Discussing Food Insecurity Among LGBTQ Older Adults with The Fenway Institute’s LGBTQIA+ Aging Project

Kyle Fradkin and Lisa Krinsky
June 14, 2022

For decades, MAZON has been deeply concerned about the unique barriers to food security for older adults. In particular, MAZON has prioritized identifying and removing barriers facing LGBTQ older adults, who experience persistent challenges to accessing services from both the charitable food network and federal nutrition safety net programs. In honor of Older Americans Month in May and Pride Month in June, MAZON’s Deputy Director of Public Policy, Kyle Fradkin, recently spoke with Lisa Krinsky, Director of the Fenway Institute’s LGBTQIA+ Aging Project at Fenway Health. MAZON is proud to partner with the Fenway Institute, and we’re excited to share this conversation discussing their work to address food insecurity among this special population. This conversation has been edited for clarity and brevity.

Kyle Fradkin: Tell MAZON and our community about yourself, what is it that you do, and what is Fenway Health and the Institute?

Lisa Krinsky: I’m the director of the LGBTQIA+ Aging Project.  We work toward equity, inclusion and community for lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual older adults, ensuring that they can age with the dignity and respect they deserve. We are part of the education and training division at the Fenway Institute at Fenway Health in Boston. Fenway Health is a federally qualified LGBTQIA+ friendly health center and the Fenway Institute is the research, education, and policy division of Fenway Health. I worked in community based elder care for the majority of my career, and have been involved with the Aging Project since it first started in June of 2001. 

The project began as a one day summit. There were mainstream elder care providers and folks at the intersection of aging and LGBT lived experience from the elder care community, there were folks from the LGBT community and allies, talking about this invisible population we had never discussed before. What was unique for LGBT older adults? What was needed? What came out of that was sort of an informal work group of issues we wanted to follow. We developed a three year action plan, and we’re now in year 21. 

A lot of this work was happening in Massachusetts when the issues about marriage equality were really coming to the table. Everybody was talking about it — Massachusetts was the first state to legalize marriage equality and the first marriages took place May 17, 2004 — the topics were really on the forefront for a lot of folks across the state, if not the country. Many older, long term lesbian and gay couples were involved in conveying the importance of legal marriage.  My work in those early years created many “lightbulb moments” for people who had never thought about LGBT older adults before. 

Kyle: What are some of the programs and projects run by the Project? How have you seen food insecurity among older LGBTQIA+ adults manifest itself while at the Project?

Lisa: We are focused on advancing inclusive services and community for older adults, engaging in advocacy to promote equity, and working around policy and practice changes in the elder care network. That means doing LGBTQ cultural competence training with elder care providers, assisted living, senior centers, area agencies on aging, and councils on aging, to help them have the capacity and the skill set to create a welcoming and safe place for our older adults. Creating community programs for our older adults as well. We offer an LGBTQ bereavement group for folks to have a safe space to talk about those losses without feeling like other people aren’t going to understand them.

One of the things we have been really proud of is that in the 20+ years we have been working with area agencies on aging, many of whom run nutrition programs or Meals on Wheels programs, we have worked with them to develop LGBTQ friendly community meal programs and cafes, with the idea that it’s creating an affinity group space for LGBTQ folks and allies to come together. There are 23 LGBTQ-friendly community meal programs across the state of Massachusetts. These are places where folks can come together for a nutritious meal. Frequently there are speakers who come in, or entertainment or a program, and so it’s about social connection too. It’s also about connecting to the elder service organization that is the host. They get to connect with people and talk about what other services their agencies offer. 

It really is so meaningful. Those have been tremendously popular gathering spaces for folks, and one of the things that has been interesting is that we were not asking anybody about their food insecurity. We offered this as a social setting and a nutritious meal, but for some people, this was their significant good meal of the week or of the day. There are folks who won’t say explicitly that they have food insecurity but might ask, “are there extras that I can take home?”, so staff would informally know to pack up extra food for this person.

It is hard for people to speak up and to come out about food insecurity, and so we know that there has been this amazing network of providing meals to folks but there hasn’t been a process on the other side of asking them to assess their access to healthy nutritious food. Clearly, it’s an important place for folks, and those meal sites have been and can be replicated in lots of other communities.

Kyle: Are there other things you either have come across or heard about which keep LGBTQ older adults from food security?

Lisa: One thing to consider is anticipated discrimination when we’re talking about congregate meal sites, you have to get yourself to that physical space and have to share food with folks there. Who are  those other elders? How will they receive a LGBTQ person? Transportation is another significant issue. Or, even with home delivered meals, there is anxiety that comes from somebody coming to your house. There can be this real reluctance about, “Are they going to come into my house? If so, do I have to straighten up the house and move photos or anything that would out me?  Is the meal driver going to deliver the meal to me or my partner? Am I going to be outed by virtue of who I live with?” There may be some reservations from folks about whether they want to sign up and have meals delivered to them in the first place.

Kyle: That’s a really important point to consider. Thank you for adding that. You talked about the Institute’s work at Fenway Health and the policy advocacy aspect of the work, so what role does policy advocacy take whether it’s with the LGBTQIA+ Aging Project itself or the Institute as a whole, and how important is that aspect to the ongoing role of Fenway Health?

Lisa: Policy is an essential piece, and we can’t talk about healthcare or any of the other issues which impact sexual and gender minority people, and those who are HIV positive, without it. Policy and practice go together. In Massachusetts we have the country’s first legislative Commission on LGBT Aging. We have focus areas in public health, long term services, legal issues, housing, senior centers and community engagement. Since 2014, we’ve done a deep dive, looking at what the policies are and how they impact LGBTQ older adults, what already exists and what our folks can be a part of. We have to be able to change and impact the larger systems in order to make sure that they are welcoming and affirming, and that the policies recognize and see LGBTQIA+ older adults, and  that they are also being really clear for transgender older adults. 

When I first came to the Aging Project, we said, “gosh, they don’t ask sexual orientation and gender identity (SOGI)  on the assessment forms, so we’re going to go and advocate that the forms get changed.” And then, what about the providers who have to ask older adults the SOGI questions?  You have to train them, you have to educate them, you have to help them understand how to do this and you have to enhance their practice. You can’t just have people doing this without a policy that says we want this to be happening broadly, but you also can’t change a policy without supporting how the practice takes place. 

Kyle: And without providing at least some central support, a policy is just floating around. And oftentimes putting that out without the support behind it just means the death knell of a policy, which also feeds into the narrative of those who don’t want the policy change.

Lisa: One of the things that we saw happen in the policy realm that came out of the LGBT Aging Commission was the legislation we got passed in 2018 that requires that everybody who contracts with and is overseen by our state unit on aging must have LGBTQ aging training. Regardless of where you are in Massachusetts, regardless of where you enter the elder care system, those people are required to complete a one-hour training module that the Aging Project created for the Executive Office of Elder Affairs.  It’s one hour, but it’s a start, and it’s a foundation. That was both a policy of saying that there needs to be legislation which requires this and creating the training and making sure that the practice is taking place so that both providers and consumers can feel more confident that there’s some awareness about our community. 

Kyle: This feeds into my final question for you. We talked about the state LGBT Aging Commission that Massachusetts created, so what would you recommend for other states? What is needed to respond to a community which is only going to be growing in the next 5-10 years?

Lisa: That’s a great question. It’s looking at whether there is awareness in the elder care system, and trying to bring more attention and visibility to LGBTQ issues and LGBTQ aging. Also, we need to look at the Older Americans Act and the inclusion of LGBTQ older adults as a population of greatest need and how that’s being implemented in each state. 

Also, there needs to be an effort to gather information to know how many older LGBTQ adults you have in your state. It ties into data collection, it ties into looking at the programs and how they’re being delivered, as well as building connection and community. What is happening is that you may have one senior center which decides to create a welcoming space and to offer a LGBTQ friendly meal once a month, but they may be functioning in isolation, not connected to similar efforts in their region. Building a network of providers for whom this is an important issue and having that network then build some strength is really important. 

It takes time, and what’s really important is that LGBTQ older adults are engaged in this work. It can’t just be younger people who consider this an important policy issue and a passion project. We have a history of “nothing about us without us,” and we need to make sure that they are at the table as well.

Kyle: Wonderful. That was a really enlightening conversation for us to have and as we wrap up Older Americans month and head into Pride month, we have a lot to think about. At MAZON, we are so thrilled to be in partnership with this work, with the Fenway Institute, and all the great work that you all are doing. Thank you so much for taking the time to speak with me.

Thank you to Philip Bern, MAZON’s summer intern, for transcribing this interview.