Struggling to Get By: Economic Insecurity and LGBT Seniors in Massachusetts

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Struggling to Get By:

Economic Insecurity and LGBT

Seniors in Massachusetts

Mary Gatta, PhD

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Wider Opportunities for Women (WOW) has promoted empowerment, equity and economic security across the lifespan since 1964. Through advocacy, research, training and technical assistance, WOW advances equal education and employment opportunities, non-traditional occupations for women, freedom from financial abuse and secure retirement.

WOW’s Family Economic Security Project (FES Project) and Elder Economic Security Initiative (Elder Initiative) improve policy and programs by defining and advocating for economic security. The FES Project and Elder Initiative work in WOW’s hometown of Washington, DC and with their partner networks to improve the lives of workers, families and seniors across the country.

During 2014 the Massachusetts Association of Older Americans (MAOA) entered its 45th year of providing Advocacy and Education for MA seniors, their family members and those who provide vital health and social services to make later life a rewarding time. Emphasizing issues related to elder economic security and to the mental health needs of elders has enabled MAOA to keep a public focus on the critical need to address the growing income insecurity among elders and the costly consequences of inadequate mental health care and treatment. The Elder Economic Security Initiative’s successful 2013 effort to secure creation of a special state Elder Economic Security Commission to study economic conditions among MA elders is one important step toward addressing the crisis of economic insecurity facing too many elders in Massachusetts today.

© Copyright Wider Opportunities for Women, 2014.

The Elder Economic Security StandardTM Index is calculated by the Gerontology Institute at the University of Massachusetts Boston as part of the national Elder Initiative led by WOW.

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Wider Opportunities for Women (WOW) and the Massachusetts Association of Older Americans (MAOA) issued Living Below the Line: Economic Insecurity Among Massachusetts Eldersin the Spring of 2014. It isan in-depth analysis highlighting patterns of economic insecurity among retired Massachusetts elders age 65 and older who are living in the community. The report demonstrated that elders who live alone are much more likely to lack economic security, as defined by the Elder Economic Security StandardTM Index, than elder couples, and that elder women experience higher economic insecurity rates than elder men. In addition, the report revealed wide

disparity in economic insecurity rates among African American elders (81%), Hispanic elders (91%) and White elders (61%).

The Elder Index is a powerful tool to help policy makers, elders, researchers and advocates understand the economic security of elders and the possible effects of policy change on economic security. Given differences within the elder population (related to race and gender) that were highlighted in Living Below the Line, we began to explore the idea of economic disparities, rooted in discrimination, that increase economic insecurity among other groups of seniors, specifically lesbian, gay, bisexual and transgender (LGBT) elders. The US Supreme Court decision striking down Section 3 of the so-called Defense of Marriage Act (DOMA) provides an opportunity to explore the economic effects of discriminatory public policies as well as the potential impact of changing them. The DOMA decision opened access to previously denied protections and public benefits—including Social Security survivor benefits, family and medical leave, and the ability to pool resources as a family without unfair taxation— to married same-sex couples.

MAOA and WOW conducted focus groups of LGBT elders to discuss their economic security and how, for those who were married, the DOMA decision might affect their security. Participants engaged in thoughtful, substantive discussions of economic discrimination faced during their work years, their current insecurity

concerns and their hopes for the future. Their thoughts and perspectives form the basis of our report. Our report concludes with recommendations for measures to strengthen LGBT elders’ ability to age with dignity and

economic security. While much additional research needs to be done, our goal is to begin to understand the economic security of LGBT elders, to contribute to a discussion of the effects of the court’s decision on access to benefits previously denied, and to explore the usefulness of the Elder Index in examining potential public policy changes.

We deeply appreciate the commitment, contributions and thoughtfulness of all who gave their time, experiences and ideas to this project. Group participants were open and reflective in sharing their experiences. The many contributions of Jim Campbell and Gordon Burns were vital to the success of the project. The efforts of Lara Collins, Lori Kagan and Lorraine Diemer, three talented MAOA interns from Salem State University School of Social Work, also contributed greatly to its success.

Chet Jakubiak Jo Reed

Executive Director Director, Elder Economic Security Initiative MA Association of Older Americans Wider Opportunities for Women

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Struggling to Get By 2 Massachusetts’ seniors face some of the highest living costs in the nation, and do so with incomes that have not kept pace with increases in the costs of basic needs such as housing, health care and food. Wider

Opportunities for Women (WOW) has compared seniors’ incomes to the Elder Economic Security StandardTM Index (Elder Index), a measure of the cost of elder households’ basic expenses, and found that 63% of Massachusetts’ retired elder households are economically insecure. While insecurity, and the threat of insecurity, affect seniors of all backgrounds, economic insecurity rates vary greatly according to household composition, housing status, race, gender and where in Massachusetts elders live. This report will share the findings from focus groups conducted to provide a snapshot of the challenges that LGBT seniors face in achieving economic security.

In 2014 WOW and the Massachusetts Association of Older Americans (MAOA) released Living Below the Line: Economic Insecurity Among Massachusetts Elders, an in-depth demographic analysis that highlights these patterns. We found that elders who live alone are much more likely to live in insecurity than elder couples. The economic insecurity rate for single elder households in Massachusetts is 70%, compared to 47% for elder couple households. Seventy-three percent of single elder female households are insecure, compared to 63% of single elder male households. In addition, we found that ninety-one percent of Massachusetts’ Hispanic senior households and 81% of its African American senior households are economically insecure. And looking across gender, elder women experience higher economic insecurity rates than elder men. Sixty-four percent of elder women and 53% of elder men in Massachusetts lack security incomes.1 Men’s median annual incomes in retirement exceed women’s by nearly $9,300.

The demographic data are striking and illustrate severe levels of economic insecurity among

Massachusetts elders. Yet only when one digs deeper to capture the stories behind those statistics can a better understanding emerge as to how seniors are surviving day-to-day in precarious economic circumstances. Doing so allows us not only to highlight how difficult the situation is for seniors in Massachusetts, but also to provide insights into particular demographic groups that may not as easily be captured in national datasets. To this purpose, WOW and MAOA conducted two focus groups with lesbian, gay, bisexual and transgendered (LGBT) seniors. The aim was to present a snapshot of lived experiences of this group of seniors “struggling to get by” in

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The demographic data compare the 2011 Massachusetts statewide Elder Index to 2011 Census income data.

The Elder Economic Security Standard Index for Massachusetts, 2014

Elder Person Elder Couple

Expenses Owner w/o Mortgage Renter Owner w/ Mortgage Owner w/o Mortgage Renter Owner w/ Mortgage Housing $697 $1,048 $1,665 $697 $1,048 $1,665 Food $252 $252 $252 $463 $463 $463 Transportation $261 $261 $261 $404 $404 $404 Health Care $473 $473 $473 $946 $946 $946 Miscellaneous $337 $337 $337 $502 $502 $502

Elder Index Per Month $2,020 $2,371 $2,988 $3,012 $3,363 $3,980

Elder Index Per Year $24,240 $28,452 $35,856 $36,144 $40,356 $47,760

Source: The Economic Security Database,Wider Opportunities for Women. Calculation by the Gerontology Institute, University of Massachusetts Boston.

Note: For more information on the Elder Index methodology, see The National Elder Economic Security Standard. (Boston: The Gerontology Institute, University of Massachusetts Boston, 2013).

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the current economic climate, illuminating individuals’ challenges and the ways they make ends meet. A secondary aim was to explore perceptions, knowledge and experiences of the potential economic benefits to LGBT couples as a result of Windsor v United States. The end of the Defense of Marriage Act (DOMA) made previously denied economic protections and responsibilities—including Social Security survivor benefits, family and medical leave, and the ability to pool resources as a family without unfair taxation—available to married same-sex couples.

WOW and MAOA talked with 17 LGBT seniors in the Boston metro area over a two-day period. Through these focus groups we were able to identify two main themes.

1. Economic insecurity exists within the LGBT community; however, much of the challenge is not unique to the LGBT population. In our focus groups, LGBT participants identified housing, health care and food costs, along with having inadequate savings, as key barriers to economic security in Massachusetts. 2. Participants did express some concerns specific to the LGBT community that exacerbated their economic

insecurity, and also raised concerns about aging.

a. Participants reported that discrimination against LGBT individuals during their working years (particularly access to promotions) impacted the amount of retirement savings they could accumulate and the Social Security payments they later received.

b. The prevalent stereotype that members of the LGBT community, and particularly gay men, are “rich” impacts their ability to communicate their economic insecurity.

c. Participants expressed uncertainty about newly available public benefits and how to access them. d. Participants raised concerns about having to go “back in the closet” if they need to be placed into

a nursing home because of perceived homophobia among staff.

e. Participants also reported they were not as likely to have children (although they did feel future LGBT generations will be more likely to have children); so there is concern about who is going to care for them as they age.

Housing and Health Care—Significant Costs for ALL Massachusetts Seniors

In our 2014 report, we found that housing and medical expenses were the greatest threats to elders’ economic security. Housing and health care costs comprise over 60% of the Massachusetts statewide average Elder Index budget. Nearly 45% of all Massachusetts elder homeowners studied, with or without a mortgage, devote more than 30% of household income to housing expenses, and approximately 22% put more than half of their income toward housing. And while rents vary greatly in Massachusetts, senior renters generally are experiencing challenges in affording their homes. In counties with the least expensive rents, a typical

economically secure senior will allocate more than 36% of his or her income to rent. In counties with the most expensive rents, a typical economically secure single renter will devote nearly 49% of his or her spending to housing. Such high rents make traditional measures of housing cost burden difficult to apply; for example, over 25% of elder renters spend more than 50% of their budgets on housing, above the statewide average Elder Index and dramatically higher than the 25-30% of income typically cited as an appropriate proportion.

Further, we found that even stronger than the connection between security and housing is the connection between security and health. Those elders having difficulty living independently due to poor health are most likely to have elevated health care costs, and are highly likely to lack economic security. Over 74% of elders who have

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difficulty with self-care are insecure, and nearly 71% of elders who report having trouble living independently are insecure. Only 13% of elders who report having difficulty living independently own their own homes without a mortgage. Among these seniors, 30% reserve more than half of their income for housing costs.

Through our focus group work with the LGBT community, we found a very similar pattern. LGBT seniors often reported that housing was their biggest expense and concern in Massachusetts. Among seniors who did own their homes, this was not a guarantee that they would be economically secure. For instance, LGBT seniors who own their homes outright voiced concerns about how they would pay other housing-related expenses.

If you own and paid the mortgage, then it is heating and property taxes. Owners have high real estate taxes that keep going up.

The taxes and municipal stuff is driving people out of their homes. It needs to be addressed. [We need] some kind of meaningful tax break for owners so they can stay in their own home.

Among renters, the situation was often quite dire, as they talked about how they would cover their rising housing costs.

My rent is going up hundreds of dollars every year because I live in Boston.

Another LGBT senior, who owned his home, noted how a second income of a partner made a difference in his economic security.

Today, I could never afford to buy the condo I own because I bought it 20 years ago, but I have a husband who is younger than I am who is still working. The income makes a big difference in my feeling secure.

Among LGBT seniors with disabilities the challenges with housing costs become even more pronounced. One senior told us that:

Affordable housing is a disaster. What they consider affordable housing is about ½ to ¼ of retired income. Affordable housing is about $1,800 a month. This is why I don’t live in Boston. The greatest chunk of my disability goes to housing. I am pretty much one check away from being homeless. If I don’t have my disability check on the first, I am in trouble. I pay $1,300 a month for rent. I gave my notice that I am leaving. I am going down to Florida because I cannot afford to live here. I want to get into housing as a disabled veteran, but I cannot because I have a partial pension from a previous job, and I am over income by a couple hundred dollars, which means that I can never go home again because I qualify out because I am making too much money, which is never enough. You are told that you are not eligible for anything, but you cannot afford to live where you grew up. It is really hard that I cannot live where I grew up. I live far away, but now I need to have a car. I would rather live in the city so I could use public transportation more, but I have to have a car and it is expensive.

Another senior reported that his Social Security payment would not even cover his rent each month.

Same situation as me, my husband is working which keeps me a refrigerator box away from homeless. He is also much younger than me. My Social Security is $1,400 and my rent is $1,403. [Isn’t this the same guy as above?]

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However, housing was not the only significant cost concern to LGBT seniors. Similarly, health care and medical expenses represented a significant portion of LGBT seniors’ economic insecurity. As one senior vividly told us:

I am Medicare away from being bankrupt. I can’t afford Medicare Bronze, which is really the best. They force you to have these procedures and the cost keeps rising. Who knows how much this whole thing is going to cost me? I have to pay 20% of whatever the cost is, and I don’t know where that is going to come from.

Others talked about the benefits of being on MassHealth, and their concerns about policy changes that could impact them.

We are on MassHealth because of our HIV status. We are pretty lucky in that aspect. It could change. It is a juggling act.

Seniors who received their health care through the jobs they held prior to retirement also voiced concerns about rising costs.

[The] town just increased my health care insurance premiums. These are things you don’t have control over. It seems to me when you are retired, you deal with things but they should not be such a pressing issue.

I am a retired teacher. The city pays 40 percent, I pay 60 percent. Blue Cross is the only one that covers out-of-state coverage. My kids live outside of Massachusetts so I have to get the most expensive one. Right now, I have two long-term care policies because I don’t want to be a burden to my children. $6,000 a year for long-term care on top of everything else I pay for health care. It is a lot.

Specific Concerns for LGBT Seniors and Economic Security

While LGBT seniors share many of the same concerns as many Massachusetts seniors, they also raised some specific concerns. First, they reported that discrimination against LGBT persons during working years (particularly blocked access to promotions or movement out of lower paying work) impacted the amount of retirement savings and Social Security payments they had today. Several LGBT seniors shared stories around this theme.

I experienced it. I wasn’t out at the time. I didn’t get promotion because I didn’t have a wife or child. I didn’t need the income, they said.

They were eventually forced to promote me, but all those years it impacted my income.

I wasn’t out while I was working, but Maine hadn’t passed any protection for LGBT. The director of human resources brought senior management into a meeting. If you have a gay or lesbian in your department and it makes you uncomfortable, you can fire them. It was the 1990s. I said that is not right.

I was a school teacher for a long time beginning in the late 60’s. I never came out. As an elementary school teacher I had to stay in the closet. I was the only person I could depend on for income so I needed a job.

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Struggling to Get By 6 Lesbians made less money so their retirement is lower. The pay gap is huge.

Compounding this is a prevalent stereotype that the LGBT community is wealthy.

Lovely rumor about rich gay men, but they are not the majority. I wish it was, but it isn’t the case. People could not get jobs or fit in and those who could hide their sexuality did a little better, but it forced us to be underemployed.

LGBT seniors also raised concerns regarding who would care for them as they aged, and how they would be treated in facilities. Often, many depended on partners, their spouses, families and friends.

We helped friends who didn’t have coverage and we supported them. It was horrible.

As I age, there isn’t that many people left, so I don’t have those ladies that others had in the past. All the ones I helped are gone.

I am better off being married. Once we find out how they will handle all of the federal programs, it will be better. For me, whether my husband will get my Social Security benefits when I am gone is important.

I solved it by marrying someone younger than me! We have a good social and a large family network, so we are lucky. We were caregivers for our former spouses.

My partner lives with me as my personal care attendant and that is how we get around all of the issues.

However that was not a fool-proof strategy, as one senior told us:

Someone has to be the last one to turn out the lights!! ????

LGBT seniors also reported that they often feared that because they did not have children, there would be no one available to care for them.

As people without children or grandchildren, we don’t have an informal care system around us. I am worried. How do I organize or find people who can do that and how do I pay for it?

We didn’t have kids because we didn’t want to subject them to “you have two dads.” We didn’t want to do that to children. Because of that, we don’t have a next generation; this is a big issue—caregiving. The Millennials will do well, but it isn’t as easy for us.

Yet, as one LGBT senior told us, having children was not a fully solid care plan, as he did not want to be a burden to his children.

I have a daughter and she has said to her mother and me that if there is a need she can set up her basement. Her life is busy. My partner and I have discussed it. I’m 12 years older than him. I will need help before him. We are committing to each other whatever we have. I don’t want anyone in my family burdened. If I could pay for it I would rather.

In addition to being able to afford care, LGBT seniors were also very concerned about how they would be treated in nursing homes.

When LGBT singles have to go into a nursing home, they go back into the closet, and unfortunately the suicide rate is much higher because they have been kicked out of the family, etc. It is a very difficult for us.

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Struggling to Get By 7 The nursing homes are tough. The amount of isolation the people feel. The stigma is tremendous. It feels like all these [heterosexual] people in this corner, and then the gay people in that corner. Everyone knows his or her status and it becomes a huge issue. Even hospitals are hard. People aren’t used to having patients with HIV. I had to go into a hospital for something and I had to go to a specialist and they didn’t know what to do with me because of my HIV status. This was in a major hospital in the city. Nursing homes are horrendous and there needs to be education. We need to have better programs, particularly if someone does not have a care network.

When thinking about assisted living and you are LGBT, you think that you want to be in a place with sensitivity. It is very expensive. You could get put anywhere. Dignity and comfort level could be a problem. Treatment in nursing homes and long-term care could cause financial issues that force you to be re-closeted.

People need to be educated on issues related to transgender elders. People end up in nursing homes that deny you your identity. I need to shave; to some people it may be minute, but to me it is my whole identity and I worry that they won’t shave me every day. It is important that caretakers respect anyone’s right to die with dignity.

Economic insecurity seems to pervade the retirement years of many of the LGBT seniors with whom we spoke. And while many of their concerns are shared with non-LGBT seniors, other concerns are very specific to this population. While this research was intended to provide a snapshot of the experiences of LGBT seniors dealing with economic security and insecurity as they age in Massachusetts, it has highlighted several issues that demand more in-depth research and other issues that require policy and programmatic change. In the final section we highlight our recommendations for action in both arenas.

Research and Policy Recommendations

Research Recommendations

1. Research on LGBT seniors and economic security is an area of inquiry that requires a great deal more investigation. Critical to this research are both quantitative and qualitative studies that can not only bring needed attention to the challenges of aging in Massachusetts, but also include research that investigates the experiences of LGBT seniors in their communities and in health care facilities. In addition, research needs to focus on the differences within the LGBT senior population, particularly differences around marital status, gender, race and income.

Policy Recommendations

1. MassHealth, Massachusetts’ Medicaid program, offers a home and community-based care option through which a neighbor, friend or family member can be paid for services provided to an elderly or disabled MassHealth eligible person. The MassHealth beneficiary’s spouse, however, is excluded from the list of potential paid caregivers. This imposes a significant financial burden on families with income below the state’s Elder Economic Security Standard Index, especially when the spouse providing care reduces or leaves employment to provide the care. Focus group participant comments suggest that, with the likelihood of fewer available sons and daughters and narrowing social networks, economically insecure LGBT married couples may have few options for in-home care other than each other. Massachusetts Title XIX State Plan and Chapter 118E Section 9 of the Massachusetts General Laws should be amended to

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allow otherwise eligible spouses of eligible MassHealth beneficiaries to serve as paid caregivers to their spouses.

2. Focus group participants expressed considerable concern regarding high housing costs in their

communities. Even those without a mortgage face high costs related to heat, utilities and property taxes. This burden is likely to be significantly more onerous as a result of the recently instituted 37% increase in electricity rates by a major Massachusetts supplier. Massachusetts should undertake a statewide study of current real estate abatement, deferral, tax work-off and other programs that mitigate residents’ real estate tax rates in local communities, and of eligibility criteria for such programs.

3. Focus group participants expressed uncertainty regarding the significant change in public benefits and protections that are available to married LGBT couples as a result of the Windsor v United States Supreme Court decision. A complex set of benefits and responsibilities affecting Social Security benefits, health insurance and proxy alternatives, veterans’ benefits, home ownership, taxes and pensions should become part of an LGBT couples’ economic planning considerations. Massachusetts should stimulate the

development of a public elder economic security benefits education, outreach and advocacy initiative to make LGBT couples aware of the continually evolving public benefits and protections available to support economic security.

4. With changes in thousands of federal, state and local economic protections and benefits eligibility criteria and with new loan, credit card and reverse mortgage packages being offered, Massachusetts should develop an elder economic security benefits financial counseling service, overseen by the Executive Office of Elder Affairs and modeled on the state’s successful SHINE health insurance counseling program. This service would assist LGBT couples, and other elders, to identify and access those programs that would enhance economic security among the state’s older adults.

5. Professional development should be offered to health care providers to provide them with training to better serve the unique needs of LGBT seniors. This training should include, among other things, cultural competency on LGBT issues, information about anti-discrimination policy and practices, and strategies for dealing with LGBT bullying by residents and/or staff. Massachusetts should develop a public source of funding to provide this professional development and training in nursing homes, hospitals and other health care facilities.

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Appendix

Demographic Variable N Male 7 Female 8 Transgender 1 Other 1 Single 5 Married 8 Divorced 4 Yes 7 No 10

Own w/o Mortgage 7 Own w/ Mortgage 3 Rent 5 Co-Op 1 No Response 1 Medicare 8 MassHealth 2 Commonwealth Care 1 Private Insurance 5 Other 1 Under $10,000 2 $10,000 to $20,000 2 $20,001 to $30,000 2 $30,001 to $40,000 5 $40,001 to $50,000 0 Over $50,000 6 Annual Income Total Participants: 17

Characteristics of Focus Group Participants Gender

Marital Status

Children

Housing Status

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