Isolation was already an epidemic among seniors, disproportionately affecting LGBTQs, before COVID-19. Now, LGBTQ seniors and agencies serving them are finding ways to survive what for many is their second fight with the effects of a health crisis.
Brian Lynch, a 67-year-old gay man who lives in the Castro neighborhood, said he first got involved with Openhouse after the leading service provider for San Francisco's LGBTQ seniors reached out to him.
Now, a volunteer comes to visit him weekly.
"My right leg was amputated and my left one is in pretty bad shape," Lynch, who uses a wheelchair, told the Bay Area Reporter. "I have Charcot in my ankle, which is like all your bones in your ankle breaking.
"They have this thing called a Friendly Visitor and so a young person named Ian comes over and does the things I can't," Lynch said. "Then we sit and talk. [They're] the nicest."
He was referring to Ian MacGregor, a queer person who told the B.A.R. that they first connected with Lynch through Openhouse at the end of 2019 or the beginning of 2020. MacGregor's partner, a 23-year-old, also connected with a senior through Openhouse.
"I moved to the Castro from Berkeley two and a half years ago and I knew one of the things I wanted to do was to connect with my neighbors here in the Castro who represent different generations," MacGregor, 24, said. "As a queer person myself, I wanted to explore connections with people I'd not have the opportunity to before. I like cats; he has a cat. He's an artist; I try to surround myself with artists. He lives in the neighborhood. The process was pretty straightforward."
Karyn Skultety, Ph.D., a bi woman who is the outgoing executive director of Openhouse, said she thinks senior isolation "is a huge issue."
"Maybe the good news — if there is such a thing — is that isolation was such a big issue for LGBTQ seniors at the beginning of the pandemic that it was already something we were attuned to: knowing that people needed more than a typical senior model of relying on family and spouses," she told the B.A.R. "I think we have done a good job in proactively establishing connections with people, before things got really bad."
Skultety, noting that "when you feel isolated, it's hard to reach out to others," said that Openhouse took the first step at the start of the COVID-19 restrictions by reaching out to seniors to ask if they were OK.
"Some people said 'call me next week.' For people who say 'no thanks, I'm done,' we check in again," Skultety said. "It doesn't solve every problem, but it's building that connection."
Openhouse also took the step of creating 600 gift baskets for LGBTQ seniors who live in San Francisco who'd been going to Openhouse's programs before COVID struck.
"The gift baskets were important," she said. "The real power of the gift baskets is having a staff member in front of your door, saying, 'I miss you. You're important to us. You matter.' The feedback we've gotten is that they loved the stuff in the basket, 'I loved that you visited, that I'm not forgotten.'"
Lynch receives the gift baskets himself.
"The last one, the Christmas one, was hysterical," he said. "I have a cat — a little guy who rules the roost around here — and the gift basket had a lot of stuff for the cat, but it was all stuff I needed. A lot of effort went into it."
MacGregor said Lynch has been wonderful to have in his life; Lynch gave MacGregor several of his paintings, they said.
"Things that frankly are so little effort for me make his life a lot less frustrating," MacGregor said. "It's been one of the most fulfilling things I've been able to do in the last year."
Openhouse also does 300 to 500 support calls "depending upon the week," Skultety said, adding that people are still virtually engaging with groups that used to meet in-person.
"Some of our groups are as big or bigger than before. It's taken time to get there but that's the case," Skultety said, though she noted that "trans, people of color, and marginalized people in the community are less likely to engage with those [virtual] programs."
This is "because they are more likely to lack access to technology and experience poverty at a higher rate than other LGBTQ seniors," Skultety clarified. "Technology access highlights the inequities that exist in our city already."
Skultety stated that when the pandemic began last year, isolation and food insecurity were identified as the top challenges.
"Many seniors were relying on the food/meals offered at senior centers, churches, community organizations, and senior housing as part of their weekly plan to have enough food to eat. As these locations were forced to stop offering on-site programming and food, many seniors found themselves without enough to eat. Early on, we started buying groceries and meals for seniors connected to Openhouse who found themselves in this position," Skultety stated.
"The other challenge was social isolation which has, of course, only worsened over time," she added. "We could see a difference even from the first week of the stay at home order to the second. We started making calls out to our community members immediately — rather than waiting for people to reach out for connection, we made calls proactively. The challenge with feeling isolated is that it makes it harder to reach out to others, which in turn only worsens isolation. It's a vicious cycle that we tried to prevent early on by setting up weekly phone calls with LGBTQ seniors."
Openhouse, according to its most recent publicly-available IRS form 990, had total expenses of $2.2 million in Fiscal Year 2018-2019. That year the organization took in $5.2 million.
Forty-five percent of Openhouse's funding comes from the City and County of San Francisco, according to Skultety.
Multiple layers of isolation
Larry Nelson, who has been a fixture in San Francisco's LGBTQ community for decades (he created the 2018 "Generations of Strength" San Francisco Pride theme), said that there are multiple layers to the challenge of senior isolation.
"There is more now, during COVID, especially in the gay community," Nelson, who is in his 60s, said.
"Sometimes, when someone comes out, no matter what age there is isolation," he explained. "Then they build a chosen family, as we always say, but then that family starts dying off, and then they're isolated again."
Nelson said many gay men who were traumatized by decades of the AIDS epidemic are being triggered again by COVID, not only because both are viral health crises, but because many people lost their chosen families decades ago.
"There's a gay adolescence. No matter what age you come out, you're an adolescent. When AIDS hit it went from bars to community organizing, to discussion groups, all of that," Nelson said. "The issue with many gay, senior men is that many have been isolated since they lost their friends to AIDS. Then new friends came who died, or moved away. So there's many arms and tentacles to the isolation thing. There's always isolation of seniors no matter who or where they are.
"We have really bad PTSD, which is almost unbearable for gay men in their 50s to 70s. Panic attacks. But even though we have all that, we have some experience about how to break out of isolation," he added.
Nelson said he started a part-time job at the SF ReServe Employment Program, a nonprofit organization that helps people age 60 and up, and persons living with disabilities who are 18 and older, find part-time employment.
"Part of our program is getting computers and iPads to people, to create engagement," Nelson said. "Always use the term 'engagement.' Tech outreach — teaching them how to connect with family, how to do Zoom, setting them up so that they can work from home."
SF ReServe, which is based on a national model, has succeeded at getting 65 people over the age of 60 placed, though some people hired before the pandemic have since been furloughed.
According to Nelson, SF ReServe was involved in technology training for some of the Openhouse senior clients, as part of a partnership between the two organizations.
"What does that do?" Nelson asked. "It takes people out of isolation."
On Lok ramps up meal delivery
On Lok, which runs an eponymous senior center at 30th and Dolores streets in San Francisco, has been collaborating with Openhouse on an LGBTQ senior program that will be held at Openhouse's 75 Laguna Street location post-pandemic. It has been focusing on delivering meals since the pandemic broke out.
"We had a vibrant, active community at 30th Street before with music classes, senior groups, and meals," John Blazek, the executive director of On Lok's Day Services, told the B.A.R. "Obviously, that all changed, but our commitment did not end. We decided we had to be intentional and focus on making sure people are not isolated."
To that end, On Lok has been increasing the number of meals it delivers. Each year, On Lok Mission Nutrition delivers 130,000 meals, but this year it is contracted to deliver 228,556 meals.
On Lok Mission Nutrition has added meal delivery routes, and on average serves two meals a day to 348 people.
"We don't just drop the food off," Blazek said. "We have a wellness check that comes with that home-delivered meal. The driver has a close relationship with the people they drop the food off to."
The On Lok 30th Street Center is partially funded through the City and County of San Francisco Department of Disability and Aging Services. The expansion of meal delivery this year was funded through that department, as well as both private fundraising efforts and Give2SF, a fundraising component of the city's COVID response and recovery fund.
According to the organization's most recent IRS form 990, which covers Fiscal Year 2017-18, On Lok had $13.9 million in expenses.
On Lok delivers toiletries and "also fun things like hats, scarves, so that they know they are cared about," Blazek said.
Nicole Torres, the vice president of On Lok PACE, directs the operations of that program, which is a health care plan for seniors who need support but live independently.
"Pre-COVID, the PACE program was based on the ability to provide a continuity of services in the center setting," Torres said. "With COVID, that obviously has challenges. Instead of providing care in the centers, we have been able to re-mobilize into the participant's home.
"The way older adults are reacting is similar to the rest of the world," Torres added. "There are those who are quite fearful, and not knowing how to respond; there are those who are not letting COVID 'take them down;' and those who need help, and are asking how."
Serving some of the "frailest of the frail," Torres said that "having that empathetic ear" is of prime importance.
"Some are hopeful and are welcoming of staff entering into the home," Torres said. "Others are taking a more conservative approach, and want help, but virtually whether through telehealth or over the telephone."
Moving On Lok's groups to the virtual platform have resulted in new opportunities "to engage from outside the Bay Area," Torres said.
"On Lok has an active YouTube channel. We put together exercise, musical events, participants sharing their own music and poems and reposting them through social media," she added.
Rebecca Wong, 94, is an On Lok PACE participant who has been getting meals delivered through the program for four years. Before, she'd been going to an On Lok PACE Center.
"It's good food," Wong said of the Chinese cuisine she has delivered on Tuesdays and Fridays. "It helped me a lot because I'm getting too old to get food for myself."
Wong said she gets her delivery around 1 p.m., at which time she thanks the driver "then I let them down to go away."
Blazek said the greatest challenge On Lok had to overcome was the uncertainty of the pandemic's beginnings.
"If you think back to early 2020, I think one of the challenges was the uncertainty," he said. "I remember the word going out that two million people might die, so our anticipation was daunting. There was not the PPE and social distancing and understanding of how this virus is spread. Now, we have a better idea, but then we didn't know if that would protect us."
'There's so much you can learn'
Wes Enos, who is based in New York City, said he intends to relaunch the Generations Project in virtual space this year. The project is seeking to connect LGBTQ people intergenerationally.
"One of our main concerns is the isolation of everyone in our community, but particularly elders and older adults," Enos, a gay man, told the B.A.R. in December. "The Generations Project has created three types of programs. In the past three to four months these are being fine-tuned and then, in 2021, we are really ramping up these programs in cooperation with SAGE — the older adult community center network."
These programs are live intergenerational storytelling events, intergenerational storytelling workshops, and — its most popular — intergenerational writing parties. The parties are designed for up to 100 people, who will break into smaller groups of three or four.
Enos said that the intergenerational party is free and open to the public on the third Thursday of the month through the project's website.
"That's when the actual mingling occurs," Enos said. "We try to do our best to get people to a point when they feel comfortable mingling and talking to each other. Interesting things come out in the breakout groups, which come out in the larger group.
"Before COVID, our writing parties were for time capsules that we'd create for senior centers," Enos continued. "We created these physical time capsules, and people would write short captions for photos."
Now, they will also be writing stories relating to people's reactions to the COVID pandemic.
Enos said he started the Generations Project five years ago.
"I felt like people my age — I was 27 then — didn't have the opportunity to connect with older adults. We missed out on a lot of opportunities to collect these stories, so we wanted to create an organization to pay homage to that."
Enos said that he had lived in San Francisco, disdaining history as a young adult because his dad was a history teacher in their small Oregon town.
In San Francisco, Enos met "many of the gay friends I have today." At that time, while working in a restaurant, he made a disparaging remark about a senior who was eating breakfast alone.
"My co-worker came over to me and put me in my place, saying, they used to dance just like you do and eat breakfast like you do with your friends," Enos recalled. "But his friends may have died in the AIDS epidemic and I had to learn about that. Ever since then I have tried to honor the older generations."
Nelson agrees that establishing that interhuman connection — changed by the COVID pandemic — is crucial to helping people overcome isolation.
"What can younger people do?" Nelson asked. "Talk to someone older. There's so much to know, so much you can learn.
"It's simple when you think about it," he added.
This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and the RRF Foundation for Aging.
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