LGBT Older Adults and Immigrant Care Workers: What Do They Have in Common?

By Michael Adams and Jared Renteria

The generation of people in the LGBT community that helped (or watched) the Stonewall upris­ing shatter many limits society had imposed upon them now are aging in communities focused largely on youth and youth culture. As members of this generation plan for the future, and the aging services sector prepares to address their care and service needs, unique aspects of their experi­ence must be considered—particularly their need for paid caregivers, who often are immigrants.

Estrangement from biological family is common in the LGBT community, with nearly four in ten LGBT adults in the United States reporting that they have been “rejected by a family member or close friend because of their sexual orientation or gender identity." A chosen family, typically consisting of accepting or LGBT friends and former and current partners, fills the vacuum cre­ated by this loss. As chosen families often thin with age, neighbors and other less connected individuals sometimes help out, but the dwindling of this caregiver pool is happening more often, as studies show that LGBT elders are twice as likely to be single and to live alone, and four times less likely to have chil­dren than their heterosexual counterparts.

Partly a legacy of the solidarity formed during the height of the HIV/AIDS crisis, caring for one an­other in illness and in older age among LGBT elders is prevalent: One study shows that 54 percent of LGBT eldercare recipients receive care from a partner, and 24 percent receive care from a friend. Though these arrangements can be mutually supportive, discrimination, caregiver burnout and isolation pose significant hurdles. Thus, LGBT older adults rely disproportionately on pro­fessional care. Depending upon circumstances, professional care can alleviate isolation, provide respite and allow LGBT care recipients to benefit from caregiving provided by trained professionals.

The Undervalued Immigrant Workforce

While professional eldercare is extremely important to society at large, and especially to LGBT older adults, it also is seriously undervalued in the United States. Despite the work’s value, and the risks associated with it (e.g., homecare workers’ high injury rates), the median hourly wage for direct care workers is only $11.03.

Many of these underpaid workers are immigrants. PHI estimates that “[I]n 2016, 25 percent of the direct care workforce were immigrants”—people who face significant hurdles under the best of circumstances ( The percentage of direct care workers who are immi­grants is growing, making those needing eldercare increasingly reliant on individuals not born in the United States.

The immense challenges facing immigrant direct care workers are well-known: One in two direct care workers leave the job within 12 months because of low wages, lack of benefits and opportunities to advance, and the work’s high demands. Also, these workers now must cope with hostility from the federal government—executive orders, immigrant raids, draconian border pol­icies and streams of anti-immigrant rhetoric.

The current administration has wreaked havoc among immigrants from source countries of many direct care workers, ordering temporary bans on entry of people from many Muslim-major­ity countries; ending the Temporary Protected Status programs covering Haiti, El Salvador, Nica­ragua and Honduras; and imposing harsh policies at our southern border. Such an anti-immigrant posture has cost the workforce: 11,000 U.S. direct care workers are from “Muslim ban” countries, 34,600 are from Temporary Protected status countries and 69,800 are from Mexico.

Proactive Policy Needed for All Caregivers

While many LGBT people, communities and organizations rightly oppose the federal govern­ment’s anti-immigrant campaigns on humanitarian grounds, there are additional reasons to fight these policies. The interdependence of LGBT elders and immigrant communities creates powerful reasons to work together on mutually supportive policies, and to encourage aging services provid­ers to do likewise.

The nation’s population of people ages 65 or older will more than double by 2050, and diversity will increase in this cohort from one in five older adults being a person of color to one in three. As this occurs, immigrant eldercare workers may have more and more in common with their care recipients.

LGBT older adults have strong reasons to encourage policies that create better work conditions for all caregivers. One example is the federal RAISE Family Caregivers Act, which puts forth a national strategy to support family caregivers. Additionally, there are state-level Medicaid initia­tives to expand data collection in order to increase workforce recruitment and retention, and to increase direct care workers’ reimbursement rates.

It would invigorate the workforce to create new positions in the field, such as New York’s “advanced home health aide,” which expands the type of care paid professionals can provide, while offering workers access to a more robust professional ladder. These kinds of policies not only are the right thing to do for workers, they also increase the quality and availability of high-quality eldercare.

Moving Forward: Strategies to Support LGBT and Immigrant Communities

Employers of direct care workers should provide bilingual employee resources and trainings to facilitate better performance, higher retention rates, a welcoming environment and opportunities for effective and constructive communication between employee and employer.

Employers also can institute cultural competency trainings to help other employees be sensi­tive to immigrant employees and extend the welcoming environment beyond training sessions. Providers can build connections with immigrant-supportive organizations in the community and connect immigrant employees to these organizations. To support these efforts most effectively, we need more data. More studies directly focusing on immigrant direct care worker contributions, needs and prominence in serving LGBT older adults would benefit workers, elders and the aging services sector.

LGBT older adults disproportionately rely upon paid caregivers as they age. Professional di­rect-care workers, who struggle with a devaluing of their con­tributions and poor work conditions, are disproportionately immigrants. The rights and dignity of both LGBT elders and immigrant care workers are under assault by the Trump Administration and ascendant forces in America of bigotry and nativism.

Given the intertwined interests of LGBT elders and immigrant care workers—and their common foes—these two communities should jointly oppose attacks on their well-being and collaboratively advance policies and practices that allow LGBT older people to age with care and dignity, and to en­sure that immigrant care workers are treated as the highly valuable professionals that they are.

Michael Adams is the CEO of SAGE, Advocacy and Services for LGBT Elders and Chair-Elect of the ASA Board of Directors. Jared Renteria is a third-year law student at California’s Santa Clara University School of Law.