LGBT Kinship and Aging in Place

A recent story on NPR profiled a new program in South Africa meant to combat isolation among older adults and help them age in their homes (“age in place”).

AgeWell Global encourages older adults to visit one another on a routine basis. Participants are given a mobile phone app that allows them “to collect wellness information and to make informed recommendations on medical and social service needs.” Both participants experience reduced isolation, the volunteer is given a task to occupy their time and keep them involved in the community, and the health and wellness data can alert medical providers to important health problems before they reach emergency status.

Setting aside my omnipresent low-grade discomfort with collecting medical data over smartphone apps (happy birthday Discipline and Punish!), I think this program sounds fantastic. Combating isolation is an essential part of aging well, and regularly preventative health screenings are an important way to help people age in place and avoid costly, difficult, and emotionally draining trips to the emergency room.

AgeWell is based on what we call a horizontal care model. Horizontal care is informal (non-professional) care provided by people in the same age cohort. Vertical care, by contrast, is care provided by people different ages. What I found noteworthy about this segment is that the AgeWell participant NPR interviewed is enmeshed in both vertical and horizontal networks of care. The interview begins with her sending her grandchildren off to school, and then follows her as she visits and cares for other older adults in her community.

What many people do not realize is that vertical care networks are almost all based in heterosexual and heterosexist family structures. Vertical care is overwhelmingly provided by biological or legal relations, usually daughters, daughters-in-law, and grandchildren. Many LGBT older adults are not in contact, or have strained relationships with, their biological or legal relatives. Most LGBT older adults do not have children. They rely on what we call “families of choice,” kinship networks consisting of people who are not biologically or legally related, but function as family.

My favorite family of choice.

My favorite family of choice.

Families of choice and alternative kinship structures are essential to LGBT flourishing. The catch is LGBT older adults often rely exclusively on horizontal care, placing them in a very vulnerable position. Two people in their 80s are likely experiencing many of the same health problems, and caring for another person is difficult physical labor. When these care networks collapse it leaves LGBT older adults isolated both emotionally and physically, with nowhere to turn except emergency care or aging facilities that are often hostile to their LGBT identity.

This is why I want to praise programs like AgeWell, but only if we recognize that voluntary participation in horizontal care is often predicated upon access to vertical care. We cannot expect older adults to shoulder the burden of caring for one another unless we are providing them with other supports. I’m happy to accept AgeWell as an exciting and beneficial program, but only if we make sure it is understood as a way to expand and diversify already strong networks of care.

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