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NEW YORK — For New York City's gay and gray community — the first generation of openly LGBT Americans to grow old — an advocacy organization that's nearly as old as the LGBT-rights movement itself is bridging long-standing gaps. Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE)has two community centers targeting different populations: the main center, which opened early last year in Manhattan's Chelsea neighborhood and serves seniors from across the city, and a smaller satellite location in Harlem. The group also has a national network of affiliate service providers.
While other cities, notably Philadelphia and Los Angeles, have developed LGBT-specific senior housing, SAGE has pioneered a community-based-care model that is municipally funded and designed around independent urban living. The Chelsea center offers services that would not be out of place at other senior centers — computer classes, exercise sessions, discussion groups for bereavement and legal counseling on health benefits — but the atmosphere is decidedly LGBT-inclusive. So the legal session might focus on benefits for same-sex couples, and the support group may touch on friction with a partner's unaccepting family. Meanwhile, the Harlem branch caters to black and Latino populations, which have historically been isolated both from mainstream elder-carefacilities and from the LGBT civil rights movement, which has largely been dominated by white-led organizations.
SAGE's model is sensitive to the needs of LGBT elders in small ways that nonetheless make a big difference, avoiding missteps commonly seen at mainstream facilities. Intake interviews don’t feature assumptions about husbands and wives, the walls aren't decorated with posters featuring only smiling heterosexual couples, and transgender elders are called by their preferred pronouns. And staffers make it clear that there is no prejudice against clients with HIV.
Despite major legal advances for members of the LGBT community — including new state laws permitting same-sex marriage, a landmark Supreme Court ruling expanding the rights of same-sex spouses and pending legislation to bar discrimination in the workplace on the basis of sexual orientation and gender identity — many LBGT seniors still face cruel barriers. As they age, many report "feeling like they have to go back into the closet in order to feel safe and comfortable receiving senior-related social services," says Gary Gates of the Williams Institute, an LGBT-focused think tank at UCLA.
Indeed, compared with heterosexual seniors, LBGT elders are particularly vulnerable to violence and discrimination. According to a 2011 survey by researchers with the Institute for Multigenerational Health, some 80 percent have endured verbal or physical abuse or other forms of victimization, such as the destruction of their property and employment discrimination. Transgender people in particular are often denied insurance coverage for hormone therapy or gender-transition surgery. And the community as a whole suffers from an acute need for HIV/AIDS treatment, along with high rates of mental distress.
Mainstream care facilities can be less than welcoming to LGBT clients.
In nursing homes and doctors' offices, LGBT clients may face bias from both staff and other seniors. The discrimination may be overt — such as jeers and harassment from fellow residents — or simply ingrained in the service system, like when facilities refuse to let same-sex couples room together or have visits.
In testimonies recorded as part of a 2011 study on LGBT seniors in long-term care by the National Senior Citizens Law Center and other advocacy groups, seniors and care workers observed bigotry toward clients perceived to be gay, bisexual or transgender. Examples included LGBT elders' being shunned or insulted by staff and residents, care providers who were uneasy about bathing a gay person or seniors' being told they would go to hell because of their sexual orientation or gender identity.
SAGE as pioneer
When SAGE was founded in a tiny Greenwich Village office in 1978, less than a decade after the Stonewall rebellion, LGBT people were struggling for basic respect as human beings; for the general public, seeing them as elderly Americans with ordinary lives and family ties was a radical idea. Today the SAGE Center in Chelsea serves about 1,400 registered members and many informal drop-in clients, and the uptown satellite has about 600 members in its database. In addition, the organization has over the years cultivated a nationwide network of affiliate care providers.
Their services are interwoven with New York's "aging in place" system — a network of neighborhood-based care programs to provide relatively low-cost services to ethnically and culturally diverse communities. For the many LGBT elders who live alone or are estranged from family, the independent-living approach can move them out of social seclusion and make sure they get regular hot meals, socialize with peers and stay active with periodic fitness classes and parties. As the membership has diversified, the program has evolved to include black men's support groups and women's writing workshops.
For LGBT seniors who don't have access to specialized services or just prefer a more integrated setting, SAGE runs training programs with staffers at mainstream care providers on cultural sensitivities and bias issues related to gender identity and sexual orientation. But overall, says SAGE director Michael Adams, "there are very few places, unfortunately, where LGBT older adults can feel welcome. So certainly for the foreseeable future, it's going to be important for us to create LGBT-specific places."
SAGE's community-based care system is a good fit for seniors like Albert Walp, who was just 15 when the police busted into the Stonewall Inn and rounded up the patrons of the gay nightspot in the West Village in 1969. One of the youngest witnesses to the historic uprising, he spent most of his youth working in the city's fashion industry, doing drugs and indulging in casual sex. When he was diagnosed with HIV in 1984, he recalls somberly, "people were dying like crazy," and gay men were feared and demonized as social deviants andpublic-health threats.
But today Walp is clean and maintains a treatment regimen as an active member of Gay Men's Health Crisis, an HIV/AIDS service and advocacy organization, though he prefers the more relaxed atmosphere of the SAGE Centerin Chelsea. There, rubbing shoulders with silver-haired radicals and baby-boomer male couples or watching karaoke sing-alongs, he knows no one will ever treat him differently because he has the virus. He spent most of his youth bingeing on drugs and not even bothering with medication, he says, assuming death was around the corner. But now, he says, "I expect to stay here for many, many years."
SAGE in Harlem
Seventy-four-year-old Sherman Walker had a flyer advertising the Harlem SAGE center pinned to his wall for many months before visiting it in person. Now he's a regular at the center, which is housed in a majestic former hotel on Adam Clayton Powell Boulevard. He meets with his men's discussion group a few times a month and occasionally meets others from the neighborhood over potluck meals — sometimes produce from the community food co-op, sometimes fried chicken. Outside Harlem's small but growing LGBT scene, the SAGE center is known in the neighborhood for its rollicking end-of-yearholiday party.
SAGE fills a crucial gap in a neighborhood with a chronically poor and underserved population. LGBT seniors of color are more prone than their white peers to suffer financial and health challenges. Surveys indicate, for example, that African-American, Latino and Native American LGBT seniors tend to have less access to medication and are more likely to lack medical insurance. Black LGBT seniors also suffer disproportionate rates of HIV, obesity and high blood pressure.
Walker, who has prediabetes, credits his fellow SAGE members with helping him maintain his diet, eventually allowing him to shed 30 pounds. He checks in periodically with other members of Buddy 2 Buddy, the peer-led program the center started after a member was discovered dead in his apartment, his absence unnoticed for days.
A Harlem native who spent his younger adult life working as a cook in city hotels, Walker sees the center as a refuge in a neighborhood that has not always embraced him. Although his family knew he was gay, he always dressed and acted "conservatively," he says — a basic survival skill in a neighborhood that revolved around close-knit neighbors and a socially conservative church.
Despite its centrality to the cultural fabric of Harlem, the church was for many years silent on the local LGBT presence, even when the AIDS epidemic was tearing through the congregations and choirs. "I always considered it the unforgivable sin," Walker says, "that you could be a drug dealer, a wife beater or whatever else you wanted to do and still be welcomed ... but if you were gay and if you were unapologetically gay, then there was not very much room for you."
But the city — even outside the safe space of SAGE — feels surprisingly welcoming these days. He was tickled recently when he saw two young men walking hand in hand down Fifth Avenue. "I said, 'God, I hope nobody hurts them,'" Walker recalls. "My first reaction was fear, and my other was, 'Hey, look at this — you know, we're coming back!'"