The senior LGBT-advocacy organization Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (sageusa.org) estimates there are 2.9 million LGBT seniors older than 55 in the United States. Like all seniors, LGBT seniors may also require home health-care assistance or nursing-home care. In the LGBT community, however, growing older comes with its own unique issues and stigmas. Enter Rainbow Train, run through Wingspan, Tucson's LGBT support organization. Retired UA public-health professor Stuart Cohen says he works to offer an LGBT point of view to help health-care professionals understand the benefits of being culturally sensitive to LGBT clients.

What is your job as a Rainbow Train trainer?

LGBT seniors represent about 10 percent of the clientele of health-care agencies, although the staff of these agencies may be unaware of it. We want to help them be more aware. The world makes heterosexual assumptions. If you look at the forms you fill out related to health care, it will ask you for your spouse, but it never asks you for your partner. It's just assumed that the world fits in that traditional mold. We help agencies look at forms, their policies and how staff works with clients. These kinds of changes that are LGBT-friendly help. In many cases, people who have been out as younger adults are very afraid they will end up being discriminated against if they end up going into an assisted-living facility. They remain in the closet, and couples who have been together for many years often end up getting separated, because the policy is that only married people can be together (in a nursing home). We think it would be competitive for them to say that they are respectful of all ... clients.

What type of commitment is involved?

It's minimal. To become a Rainbow Trainer (requires) a two-day training (session). The training we do with agencies is two hours. We sit down with staff of an agency and first identify the unique issues LGBT seniors face (and) strategies for them to create a welcoming environment, and we show a film that gives a good example of appropriate behavior when working with someone who is LGBT. We've had positive response from the film and discovered its importance in showing how just the smallest behaviors of someone in home health care can make the difference for a LGBT senior.

What services does Rainbow Train target?

It's been a little bit frustrating. Home health care is one group we'd like to work with more, because in a community like Tucson, where you have a lot of retirees, home health care is very important. Nursing homes are, too. But (home health care has) been the hardest group to target. They simply do not want the training.

What is the knowledge that most providers need to know?

I think basically that what happens, very inadvertently, is that people assume everyone is heterosexual. And it doesn't dawn on them that the people they serve may not be heterosexual.

What are specific challenges that LGBT seniors face?

All adults age, but it's an additional burden for LGBT people. Many have never married or ... may have been rejected by their families. So, they not only deal with the consequences of aging, but social isolation, too. There are over 1,000 laws that protect heterosexual married couples that are not available to same-sex couples. Many LGBT seniors remain in the closet. You have to remember when they were younger, they could lose their job because of sexual orientation. In the state of Arizona, you can still lose your job, because there is no protection for sexual orientation. Out of the Pac-10 (Conference schools), the two Arizona schools are the only ones that do not have partnership benefits for staff. Many LGBT seniors aren't motivated to be out, and as a result, they rarely seek needed health care and services.

Do you have an example that some of our readers wouldn't think about when it comes to LGBT senior challenges?

Let's say you have two women who live together. One was a higher wage earner, and they've lived together for 35 years. They both are on Social Security, but they are not able to get their Social Security the way a married couple would. The higher wage earner dies, and instead of having the higher Social Security go to the survivor to live on, as it does with married couples, (that) doesn't happen with this same-sex couple. The survivor may lose her home because she don't have the money to pay the mortgage anymore.

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