After being widowed and left alone, an 81-year-old woman from Arecibo decided to move to an elderly home in that municipality. Once there, a defining moment kept her in suspense: she was afraid to put a picture of herself with the woman who had been her life partner in the living room of her apartment.
“She tells me, ‘I’m afraid to say that I was widowed by a woman because I don’t know if they’re going to accept me here,” said Wilfred Labiosa, director of the Waves Ahead organization, founded in 2018 to offer services to older people from the Lesbian, Gay, Bisexual, Trans, Queer, Intersex and Asexual (LGBTQIA+) communities and other vulnerable populations due to their sexual or gender identity.
The woman told Labiosa that she had heard homophobic jokes in the building’s lobby, which frightened her. The fear of not being accepted by her neighbors led her to place the photo in the privacy of her room. Last year she passed away. Labiosa preferred not to share the name of the Arecibo elderly home to protect the identity and privacy of the deceased woman.
Like her, other older people from LGBTQIA+ communities have been forced to hide their identities in order to access safe home and care services, said the director of Waves Ahead.
“They have to go back to the closet to be able to find housing,” said Labiosa, who tried to bring the training offered by Waves Ahead regarding older LGBTQIA+ people to this elderly home in Arecibo, but they were rejected. “I contacted the administration, I offered them the training and they told me, ‘Why? There’s no one like that here,’” he recalled.
Care centers for the elderly or homes in Puerto Rico presume that there is no diversity of gender identity or sexual orientation among its residents, this is one of the main findings of a survey of 80 centers and a survey of 16 elderly home carried out by the Center for Investigative Journalism (CPI, in Spanish) and El Nuevo Día.
The invisibility of these communities is contrary to the guidelines of the National LGBT Resource Center on Aging, subsidized by federal funds and directed by the American organization Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elderly (SAGE), in collaboration with 18 other organizations. These guidelines establish that assuming that there is no sexual diversity among the residents of these centers underestimates the challenges of LGBTQIA+ populations, such as discrimination, violence, and physical or emotional stress.
Eighty-six percent of the elderly care centers surveyed — which are licensed by the Puerto Rico Department of Family — do not have guidelines that educate or inform about anti-discrimination practices, inclusive language, or dignified treatment of older LGBTQIA+ people. None of the 16 elderly homes polled for this story had such guidelines. In Puerto Rico there are at least 202 homes that are subsidized by the local or federal Department of Housing. According to the Department of Family, as of May of this year, there were 1,000 elderly care centers. 23.5% of Puerto Rico’s population is over 65 years old, according to the Census.
Moreover, the survey revealed that the owners or administrators of these facilities are unaware of the needs of the elderly of these populations. Likewise, the investigation confirmed that the intervention of ideologies or religious beliefs causes discrimination against LGBTQIA+ communities and limits the service in a safe space for these populations.
“I know cases where they have not wanted to accept [a new resident] because that person is gay. Another case in which they have not wanted to accept them because they are a couple,” said José Acarón Rodríguez, director of the American Association of Retired Persons (AARP) in Puerto Rico.
The survey, which was conducted anonymously to promote honesty in responses, confirmed that religious ideologies or beliefs are a factor that causes same-sex couples to be prohibited from sharing a room in a long-term care facility, while a heterosexual couple can.
For example, the owner of a long-term care center in Hatillo accepted that heterosexual couples can share a room, but not same-sex couples in her center. “I have certain beliefs. I respect it, but I don’t support it. I disagree,” she noted in the survey.
Cases, like the one above, go against the guidelines of the Department of Family, which instructs the licensed centers to respect the coexistence of couples, regardless of sexual orientation or gender identity, and whose non-compliance entails, even, the loss of their operating licenses.
This investigation identified discrimination regarding the acceptance of couples living together or marriages in the same room in the centers. While 59 administrators or owners said they accept heterosexual couples, three — of those 59 — categorically stated that they do not accept same-sex couples, despite having the double rooms and being a guideline from the agency that licenses them. Seven of the centers surveyed also did not take a position on whether they would accept people of the same sex sharing a room. The rest of the respondents said, due to their accommodations, they do not accept couples, and, in others, the participants do not spend the night there because they are daycare homes.
“The guideline is that the couples who live together share the same room, whether they are married or they are couples who live together,” said the interim director of the Department of Family’s Licensing Office, Bárbara González Nieves.
Meanwhile, Juanita Aponte, president of the Association of Long-Term Care Center Owners, acknowledged that discrimination associated with religious beliefs or ideologies has happened. “We have people with a lot of discrimination. Many times, they are faith-based groups, and these religious sectors that sometimes want to impose a way of thinking,” she said.
González Nieves warned that anyone who owns or manages an establishment licensed by the Department of Family that discriminates against a same-sex couple or marriage, “is exposed to license cancellation, if the discrimination referral is corroborated and substantiated.”
Exacerbated discrimination among residents
Not all older people from LGBTQIA+ communities who live in elderly homes or centers hide their sexual orientation or gender identity. “I have never been in the closet,” said Verónica Vargas, a 69-year-old lesbian who lives in the Égida de la Policía elderly home in Guaynabo.
On her 60th birthday, Verónica decided to move to an apartment in an elderly home that would allow her independent living at an affordable cost and within the reach of her Social Security income. But she never received a return call from either of the two homes she initially visited and in which she applied for an apartment. Verónica explained that, when going to those places, it was evident that she is a lesbian because she usually carries items alluding to the rainbow flag, which is a symbol of the LGBTQIA + communities, for example, her shirt, purse, or bracelets.
After a six-month wait, a space opened in the elderly home where she lives, a housing project for elderly people with limited economic resources, not necessarily former members of the Police. Upon moving there, Verónica faced discrimination from other residents.
“When I got here, all I had was my bed and nothing else, so every day I went out and bought something. I ran into a lady in the elevator, and she asked me if I had a child, and I said no, I don’t have children and she told me, ‘Ah, so you still have the plastic on,’ instead of saying something else,” she said.
The expression — which Verónica said is lesbophobic — also points to a stereotyped vision of women, who, because they are not married to a man and don’t have children, are presumed to have never had any experience of a sexual nature. “[It suggests] that women are supposed to be a certain way, that they cannot have diversity, that they cannot decide over their bodies,” Labiosa said.
Verónica recognized herself as a lesbian woman when she was a teenager. “At the age of 14, I kind of knew that I liked girls,” she said. Her sexual orientation was not a secret in her home, and she did not hide it from society either. “They always look down on you, but I didn’t care,” she said.
Miosotis De León, the social worker of the Égida de la Policía, said “there are protocols for any type of discrimination” there and that there is a coordinator dedicated to addressing related complaints. De León said she was not the social worker when the events that Verónica recounted took place, but that she has completed continuing education hours “directed at the LGBTQ+ community.”
The discriminatory approach in the elevator was one of many comments that Verónica said she received from other neighbors, mainly behind her back. The interviews conducted for this investigation show that what Verónica faced are not isolated occurrences in Puerto Rico.
Ever Padilla, executive director of the Civil Rights Commission, said that in the past two years he received three complaints from older adults from the LGBTQIA+ communities, who reside in elderly homes and had been discriminated against by their neighbors.
“The complaints that we have had have been due to problems between neighbors, in which some type of homophobia has developed. Tense relationships arise, and we then ask the administrators to intervene, and have been resolved in a positive way,” he said.
One of these complaints, he explained, dealt with an older adult who did not dare to file a complaint with the administration of his elderly home for fear of not receiving an encouraging response, after perceiving a friendly connection between the neighbor and the administration.
“We intervened and the administrator showed support for the victim of verbal discrimination,” said Padilla. The neighbor never apologized, Padilla said, but for the complainant it was enough that the matter was acknowledged and that he would not continue to be invisible.
Although the Civil Rights Commission and the survey carried out as part of this investigation show a pattern of discrimination, the Department of Family said it has not received complaints of this type from licensed long-term care centers.
“To my knowledge, so far, none. Our office has not received these types of referrals, but if they do arrive, they will be addressed with the same speed as any other referral of institutional abuse or discrimination,” said González Nieves.
However, Housing Secretary William Rodríguez Rodríguez, pointed out that his agency has received complaints about discrimination associated with sexual orientation and gender identity of older adults from LGBTQIA+ communities. The Department of Housing subsidizes public housing in Puerto Rico and runs those under the Section 8 Program (voucher program) and public housing.
The Public Housing Administration has a Section 504 (Fair Housing) office and a coordinator who receives complaints. Rodríguez Rodríguez could not specify the number of complaints received and addressed. Although we followed up later, the agency did not provide the number.
Family does see the need to collect data from this population
A common response from the people who manage long-term care centers regulated by the Department of Family was that, due to a lack of verbalization by the elderly, they did not know if there were people from the LGBTQIA+ communities among the residents. To ensure fair treatment, they expressed in the survey that they “treat everyone equally” or “recognize and respect their rights” in their practices.
González Nieves acknowledged that the agency does not require or collect demographic data on gender identity or sexual orientation of older adults, although she said there is nothing that prevents the Department of Family or centers from collecting that information.
“The elderly are treated within the framework of all their needs. So, it makes no difference whether the older adult has a specific sexual orientation or not. We’re all the same. I don’t see the need to establish or collect this data for the purposes of the care service,” stated González Nieves.
However, the National LGBT Resource Center on Aging recommends acknowledging that a care center has clients from these populations to ensure inclusion.
The official, later, changed her point of view in the interview. “Information never hurts. If it’s collected, it would be excellent. There’s no limitation. Yes, obviously, then it would have to be added to the statistics with the goal of perhaps studying the need,” she said.
The Ombudsman for the Elderly, Carmen Delia Sánchez Salgado, acknowledged that this office does not collect statistics related to these populations either.
“We don’t keep specific statistics on the LGBT population. In cases of abuse, they are general complaints. The same happens then with the complaints that come from long-term care centers,” said Sánchez Salgado.
In additional comments during the survey, at least six owners and managers said the Family Department has never offered them training or information on LGBTQIA+ older adults or required training related to this population. In addition, the CPI and El Nuevo Día reviewed the brochures that the agency has available on its website and found that none were related to older people in these communities, even though there are others aimed at specific aspects that affect older adults in Puerto Rico, such as financial exploitation, protection services, abuse prevention, among other issues related to aging.
Family does not provide guides or training
González Nieves acknowledged that the agency does not have any active guidance or training available for center operators related to the services and needs of LGBTQIA+ older adults. But she said that, on an individual level, nothing prevents the centers from offering them.
“Every facility is required to contract the services of a licensed social worker. This social worker has the duty to develop a service plan for each elderly person who resides there and executes it according to the needs of the elderly person,” she stated.
The initiative, however, would depend on the older adult him or herself expressing their sexual orientation or gender identity, while the guidelines of the National LGBT Resource Center on Aging recommend, instead of waiting for them, to proactively recognize that there are diversities of sexual orientation and gender identity.
González Nieves said this type of facility is “one of the most regulated industries.” She said that, in terms of supervision and compliance, elderly care centers are governed by the Establishments for the Elderly Act (Act 94 of 1977). But this law does not address issues of discrimination or sexual orientation or gender identity.
These centers must also be guided by the Regulation for the licensing and supervision of elderly care establishments (Regulation 7349). In its article 24, the regulation indicates that no licensed center may discriminate based on race, color, age, birth, gender, origin, social status, or political or religious ideas “or any other illegal cause.”
“It obviously includes the issue that you’re asking us about, which is sexual orientation,” said González Nieves.
The Housing Secretary, meanwhile, said the elderly homes the agency oversees, the Section 8 Program (voucher program) and public housing are governed by standards against any type of discrimination, both in the admission of participants as in the services of each provider.
“We are very vigilant in that there is no discrimination, not only in admission and eligibility in admission processes, but also in the services offered in each of our projects,” he said.
Rodríguez Rodríguez assured that, in the case of Public Housing, the agency offers “recurring training,” aimed at employees and the general population in the elderly home, on non-discrimination and compliance with legislation and regulations on non-discrimination. He said that, since 2012, they must comply with a federal standard that ensures equal access to housing, regardless of the applicant’s sexual orientation or gender identity.
“In the [elderly homes] that we own and manage, when we give different talks and anti-discrimination orientations, the issue of discrimination against the LGBTT community is undoubtedly included,” he said.
The agency was asked to provide documents related to the training they offer and the educational content around non-discrimination based on sexual orientation and gender identity, but they were not provided either.
‘Going back to the closet after coming out’
Older adults often face discrimination based on age or ageism, explained José Acarón Rodríguez, director of AARP in Puerto Rico. This form of discrimination is exacerbated when it intersects with other manifestations of discrimination, such as racism, machismo or homophobia, he added.
Elderly homes and long-term care centers are not exempt from this type of manifestations and intersections of discrimination, Acarón Rodríguez said. “Homes and elderly care centers are a microcosm of the general community of society. That population also has prejudices and stereotypes and discrimination,” he pointed out.
Acarón Rodríguez agreed that one of the consequences of these discriminatory manifestations against older people from the LGBTQIA+ communities is that they decide to hide their identity when they arrive at an elderly or care center.
“The time comes when they have to go back to the closet after coming out of it, with all that it entails as adults, due to the vulnerabilities they may have, to receive services,” he said.
In an elderly home in the Aguadilla region, a female married couple decided to request separate apartments and not make their relationship public, even though they can live together. In another home in the Mayagüez region, two older women have shared with the administration that they identify as part of the LGBTQIA+ communities, but are afraid of expressing their identity publicly, the survey revealed.
In other cases, administrators or social workers surveyed said they knew that, among the residents of the elderly home where they work, there are older LGBTQIA+ people who have not identified themselves as such, either to the administration or to other residents. They said they found out from comments that reach administrative staff from other residents or from stereotypes about gender identities and sexual orientation.
For example, a social worker acknowledged that, among residents, she has heard “jokes” related to a neighbor’s sexual orientation, and that she has “more or less” shared educational information about LGBTQIA+ communities.
“There is always someone who comments, like they say, ‘look, this guy likes men,’ things like that. That is one of the jokes that you usually hear out there. If I hear them and I’m close, I tell them, ‘Drop the topic and be reasonable, because everyone here has the right to choose what they want.’ […] We respect others a lot,” said the social worker about how “jokes” about sexual orientation are handled in the elderly home in which she works.
González Nieves confirmed that Regulation 7349, which mandates annual training courses for center administrators and staff required for operating licenses, has been under review since August 2022 to add, in socialization, “the issue of sexuality.” This review, she said, included recommendations from the owners of these establishments and associations such as AARP, the Association of Long-Term Care Center Owners, and the Puerto Rico Federation of Long-Term Care Institutions. No organization that watches over the rights of LGBTQIA+ populations was included.
The president of the Association of Long-Term Care Center Owners, said, however, that the Department of Family did not request a recommendation regarding older LGBTQIA+ people, although they endorsed the amendment to the regulation. The Association is working under the leadership of the AARP on a proposal for amendments in favor of older adults from LGBTQIA+ communities in the Bill of Rights and the Government’s Public Policy in Favor of Older Adults (Act 121 of 2019).
“It must be guaranteed that their rights [to LGBTQIA+ populations] are respected and their gender identity is respected,” Aponte said.
He also confirmed the results of the survey carried out by the CPI and El Nuevo Día by noting that, “there has been no training aimed at providing services” to older LGBTQIA+ adults coming from the Family Department .
The courses that the Department of Family offers include sensitivity in care, characteristics and physical needs, knowledge and management of common diseases, nutrition and food, health and hygiene, abuse and neglect, recreation and occupation, and eviction techniques in emergencies, according to Regulation 7349. However, this investigation found that none of these courses refer to the sexual orientation or gender identity of the elderly. Although the licensing director said she expects the amendments to the Regulations to be ready on or before November, she could not specify when the agency will begin offering the new course.
“Within this variety of courses that are now being added to the list, there is obviously the issue of handling situations that may be related to discrimination, whether due to sexual orientation or any other type of discrimination,” said González Nieves.
Contrary to the agency, the Waves Ahead organization offers training sessions that cover the most basic topics, such as what each letter of the LGBTQIA+ acronym means and what are some health situations that most impact these communities, Labiosa explained.
Even though it is the only organization that offers services to LGBTQIA+ older adults, Labiosa said it has not received any consultation or request for a recommendation from the Department of Family during the process of amendments to the regulations.
Waves Ahead offers a credentialed program that provides LGBTQ+ competency training and consultation on LGBTQIA+ aging issues to service providers after which agencies are certified as capable of serving LGBTQIA+ individuals.
The training sessions address topics such as support for LGBTQIA+ older people, how to create inclusive communities for older adults, specific aspects of caregiving, information and suggestions aimed at serving trans aging people, and asking demographic questions about sexual orientation and gender identity.
González Nieves said the new courses included in the amendments to the regulations will be taught by entities that are certified by the Family Department. “As part of the requirements that these educational entities are asked for is submitting a curriculum, [which] is evaluated by the specialist from the Licensing Office,” she explained.
“There is a lack of education among all these people who are opening these spaces for the elderly in Puerto Rico; they’re not receiving the training,” said Labiosa. He added that the organization — which has trained 269 service providers for the elderly — would be available to offer the training required by the Department of Family, when the amendments to the regulations are finalized.
Physician and gerontologist Astrid Santiago Orria, who has worked with LGBTQIA+ older populations, recommended updating these courses to integrate topics such as respect for diversity, sensitivity, and competence (basic knowledge), which are essential for people who manage long-term care centers and homes for the elderly.
“It’s important to educate these professionals, because the intervention has to be based on uniting the culture and sensitivity of the LGBT population, that is, their needs, preferences and strengths,” she said.
Acarón Rodríguez believes that reinforcing the inclusion of more aspects that prevent discrimination against older LGBTQIA+ people should guide a better quality of life for them.
“Nursing homes, multi-activity centers and elderly homes are places for people to go on with their lives as they define it. No one has the right to question the decision of how someone wants to live their life, regardless of age. And I believe that that is what the Constitution of Puerto Rico stipulates, that the dignity of the human being is respected, no matter what,” he said.
The survey conducted by the Center for Investigative Journalism and El Nuevo Día was carried out through telephone calls between April and May 2023. Of the 88 licensed and certified centers for older adults contacted, 80 agreed to be surveyed and eight declined to participate. The confidence level is 90% and the margin of error is 10%. The Puerto Rico-level sample for this survey was designed with the technical support of demographers Judith Rodríguez and Raúl Figueroa.
A survey was also carried out on 16 elderly homes, out of a total of at least 202 in Puerto Rico, according to the lists of the Puerto Rico Department of Housing and the U.S. Department of Housing and Urban Development (HUD).
This journalistic investigation does not identify all the names of the elderly homes and centers surveyed to promote honesty in the responses while protecting the identity of older people in the LGBTQIA+ communities who have not necessarily shared their sexual orientation or gender identity openly.
This investigation is the result of a grant from the Centro de Periodismo Investigativo’s Journalism Training Institute and was made possible in part with the support of the True Self Foundation.