U.S. Department of Health and Human Services Hubert Humphrey Building. (Public domain photo courtesy GSA)
Ahead of National HIV/AIDS and Aging Awareness Day Sept. 18, the Washington Blade spoke with Aaron Tax, director of federal government relations for SAGE, to discuss what proposed updates to the Older Americans Act might mean for LGBTQ+ elders and older adults living with HIV.
The conversation followed the conclusion of the public comment period for a Notice of Proposed Rulemaking filed by the Administration for Community Living, a U.S. Department of Health and Human Services agency that is responsible for administering the statute.
An HHS spokesperson told the Blade a final rule is expected “early next year.”
“We’ve looked at the many challenges facing LGBT older people and older people living with HIV,” said Tax, whose organization, Services and Advocacy for GLBT Elders, is the country’s largest group focused on the needs of LGBTQ+ seniors.
These populations experience “higher rates of social isolation” and “higher rates of poverty” and are “less likely to be partnered, less likely to have children, [and are] more culturally and socially isolated from mainstream institutions,” he said.
Therefore, they “seem to fit the definition of greatest social need quite well,” Tax said, referring to a distinction in the legislation that SAGE has sought to effectuate for LGBTQ+ elders and older adults with HIV, coming “quite close” in the law’s 2020 reauthorization.
Tax explained, “what we got at the end of the day is some language that requires every state unit on aging in the country and every area agency on aging in the country — which are basically state departments of aging and local departments of aging — to do three things.
“One,” he said, “engage in outreach to LGBT older people; two, to collect data on their needs; and three, to collect data on whether they are meeting their needs.”
SAGE is now working with these state and local entities to ensure “they’re, in fact, carrying out these requirements” Tax said.
Next year, the Older Americans Act will be up for reauthorization again, so “we will once again be fighting for an explicit greatest social need designation again for LGBT older people and older people living with HIV,” he said, adding, “And we recently introduced legislation with [U.S. Rep.] Suzanne Bonamici [D-Ore.] that would try to accomplish that goal in 2024.”
The legislation, Tax explained, originally “came about in 1965 under Lyndon Johnson’s Great Society as a counterpart to Medicare and Social Security,” which respectively addressed the medical and financial needs of older Americans.
“The Older Americans Act is everything else that should enable you to age in place in your community,” Tax said — and, as such, the statute covers, among other programs, “home and congregate meals and meals at senior centers, Meals on Wheels, transportation assistance, legal assistance, caregiver support, respite, all the things that have enabled people to age in place in their community.”
SAGE’s legislative efforts are coupled with advocacy around the administration and enforcement of the statute by ACL, which prior to the forthcoming rulemaking has not issued new regulations on the Older Americans Act since 1988, Tax said.
“Part of that,” he said, “is because there have been so many legislative changes since the law came about in 1988, so, their goal now is to modernize those regs and recognize the changes to the OAA and also maybe put some additional information in there or some additional guidance in there that might not be captured in the statute.”
SAGE wants the ACL “to be as explicit as possible, as proscriptive as possible, about ensuring that the aging network is meeting the needs of both LGBT older people and older people living with HIV,” Tax said, which informed the organization’s public comment to the agency.
This work is important because there are state-by-state differences in how older LGBTQ+ adults and seniors with HIV are treated, Tax said.
For instance, the “New York State Office for the Aging is extremely aware of the needs of LGBT older people and older people living with HIV,” he said. “They acknowledge that in the work that they do; they’re very intentional in the work that they do to meet the needs of LGBT folks and older people living with HIV.”
Tax said, “we are working hard at SAGE to make sure that other states first acknowledge that this population, or these populations, even exist, and secondly, [that they] are doing more to make sure that LGBT older people and older people living with HIV have access to the same aging services and supports other older people have access to.”
Politics, unfortunately, can play a role, Tax told the Blade.
“When anti equality forces are in control in the White House, of course, that does have an impact on the types of rules and regulations you see coming out of the administration and its agencies” he said.
By contrast, “it’s pretty clear now with the Biden administration’s focus on equity and its interest in making sure that LGBT folks are treated like everybody else, that we’re seeing regulations or proposed regulations that incorporate those important themes.”
“There are good people in state agencies across the country who want to do the right thing,” Tax said, but “Sometimes they bump up against the political realities of their states.”
“We are working hard at SAGE to make sure people who want to do the right thing regardless of what state they live in have the resources and the information and the tools that they need to take care of all of the older people in their states,” Tax said.
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