For LGBTQ Americans of all ages, this is a disorienting moment. While much of the country, and the world, has become inclusive and supportive of the rights of the LGBTQ community to live in dignity and with respect, at the same time, extreme political operators are proposing to not only rollback hard-fought rights and opportunities but they have also created a new climate of intolerance and even harassment along with fear among LGBTQ people. In fact, The Human Rights Campaign, an LGBTQ civil rights organization, recently declared a state of emergency for LGBTQ individuals in America.

Imagine, then, added to that turmoil are the inevitable challenges we all face as we get older: taking care of older parents, gaining access to necessary care for ourselves, finding the right housing, maintaining social connections, and even making plans and decisions regarding late-in-life treatments. Not to mention financial woes and retirement worries. For LGBTQ older adults, these challenges are often exacerbated, as they may lack family support, inclusive housing opportunities, and social connections alongside ongoing fear and discrimination. Navigating all of these challenges in your later years may prove daunting and overwhelming.

With regard to housing and long-term care options, many older LGBTQ adults fear they may have to suppress their authentic selves in order to gain care and support, either in their own homes or in long-term care communities. To help gain access to more inclusive and welcoming facilities or retirement communities, SAGE, along with The Human Rights Campaign, has created an up-to-date report and search opportunity, which not only provides a model and template for facilities to become more inclusive but also gives LGBTQ seniors the opportunity to find such residences when they are considering the transition to long term care. You can find out more about the creation of this Long Term Care Equality Index here and here, and you can search the index for your own needs here. And if you or an LGBTQ loved one think retiring abroad is more inviting, click here to read about the most welcoming places to consider overseas.

When it comes to health and well-being, the National Institute on Aging is supporting numerous research studies to better understand the needs of this aging community as well as how bias, prejudice, and discrimination may have impacted the health of LGBTQ adults as they’ve gotten older and as they continue to navigate the healthcare system. Generally speaking, many indicators of aging are worse in the LGBTQ community, including poor general health, mental health challenges, sleep problems at higher rates, and elevated risk of such chronic conditions as cardiovascular disease, arthritis, and asthma. They are often also at higher risk for cognitive impairment and dementia due to a lack of social connections and loneliness. Specific to their identity, many have issues around access to safe and welcoming care, along with previous poor experiences in the health care system. Furthermore, many LGBTQ older adults avoid seeking out care due to fear of how they’ll be treated, only to delay to the point of serious or irreversible harm. One positive sign of change is the introduction of a specialized Medicare Advantage plan offered by SCAN (and only available in a limited number of states) that is specifically intended to provide inclusive and welcoming care and treatment for LGBTQ seniors.

Finally, when it comes to advance care planning and considerations around end-of-life care, always challenging topics no matter who you are, those in the LGBTQ aging community perhaps have it even more challenging. Who is available to help make surrogate decisions should the need arise, and who would know best what the patient would want, are often intrinsically more challenging with LGBTQ patients, who may be estranged from biological family members but may be quite close to “chosen” family members. Special planning may need to take place to make sure chosen surrogates have the legal authority to be involved with treatment decisions. This is true both for end-of-life treatments along with after-death decisions, for which a traditional durable power of attorney is no longer legally valid. For more on the complexities of this decision process, read here, and for those who have the need, take a look at a handbook created in Louisiana (but valuable no matter where you live) that specifically focuses on end-of-life decisions for the LGBTQ community.

And to all those in the LGBTQ community and their loved ones, Happy Pride Month!