Improving the Lives of LGBTQ+ Older Adults

Welcome to the Living to 100 Club Podcast.

Well, hello to everyone joining us today on our podcast. You're listening to one of our Successful Aging episodes this month on the Living to 100 Club program. I'm your host, Joseph Casciani. On each program, our conversations educate and inspire, helping you get the best out of all the years we're given, regardless of what obstacles come our way. You can learn more about our club at our website Be sure to take a look at my new training manual and activities program, Better, Longer, and Happier: A Guide to Aging with Purpose and Positivity. This is a series of 12 modules in a card deck format developed for activities directors at senior living communities and organizations. All modules are now on sale. Visit the website livingto100.club/blh. Now on to our podcast. On today's program, our guest is Michael Adams, CEO of SAGE. SAGE is the world's largest organization dedicated to advocacy, services, and innovations for the LGBTQ+ elders. Michael introduces our audience to the mission of SAGE, its policy advocacy role, and the array of community-based services it offers in New York and Florida. We explore the unique challenges of this group, from social isolation to ageist stereotypes that can exceed the usual hurdles faced by most older adults. How does the SAGE organization serve the unique needs of the LGBTQ+ elderly through its different roles. Join us for this important and engaging conversation. First, a little background. Michael Adams is the Chief Executive Officer of SAGE. Founded in 1978 and headquartered in New York City, SAGE is a national organization that offers supportive services and consumer resources for LGBTQ+ older people and their caregivers. Advocates for public policy changes that address the needs of this group, provides education and technical assistance for aging providers and the LGBTQ community organizations through its National Resource Center, and offers cultural competency training through SAGE Care. Prior to joining SAGE, Michael spent a decade leading cutting-edge litigation that established new rights for LGBTQ people, first as Associate Director of the ACLU's project and then as Deputy Legal Director at LAMBDA Legal. A graduate of Stanford Law School and Harvard College, Michael has authored numerous publications on an array of LGBTQ issues. He's taught law school courses on sexual orientation and gender identity, and has served on advisory councils for AARP, Fortune 500 companies, leading universities, and the New York City Department for Aging, among others. Michael is the former chair of the board of directors of the American Society on Aging. Impressive background, Michael. You've accomplished a lot over the years.

Thanks, Joe. Yeah, I, um, it's a great honor for me to do this, um, to do this work with SAGE. And yeah, I look forward to our conversation today to talk about these issues.

Yeah, good, me too. So I always like to open by asking our guests to share maybe the highlights of the journey that brought you to where you are today. We touched on a lot of it, but maybe the highlights.

Well, you know, I think for me, I'm in my 18th year as the head of SAGE. And this work and SAGE's mission to improve the quality of life of LGBTQ+ older adults means a great— it means a great deal to me. And I first got involved with SAGE when I was in my mid-40s. And at the time, my grandmother, who I was very close to, was struggling with her health, and she actually passed away shortly after I arrived at SAGE. And it was a in a sense, an early window into how important SAGE's mission is, because my grandmother was very fortunate to be surrounded by a large family of people who loved and loved her and cared about her. And even with all that support, the last couple of years of her life were, were difficult in a variety of ways. And so at the beginning of my time at SAGE, I found myself contrasting the the experience and the support that my grandmother had aging, as opposed to the real lack of support that so many LGBTQ+ older folks face as they age, and recognizing what a big challenge that is and why SAGE's mission is so important. And fast forward 18 years, and I'm now in my early to mid-60s myself, right? And so the mission actually takes on even a more personal meaning for me as I start to more directly confront my own aging process. And so all along the way, it's— this work has had a really special— it's had a really special meaning for me, and it's been an honor to do everything that I can do with our team, our amazing staff and volunteers and board of directors, to try to make life better for all of us as we're aging as LGBTQ people.

Sure, sure. Yeah, thanks. Um, uh, so you were able to see in your family and personal history what the potential is for supportive family members and caring family members and how that might contrast with so many other people who don't share that kind of support and family interaction. So I could see that plants a lot of seeds. So I— let me ask you though, SAGE's mission is really to ensure that the LGBTQ+ population is not invisible. How does it make this happen?

Yeah, that, that, so SAGE's tagline is "We refuse to be invisible," and that really speaks to the fact, you know, historically enforced invisibility has been one of the key means of denying LGBTQ people equality and human rights by making believe we don't exist, by trying to force us to hide who we are. And that's been a historical reality and challenge for LGBTQ people. And then that reality, in a sense, becomes even more intense for older members of LGBTQ communities who have to struggle not only with the pressures in our society to hide who we are as LGBTQ people, But also the fact that in many senses, many, many old people, as we age, we become invisible to society as a whole. And that's true within the LGBTQ community as it is in other parts of our society, right? Where there's a great orientation toward youth, there's a great orientation toward what's happening today, what's happening in the moment. And there are a lot of factors that contribute to the invisibility of our elder pioneer generation for LGBTQ communities. And so at SAGE, so much of our work is about breaking that invisibility. And that comes through everything from what we were doing last month, which was showing up and appearing in pride parades all across the country and making sure that elders are very visible in those parades and our participation is very seen in the various pride celebrations that go on across the country, to the, the media work that we do to tell the stories and help elders in our community tell their own stories. And so just last month, we had major segments on Good Morning America and ABC News and NBC News talking about LGBTQ aging, to the work that we do to support elders in our community and being spokespeople around different issues and activists and advocates. There are so, so many ways that we work to support our elders in fighting back against invisibility. And it's, we make progress, and at the same time, it's an ongoing struggle.

Yeah. Well, that's obviously the mission, the great tagline, "We refuse to be invisible." I mean, everything derives from that, right? I mean, focusing on so many issues, so many dimensions of that. Admission. So you mentioned social isolation, and we all know how that affects older adults, but it might be more keenly involving the LGBTQ+ community. Why is that, do you think?

Yeah, there are some dynamics that make social isolation particularly acute among many older LGBTQ people. Part of it is that We're much less likely to be parents than older Americans in general, 4 times less likely actually to be parents than older Americans in general. We're also much more likely, twice as likely to grow old single and living alone. And often because of historical discrimination, we're disconnected from our families of origin. So, we're less likely to have the same kind of close ties to the families that raised us and that we grew up with. So, when you put together in many, many cases, the lack of adult children, the lack of spouses or partners, and then lack of other kinds of family ties, that creates a much, much higher risk for social isolation. And while as a community we often talk about families of choice that we've built in many respects our own families among our friendship circles to, in a sense, take the place of families that we haven't had the opportunity to have, More often than not, those families of choice, those peer networks, are people who are the same age as us. And so it's different from a traditional family where there are grandkids and kids and generations, all different generations. And so in a network, in a created family that's primarily one generation, that generation becomes thinned out as we get older, as people pass on, as people in some cases become become sick. And that, so that also contributes to the lack of social connection and the lack of community supports that so many LGBTQ elders face.

Yeah, those are some powerful dynamics, the risk factors there. Yeah, solo agers, no real family. I mean, not a lot of grandchildren, children around. Kind of, as you say, kind of the surrogate family. We create a surrogate family that people in our own age group— and, you know, we always recommend for older adults to find people who are younger than us, and, you know, so there's more connection and fewer of the friends who might pass away. So that's an interesting dynamic that the families of origin may not be so present in the lives of these individuals.

Yeah. Yeah, yeah, absolutely. And it does make the, the need to build ties and create ties across generations, I would say, if anything, even more important for older folks in LGBTQ communities. And one of our priorities here at SAGE is to encourage the building of ties across generations in any way that we can. Both to promote social connection and also to help elders in our community see that they're valued, that they're celebrated. I think part of the, the invisibility that people can feel, that can feel really painful, is for generations of older people that SAGE works with who really done so much to create the LGBTQ community, to struggle so hard to help win the legal rights and equality that we enjoy today. If, if there's no interest from, from younger people, there can be a sense inside of feeling that that's not recognized, that that's forgotten, that those contributions aren't valued. And, and that also is part of the reason why it's so important to create the opportunities for younger members of of our community, LGBTQ community, but communities more broadly to be able to build ties with LGBTQ older folks.

Yeah. Well, that's so important. So I'm curious, so poverty levels, rates of chronic health conditions appear to be higher in this cohort group.

Would you agree with that?

Yes.

Yes. There are notably higher levels of poverty among LGBTQ older adults than older Americans in general. And quite a lot of that has to do with the cumulative impact of lifetime discrimination in employment, right? So employment discrimination ends up suppressing wages and suppressing the kinds of incomes we can earn over our lifetimes. The denial of opportunities for promotion also does that. And then historically, while this thankfully has started to change in recent years. Historically, we have been denied really important benefits like, like health insurance benefits for your partner, which many folks take for granted as something they can get through their job. But historically, that's only been available through marriage. And until a few years ago, we weren't able to marry as same-sex couples. And so all of those things contribute to higher levels of poverty in old age. And then we have other particular things that have been impoverishing. For example, the AIDS epidemic, which wiped out, you know, a whole generation of gay men and wiped out the savings and economic viability of many folks in the community. And we still feel the repercussions of that many years later. So poverty is a significant challenge, as are chronic health conditions. I mean, obviously, I just mentioned one of the ones that's most significant for our community, that we have notably higher levels of people living with HIV than the population in general. But it's not the only one. We have higher levels of mental health challenges, higher levels of substance abuse of various sorts. And most of the data indicates that those higher levels of mental health challenges and substance abuse challenges probably relate to what some people call minority stress, you know, the, the stressful impact of living in a community and a society where you have to worry about bias, where you have to worry about violence against you, where you have to worry about mistreatment and marginalization and the impact that has on your psyche and on your emotional health over the course of a lifetime. So these are some of the particular challenges that LGBTQ older folks face. And it's worth lifting up that those challenges are worse for, for subsections of the community. So, for example, older women in the community, older lesbians have even higher rates of poverty than, than say older gay men. Transgender older adults have higher levels of poverty. LGBTQ elders of color have higher levels of poverty and face higher levels of discrimination, right? So there are these compounding impacts for people in the community depending on their particular circumstances and lived experiences.

Those are monumental issues. I'm really happy or honored to be, you know, a vehicle for presenting these challenges to my audience and hopefully to others who listen to this. So again, gold stars for SAGE and for the work you're doing. I'm just curious about, you know, if the LGBTQ individual is not sexually active, maybe obviously some are, many are, but if they're not, they still retain the identity as gay. Does that change at all as their sexual activity slows down or decreases?

Yeah, that's a great question, Joe, and I think it's something that in some ways ends up being embedded in some of the challenges that LGBTQ older people face. Because historically, I think in many people's minds, what's distinguished us is our sexuality, right? It's who we're attracted to sexually, who we sleep with. And so, are we still LGBTQ if we stop having sex? And one thing that we try to lift up and remind people of is that there is this ageist stereotype that old people don't have sex, when in fact we know that many old people have lots of sex, and that's just as true of LGBTQ people as anybody else. But obviously, you know, some folks become less sexual or asexual as they age, and that's true in our community as well. But the reality is, is that being LGBTQ is not just about sex or sexuality. It's really about identity and about a cultural experience. And because we are treated and historically have been treated so differently, by society as a whole because we've been kind of set apart and marginalized in so many ways historically. We've built up our own, our own communities, our own culture, our own identities, our own ways of enjoying life and building life at times when that was denied us by the community at large. So, so being LGBTQ is very much— sexuality is a piece of it, but it's only a piece, and, and it really is about a shared cultural experience and shared identity and And that doesn't go away. It really doesn't go away at all. But it is true, I think, that sometimes when people think about LGBTQ people, they don't think of us as being old because they associate LGBTQ with being about sex, when in fact, that's just one piece of it.

Yeah. Well, thank you for that answer. That was a very good answer. You know, when I talk about aging and Successful aging to me, it's staying positive no matter what gets in the way. And I'm just curious if members of SAGE have this, have endorsed this philosophy as well, or are they struggling with their own aging challenges and kind of get negative or pessimistic about it? Is there a difference from your perspective?

Well, you know, I think certainly many folks in our community struggle. With aging and the aging process and the aging experience. But at the same time, there is a tremendous tradition of resilience among— within our community and among older LGBTQ people. The very things that I just described, which are the challenges that people face and the people have faced historically for, you know, for many years, you know, where we're talking about folks who grew up and came of age in some instances in the 1950s, 1960s,, you know, through the AIDS epidemic, extraordinarily difficult times for LGBTQ people. But struggling through those times and living through those times has built resilience. And, you know, we talked a little bit earlier about cultural identity, right, and LGBTQ cultural identity. And one of the things that has always been a hallmark of our community has been the ability to celebrate and find joy and to find humor, even in things that are very difficult and challenging. And so there's a great deal of resilience and joy that exists among older people in LGBTQ communities, in spite of it all. In spite of all the challenges and in spite of all the difficulties. If you were to step into one of our SAGE centers, which is our older adult centers, you don't see people sitting around and moaning and groaning about the problems they have and the ways they're being discriminated against or the ways they're socially isolated. You see people being joyful and building their lives and doing everything that they can to to be positive and to be thankful for still being alive, which you can't take as a given, actually, as an LGBTQ person, certainly as an older person who's lived through, you know, whether it's AIDS or violence against our community and other kinds of things.

Yeah. Yeah. So, maybe not in spite of the challenges, but because of the challenges, the resilience factor may be higher. I don't know. Just a hypothesis, maybe higher in this group because they have endured. People do fight challenges and get knocked down and keep getting back up off the mat.

I mean, that's very much the case. Frankly, if there was not a high degree of resilience among LGBTQ people and within our community, I don't know that we'd still be around, right? It is something that exists. I in part because of the challenges that the community has faced and the determination on part of people to not give up and to really live adventurous, joyful lives in spite of the fact that historically we've been told that we're not allowed to do that.

Yeah, so really a critical factor for anyone, for everyone, that ability to get back up and to stay positive no matter what gets in the way, no matter what your orientation is. But we always face these challenges and keep getting back up. So that's so important to keep encouraging this determination and motivation.

Yes, for sure.

So let me ask you about SAGE. Um, we kind of touched on it, but what are the, what are the primary actions or roles of SAGE, and how do these benefit the LGBTQ population?

Yes, so our, you know, our fundamental orientation and philosophy and our vision is to build a world in which every LGBTQ older person has the full range of opportunities that they deserve as they age. And as an organization, we do that in a variety of ways. Some of that is that we run our own programs, our own SAGE centers and online programs and things of that nature. That help people to live the best lives they can, to have opportunities to have fun, to have opportunities to learn, to have opportunities to engage with other folks. So, we do our own programming of various sorts. We also do a lot to ensure that the larger world, the larger ecosystem, so to speak, that's designed to be available to people as they age, to support people as they age, is welcoming. Of LGBTQ older folks. Often what we've heard historically at SAGE is that older members of our community feel that they're not welcome in senior centers, say in neighborhood senior centers, or in nursing homes, or in other places where older folks congregate. And we do a lot of work to change that. We have a lot of training programs where we train the staff at different kinds of, elder care settings and how to work respectfully and supportively with LGBTQ older adults to ensure that, that we can access the same kinds of things that everybody else can as they age. Because the reality is, even though organizations like SAGE might run our own programs, we can't build an alternative universe that's going to support and take care of all older LGBTQ people in this country. Most of us are going to get our services, our care, our support from the very same places that everybody else else does. So that training work is really important. And then the third big body of work that we do as an organization is policy advocacy, public policy advocacy, because the fact is, is there are a whole system of laws and regulations in this country that are designed to fund older adult services, to make things like senior centers and other kinds of programs available to people who want them and who need them, to ensure that we're not discriminated against in different kinds of settings. Those laws historically have not really taken LGBTQ people into account. And so we've had to do a lot of work in our policy advocacy over the years to, at the federal level and at the state and local level, to change those laws, to adjust those laws, to recognize that, that LGBTQ older people exist, that we have the same needs as everybody else does as they age, and that we're We should be entitled to the same kinds of opportunities and protections. So, community services, training, policy advocacy, those are the three big areas of our work.

Yeah. And the community centers are, I think I mentioned in New York and Florida, is that right?

Yes. In New York and in South Florida, those are the programs and centers that we run directly. And then in various ways, we provide support to similar community activities for LGBTQ older adults in other communities across the country, you know, that will be run by any number of different kinds of organizations.

Sure. So complementing what they're already doing.

Exactly. Complementing, helping people think about how to design programs historically. For example, there's a large network of LGBTQ community centers across the country. Historically, those community centers have been more youth-oriented.. And in recent years, SAGE in a variety of ways has done work to encourage those community centers to build their own older adult programming, right? So, SAGE doesn't need to go and do that in hundreds of cities across the country. We can help support existing LGBTQ community centers to do that.

I see. Offer them some guidance on how to incorporate the other age groups.

Yeah, exactly.

Yeah. So, is there one center in New York and one center in Florida, or are they kind of Spread out?

No, there are 5 centers in New York City in different boroughs in New York City. And then the programs look different. We have programs in Miami and we have programs in Fort Lauderdale as well. And in South Florida, our Friendly Visitor program, which is a program that pairs up volunteers with older adults who are homebound or otherwise experiencing high levels of social isolation. For companionship and support. That's a particularly popular program in our South Florida activities. But we have, we have social workers in South Florida also who are working to provide— in a sense, our SAGE social workers do many of the kinds of things that an adult son or daughter would do if that person was present, right? You know, making sure that if somebody has to move into different kind of housing, where they can find a new place to go. If they if they need to get access to their veterans benefits, if they know how to fill out the application, all that kind of stuff, right? That often, like, that I would do, say, for my mom or my dad if they needed help. That's what our social workers will do for older folks in our community since often there is no adult child present to help with that kind of thing.

Yeah, these are common issues, and we need help with a lot of these issues—

health insurance and doctor's appointments and travel and, you know, Medicare and all that kind of stuff.

Exactly. I know I could use some of that help myself.

Yeah, anybody that gets to that age, credit.

So how could our listeners, um, uh, get involved with SAGE if they want to contribute in any way?

Well, we encourage folks to go to our website, which is www.sageusa.org, and on our website There are opportunities to contribute financially to the organization's work. There are opportunities to volunteer in our different kinds of programs, and our, our volunteer opportunities aren't just limited to in-person activities because we have online programs where there are sometimes volunteer opportunities as well. And we encourage people to come to our website, get involved and support us, but also learn about learn about the lives and the opportunities and the challenges of LGBTQ older folks, because that way each and every one of us can become part of that, of that campaign to break that invisibility and to lift up our LGBTQ elders. For our community, they're our pioneers, right? They're the folks who paved the way for the lives that we enjoy today. And so we really want everybody to be aware of the contributions that LGBTQ elders have made and continue to make and to celebrate those contributions.

That's good to bridge that gap, so to speak. We're all part of this system, and let's understand each other and how we can benefit and support and grow together. Yes, that's great. Yeah. So what's the takeaway, Michael? What would you hope our listeners take away from this conversation?

Yes, what I hope your listeners would take away is that, you know, we all at the end of the day, I think, have similar goals, right, in terms of the lives we hope to have as people as we age, right? We want to be able to age in our community and age in a community that respects us and supports us and cares about us. We want to have ways that we can be engaged and still feel still feel valued and still feel like there's a way to really live. LGBTQ older people are no different, really. We have a particular set of challenges, which we've talked about over the course of this conversation. But the fundamentals really are very similar. And we, as members of the LGBTQ community, are looking to age in a healthy and joyful way in the same way everybody else is. We need society to recognize both that we have particular challenges, some of which are created by society and government, but fundamentally that we're after the same thing and that we can be supportive of each other so that we can all be members of a community that is taken care of and is supported and respected as we get older. And I think that would be something that would be really a big step forward for LGBTQ elders. And frankly, I think if our our society and our country adopted more of that kind of philosophy of just, you know, having each other's backs and respecting each other as human beings, we'd probably be a lot better off. Yeah, yeah.

And we're not different at all. We're not so different at all.

Yeah, you know, I feel like there's a lot of— sadly, in our society, there seems to be a lot of energy around setting people against each other and dividing people from each other. And that's not what we're about. We're about the opposite of that. We're about helping helping all of us see that our goals are fundamentally the same and that we should care about and support and respect each other in achieving them.

Yeah. Wow. Well, great. Thank you so much for this information, for this conversation, Michael. I really admire the work that you're doing with your organization, and I hope you can keep doing it forever and ever. Yeah. Yeah.

Thank you, Joe. Thank you so much. I hope SAGE will keep doing it forever and ever. I probably won't be around forever and ever, but for a while longer anyway. Way.

You never know, right?

Yeah, you never know. You never know what's going to come along in terms of, uh, scientific progress.

It looks like we're out of time though. Uh, before we wrap up, I just want to remind my listeners to visit my website livingto100.com, sign up for my email list, and download a free copy of my 9 tips to make living longer enjoyable. And if you're affiliated with a senior living setting or community organization, Be sure to look for my new training manual and activity guide, Better, Longer, and Happier. Michael, the website again is sageusa.com?

Sageusa.org.

Okay, that's right, with that. Okay, thanks so much for being a guest on our program, and thanks to all of our listeners for tuning in. Hope to see you next time.

All right, thank you so much, Joe.