Being Trans, Senior and Homeless

When thinking about homelessness, most people don’t think of senior citizens. We presume that older adults have Social Security, pensions and cozy little homes that have been paid off for years. That’s often not the case for Transgender people, who have spent years struggling with health care, and discrimination in the work force and housing.

There is a large and troubling number of elderly residents of our community who do indeed live in their cars, moving from place to place to avoid neighbor complaints. Others seek out alcoves and nooks where they can stay out of the weather. Still others seek refuge at local homeless shelters.

The toughest age bracket is age 55 to 62, when many older adults feel they are too old to compete for jobs yet still too young to qualify for Social Security, is added to the already burden of discrimination based on gender identity. And while age 55 may seem young, aging on the street takes a toll. According to numerous experts, the average life expectancy for un-sheltered homeless people is 64 years. According to National Health Care for the Homeless Council, homeless people over 50 have four times the mortality rate of younger homeless people because “weathering” of un-housed people can prematurely age them by 10 to 20 years, and if that sounds awful, keep in mind those are numbers that represent the general population. For trans and other LGBTQ, it’s a human tragedy.

According to an NTDS Report:

▪ Survey participants reported very high levels of postponing medical care when sick or injured due to
discrimination (28%) or inability to afford it (48%);
▪ Respondents faced significant hurdles to accessing health care, including:
• Refusal of care: 19% of our sample reported being refused care due to their transgender or
gender non-conforming status, with even higher numbers among people of color in the survey;
• Harassment and violence in medical settings: 28% of respondents were subjected to
harassment in medical settings and 2% were victims of violence in doctor’s offices;
• Lack of provider knowledge: 50% of the sample reported having to teach their medical
providers about transgender care;
▪ Despite the barriers, the majority of survey participants have accessed some form of transitionrelated
medical care; the majority reported wanting to have surgery but have not had any surgeries yet;
▪ If medical providers were aware of the patient’s transgender status, the likelihood of that person
experiencing discrimination increased;
▪ Respondents reported over four times the national average of HIV infection, 2.64% in our sample
compared to .6% in the general population, with rates for transgender women at 3.76%, and with those
who are unemployed (4.67%) or who have engaged in sex work (15.32%) even higher;
▪ Over a quarter of the respondents misused drugs or alcohol specifically to cope with the
discrimination they faced due to their gender identity or expression;
▪ A staggering 41% of respondents reported attempting suicide compared to 1.6% of the general
population, with unemployment, low income, and sexual and physical assault raising the risk factors significantly.

One of the major factors delaying medical treatment in our community is access to insurance, discrimination, medical professionals lacking education on trans issues, and according to this same study., in terms of preventive care, those without insurance reported delaying care due to inability to afford it much more frequently (88%) than those with private insurance (39%) or public insurance (44%). Failing to obtain preventive care is known to lead to poor long-term health outcomes.

A bipartisan group of 76 U.S. House members is calling on the White House to restore to a federal health survey for elders a question the Trump administration has struck out allowing them to identify as transgender.

In a letter dated July 21 and led by Rep. Ted Deutch (D-Fla.), chair of the LGBT Aging Issues Task Force, lawmakers call on the White House Office of Management & Budget to reinstate the question in the National Survey of Older Americans Act Participants, or NSOAAP.

“We have to ensure we are meeting the needs of the most vulnerable among us,” Deutch said in a statement. “Study after study has shown that transgender older adults face greater social isolation, food insecurity and disparate health impacts. It is cruel to remove a previously included transgender-specific demographic question and, in essence, send a message to transgender seniors that their needs are not important.”

Earlier this year, the Administration on Community Living at the Department of Health & Human Services indicated it would eliminated from the NSOAAP questions allowing LGBT elders to identify their sexual orientation and gender identity. Amid pressure from LGBT rights supporters, HHS agreed to restore the sexual orientation, but kept out a question allowing elders to identify as transgender.

Fortunately, there are programs emerging to help combat the issue of isolation in the senior trans community. Groups such as Lavender Seniors and SAGE perform outreach to elder members of the transgender community and provide a safe and welcoming place for them to socialize and find support. The reach of these programs remains limited, though, and tends to be concentrated in more progressive large cities.

It is also important that we continue to speak out for our Trans seniors that have walked the paths, we find just a little more comfortable to walk today.