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  • Oliver Whitney

Gen Silent: The Crisis of Care for LGBTQ Elders

By Oliver Whitney

Khrysallis Anne in Gen Silent (Courtesy of Stu Maddux) 

“I’m going to do everything I can to stay.”

Those are the words of Khrysallis Anne, an older transgender woman and Vietnam veteran with terminal lung cancer who’s desperate to remain in her home instead of moving into a nursing home. She’d gone that route before and it was a traumatizing experience that any trans person could understand — “They didn’t want to touch my body,” she recalled of the medical staff. 


Khrysallis Anne is one of the subjects of Stu Maddux’s 2019 documentary Gen Silent, which explores the lives of six LGBTQ seniors in Boston and their experiences with homophobic and transphobic discrimination in long-term care facilities. We spend time with lesbian couple Sheri Barden and Lois Johnson, who speak of wanting to be cared for only by their local gay community. We follow professor Lawrence Johnson as he takes trips to a nursing home to visit his long-time partner Alexander who’s living with Parkinson’s dementia. And then there’s Mel, who after finding his sick partner safe care from an inclusive agency, publicly discloses their 39-year relationship for the first time. 


In Gen Silent, multiple folks in the long-term care and nursing home industry shed light on the myriad of horror stories LGBTQ older adults experience. “LGBT elders are more likely than the general population to age alone because many gay elders never had children, or have not had great relationships with their family of origin,” says a case worker supporting Khrysallis Anne in an interview. 

LGBT elders are more likely than the general population to age alone because many gay elders never had children, or have not had great relationships with their family of origin.

According to research from the National Center on Elder Abuse (NCEA), LGBTQ elders are at high risk for elder abuse, neglect and exploitation, and many avoid care out of fears of homophobia and transphobia. Khrysallis Anne is just one example of the latter, a woman who came out and transitioned later in life — just a couple years before her cancer diagnosis — and whose entire family has refused to accept or speak to her. In the film’s most heart wrenching scenes we watch as her health deteriorates and she struggles to breathe and move around her home easily. It’s fear and trauma that keep her from accepting care elsewhere, but eventually her case worker convinces Khrysallis Anne to get professional care, and rallies to ensure she has a proper support network of allies during recovery. It’s a beautiful moment of the power of communal care, and how life-altering it can be for an LGBTQ+ elder to find support after years of painful isolation. 


There’s also the issue of queer seniors being forced to go back into the closet when their health takes a turn for the worse. A study from SAGE, a national advocacy organization for LGBTQ+ elders, found that 70 percent of LGBTQ+ elders fear having to “re-closet” themselves when seeking elder housing. According to a 2014 Harris Poll, 40 percent of LGBTQ older people in their 60s and 70s say their healthcare providers don’t know their sexual orientations. 


"You just know when they don't want you there,” Lawrence Johnson says in the documentary after recounting his and his partner Alexander’s first experience at a nursing home that didn’t feel safe for a gay couple. “If you feel you’re not wanted someplace you’re in a state of stress,” Johnson says, and stress about safety tied to your identity is the last thing a person who can’t feed or bathe themselves should experience. 

Lawrence and his partner Alexander in Gen Silent (Courtesy of Stu Maddux) 

Others in the documentary share stories of queer elders who were forced to pray their gay away by extremist religious orderlies in care facilities, and of one man who out of fear “reverted to internalized homophobia” when entering a nursing home by refusing to let any of his gay friends visit. 


The types of discrimination LGBTQ elders experience in long-term care facilities is varied. According to NCEA’s research, this includes denial of visitors, a refusal to allow same-sex couples to share rooms, a refusal to place a transgender elder in a ward that matches their gender identity, keeping partners from participation in medical decision making, and even physical and psychological abuse for trans elders in particular.  


As of early 2023, 29 states lack explicit inclusion of sexual orientation or gender identity in long-term care housing protections. The problem also lies with the nursing staff, as one glaring statistic shared in Maddux’s documentary revealed that 50 percent of nursing home staff said their colleagues would be intolerant of LGBTQ people. 


The crisis of aging for queer and trans people is such a systemic issue it can be daunting to figure out where and how to tackle it, and how to make long-term care facilities safe and inclusive to LGBTQ folks. But there are solutions. 

Sheri and Lois in Gen Silent (Courtesy of Stu Maddux) 

Gen Silent spotlights Ethos, a Boston-based non-profit that works to help elders stay at home to receive care. There’s also a scene involving Lisa Krinsky of the LGBT Aging Project as she leads an LGBTQ inclusion training for caregivers. But we need more of these types of trainings and programs. A study conducted in 2023 about caring for LGBTQ+ elders at home concluded that “universal funding to train the existing home care workforce as well as building a more diverse and representative workforce is critical to providing equitable and affirming care to LGBTQ + older adults.” Having a stranger enter the home of a queer or trans elder can be an incredibly distressing experience alone, since so many of these folks already live in isolation and have been treated poorly. That’s why it’s especially vital that caregivers who aren’t family members or friends are properly trained and equipped with how to care for LGBTQ folks with warmth, compassion, and acceptance. 


Aging is a major issue for Americans across the board, and it’s vital that queer and trans elders are included and considered in solutions to improve broken systems moving forward. A quick scan of recent mainstream headlines reveals that the U.S. is currently in the midst of a national long-term care crisis due to aging baby boomers, skyrocketing costs of home care, and the failures of long-term care insurance. But these articles all fail to address the specific struggles LGBTQ+ elders face. Currently there are at least 3 million LGBTQ adults over the age of 55, and by 2030 there will be 7 million LGBTQ+ folks over the age of 65. That suggests we need to work harder and faster over the next several years to advocate for wide-spanning legal protections, safe and affirming long-term care staff, and solutions for elder home care. Many LGBTQ+ older adults have already faced extreme challenges over the course of their lives. They deserve nothing less than to age and be cared for in environments that offer unwavering support, and allow them to spend their final years free to be and express themselves to the fullest. 


You can watch Gen Silent on Kanopy and learn more about setting up a public screening event here. Learn more about SAGE’s advocacy work, research, and upcoming studies here


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