Summary: Invisible and Aging

Michael is 79. He lost his partner of thirty years to AIDS in 1994. In the decade that followed, he buried eleven more friends. He rebuilt a life. Now those survivors are dying too, of the usual things. He needs more help than he can manage alone. He has looked at assisted living. The intake forms ask about “spouse” and assume grandchildren. He is considering going back into the closet. He thought that chapter was over.

An estimated 3 million LGBTQ+ adults over 50 live in the United States, projected to reach 7 million by 2030. They are twice as likely to live alone as heterosexual peers and four times less likely to have children. Many experienced decades of employment discrimination before legal protections existed, resulting in lower earnings and smaller retirement savings. Same-sex couples were excluded from marriage until 2015, missing decades of survivor benefits and tax advantages.

For gay men who survived the AIDS epidemic, the grief is compounded. Entire chosen families were decimated. Those survivors are now experiencing a second wave of loss as remaining friends die of age-related causes. The clinical literature on prolonged grief has barely begun to address survivors of mass bereavement events.

The documented phenomenon of concealing identity in care settings reflects a rational calculation. Long-term care facilities are often structured around heteronormative assumptions. Staff may lack LGBTQ+ competency training. The February 2024 Older Americans Act updates explicitly designated LGBTQ+ older people as populations of greatest social need. SAGE has trained over a thousand providers. These are signs of progress. Most facilities have not been assessed. Most staff have not been trained.

Michael, considering whether to hide who he is to access care he needs, should not have to make that calculation. That he still does is a measure of how much work remains.