers, or rarely discussed it. The Caring and Aging with Pride Project (Fredriksen-Goldsen et al., 2011) found 11% of LGBT respondents had not told their primary physician about their sexual orientation or gender identity. A national survey of transgender individuals found 28% of respondents had postponed health care due to fears of discrimination (Grant, Mottet, & Tanis, 2010). Cantor et al. (2004) studying LGBT caregivers in New York City report 50% did not disclose sexual orientation to service providers.
LGBT Friends, Family, and Caregiving
83
Disclosure of sexual orientation to a medical provider has been shown to be positively linked to regular health care use (Steele, Tinmouth, & Lu, 2006). The failure to disclose makes LGBT people invisible to service providers (Brotman et al., 2003; Clark, Landers, Linde, & Sperber, 2001; Fredriksen-Goldsen et al., 2011; Jackson et al., 2008) and, therefore, limits their ability to deliver appropriate services and medical care specific to the client.
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
PURPOSE AND RATIONALE Even with previous studies detailing trends in LGBT caregiving, much is still unknown about the diversity of the LGBT caregiving experience. This study sheds additional light on the frequency and nature of caregiving within the LGBT community at midlife and older ages. The data used in this study were derived from a 2012 Twin Cities Metropolitan Statistical Area (MSA; U.S. Census Bureau, 2012) LGBT aging needs assessment survey that was intended to generate information for use in local planning (Croghan, Moone, & Olson, 2012). Responses from individuals 48 years old (the youngest baby boomers) and older were included in this study.
METHOD Participants A total of 792 people responded to the survey and ranged in age from 18 to 85 years old. Of those, 242 (31%) were younger than 48 and were, thus, excluded for the purposes of this study. Of the remaining 551 respondents, 56 participants were excluded if they reported a zip code outside of the Twin Cities MSA, or if they reported they were both cisgender1 and heterosexual. The final sample consisted of 495 participants. Three in ten respondents (29.7%; n = 147) were 48 to 54 years old, 45.5% (n = 225) were between the ages of 55 and 64 years old, 20.4% (n = 101) were 65 to 74 years of age, and 4.4% (n = 22) were 75 and older (see Table 1). Nine percent (n = 45) were bisexual, 46.7% (n = 231) were lesbians, 38.7% (n = 191) were gay men, and 5.3% (n = 26) were queer/other. Nine in 10 (90.1%) were cisgender, including 247 women and 199 men. Approximately 10% were transgender, including 31 women, 16 men, and 2 non-male/female identified individuals. The sample was predominantly White, non-Latino (93.2%), and most participants had a Bachelor of Arts/Bachelor of Science or more formal education (80.8%). Less than one-third were retired (29%). Less than 1 in 10 (7.5%) reported household incomes under $20,000, and more than one-fourth (26.5%) reported a household income of $100,000 or more.
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TABLE 1 Sample Demographics
Downloaded by [University of Western Ontario] at 09:25 10 February 2015
Variable Gender identity Transgender woman Transgender man Transgender other Cisgender woman Cisgender man Sexual orientation Gay man Lesbian Bisexual woman Bisexual man Queer/other Heterosexual Age 48–54 years 55–64 years 65–74 years >74 years Relationship status Single Partnered/married Widowed Education
