The Long-Term Care Needs of Same-Sex Couples

With the increased visibility of the older adult gay, lesbian, and bisexual (LGB) population, new research is identifying health disparities that affect the well-being of LGB older adults. One emerging line of research in this area is on the long-term care (LTC) needs of the LGB population. LGB older adults experience higher rates of chronic stress due to stigma and discrimination, which leads to increased physical and mental health burden. Further, most states lack laws that prevent employment and other structural discrimination against LGB individuals, leaving most LGB older adults with fewer resources to manage the health and functional needs that can accompany aging. A study in the American Journal of Public Health examines whether older adults living with same-sex partners are more likely to need LTC than those living with different-sex partners.

The study is based on data from the nationally representative 2009 American Community Survey, which sampled almost 2 million US households. Participants included in the analysis were all same-sex and different-sex couples in which at least one partner was 60 years old or better, and in which neither partner was younger than 40. Survey items used to assess LTC needs were whether or not participants reported difficulty with self-care (dressing and bathing) or with completing errands (such as shopping or attending a doctor’s visit). The researchers compared the needs of individuals cohabiting with same-sex partners with those of individuals who were married to, or cohabiting with, a different-sex partner. For the analysis, investigators separately looked the LTC needs of men and women, controlling for education, race/ethnicity, and age.

Individuals in same-sex couples had higher LTC needs than both married and unmarried individuals living with different-sex partners. These differences varied by sex. Men in same-sex couples were about 1.6 times more likely to report difficulty with errands than married or unmarried men living with different-sex partners, but had no significant differences in their self-care difficulties. Women in same-sex couples were about 1.5 times more likely to report difficulty with self-care than married women living with a different-sex partner, and 1.3 times more likely than unmarried women living with a different-sex partner.

The authors note that, with the lack of federally recognized same-sex marriage, same-sex couples do not have many of the financial protections afforded to married individuals with LTC needs, such as policies to protect the wealth and homes of different-sex couples in which one partner requires nursing care. This, coupled with the lack of legal protection against discrimination that LGB older adults are confronted with in many US states, suggests that LTC needs are likely a greater financial burden on same-sex couples.


Hiedemann B and Brodoff L. Increased risks of needing long-term care among older adults living with same-sex partners. American Journal of Public Health (2013); 103(8): e27–e33. DOI: 10.2105/AJPH.2013.301393


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