17. Mistreatment and Victimization of LGBT Elders

The purpose of this chapter is to explore the scope of the problem of the mistreatment of LGBT elders . In the first part of this chapter, we look closely at those who are characterized as mistreated. Second, we discuss possible remedies to the problem of mistreatment and victimization. Next, we suggest future research on the topic. Finally, we examine model programs and approaches for prevention and intervention. Chapter 17 provides an important adjunct to Chap. 16 and provides information concerning who is mistreated, how they are mistreated, and why they are mistreated. Elder mistreatment and victimization are recognized as both a national and international health crisis. Research suggests that elder mistreatment and victimization occur across all ethnicities, in various settings, and within cultures that once held elders in high regard. Although LGBT elders often experience the same types of mistreatment and victimization as elders in general, LGBT elders have their experiences within the context of being sexual minorities. This additional positionality not only sets LGBT elders apart from their non-LGBT counterparts, it also necessitates specific and unique approaches to addressing the problem of elder mistreatment and victimization. Given this context, it is our intent to highlight discrimination by practice and policy against LGBT elders and to focus on disparities in response to mistreatment and victimization of LGBT elders as a culturally diverse population that is already marginalized by age, socioeconomic status, and a host of other demographic characteristics.

According to Gates (2011), approximately nine million Americans identify as lesbian, gay, bisexual, or transgender (LGBT). Of that population, the Movement Advancement Project (MAP), Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE), and the Center for American Progress (CAP) (2010) estimate that 1.5 million adults aged 65 and over are LGB, with no reliable estimates for elders who identify as transgender. All estimates are likely undercounts due to the as yet considerable stigma associated with “coming out” at any age. “Coming out” for elders may be even more problematic than for their younger counterparts (e.g., historical mistreatment of those who identify as LGBT, decreased desirability being older and LGBT, increased possibility of being dependent on others). Elders who identify as LGBT face yet another challenge, which is that of experiencing elder mistreatment. Some LGBT elders must often contend with abusing, neglecting, or exploiting family members, including intimate partner violence that can result in social isolation and low help-seeking behaviors (National Center on Elder Abuse 2013).

It is necessary to emphasize at the outset of this chapter that the information available on the mistreatment of LGBT elders is, at best, only a rough estimate or extrapolation from extant data sources. Furthermore, information on transgender elder mistreatment is even more limited. Stated in earlier chapters, many elders are highly reticent to “come out” or stay out because of the treatments and attitudes that they have witnessed: the AIDS epidemic, various court cases concerning same-sex marriages, and individual treatment and classification of LBGT persons that, despite apparent greater acceptance, are still pervasive today. According to the MetLife Mature Market Institute LGBT elders study (2006), 27 % of baby boomers reported that discrimination was a great concern for them.

D’Augelli and Grossman (2001) surveyed 416 LGB elders aged 60 and over to explore lifetime victimization based on their sexual orientation. Nearly two-thirds reported experiencing some form of sexual orientation victimization, with males reporting more overall victimization than their female counterparts. Of that group, the authors went on to say that 29 % had been physically assaulted. Similarly, Frazer (2009) surveyed 3500 LGBT elders aged 55 and older and found that 8.3 % reported being abused or neglected by a caregiver due to homophobia; 8.9 % reported being financially exploited for the same reason. Persons who identify as transgender reported that 42 % experienced some type of physical violence or abuse and that 80 % experienced verbal abuse or harassment (MAP 2009). Fredrikson-Goldsen et al. (2011) found, in a study of 2560 LGBT elders , that due to the perception of being LGBT, 82 % of elders had been victimized once in their lives, with 64 % being victimized at least three times.

One area almost never considered in the elder mistreatment literature is that of transgendered elders (Cook-Daniels 2002) (see Chap. 14). Research is bearing out that the social intolerance of transgendered people may be even more intense than that of LGB persons (Lombardi et al. 2002). Violence is caused both by those who are intimate and by those who are distant to him or her. Such maltreatment serves to decrease help-seeking and increase isolation, which in turn make transgendered individuals even more at risk for abuse (e.g., little social support and a history of experiencing a traumatic event) (Acierno et al. 2010).

Although research is continually refining estimates of the incidence and prevalence of elder mistreatment , major national studies of elder mistreatment have, in the main, neglected to include variables that identify elders who are LGBT (Chap. 16). However, it is possible, by extension, to develop a rudimentary understanding of elder mistreatment as it affects LGBT victims, whose unique and individual experiences are discussed below.

LGBT victims of elder abuse are victimized in several ways. First, as Cook-Daniels stressed (2002) the society in which LGBT elders aged was extremely homophobic. For example, gay men were routinely fired from their positions, rejected by their families, targets of police brutality and harassment, and, until present times, denied the right to marry and its associated rights. Further,

Social condemnation of people who have relationships or sex with persons of their own gender is so strong that even those who do not identify themselves as gay or lesbian, those who do not associate with other known Gays or Lesbians, and those who ‘come out’ late in life nevertheless adopt many of the same protective behaviors and social adaptations as those who have long labeled themselves as Gay (Cook-Daniels 2002, p. 3).

Although some protective behaviors may safeguard elders from abuse (e.g., larger friend networks in later life), other behaviors result in becoming more isolated over time and consequently make the elder more vulnerable to abuse, neglect, and exploitation (Acierno et al. 2010). A number of factors, including being LGBT, as well as age-related changes, can make an LGBT elder at risk for abuse.

LGBT elders are particularly vulnerable to abuse for a variety of reasons. These individuals are more likely to be estranged from family members or to be childless, which decrease access to children or family members for support when they need care. Another reason LGBT elders are at risk for mistreatment and victimization is discrimination in healthcare, human services, and some long-term care (LTC) facilities. Too often the forms of discrimination in LTC facilities are dismissed or ignored. Examples of mistreatment and victimization include harassment, limits on visitors, prohibiting same-sex couples from sharing a room, or refusal to recognize a person’s gender identity.

Characteristics of Victims. In a national prevalence study by Acierno et al. (2010), in which self-report data were collected from 5777 older adults, average age of 71.5 years, 60.2 % (3477) were female and 39.8 % (2300) were male. As of yet, no information on sexual orientation of the men and women has been discussed in peer-reviewed publications. Respondents indicated that 56.8 % were married or cohabitating, 11.8 % (677) were separated or divorced, 25.1 % (1450) were widowed, and 5.2 % (303) had never married. Also, and by self-report, 87.5 % (4876) of respondents were white, 6.7 % were African American, 2.3 % were American Indian or Alaskan Native, 0.8 % (49) were Asian, and 0.2 % (13) were Pacific Islanders.

Similarly, in the New York State Prevalence study by Life span of Greater Rochester (2011), which surveyed 4136 adults aged 60 years of age and older and which also did not provide information on sexual preference, respondents’ self-reports revealed the following victims’ characteristics: 20.3 % were between 60 and 64 years of age, 38.0 % were between ages 65 and 74, 29.1 % were ages 75 and 84, and 12.7 % were aged 85+. The self-reported gender breakdown was 35.8 % male and 64.2 % female. Respondents self-reported being 65.5 % were Caucasians, 26.3 % were African Americans; 1.6 % were Asian/Pacific Islanders; 7.6 % were Hispanic/Latino; 1.9 % were American/Aleut Eskimos; and 2.9 % were “other” races.

A much smaller and national study, which also did not collect data on LGBT elders , examined 26 cases reported and screened in for investigation concerning the alleged sexual abuse of older men (aged 50 and older) residing in nursing homes. Cases occurred in five states within a six-month time period. Of these, six were confirmed upon investigation by Adult Protective Services (APS) or other regulatory agencies. Victims tended to be predominately white males with cognitive and physical deficits that limited their ability for self-care. The most typical sexual abuse alleged and substantiated was fondling. Residents were more often substantiated as the abuser than other perpetrators. The sexual abuse of older men in nursing homes crossed gender, cultural, and role boundaries.

Victims’ Risk Factors. Age may well be a risk factor for mistreatment , although studies regarding its significance are ambivalent. State agencies (e.g., APS; Teaster et al. 2006) and empirical studies concentrating on specific types of abuse (e.g., sexual, financial) have identified adults aged 75 and older as being particularly susceptible to mistreatment (Burgess et al. 2000; MetLife Mature Market Institute2011). National community-based studies by Acierno et al. (2010) and Laumann et al. (2008) revealed that young-old individuals (60–69) were more prone to abuse than their older counterparts, especially emotional and physical abuse. The linkage between age and risk of mistreatment or abuse may be related to the increasing numbers in the population of old–old and oldest–old elders, many of whom may experience a decline in health results in greater dependence on others for self-care than for the general population of older adults.

Lack of social support. Elders at advanced ages may also experience reduced interactions with members of their social network than those of their younger counterparts, which may be a protective factor for mistreatment . According to Charles and Carstensen (2010), older adults have a propensity to judge the trustworthiness of others more favorably than do their younger counterparts and, consequently, may exacerbate their vulnerability for financial exploitation. Castle et al. (2012) examined age differences in perceived trust using neuroimaging methodology and posited that “older adults might have a lower visceral warning signal in response to cues of untrustworthiness, which could make deciding whom to trust difficult” (p. 20851).

Both Acierno et al. (2010) and Amstadter et al. (2011) stress that low levels of social support are correlated with the occurrence of all types of elder abuse . Elders who are lonely or isolated are significantly more vulnerable to elder mistreatment than are elders with strong support systems. According to Acierno et al. (2010), low social support was associated with more than triple the propensity for mistreatment of any form to be reported by elders. Further, Amstadter et al. (2011) found that low levels of social support significantly predicted the likelihood of older adults experiencing emotional and physical mistreatment (see Chap. 30 for further discussion of social isolation ).

Gender. In the general older adult population, older women are more likely to be victimized than older men (Hightower 2004; Wisconsin Coalition Against Domestic Violence 2009; Krienert et al. 2009). Higher rates of older women who experience mistreatment may be attributed to their longer life span (and the associated vulnerabilities mentioned above), which may provide the occasion to be in contact with potential abusers (Krienert 2009). Women are subjected to higher rates of family violence across their life span than men. This fact, together with research by Acierno et al. (2010) revealing that previous exposure to a traumatic life event (e.g., interpersonal and domestic violence) increases an elder’s risk of late life mistreatment, may explain how vulnerabilities related to gender and power dynamics create a component of risk for elder abuse (Wisconsin Coalition Against Domestic Violence 2009).

Race. In addition to gender, Lachs et al. (1997) found that race was a risk factor for mistreatment : more black elders appeared at risk for mistreatment than their white counterparts. However, the authors acknowledged that a limitation of their findings was their use of APS cases as the unit of analysis. Similarly, Tatara (1999) found that black and Hispanic elders were overrepresented in data on elder abuse victims (31 state APS systems), whereas nearly one in three victims known to authorities was a minority elder. Different cultures and how they define and approach elder mistreatment may serve to protect or promote the occurrence of a minority elder’s risk for mistreatment (DeLiema et al. 2012; Horsford et al. 2010).

Physical health. Poor overall health and disabilities that impair an elder’s ability to self-care may exacerbate his or her risk for abuse. According to Laumann et al. (2008), older adults who reported any type of physical vulnerability were 13 % more likely to report verbal mistreatment than study participants who reported none. Similarly, Acierno et al. (2010) reported that the likelihood of financial exploitation by both family members and strangers increased for older adults with more severe physical disabilities and that poor health predicted neglect. Further analysis of these data by Amstadter et al. (2011) revealed that the need for assistance with activities of daily living and poor health status were significant correlates of emotional abuse, physical abuse, neglect, and financial abuse and exploitation of older adults (see Chap. 33 for additional information on LGBT elders and disabilities).

Cognitive Impairment. Changes in cognitive functioning also have been associated with increased risk of physical abuse, emotional abuse, caregiver neglect, and financial exploitation. In a study of 8932 older adults in Chicago, of which 238 were identified as victims of elder abuse by social service professionals, Dong et al. (2011) noted that several types of age-related cognitive changes contributed to elder abuse risk. After controlling for other known risk factors (e.g., medical conditions, depressive symptoms, and little social support), lower levels of global cognition, higher dementia severity, lower levels of episodic memory, and slower perceptual speed were all independently associated with an increased risk of abuse. Cognitive impairment increases exponentially with age and is perhaps the most pervasive and salient risk factor for financial abuse and exploitation (Sherod et al. 2009).

Other risk factors. Additional risk factors for the general population of elders were examined by Acierno et al. (2010) who found that 45.7 % (2262) of respondents self-reported low household incomes, 80.9 % (5174) were unemployed or retired, 22.3 % reported poor health, 62.0 % had experienced a previous traumatic event, 43.6 % perceived their social support as low, 40.8 % used some form of social services, and 37.8 % needed some assistance with activities of daily living.

In the Lifespan of Greater Rochester study (2011), for victims for whom respondent agency/programs reported about living arrangements, 45.8 % lived alone, 16.9 % lived with spouses or partners, 17.3 % lived with adult children, 7 % lived with sons-in-law or daughters-in-law, 6.3 % lived with grandchildren, 4.7 % lived with other relatives, and 8.8 % lived with other non-relatives. Over three-fourths of agencies were unable to provide incomes of reported victims; however, for the 17.4 % who could report this information, 59.3 % of victims were living at or below the poverty threshold.

Findings from the research literature on heterosexual adults suggest that many factors—demographic, social, cultural, historical, behavioral and psychological—singularly or in concert, may exacerbate, moderate, or reduce the risk for LGBT elder abuse . In addition to conditions shared with their heterosexual counterparts, older LGBT adults have different healthcare needs by virtue of their sexual minority status. Such needs include diets that may be too rich and exercise that is too infrequent, stresses from unhealthy or violent relationships, and sexually transmitted diseases that are ignored or poorly diagnosed because of societal stigma (Institute of Medicine [IOM] 2011). A 2012 CDC report on HIV among gay, bisexual, and men who have sex with men (MSM) revealed that health challenges for this population include higher risk factors and incidence of health disorders among lesbian and gay elders (see Chap. 20). By extrapolation, these healthcare needs create the potential for LGBT elders to be dependent upon others for care in ways different from their heterosexual counterparts, and in addition to these disparities, their sexual minority status may exacerbate their vulnerability, and hence, their potential to be abused in old age. Reticence to ask for help may increase their susceptibility to episodic and prolonged periods of abuse, as evident from the MetLife Mature Market Institute study (2006) revealing that more than 50 % of LGBT baby boomers believed they would receive disrespectful and undignified treatment from healthcare professionals.

A recent cross-sectional study by Fredriksen-Goldsen et al. (2014) of 2560 LGBT adults aged 50 and older investigated the relationship between physical and mental health-related quality of life. The study revealed that physical and mental health quality of life was negatively associated with discrimination and chronic conditions and positively associated with social support and being male. The authors found that mental health was positively associated with positive sense of sexual identity and negatively with sexual identity disclosure. The influence of discrimination on the 80+ group affected them more than other age groups.

Though in no way all, some LGBT elders may be disproportionately victims of intimate partner violence (Cook-Daniels 2002). Similar to the experiences of younger victims, issues of power and control are pervasive when considering this form of elder abuse (Brandl 2004; Nelson et al. 2004; Pillemer and Finkelhor 1988; Podnieks 1992). Though little data exist, some older LGBT persons possess a “perfect storm” of risk factors for intimate partner violence: societal homophobia, reduced social networks, previous exposure to a traumatic event, reticence to help-seek, low self-esteem, and fear of being outed and being placed in a facility.

The interaction between discrimination and physical and mental health quality of life requires a consideration of LGBT elders in LTC facilities. Like their non-LGBT counterparts, more elders are using the broad spectrum of services offered by the LTC industry including nursing homes, continuing care retirement communities, skilled nursing facilities, and boarding homes to name a few. LGBT elders are, however, more likely to rely on LTC facilities because of fractured or unavailable traditional systems of support (SAGE 2010). Often, as stated earlier, many LGBT elders conceal their sexual orientation and gender identity for fear of discrimination or victimization. Between October 2009 and June 2010, a national online survey conducted by the National Senior Citizens Law Center (NSCLC) in collaboration with Lambda Legal, National Center for Lesbian Rights, National Center for Transgender Equality, National Gay and Lesbian Task Force, and Services and Advocacy for GLBT Elders (SAGE), sought to identify issues facing LGBT elders in LTC. Of the 769 respondents that included family members, friends, and social as well as legal service providers, 284 self-identified as LGBT elders. Survey data indicated that over 40 % (328) of the respondents reported 853 incidents of elder mistreatment in various LTC facilities, with verbal and physical harm caused by residents and staff being the most common form of mistreatment. Survey results also showed that more than 50 % of LGBT elders surveyed believed that they would suffer neglect or abuse by staff of the LTC facility, with a majority believing that disclosing one’s sexual orientation or gender identity would attract discrimination from LTC facility staff and residents alike.

It is clear that little work has been conducted on LGBT victims of elder mistreatment . At the same time, it is also clear that elder LGBT victims do experience elder mistreatment and, in some respects, may be even more vulnerable to it than those of the majority population. This vulnerability is compounded by the fact that interventions for the abuse and its effects on LGBT individuals, both mentally and physically, are woefully lacking. Thus, the victimization of such elders may be either a re-victimization at a later age or a new victimization altogether. Also, LGBT elders may more likely be polyvictims (see Chap. 16) than their heterosexual counterparts. Suggested in earlier chapters, one way of addressing such problems is to understand and be sensitive to the needs of LGBT elders. Another is to understand those who perpetrate this type of elder mistreatment and in this way, to both intervene in and prevent the problem from occurring in the first place.

If there is little known about LGBT victims of elder mistreatment, even less is known about abusers of LGBT elders. This paucity of information is understandable in light of the fact that there is so little known about LGBT victims and that there is so little known about elder abusers in the general population as well. As with the section above, at this time, it is only possible to characterize the perpetrators of elder mistreatment and then, by extrapolation, understand some of the characteristics of those who abuse LGBT elders.

Amstadter et al. (2010) examined perpetrator and incident characteristics of the mistreatment of older adults (age 60+) in a national sample of 5777 older men and women. The sample revealed that perpetrators of physical mistreatment against men had more “pathological” characteristics as compared to perpetrators of physical mistreatment against women. Perpetrators of physical mistreatment (compared to emotional and sexual mistreatment) evidenced increased likelihood of legal problems, psychological treatment, substance use during the abuse incident, living with the victim, and being related to the victim.

The Lifespan study of mistreatment (2011) revealed that, for the two-thirds of agencies able to report age information for abusers, 7.7 % of reported abusers were in the younger than age 18-year category; 44.8 % were in the 18–45 age category; 25.6 % were in the age 46–59 age category; and 22 % were in the 60 years and older category. For those agencies able to report some information on gender of the abuser, 66.3 % were male abusers and 33.7 % were female abusers. For agency/programs able to provide information on the relationship between victim and abuser, 26 % were spouses or partners, 39.7 % were the victims own adult children, 2 % were sons or daughters-in-law, 9.5 %; were grandchildren, 9.5 %; 3.5 % were friends or neighbors, 0.65 % were paid home care workers, 13.1 % other relatives; and 5.6 % were other non-relatives.

In a national study of APS by Teaster et al. (2006), with data from eleven states, 52.7 % of perpetrators were female. For the seven states reporting ages for alleged perpetrators, 4.3 % were under 18 years of age, 10.6 % were 18–29, 16.1 % were 30–39, 25.6 % were 40–49, 18.5 % were 50–59, and 11.2 % were 60–69. Among those that provided information on the relationship of the perpetrator to the victim, the most common was that of adult child (32.6 %), followed by other family member (21.5 %), unknown relationship (16.3 %), and spouse/intimate partner (11.3 %).

Ramsey-Klawsnik et al. (2008) discussed research findings concerning 119 alleged sexual perpetrators reported to state authorities for abusing elderly individuals residing in care facilities. The largest group of accused was employees of the facilities, followed by facility residents, followed by victims’ family members and visitors to the facilities. Upon investigation by APS and regulatory staff, 32 individuals were confirmed as sexual perpetrators against vulnerable elders. Male and female alleged and confirmed sexual perpetrators were identified as well as both male and female elderly sexual abuse victims.

In a study of APS in the state of Kentucky in press found that no differences existed between number of male and female perpetrators when the sex of the perpetrator was identified. For the 96 victims (excluding self-neglect and guardianship), 37.0 % of perpetrators were adult children, 30.4 % were staff members in facilities, and 14.1 % were spouses or a significant other. Other less frequently occurring perpetrators were siblings (5.4 %), niece/nephews and grandchildren (3.2 %, each), and other perpetrators (6.5 %). Though as yet highly infrequently utilized by the justice system, states are continuing to develop remedies for the crime of mistreatment of elders, which are discussed in the following section.

Legal Remedies. LGBT elders who are victims of mistreatment have some remedies available to them; however, they are not without real costs. For mistreatment that is criminal in nature, a court case could be protracted, and upon all the information presented, the result could be that the perpetrator receives little or no punishment. Courts may be reticent to execute restraining orders for the harassment of LGBT elders in IPV cases. Furthermore, for those elders hitherto in the closet, pursuing a legal remedy may result in more exposure of the victim’s status as LGBT, and consequently to further discrimination and unequal treatment. In the USA, states have laws that address the mistreatment or abuse of elders, both community dwelling and those who reside in institutions. These laws are varied and may be statutes, which are part of APS laws, or distinct laws criminalizing elder mistreatment. In addition, basic or general criminal laws such as those relating to assault, battery, manslaughter, or murder may be used to prosecute acts against older adult victims (Heisler and Stiegel 2002; AARP 2012). Elder victims may also bring civil suits against perpetrators. Remedies available to elder mistreatment victims include restraining orders, punitive damages, compensation, and restitution for losses incurred and/or damages suffered (National Center for Victims of Crime 1999).

In some states, special laws exist that provide enhanced penalties for crimes against older adults, including mistreatment, designed to deter such crimes. For instance, in Nevada, the term of imprisonment for a crime against a person aged 60+ may be double the prescribed term for the offense; in Louisiana, the minimum sentence for any violent crime against an older adult is five years without parole, and in Georgia, enhanced penalties exist such as recovery of punitive in addition to actual damages suffered, for those found guilty of deceptive business practices involving elders (National Center for Victims of Crime 1999).

Other than laws regarding elder abuse and mistreatment , certain general criminal laws, such as laws against hate crimes or “bias crimes,” are applicable to victimized LGBT elders (Morrow 2001). Hate crimes are defined as crimes where the perpetrator’s conduct was driven by bias, prejudice, or hatred on the basis of actual or perceived notions of an individual or group’s status regarding race, color, religion, national origin, ethnicity, gender, or sexual orientation (US Congress 1992). Clearly, LGBT elders fall within this definition, subject as they often are to heterosexism and homophobia that may place them in environments that may be fearsome, dangerous, or hostile (Cahill and Smith 2002). States with bias crime laws often have enhanced penalties, such as harsher sentencing for these crimes, because bias/hate crimes cause harm to and/or increase vulnerability of already disadvantaged individuals or groups, as well as to discourage hate and bias or prevent such crimes (Lawrence 2002). Although all states in the USA have some form of hate or bias law, with a majority including enhanced penalties, as Table 17. 1 shows, less than one-third have laws that deal with bias or hate crimes based on the sexual orientation and gender identity (Human Rights Campaign 2013; Leiberman 2010; Leadership Conference on Civil Rights Education Fund (LCCREF) 2009).

In these states, laws with enhanced penalties may provide remedies to LGBT elders including right to pursue civil action in addition to criminal penalty and harsher sentencing for offenders (Lawrence 2002). Although the remedies identified above may provide some relief for elder LGBT victims of mistreatment, whether under mistreatment laws, general criminal laws, or hate/bias crime laws, more still needs to be done. In order to provide appropriate protection from harm as well as to redress or ameliorate harm if and when it does occur, the development of policy initiatives and strategies will be necessary. Such initiatives and strategies will need to address increasing the number of states with laws against sexual orientation or gender identity-related hate crimes, imposing stiffer or tougher penalties and consequences on convicted offenders, increasing requirements for mandatory reporting of offenses, providing training for professionals—legal, social, health, criminal justice, and law enforcement to help enhance prosecution (National Center for Victims of Crime 1999). In addition, it is important to increase public awareness and sensitivity about the vulnerability of LGBT elders as victims of abuse and mistreatment, both by virtue of age and LGBT status.

Services and Advocacy for GLBT Elders (SAGE). SAGE is the country’s largest and oldest organization dedicated to improving the lives of LGBT elders. With its headquarters located in New York City, its mission is to address issues related to LGBT aging. SAGE offers services and programs to LGBT older people throughout New York City and via its national affiliate program, SAGENet, which includes 27 affiliates located in 20 states across every region of the country. Affiliates provide services and programs to LGBT elders living in the community. Affiliates serve as advocates for the support of LBGT elders on the city and state policies that affect them (http://​www.​sageusa.​org/​advocacy/​sagenet.​cfm). SAGE offers a variety of services and programs (e.g., the arts and culture and health and wellness). Another service offered by SAGE, AGEWorks, is an employment program for LGBT elders that, like SAGENet, has sites around the country. SAGE conducts advocacy for public policies affecting LGBT elders at federal, state, and local levels in order to improve LGBT elders’ economic security, community support, and health and wellness. SAGE also trains aging providers and LGBT organizations on concerning how to support LGBT older elders in LTC settings. The organization offers cultural competence training as part of its National Resource Center on LGBT Aging and retains a training corps of nearly 40 cultural competence experts throughout the USA (http://​sageusa.​org/​about/​what.​cfm).

National Resource Center on LGBT Aging. Established in 2010 through a federal grant from the US Department of Health and Human Services, the National Resource Center on LGBT Aging is the only technical assistance resource center and clearinghouse in the country devoted exclusively to improving the quality of services and supports offered to LGBT elders . The Center provides training, technical assistance, and educational resources to aging providers, LGBT organizations, and LGBT elders. SAGE, discussed above, leads the Center and collaborates with 18 leading organizations throughout the USA (http://​www.​lgbtagingcenter.​org/​).

Other Organizations and Resources. As of this writing, the number of resources that address LGBT elders is proliferating rapidly. There are now assisted living facilities and nursing homes that openly cater to elders who are LGBT. Innovative programs targeted at LGBT elders and designed to provide a continuum of health, wellness, and social services to community dwelling LGBT elders are emerging in various communities across the USA. An example is the Chicago Elder Project at Howard Brown Center. This program is offered in conjunction with community partners (including Rush University Medical Center, CJE-Senior Life, Heartland Alliance, and Midwest Palliative and Hospice Care) to serve LGBT elders by providing culturally competent and sensitive care (Howard Brown Health Center, http://​www.​howardbrown.​org). Advocates for the rights of elders, such as the Long-Term Care Ombudsman (see Chap. 16), The NSCLC, Lambda Legal, the National Center for Lesbian Rights, the National Center for Transgender Equality, and he National Gay and Lesbian Task Force, are helping raise to the visibility and ensure the rights of elders who are LGBT.

Readily apparent from this chapter on mistreatment of LGBT elders is that few studies on elder mistreatment collect information on LGBT elder abuse. Also readily apparent is that the time has come for inclusion of this variable or variables in these datasets. LGBT elders who are mistreated are victims (polyvictims) in a multiplicity of ways—for their sexual orientation, gender identify, historic trauma either felt or experienced and the abuse or abuses (e.g., physical abuse, neglect, or exploitation) that they experience when they are abused. Seeking redress for elder mistreatment is also fraught with peril. Should an elder disclose what was previously undisclosed, the old issues of being ostracized or mistreated solely because of one’s sexual preference could be less tolerable than enduring the abuse. Even if an elder discloses what was previously disclosed, many service systems and providers are, as yet, untrained and unsympathetic for the elder’s plight and thus the intervention offered may do more harm than good. These authors stress that it is high time to include LGBT issues in research on elder abuse in order to understand incidence and prevalence of the problem in this community, to characterize victims and perpetrators, to delineate and bolster available remedies, to conduct meaningful research and advocacy, and, most importantly, to improve the quality of life of present and future LGBT elders.

The mistreatment and victimization of older LGBT adults are slowly coming to light in both practice and research. However, at this point, few studies examine this phenomenon. What is certain is that being LGBT may place elders at increased risk for mistreatment due to factors such as isolation, previous exposure to a traumatic event, and reticence to seek assistance from informal and formal networks. Penalties for elder mistreatment must be utilized by law enforcement more frequently, and statues that explore elder mistreatment as a hate crime also explored. It is critical that advocates, practitioners, researchers, and policy makers understand, intervene in, and prevent the mistreatment of LGBT elders .