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LGBT OLDER ADULTS, CHOSEN FAMILY, AND CAREGIVING

Published online by Cambridge University Press:  18 July 2016

Nancy J. Knauer
Nancy J. Knauer*
Affiliation:
I. Herman Stern Professor of Law and Director of Law and Public Policy Programs, Temple University, Beasley School of Law
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Abstract

In the United States, informal elder care is principally the responsibility of younger relatives. Adult children perform the majority of elder care and non-relatives perform only 14 percent of care. Caregiving in the lesbian, gay, bisexual, and transgender, or LGBT, community follows a very different pattern that reflects the importance of “chosen family” in the lives of LGBT older adults. Instead of relying on relatives, LGBT older adults largely care for each other. Relatives provide only 11 percent of all elder care. This article explores the high level of caregiving by non-relatives in the LGBT community. It asks what motivates friends, neighbors, and community members to provide care for someone whom the law considers a legal stranger. It also asks what steps policy makers can take to facilitate and encourage this type of caregiving. Finally, it asks what lessons can be learned from LGBT older adults about the nature of both caregiving and community. As the aging population becomes more diverse, aging policies will have to become more inclusive to address the differing needs of various communities, including LGBT older adults. The potential lessons learned from the pattern of elder care in the LGBT community, however, extend far beyond a simple commitment to diversity.

Keywords

LGBTagingcaregivingelder care
Type
SYMPOSIUM: GLOBAL LEGAL AND RELIGIOUS PERSPECTIVES ON ELDER CARE
Information
Journal of Law and Religion , Volume 31 , Issue 2 , July 2016 , pp. 150 - 168
Copyright
Copyright © Center for the Study of Law and Religion at Emory University 2016 

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References

1 Susan C. Eaton, Eldercare in the US: Inadequate, Inequitable, but Not a Lost Cause, in Warm Hands in Cold Age: Gender and Aging 38 (Nancy Folbre, Lois B. Shaw & Aneta Stark, eds., 2007). Informal elder care includes assistance with the “instrumental activities of daily living,” such as shopping and transportation, as well as more intimate personal care. See infra text accompanying notes 102–03.

2 Chari, Amalavoyal V. et al. , The Opportunity Costs of Informal Elder-Care in the United States: New Estimates from the American Time Use Survey , 50 Health Research Services 871 (2015)CrossRefGoogle ScholarPubMed.

3 Donald Redfoot et al., The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers, AARP Public Policy Institute (Aug. 2013), http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2013/baby-boom-and-the-growing-care-gap-insight-AARP-ppi-ltc.pdf.

4 Ziettlow, Amy & Cahn, Naomi, The Honor Commandment: Law, Religion, and the Challenge of Elder Care , 30 Journal of Law and Religion 229 (2015)CrossRefGoogle Scholar.

5 Id.

6 Id. at 231 (reporting “little knowledge of the secular law” on the part of the study participants).

7 Id. at 233 (explaining the commandment can apply to “any authority figure”).

8 Caregivers of Older Adults: A Focused Look at Those Caring for Someone Age 50+, National Alliance for Caregiving 9 (June 2015), http://www.caregiving.org/wp-content/uploads/2015/05/2015_CaregivingintheUS_Care-Recipients-Over-50_WEB.pdf. [hereinafter Caregivers].

9 Id.

10 This figure represents 70 percent of the estimated 34.2 million American adults who serve as an unpaid caregiver to someone age fifty or older. Id. at 1.

11 Karen I. Fredriksen-Goldsen et al., The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults (2012), http://depts.washington.edu/agepride/wordpress/wp-content/uploads/2012/10/Full-report10-25-12.pdf [hereinafter Fredriksen-Goldsen, The Report]. As used in the article, the term “LGBT older adult” means someone age fifty or older.

12 Id. Fifty-four percent of LGBT individuals aged fifty or older who are receiving care are receiving care from their partners or spouses. Id. Thirty-four percent of LGBT individuals aged fifty or older who are receiving care are receiving care from friends or other nonrelatives. Id. In contrast, among the general population caregiving by spouses represents only 11 percent of all caregiving for adults aged fifty and older and caregiving by friends and non-relatives accounts for 14 percent of such caregiving. Caregivers, supra note 8, at 8.

13 See, e.g., The Book of Common Prayer 423 (1979) (providing, as part of the marriage ceremony, a promise to love and care for each other “in sickness and in health”).

14 Fredriksen-Goldsen, The Report, supra note 11, at 12 (noting that 25 percent of LGBT older adults age fifty and older have children). In the general population, 86 percent of Americans aged forty-five and older have had children. Frank Newport & Joy Wilke, Desire for Children Still the Norm (Sept. 24, 2013), http://www.gallup.com/poll/164618/desire-children-norm.aspx. For younger LGBT generations, the rate of childrearing is considerably higher than it is for LGBT older adults. Gary J. Gates, LGBT Parenting in the United States (Feb. 2013), http://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Parenting.pdf. For LGBT individuals under age fifty, 48 percent of lesbians and 20 percent of gay men are raising a child under the age of eighteen. Id. at 1.

15 Id. at 51 (“most LGBT older adults care for one another”).

16 The Report uses statistics from 2010. Fredriksen-Goldsen, The Report, supra note 11, at 57. Accordingly, the category described as “spouses and partners” was primarily composed of partners (that is, non-relatives) because same-sex marriage was recognized in only five states in 2010: Connecticut, Iowa, Massachusetts, New Hampshire, and Vermont. Maps of State Laws and Policies, Human Rights Campaign, http://www.hrc.org/state_maps (last visited Sept. 29, 2015) [hereafter Maps of State Laws].

17 The State of Aging in America 2013, Centers for Disease Control and Prevention 11, available at http://www.cdc.gov/features/agingandhealth/state_of_aging_and_health_in_america_2013.pdf (last visited Sept. 29, 2015).

18 Diversity, United States Department of Health and Human Services: Administration on Aging, http://www.aoa.gov/AoA_programs/Tools_Resources/diversity.aspx#LGBT (last accessed Sept. 29, 2015) (“[O]lder minority population, aged 65+, is projected to increase by 217 percent, compared with 81 percent for older white population.”).

19 The term Stonewall refers to the Stonewall riots that began on June 27, 1969, when police raided a gay bar, the Stonewell Inn, in Greenwich Village. See generally Martin Duberman, Stonewall 203–09 (1993) (discussing history of Stonewall). The Stonewall riots are used to mark the beginning of the contemporary gay rights movement. Annamarie Jagose, Queer Theory: An Introduction 30–31 (1996).

20 Diversity, supra note 18. The range in estimates reflects the difficulty in approximating the overall portion of the population who identify as LGBT. As noted earlier, this article uses the term “LGBT older adult” to mean an LGBT individual who is aged fifty or older. The use of age fifty as the dividing line is consistent with the age used in The Report, which is the source of the data on LGBT caregiving used in this article. Fredriksen-Goldsen, The Report, supra note 11.

21 Aging Statistics, United States Department of Health and Human Services: Administration on Aging, http://www.aoa.gov/Aging_Statistics/ (last visited Sept. 29, 2015).

22 Homosexual acts were criminalized in some states until 2003. Lawrence v. Texas, 539 U.S. 558, 578 (2003) (declaring Texas homosexual sodomy law unconstitutional).

23 Homosexuality was classified as a mental illness until 1973. Ronald Bayer, Homosexuality and American Psychiatry: the Politics of Diagnosis (1987) (describing the history of the deletion of homosexuality from the Diagnostic and Statistical Manual III).

24 Kath Weston, Families We Choose 17 (1997) (explaining why LGBT families are “also called ‘families we choose’”).

25 See Jagose, supra note 19, at 30–43 (1996) (discussing birth of gay liberation movement).

26 Fifty-five percent of LGBT older adults live alone compared with 28 percent of the general older population. Fredriksen-Goldsen, The Report, supra note 11, at 13; A Profile of Older Americans, United States Department of Health and Human Services: Administration on Aging, http://www.aoa.gov/Aging_Statistics/Profile/2012/docs/2012profile.pdf (last visited Sept. 29, 2015). See also de Vries, Brian & Blando, John A., The Study of Gay and Lesbian Aging: Lessons for Social Gerontology , in Gay and Lesbian Aging: Research and Future Directions 3, 7 (Gilbert Herdt & Brian de Vries eds., 2004)Google Scholar (describing how gay men and lesbians are more likely to be single).

27 Fredriksen-Goldsen, The Report, supra note 11, at 3; see also supra note 14 (comparing percentage of LGBT older adults with children to both the general population and to LGBT younger adults under age fifty).

28 See Judith C. Barker, Lesbian Aging: An Agenda for Social Research, in Gay and Lesbian Aging, supra note 26, at 61–62. Estrangement is a natural consequence of pre-Stonewall views and beliefs.

29 Grant, Jaime M. et al. , National Gay and Lesbian Task Force Policy Institute, Outing Age 2010: Public Policy Issues Affecting Lesbian, Gay, Bisexual and Transgender Elders 91–92 (2010)Google Scholar, available at http://www.thetaskforce.org/downloads/reports/reports/outingage_final.pdf (explaining that isolation occurs when a person cannot access needed social and medical support services).

30 Fredriksen-Goldsen, The Report, supra note 11, at 22 (noting that 47 percent of LGBT older adults report a disability).

31 2012 Disability Status Report, Employment & Disability Institute 21 (2014), available at http://www.disabilitystatistics.org/StatusReports/2012-PDF/2012-StatusReport_US.pdf.

32 Fredriksen-Goldsen, The Report, supra note 11, at 26.

33 Id. (reporting 31 percent of LGBT older adults); The State of Mental Health and Aging in America, Centers for Disease Control and Prevention (2008), available at http://www.cdc.gov/aging/pdf/mental_health.pdf (reporting 7.7 percent of all older adults).

34 Fredriksen-Goldsen, The Report, supra note 11, at 26–27.

35 Id.

36 Randy Albelda et al., Poverty in the Lesbian, Gay, and Bisexual Community, Williams Institute at ii (2009), http://williamsinstitute.law.ucla.edu/wp-content/uploads/Albelda-Badgett-Schneebaum-Gates-LGB-Poverty-Report-March-2009.pdf (detailing economic factors).

37 Id.

38 Fredriksen-Goldsen, The Report, supra note 11, at 16 (reporting 89 percent of LGBT older adults).

39 Id. at 34 (reporting 91 percent and 82 percent respectively).

40 Id. at 17 (reporting 38 percent). The rate is comparable to that of the general population. Frank Newport, In U.S., Four in 10 Report Attending Church in Last Week, Gallup (Dec. 23, 2013), http://www.gallup.com/poll/166613/four-report-attending-church-last-week.aspx.

41 More than two-thirds of LGBT older adults have a will and nearly as many indicate that they have a durable power of attorney. Fredriksen-Goldsen, The Report, supra note 11, at 39 (70 percent of LGBT older adults have a will and 64 percent have a durable power of attorney); Where There Is a Will … Legal Documents Among the 50+ Generation: Findings From an AARP Survey, AARP Research Group (April 2000), http://assets.aarp.org/rgcenter/econ/will.pdf (reporting that 60 percent of people fifty years of age and older have a will and 45 percent have a durable power of attorney).

42 Fredriksen-Goldsen, The Report, supra note 11, at 19.

43 Id. at 19 (stating that 82 percent report victimization).

44 Jonathan Starkey, Out of Isolation: Advocacy Group Assists Long Island Gays and Lesbians Who Grew Up in Less Accepting Times, Newsday, Feb. 1, 2008, at B6.

45 Fredriksen-Goldsen, The Report, supra note 11, at 38.

46 The Centers for Disease Control and Prevention defines “aging in place” as “the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” Healthy Places Terminology, Centers for Disease Control and Prevention, http://www.cdc.gov/healthyplaces/terminology.htm (last visited Sept. 29, 2015).

47 Fredriksen-Goldsen, The Report, supra note 11, at 38.

48 National Senior Citizens Law Center, LGBT Older Adults in Long-Term Care Facilities: Stories from the Field 11 (2011), http://www.lgbtagingcenter.org/resources/pdfs/NSCLC_LGBT_report.pdf.

49 Id. at 9.

50 Id.

51 Id. at 12–13.

52 Id. at 13–15.

53 Id. at 11.

54 See Jane Gross, Aging and Gay, and Facing Prejudice in Twilight, New York Times, Oct. 9, 2007, at A1.

55 Id.

56 Id.

57 Gerry Shih, Suit Charges Elderly Gay Partners Were Forced Apart, New York Times, Apr. 20, 2010, http://bayarea.blogs.nytimes.com/2010/04/20/suit-charges-elderly-gay-couple-was-forced-apart/.

58 Id.

59 Lois Pearlman, No Reason to Separate Gay Couple, Friend Says, Bay Area Reporter, Apr. 29, 2010, http://www.ebar.com/news/article.php?sec=news&article=4748.

60 Paul Payne, Gay Rights Lawsuit Includes Evidence of Domestic Violence, Press Democrat, Apr. 21, 2010, available at http://www.pressdemocrat.com/csp/mediapool/sites/PressDemocrat/News/story.csp?cid=2246354&sid=555&fid=181.

61 Mac McClelland, Plot Thickens in Sonoma Discrimination Case, Mother Jones, Apr. 29, 2010, available at http://www.motherjones.com/rights-stuff/2010/04/plot-thickens-sonoma-discrimination-case.

62 Pearlman, supra note 59.

63 First Amended Complaint, Green v. County of Sonoma, 11–12 (Cal. App. Dep't Super. Ct. Mar. 22, 2010) (No. SPR-81815), available at http://lizditz.typepad.com/files/greene_v_sonoma_county.pdf.

64 Bob Egelko, Suit by Elderly Gay Couple to Be Settled, San Francisco Chronicle, July 25, 2010, at C2.

65 See Scott James, An Unlikely Plaintiff. At Issue? He Dares Not Speak Its Name, New York Times, May 7, 2010, at A19.

66 Weston, supra note 24, at 44 (noting possibility of medical intervention).

67 Funders for Lesbian & Gay Issues, Aging in Equity: LGBT Elders in America 5 (2004), available at http://www.lgbtfunders.org/files/AgingInEquity.pdf (“‘[P]assing’ as heterosexual has been a lifelong survival strategy.”).

68 Ski Hunter, Midlife and Older LGBT Adults: Knowledge and Affirmative Practices for the Social Services, 13–14 (2005).

69 Fredriksen-Goldsen, The Report, supra note 11, at 15 (reporting 92 percent out to a close friend).

70 Gabriel Arana, When I'm Old and Gay, The American Prospect, Aug. 22, 2013, available at http://prospect.org/article/when-im-old-and-gay.

71 Gross, supra note 54 (quoting LGBT older adult).

72 Fredriksen-Goldsen, The Report, supra note 11, at 15.

73 Id. (reporting 54 percent).

74 Id. (reporting 31 percent, 33 percent, and 27 percent, respectively).

75 Id. (reporting 21 percent).

76 Loree Cook-Daniels, Trans Aging, in Lesbian, Gay, Bisexual and Transgender Aging 20, 27–28 (Douglas Kimmel et al. eds., 2006).

77 See supra text accompanying notes 48–53.

78 Fredriksen-Goldsen, The Report, supra note 11, at 15.

79 Gross, supra note 54.

80 Id.

81 Caregivers, supra note 8, at 1, 10. For more on the burden of caregiving for adult daughters, see M. Christian Green's article, “‘Graceful Pillars': Law, Religion, and the Ethics of the ‘Daughter Track,’” in this symposium issue.

82 Id. at 1.

83 Fredriksen-Goldsen, The Report, supra note 11, at 46.

84 Id.

85 Id. at 47.

86 Id.

87 Kimmel, Douglas C., Issues to Consider in Studies of Midlife and Older Sexual Minorities , in Gay and Lesbian Aging: Research and Future Directions 268 (Gilbert Herdt & Brian de Vries eds., 2004)Google Scholar (defining chosen family as “groups of friends who function as if they were kin” and who “provide more support, in many cases, than the individual's biological or legal ‘family’”).

88 Still Out, Still Aging: The MetLife Study of Lesbian, Gay, Bisexual, and Transgender Baby Boomers, MetLife 16 (Mar. 2010), available at https://www.metlife.com/assets/cao/mmi/publications/studies/2010/mmi-still-out-still-aging.pdf [hereinafter MetLife] (reporting 64 percent).

89 Weston, supra note 24.

90 See supra note 27.

91 Obergefell v. Hodges, 135 S.Ct. 2584 (2015).

92 Weston, supra note 24, at 25.

93 Id.

94 Id. at 111. See also Fredriksen-Goldsen, The Report, supra note 11, at 48.

95 Weston, supra note 24, at 117.

96 MetLife, supra note 88, at 16.

97 The first wave of the AIDS/HIV pandemic hit the current generation of LGBT older adults especially hard. As a result, some gay men have already experienced multiple losses of partners and members of their chosen families.

98 Paula Span, Near the End, It Is Best To Be “Friended,” New York Times, Sept. 25, 2015, http://www.nytimes.com/2015/09/29/health/near-the-end-its-best-to-be-friended.html.

99 See supra note 25 (discussing that LGBT older adults are more likely to be single).

100 See, e.g., Knauer, Nancy J., LGBT Elders in a Post-Windsor World: The Promise and Limits of Marriage Equality , 24 Texas Journal of Women Gender & Law 1, 42 (2014)Google Scholar. In addition, it is possible that the existence of marriage equality may further marginalize same-sex couples who choose not to marry. Id. at 60. It may also reduce the legal recognition for nonmarital partnerships. Id.

101 Id.

102 Long-Term Care for the Functionally Dependent Elderly, Centers for Disease Control and Prevention 1 (Sept. 1990), http://www.cdc.gov/nchs/data/series/sr_13/sr13_104.pdf.

103 Caregivers, supra note 8, at 2.

104 Id. at 4 (reporting that 14.3 percent of all adults in the United States have provided care to a person aged fifty or older in the last twelve months). Kim Parker and Eileen Patten, The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans, Pew Research Center (Jan. 30, 2013), http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/.

105 Caregivers, supra note 8, at 1.

106 Id. at 8.

107 Id. at 4.

108 Muraco, Anna & Fredriksen-Goldsen, Karen, “That's What Friends Do”: Informal Caregiving for Chronically Ill Midlife and Older Lesbian, Gay, and Bisexual Adults , 28 Journal of Personal and Social Relationships 1073, 1075–76 (2011)CrossRefGoogle ScholarPubMed.

109 Fredriksen-Goldsen, The Report, supra note 11, at 46 (reporting 54 percent). The Report does not differentiate between spouses and partners. Id.

110 Id. (reporting 34 percent).

111 Id.

112 Id. at 12.

113 Id. at 46 (reporting 16 percent are providing care to parents). With respect to LGBT older adults who are providing care, 8 percent are providing care to relatives. Id. Sixteen percent are providing care to a parent or parent-in-law. Id. Accordingly, one in six LGBT older adults who are providing care are providing care for their parents or parents-in-law, but only a handful are receiving care from adult children. Id.

114 Id. at 47 (reporting 41 percent).

115 Id. at 46 (reporting 44 percent).

116 Id. at 45 (reporting 27 percent). In contrast, approximately one in seven adults in the general population is providing care to a person aged fifty or older. See Caregiving supra note 8, at 4 (reporting rate of caregiving at 14.3 percent).

117 Id. at 4 (reporting 30 percent for women and 26 percent for men); see also Muraco & Fredriksen-Goldsen, supra note 108, at 1088.

118 Caregivers, supra note 8, at 8.

119 See, e.g., The Book of Common Prayer 423 (1979) (“Will you love [him/her], comfort [him/her], honor and keep [him/her], in sickness and in health … ?”).

120 Muraco & Fredriksen-Goldsen, supra note 108, at 1076 (discussing gender roles).

121 Id. at 1074.

122 Id. at 1087.

123 Id. at 1083.

124 Id. at 1082.

125 Id. at 1083 (quoting a non-relative caregiver for an LGBT older adult: “[T]hat's what friends do. I know I'm doing the right thing and I feel good about it.”).

126 Id. at 1087.

127 Weston, supra note 24.

128 Muraco, Anna & Fredriksen-Goldsen, Karen, The Highs and Lows of Caregiving for Chronically Ill Lesbian, Gay, and Bisexual Elders , 57 Journal of Gerontological Social Work 251, 253 (2013)CrossRefGoogle ScholarPubMed.

129 Muraco & Fredriksen-Goldsen, supra note 108, at 1086–7 (discussing that friendship norms do not fully explain why individuals undertake caregiving).

130 See generally Jeffrey Wattles, The Golden Rule 4 (1996) (exploring different formulations of the rule across religions and cultures).

131 Erosheval, Elena A. et al. , Social Networks of Lesbian, Gay, Bisexual, and Transgender Older Adults , Research on Aging 1, 3 (2015)Google Scholar.

132 Muraco & Fredriksen-Goldsen, supra note 128, at 254 (describing communal relations theory).

133 Muraco & Fredriksen-Goldsen, supra note 108, at 1088 (“The legacy of AIDS caregiving may have shaped social norms in LGB circles such that there is a culture of care for community members, which lasts through middle and older adulthood.”).

134 Id. at 1076.

135 Id. (“Most studies show that gay men and lesbians are particularly willing to provide caregiving support within their own communities.”).

136 Id.

137 Id. at 1089.

138 Weston, supra note 24, at 27.

139 Muraco & Fredriksen-Goldsen, supra note 108, at 1076 (“reinforces a community identity that preserves a sense of political and social solidarity”).

140 Despite all the limitations of chosen families, the percentage of LGBT older adults who experience neglect is smaller than the national average. Fredriksen-Goldsen, The Report, supra note 11, at 28 (reporting 3 percent of LGBT older adults). Acierno, Ron et al. , Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study , 100 American Journal of Public Health 292 (2010)CrossRefGoogle ScholarPubMed (reporting 5.1 percent of the general population).

141 Fredriksen-Goldsen, The Report, supra note 11, at 38.

142 See supra text accompanying notes 78–80 (discussing costs of concealment).

143 Maps of State Laws, supra note 16.

144 Equality Act of 2015, H.R. 3185, S.1835, 114th Congress (2015).

145 Older Americans Act, SAGE, http://www.sageusa.org/issues/oaa.cfm (last visited Sept. 29, 2015).

146 Id.

147 California Assembly Bill 663 required LGBT-cultural-competency training for residential care facility administrators. California Legislature Passes Bill to Ensure LGBT Seniors Receive Respectful, Competent Elder Care, Equality California (Sept. 3, 2013), http://www.eqca.org/site/apps/nlnet/content2.aspx?c=kuLRJ9MRKrH&b=5609563&ct=13257279&notoc=1.

148 For a graphic history of the struggle for relationship recognition see Maps of State Laws, supra note 16. For an overview of the importance of a second parent for same-sex couples, see Second Parent Adoption, Human Rights Campaign, http://www.hrc.org/resources/entry/second-parent-adoption (last visited Nov. 15, 2015).

149 See, e.g., Colorado Revised Statute § 15-22-101 (2013) (granting limited rights to “designated beneficiaries”).

150 Obergefell v. Hodges, 135 S. Ct. 2584 (2015).

151 Knauer, supra note 100, at 60. It may also make nonmarital recognition of same-sex relationships less available. Id. For example, many employers have discontinued domestic partnership benefits citing that they are no longer needed to correct for the absence of marriage equality. Id.

152 See generally Unified Health-Care Decisions Act § 2 (1993) (stating rules regarding advance health-care directives).

153 See, e.g., Kentucky Revised Statutes § 311.631(1) (listing relatives authorized to make medical decisions in order of priority).

154 See, e.g., Uniform Health Care Decisions Act § 5(c) (“[A]n adult who has exhibited special care and concern for the patient, who is familiar with the patient's personal values, and who is reasonably available may act as surrogate.”).

155 Uniform Probate Code § 2–105 (2015) (providing rules governing escheat).

156 Family Medical Leave Act of 1993, Public Law 103–3; 29 U.S.C. § 2601.

157 See, e.g., Mickey Rapkin, The Gay Retiree Utopia, Bloomberg, May 16, 2013, available at http://www.businessweek.com/articles/2013-05-16/the-gay-retiree-utopia.

158 Id.; see also Catherine Trevison, Gay Retirement Homes Still Difficult to Market, St. Paul Pioneer Press (Minn.), Mar. 20, 2008, at 7E (noting some developments have “difficulty filling”).

159 Ninety-one percent of all Fortune 500 companies have nondiscrimination policies for sexual orientation. Corporate America Champions LGBT Equality in Record Numbers, Human Rights Campaign, Dec. 9, 2013, available at http://www.hrc.org/press-releases/entry/corporate-america-champions-lgbt-equality-in-record-numbers.

160 The Human Right Campaign maintains the Health Care Equality Index, which rates health care facilities with respect to their responsiveness to LGBT concerns, including long-term care facilities. Health Care Equality Index, Human Rights Campaign, available at http://www.hrc.org/campaigns/healthcare-equality-index (last visited Nov. 15, 2015).

161 The U.S. Administration on Aging has developed LGBT-cultural competency training materials for long-term care and other service providers. Building Respect for LGBT Elders, United States Department of Health: Administration on Aging, available at http://www.lgbtagingcenter.org/training/buildingrespect/index.cfm (last visited Sept. 29, 2015).

162 Special Concerns of LGBT Caregivers, Family Caregiver Alliance (2015), https://caregiver.org/special-concerns-lgbt-caregivers.

163 See Darlene Yee-Melichar et al., Assisted Living Administration and Management: Effective Practices and Model Programs in Elder Care 350 (2011) (noting that the “inequities” LGBT elders face include discriminatory policies); see Opening Doors: An Investigation of Barriers to Senior Housing for Same-Sex Couples, Equal Rights Center (2014), available at http://www.equalrightscenter.org/site/DocServer/Senior_Housing_Report.pdf (reporting widespread housing discrimination against LGBT older adults).

164 Id.

165 Rafael Guerrero, Buddies Give LGBT Seniors Joy, Beverly Press, Feb. 17, 2011, http://beverlypress.com/2011/02/buddies-give-lgbt-seniors-joy/.

166 Knauer, Nancy J., LGBT Elder Law: Toward Equity in Aging , 32 Harvard Journal of Law & Gender 1, 32–33 (2009)Google Scholar.

167 See, e.g., Uniform Probate Code § 2–101 (2014) (covering rules governing distribution by intestacy).

168 See contra Ziettlow and Cahn, supra note 4, at 250 (“Although most of those interviewed knew nothing about the legal framework, the law, in effect, mirrored their assumptions about who would assume the decision-making role.”).

169 See supra note 41.

170 Rosie Harding, Regulating Sexuality: Legal Consciousness in Lesbian and Gay Lives 22–24 (2010).

171 Knauer, Nancy J., “Gen Silent:” Advocating for LGBT Elders , 19 Elder Law Journal 289, 323–36 (2011)Google Scholar (describing an integrated elder-care plan).

172 Aging Statistics, supra note 21.

173 Obergefell v. Hodges, 135 S.Ct. 2584 (2015).

174 Gary J. Gates, LGBT Parenting in the United States, Williams Institute 4 (Feb. 2013), available at http://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Parenting.pdf.

175 Id. at 1.

176 Redfoot et al., supra note 3.

177 Aging Statistics, supra note 21.

178 Jennifer M. Ortman et al., An Aging Nation: The Older Population in the United States, U.S. Census Bureau 3 (May 2014), https://www.census.gov/prod/2014pubs/p25-1140.pdf.

179 Id. at 11.

180 Natalie Angier, The Changing American Family, New York Times, Nov. 25, 2013, http://www.nytimes.com/2013/11/26/health/families.html?pagewanted=all&_r=0.

181 Id.

182 Span, supra note 98; see also Jessica E. Brill Ortiz, Advocating for the Unbefriended Elderly, National Consumer Voice (Aug. 2010), http://ltcombudsman.org/uploads/files/issues/Informational-Brief-on-Unbefriended-Elders_0.pdf.

183 See supra note 12 (describing rate of non-relative caregiving in LGBT community).

184 One option is the “naturally occurring retirement community,” or NORC, where a group of individuals choose to age in place and leverage social services and other forms of assistance. NORC Public Policy, Naturally Occurring Retirement Communities, http://norcs.org/norc-national-initiative/public-policy#3 (last visited Sept. 29, 2015).