Every Pride Month, we celebrate the resilience, visibility and achievements of the LGBTQ+ community. But amid the rainbow flags and joyful parades, it’s also important to remember the quiet battles many of those who identify as LGBTQ+ still face, especially as they age. One of the most pressing among them is access to quality health care, culturally competent care teams and supportive communities.
Approximately 20% of LGBTQ+ people report avoiding medical care out of fear of discrimination. For older adults, many of whom have lived through decades of systemic marginalization and personal loss, that fear can be deeply ingrained.
Nationally, nearly three million adults over the age of 50 identify as gay, bisexual or transgender – and in New York State, almost a third of LGBTQ+ adults are over 50. That’s more than 220,000 New Yorkers who may be forgoing critical health care simply because they don’t feel safe sharing their true selves with their doctor and care teams.
At Oak Street Health, where I care for older adults on Medicare in Brooklyn, I see firsthand how critical it is to offer inclusive, affirming care. And I’m not just talking about checking a box that indicates how my patients identify. I’m talking about a comprehensive, intentional approach to care. One that treats the whole person: mind, body, and spirit.
This is critical because more than 2,500 patients openly identify as LGBTQ+ across our organization, with many more likely not reporting their sexual orientation or gender identity due to fear of stigma and discrimination. Our commitment to this is therefore not just theoretical; it’s essential to the way we serve our communities every day.
It starts with a three-pronged approach: physical, mental and social well-being. Physically, our care model emphasizes prevention, chronic condition management and reducing avoidable hospitalizations. Our care is tailored to the unique health profiles of older adults including addressing key disparities encountered due to systematic and environmental factors.
And through our social support programming, we provide personalized support for food, housing and other key needs. Mental health support is woven into our clinical model through our behavioral health specialists, who are trained to comprehensively address mental health needs such as anxiety and depression, conditions that disproportionately affect older adults, including those in the LGBTQ+ community and those who have experienced rejection or social isolation because of their identity.
Our behavioral health specialists and social workers are also well-versed in trauma-informed care to address the social factors that disproportionately affect the LGBTQ+ community. Lastly, our community-based activities (like Zumba or salsa dancing) and social engagement through community events help patients feel seen and connected, all while improving their overall well-being.
This model is so important because many older LGBTQ+ adults may live alone, without the traditional family support systems their heterosexual counterparts may take for granted. In fact, by 2030, the number of LGBTQ+ older adults is expected to double. Many won’t have partners, children, or grandchildren to help care for them, AARP research indicates. This means their physical and mental health risks are compounded, and without affirming care in a safe environment, they may continue to delay seeking help until it’s too late.
Even when LGBTQ+ patients do seek primary care, many don’t feel empowered to speak openly about their health. Studies show LGBTQ+ individuals are less likely to discuss sexual health or relationship-related concerns with their providers because they fear misunderstanding, judgment or outright bias. When a patient doesn’t feel comfortable disclosing who they are or what they’re experiencing, the quality of care inevitably suffers.
That’s why creating a culturally competent and inclusive health care environment isn’t just a nice-to-have. It’s essential. It starts with providers like me being educated on LGBTQ+ health disparities and cultural competencies, and continues with the daily practice of empathy, curiosity and respect. At Oak Street Health, we create intentional safe spaces for all patients, regardless of gender identity, sexual orientation or background, so they feel empowered to actively participate in their care.
For example, we routinely collect preferred name, pronouns, sexual orientation and gender identity data on all our patients. We strive to use a patient’s preferred name and pronouns and gender neutral terminology during every visit and have developed evidence based guidelines on preventive care for our providers to use for our LGBTQ+ patients.
This Pride Month, I urge health care providers and community advocates here in Brooklyn and beyond to reflect on how we serve our aging LGBTQ+ population. Are we showing up with the sensitivity and curiosity they deserve? Are we acknowledging the unique challenges they face and designing care models that meet those needs? Are we ensuring that no one, regardless of who they are, fears going to the doctor?
Everyone deserves to age with dignity. And no one should be afraid to ask for help.
Dr. Akash Patel is the Center Medical Director at Oak Street Health Bushwick.
