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Service Delivery Innovation Profile

Multiagency Collaboration Improves Access to Culturally Sensitive Care and Support Services for Lesbian, Gay, Bisexual, and Transgender Seniors


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Snapshot

Summary

Between 2005 and 2009, Aging as Ourselves worked to improve access to culturally sensitive health-related resources and support services for lesbian, gay, bisexual, and transgender seniors in San Diego County through a community-based collaboration of agencies. "Mainstream" (i.e., those who do not specifically cater to lesbian, gay, bisexual, and transgender individuals) and lesbian, gay, bisexual, and transgender service providers offered a safe and caring network of health, legal, and social services to lesbian, gay, bisexual, and transgender seniors. The program also conducted community education initiatives designed to raise awareness of the unique issues facing lesbian, gay, bisexual, and transgender seniors. The program improved access to culturally appropriate care and services and led to more social interaction, better mental health, and an increased willingness to disclose sexual orientation to health care providers and others. Although the program formally ended in 2009 due to funding issues, participating agencies continue to provide many of the program's services to lesbian, gay, bisexual, and transgender seniors.

Evidence Rating (What is this?)

Moderate: The evidence consists of post-implementation survey responses on access to service and social interaction from LGBT seniors served by the program as of 2008, comparisons of pre- and post-intervention mental health evaluation questionnaires from 139 participants provided with mental health services between January 2006 and March 2009, and comparisons of pre- and post-intervention survey responses on sexual orientation disclosure from a group of 36 new clients receiving program services between March 2008 and March 2009.
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Developing Organizations

Alliance Healthcare Foundation; Elder Law and Advocacy; ElderHelp of San Diego; Family Health Centers of San Diego; PALS/LINC-age; S.A.G.E. of California; San Diego LGBT Community Center
ElderHelp of San Diego served as the lead collaborating agency. One original collaborating agency, PALS/LINC-age, left the program during its operation.end do

Date First Implemented

2005
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Patient Population

Age > Aged adult (80 + years); Vulnerable Populations > Lesbian/gay/bisexual/transgender; Age > Senior adult (65-79 years)end pp

Problem Addressed

Despite their growing numbers nationwide, lesbian, gay, bisexual, and transgender (LGBT) seniors remain a hidden group in American society. Often socially isolated and in fear of discrimination, LGBT seniors experience unique barriers to care.
  • A growing population: The National Gay and Lesbian Task Force estimates that there are approximately 3 million LGBT seniors in the United States and that, by 2030, that number will nearly double.1
  • Fear of discrimination, leading to isolation: LGBT seniors face a number of unique challenges as they age, including social isolation and inadequate access to health care, housing, and social services due to fear of discrimination. A 2006 survey found that more than one-fourth of LGBT individuals reported great concern about discrimination as they age, and less than one-half expressed strong confidence that health care professionals will treat them with dignity and respect.2
  • Increased barriers to care: LGBT seniors have more limited access to care than does the typical American; LGBT seniors, for example, are less likely to have had a recent physical examination, while many lesbian seniors do not receive regular mammograms or pelvic examinations. Among LGBT seniors who do seek care, most rarely or never discuss issues of sexual orientation with their health care providers. In addition, many LGBT seniors do not have traditional family support systems in place to help them in their later years.3
  • Less access to financial protection: Federal programs designed to assist the elderly often do not apply to LGBT seniors, leaving them more financially vulnerable and less able to afford services as they age. Same-sex partners in lifelong relationships do not have access to Social Security spousal benefits (or to survivor benefits for widows and widowers), nor are they affected by Medicaid regulations that protect the assets and homes of married spouses when the other spouse enters a nursing home.1

What They Did

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Description of the Innovative Activity

Between 2005 and 2009, Aging as Ourselves worked to improve access to culturally sensitive health-related resources and support services for LGBT seniors in San Diego County through a community-based collaboration of agencies. Mainstream and LGBT service providers offered a safe and caring network of health, legal, and social services to LGBT seniors. The program also conducted community education initiatives designed to raise awareness of the unique issues facing LGBT seniors. Key elements of the program included the following:
  • Shared leadership and responsibility among collaborating agencies: Aging as Ourselves operated as a collaboration of five health and social service provider organizations (three mainstream and two serving the LGBT community) that worked together to ensure that services across San Diego County address the specific needs and interests of LGBT seniors. All five collaborating agencies shared responsibility for leadership of the program and for programming, finances/fundraising, and reporting. Each agency also contributed services and staff time. The program held monthly tactical meetings for direct service staff from all collaborating agencies, as well as quarterly collaborative leadership meetings for agency directors and senior management.
  • Multiple access points and coordinated network of care: Aging as Ourselves did not mandate a standardized intake process; rather, LGBT seniors could become participants in the program through access points at any of the collaborating agencies. Staff at each agency screened new program participants to identify areas of need, then made referrals to other collaborating agencies for delivery of appropriate services. For example, a senior seeking legal assistance at Elder Law and Advocacy (a collaborating agency) who expressed interest in visiting a support group might be provided with a referral to San Diego LGBT Community Center, another collaborating agency that hosts such groups.
  • Direct services to LGBT seniors: Aging as Ourselves provided LGBT seniors with a comprehensive network of case management, counseling, legal, and other support services through its collaborating agencies. Program services included the following:
    • Case management: Case managers assessed the individual needs of participating LGBT seniors and developed a corresponding care plan. Collaborating agencies provided appropriate services whenever possible, with case managers providing referrals to outside community resources for additional services such as housing and home health care when necessary. Case managers aimed to welcome, support, and empower LGBT seniors to help them remain independent and safe in their homes.
    • Counseling and support groups: Aging as Ourselves offered individual mental health counseling and general support groups, along with specialized support groups that focused on issues such as prostate cancer, substance abuse, and living as a transgender individual. These programs all catered to individuals older than 50 years.
    • In-home care: Collaborating agencies trained volunteers to provide "friendly visits" to LGBT seniors in their homes, many of whom live alone and suffer from isolation. Volunteers ran errands, went grocery shopping, provided free transportation, or simply offered companionship.
    • Health and wellness support: LGBT seniors could attend health and wellness groups, take yoga and tai chi classes, and receive education and support around issues such as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), sexually transmitted diseases, and safe sex.
    • Legal assistance: Collaborating agencies provided free legal counseling and assistance focused on the unique needs of the LGBT senior community, including issues related to power of attorney, wills and trusts, advance medical directives, Social Security, finance, and real estate.
    • Social activities: Participating LGBT seniors could choose to take part in organized social groups focusing on a number of topics, including art, music, reading, dining out, cooking, and needlecraft.
  • Social marketing campaigns: In addition to direct services, Aging as Ourselves designed and implemented social marketing campaigns to increase awareness of specific issues facing the LGBT senior community. In 2006, the program ran a campaign targeted toward gay men older than 50 years, focusing on HIV risk factors and testing as well as safe sex practices. In 2008, the program ran a campaign intended to encourage LGBT seniors to reveal their sexual orientation to their doctors.
  • Cultural competency training: Aging as Ourselves periodically hosted 2-hour cultural competency workshops for health and social service agencies to heighten awareness of LGBT seniors and the issues they face. In collaboration with the University of California at San Diego, the program also created a 13-module, 6-hour online cultural competence course to train doctors and allied health professionals on how to create a more welcoming environment for LGBT patients, with the goal of making these patients feel more comfortable revealing their sexual orientation.

Context of the Innovation

Aging as Ourselves was formed in 2005 as a collaboration between three mainstream senior service organizations (ElderHelp of San Diego, Family Health Centers of San Diego, and Elder Law and Advocacy) and three agencies serving the LGBT community (S.A.G.E. of California, the San Diego LGBT Community Center, and PALS/LINC-age). One original participant—PALS/LINC-age—subsequently dropped out of the program. The program was developed in response to the previously described discrimination, barriers, and challenges faced by LGBT seniors in San Diego and throughout the United States.

Did It Work?

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Results

The program improved access to culturally appropriate care and services and led to more social interaction, better mental health, and an increased willingness to disclose their sexual orientation to their health care providers and to others.
  • Improved access to services: All of the more than 200 participants who received case management services as of 2008 reported improved access to culturally appropriate health care and support services. In addition, 83 percent of participants who had specific problems identified as part of their case management assessments reported that those problems had been resolved.
  • More social interaction: All participants who indicated a need for increased social contact as a part of their case management assessment showed demonstrated improvements in social interaction.
  • Better mental health: As of March 2009, participants provided with mental health counseling reported statistically significant improvements in a number of areas, including reduced symptoms of depression, less anxiety and hostility, and increased coping skills and life satisfaction.
  • Increased willingness to disclose: As of March 2009, program participants reported an increased willingness to disclose their sexual orientation to health care providers, neighbors, family members, and friends.

Evidence Rating (What is this?)

Moderate: The evidence consists of post-implementation survey responses on access to service and social interaction from LGBT seniors served by the program as of 2008, comparisons of pre- and post-intervention mental health evaluation questionnaires from 139 participants provided with mental health services between January 2006 and March 2009, and comparisons of pre- and post-intervention survey responses on sexual orientation disclosure from a group of 36 new clients receiving program services between March 2008 and March 2009.

How They Did It

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Planning and Development Process

Key steps in the planning and development process included the following:
  • Conducting needs assessment: In 2000, the San Diego-based Alliance Healthcare Foundation formed an LGBT Senior Community Advisory Committee, composed of funders, social service and health care providers, and concerned citizens. In 2004, the committee conducted a comprehensive needs assessment for the LGBT senior community in San Diego, the results of which identified a spectrum of needs and concerns, ranging from health care access to legal worries to finances. A second advisory committee was formed, with a mandate to design a program to address these needs and concerns.
  • Identifying and recruiting collaborating agencies: The program selected agencies to serve as collaborating partners based on interest, capacity, and the types of services offered. Some collaborating agencies became involved through representation on the LGBT Senior Community Advisory Committee, whereas others were recruited. As the program began to secure funding and establish direction, agency roles and responsibilities became more solidified.
  • Obtaining funding: Aging as Ourselves sought and received significant initial funding from local organizations, including the San Diego Human Dignity Foundation, San Diego National Bank, The California Endowment, Alliance Healthcare Foundation, and the Price Galinson Collaborative Fund. In addition, Aging as Ourselves received a $500,000, 4-year matching grant from the Robert Wood Johnson Foundation to support the program's launch and ongoing operations.
  • Volunteer training: Through ElderHelp of San Diego, volunteers who conducted home visits attended a 2-hour orientation course on working with senior citizens, as well as an additional in-service training on the specific issues facing LGBT seniors.
  • Terminating program due to funding difficulties: As of March 1, 2009, program leaders terminated the program due to an inability to raise adequate matching funds to maintain current grants. Although the program's official collaborative efforts are no longer offered, participating Aging as Ourselves agencies continue to provide many of the program's direct services to LGBT seniors.

Resources Used and Skills Needed

  • Staffing: Aging as Ourselves paid the salary of one full-time staff member operating out of the San Diego LGBT Community Center. In addition, ElderHelp of San Diego employed a full-time Aging as Ourselves case manager, who reported to leaders of the program. All other individuals who contributed time to the program did so as part of their responsibilities at the respective collaborating agencies. In addition, volunteers provided clerical support to the program and conducted "friendly visits" to LGBT seniors in their homes.
  • Costs: Aging as Ourselves' 2007 budget totaled $250,000. Funds were disseminated to collaborating agencies based on need and services provided.
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Funding Sources

Archstone Foundation; Robert Wood Johnson Foundation; Alliance Healthcare Foundation; San Diego Human Dignity Foundation; San Diego National Bank; California Endowment; Price Galinson Collaborative Fund
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Adoption Considerations

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Getting Started with This Innovation

  • Recruit collaborating agencies and build trust: The success of a shared leadership model depends on trust and open communication between collaborating agencies. To that end, recruit agencies committed to working together to improve outcomes for participants.
  • Establish infrastructure, roles, and processes early: Ensure that all necessary contracts and agreements are in place before the program launches. Define agency roles, decisionmaking processes, and referral methods ahead of time so that the program is easy for participants to navigate.
  • Emphasize focus on large goals: Before beginning service delivery, all collaborating agencies must achieve a shared understanding of the project's larger goals and their responsibilities in achieving them. Without this understanding, participating agencies will tend to focus on meeting individual service delivery goals.
  • Build client referral and tracking mechanisms: Establish effective and confidential means of sharing and recording client data across collaborating agencies, as this step is critical to evaluating and improving program services. If possible, develop these mechanisms early in the planning process so that they become ingrained in program operations.
  • Secure funding: Major national organizations represent ideal sources of funds, as they can offer both monetary support and exposure for the program.
  • Raise awareness among funders and other stakeholders: Speak to potential funders and providers about the issues and challenges facing the LGBT community.

Sustaining This Innovation

  • Continue to seek funding: Periodically approach large foundations to ensure that LGBT senior issues are on their "radar screen" for future funding.
  • Consider charging for some services: A membership-based program could be set up to charge participants who have the ability to pay for at least a portion of the cost of services.
  • Avoid competition: Maintain a cooperative environment by avoiding competition between collaborating agencies, thus ensuring that these organizations continue to work toward the same goal.
  • Standardize data collection: Ensure that all collaborating agencies share an understanding of and protocol for data collection to allow for effective evaluation of the program over time and across settings.

More Information

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Contact the Innovator

Anya Delacruz
Member Services Director
ElderHelp of San Diego
6150 Mission Gorge Dr. #140
San Diego, CA  92120
Phone:(619) 284-9281, ext. 125
Fax: (619) 284-0214
E-mail: adelacruz@elderhelpofsandiego.org

Innovator Disclosures

Ms. Delacruz reported having no financial interests or business/professional affiliations relevant to the work described in the profile other than the funders listed in the Funding Sources section.

Footnotes

1 Aging. National Gay and Lesbian Task Force Web site. Available at: http://www.thetaskforce.org/issues/aging
2 Out and aging: the MetLife study of lesbian and gay baby boomers. MetLife Mature Market Institute. Available at: http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-out-aging-lesbian-gay-retirement.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)
3 It's About Time: LGBT Aging in a Changing World. SAGE Fourth National Conference on LGBT Aging. Available at: http://forge-forward.org/wp-content/docs/SAGE_Conference-Findings.pdf.
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Original publication: March 16, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: April 09, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: March 17, 2014.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.