Research On Aging LGBTQI and Nonbinary People ft. Jason Flatt, PhD, MPH

Research On Aging LGBTQI and Nonbinary People ft. Jason Flatt, PhD, MPH

***DISCLAIMER: KB ONLY***

This podcast is a series of interviews with medical providers, mental health professionals, community members and advocates. Each interview represents the opinions of the individual. Individuals may use different terminology than what you’re used to. The intention is to educate not discriminate, and we welcome positive and constructive feedback. Please keep in mind; this is not a replacement for medical care or advice. I am simply presenting my views along with educational information that will be both evidence based research and external networks that have an impact on LGBTQI and nonbinary health care. Consult your provider for any medical or mental health concerns. My name is Kerin “KB” Berger and welcome to Queer MEDucation!

***INTRO MUSIC***

***INTRO TO EPISODE: KB ONLY***

Thank you for joining us for our fourth episode of Queer MEDucation. When you get the chance, please leave a little review for us on iTunes, Stitcher, Google Play or wherever you get your podcasts. We are so grateful for the love and support, but also to all those dedicating their lives to the health and well being of LGBTQI and nonbinary individuals. Thank you.

And special thanks to Erica Berger-Hausthor and her associates for their kindness and their dedication to the aging LGBTQI and nonbinary communities. Erica Berger-Hausthor is a lawyer practicing estate planning and elder care law in Orlando, Fl. They recently visited the LGBT Center in Orlando, Fl to present to a group of twenty five aging LGBTQI and nonbinary on end of life legal concerns and documentation. Not only did they educate the folx on queer end of life planning, but they drafted advanced directives free of charge. Although the world seems like a bizarre and negative place these days, it’s important to focus on the positivity instilled in our guests, community members, advocates and allies. 

Did you know only 25% of aging LGBTQI and nonbinary individuals are in a legal partnership? Not only that but a quarter of the aging queer individuals have concerns about who is going to take care of them when they can no longer care for themselves. Talk about marginalized population: the first large population based study funded by the NIH on the aging queer population was published in 2011 under President Obama. Aging LGBTQI and nonbinary people are defined as “a population of sexual and gender minorities over the age of 50” according to the NIH. Studies show there are between 1.75-4 million queer aging adults. Now, I live in LA. Housing is a HUGE problem for everyone, especially our aging LGBTQI and nonbinary population. In this week’s, episode we talk to Dr. Jason Flatt about his research at UC: San Francisco on the aging LGBTQI and nonbinary population. Jason has his hands in many pots but a with a single mission of understanding and improving the lives of aging queer adults. Please enjoy!

***INTERVIEW: KB AND JASON FLATT (JF)***

KB:                 Hey, what's up? It's KB. I'm here with a very special guest. I'm going to let them introduce themselves.

JF:                   Hi KB! This is Jason Flat. I'm an assistant professor, uh, the University of California, San Francisco. My focus area has been on LGBTQ, older adults, really thinking about aging as well as dementia risk and even issues around sort of ensuring that our aging community has access to affordable and inclusive housing.

KB:                 And what are your credentials, Jason?

JF:                   Yeah, so I have a PhD. It's in public health. It's with a focus in behavioral and community health. So that's really focused on like understanding health behaviors and understanding aspects that are important in late life. So I have a graduate certificate in Gerontology with a focus in mental health. And I also, I actually am a master certified health education specialist. So I bring in some of, uh, my previous training and experience in being a health educator to my work. During a lot of my training I focused on, so my dissertation, which was in 2013, focused on social relationships and cognitive health. I've expanded my work really to think more about the needs of LGBTQ seniors. And, uh, I did some training in epidemiology, really understanding risk factors for disease in late life and some work in neuro imaging. So now as an assistant professor, I'm focused on, I have a career development award from the National Institute on Aging to look at dementia risk among LGBTQ older adults are, we use the term sexual and gender minority.

KB:                 Sounds like you have a pretty diverse academic background. How did you get to where you are today?

JF:                   A lot of this was driven by life experiences and a bit of, I would say my passion, but also I really believe in following things that I find rewarding and that I'm good at. So I started off really my focus in undergrad was around, I thought I wanted to be a medical doctor, but at the time I was actually coming to terms with my sexuality and finally having, you know, not being in high school, having some freedom to explore my own identity. Uh, I knew it wasn't the right time for me to be studying as much, but I was always very interested in health. So I ended up getting a bachelor's degree in health science with a focus on community health. And this was back over, uh, 16 almost 17 years ago. And there wasn't a huge focus on public health at the time. So I was really more of a health educator and a lot of my focus was on tobacco prevention among high risk groups. So I worked with the American Cancer Society as an intern and did a lot of health education outreach to blue collar workers, to high school students, any of the high risk groups that might be, you know, using tobacco. And I really found that rewarding, and so that prompted me to go get a master's in public health. And I did that at the University of South Carolina in Columbia. And it was a focus in health promotion, education and behavior. And there I was also, what drove my interest in aging a little bit was in high school I worked at an assisted living facility doing social activities on the weekends. So I was having to get up at like 6:00 AM and get to the assisted living facility to call Bingo at 9:00 AM

KB:                 Very important.

JF:                   Yeah, it was awesome. Coffee Talk, ice cream, socials, booking entertainment. It's probably one of the most rewarding jobs that I had. And so, uh, while I focused and sort of substance use and abuse and tobacco use for awhile, I worked actually in work site wellness. I decided, you know, in 2009 to go back and get my PhD. And so I did that at the University of Pittsburgh and I did some soul searching on sort of what was the most rewarding but also a population that I really cared about. And that's what drove me to kind of a focus in like gerontology. So I did that a lot of training and understanding dementia risk and mental health concerns in late life. So the importance of sort of, uh, other people, the value of being engaged in life, what brings people meaning and purpose. So I did some additional training, which eventually drove me. I got married to my husband in, uh, 2014 we really wanted to explore, you know, one living in a very inclusive environment, but also just to explore, you know, sort of our futures together. So we moved to San Francisco. So that was, you know, in 2015 that we moved here through just kind of me wanting to find ways that I can contribute. I ended up moving my work into understanding the needs specifically for LGBTQ people. It was definitely a, uh, additional time where I did some soul searching, right. So I, I had struggled a bit with, you know, moving to the area and people sort of being like, well, you're gay, you should focus on this area. And I, and I had experienced that even in my PhD training. You know, there was a, uh, a thought that I should also be doing, you know, sexual and gender minority work because I was a gay man. I resisted it for a while cause I, I felt a concern that I maybe was taking... One: I felt like very privileged. I'm a very fortunate, you know, I'm a gay white man. I have a lot of freaking privilege. And I also was concerned about taking advantage of that privilege but also to advance my career and potentially take advantage of a community that I actually really care a lot about. So I did some major soul searching and actually got a small grant from UCSF. It's a, so we call them the National Institute on Aging funds, these resource centers for minority aging research. And it was very fortunate that in like, I think 2016 the National Institute for Minority Health Disparities named LGBTQ people as a disadvantaged group that was vulnerable. And so they use the term sexual and gender minority. So that meant that there was, you know, an interest for these centers to focus on the needs of older LGBTQ people. And so I applied to one of the centers that UCSF, the Center for Aging and Diverse Communities, and I got my first grant to explore this work. It was also funded through, USCF has a Pepper Center, it's like the Claude Pepper Center, which is focused on aging as well and they all sort of supported this project. And the purpose of the project really was for me to explore what is, what are LGBTQ seniors concerns around dementia, but also to explore sort of life course. What were the experiences that these seniors had over their life that maybe could be considered protective, you know, sort of to help them be resilient in the face of aging concerns, but also to look at risk factors. And I wanted to understand, you know, were there unique risk factors? Uh, for instance, the literature showed higher rates of depression among LGBTQ people and we know that depression can be a two to three fold increase in your risk for dementia if you have depression, especially in late life. So I wanted to explore that, but also thinking of other minority populations, we know that there's a history of the LGBTQ older people facing discrimination and there's been work among racial ethnic minorities showing that discrimination leads to cognitive, you know, health problems and leave life. I started to really explore that and I did 20 interviews with LGBTQ seniors across, you know, living in San Francisco and in the bay area. And thanks to my community partners, I partnered with Open House here in San Francisco and I'll talk more about them, but also I partnered with Lavender Seniors in the Oakland, like the East Bay. And they helped me get the word out to seniors about participating in a two hour interview. And I really focused on recruiting racial, ethnic minorities as well as trying to identify trans seniors, uh, and other gender minorities. So I ended up interviewing two intersex older adults. These interviews changed my life, honestly, they were, um, I spent two hours or more with these incredible people who told me about their life story, told me about challenges they had overcome, told me about the, you know, how they fought for rights or, you know, even told me about really horrible experiences that they had encountered in their life of being, you know, uh, an LGBTQ person. Those experiences, you know, when I was thinking about, I said I was doing some soul searching I realized like, wow, everything I've learned, all of the topics, my commitment to aging and research have prepared me to do this work. Not only was I committed based on, you know, the stories I heard, but I felt like I as a gay man, had a connection to this community and that my skillset could be used to help. So that was in 2016 and since then I really have decided to commit my research and my, you know, my health education work and my teaching to this area.

KB:                 That's incredible. What was the demographic breakdown of those 20 individuals?

JF:                   A third of them identified as a racial ethnic minority, and I included, that was sort of diverse, So it included a American Indian, it included Asian Americans, Black, Latino. So for that sense it was pretty diverse. I also interviewed two intersex older adults. I was able to identify to trans older people as well as I recruited bisexual, gay, gay men living with HIV, lesbian and gender nonconforming.

KB:                 Wow. So you, I mean, you really had a nice spectrum in those 20 individuals.

JF:                   Yeah. Well, it was like a focus, you know with qualitative research you can do more of like a purposive recruitment so I was specifically trying, I thought some people have tried to pigeon hole me into like, well just study gay men or just study this group. And I really was more interested in, while our community has major differences, and sometimes things that really divide us, there was also some similarities and so I wanted to focus more on the broader needs of the community versus just for a specific group.

KB:                 What was the push for, from other individuals to focus on a particular group?

JF:                   I don't know if it's like this ideological... I am not really sure where it comes from. You know, if it's the thought that like, Oh, you should study a group that you're closest to that maybe you can add as much because I would not a, you know, I don't identify as a gender minority and it's true, I don't understand completely the experiences of other groups, but I don't think that that means I can't help. Right. And, yeah. So I've just framed it as like, I'm not, maybe it's like my own, like I don't care <LAUGH>, what you say. And I'm very careful to make sure that that doesn't mean I should speak for those communities. So that's important to remember, but that doesn't mean that I can't help and help them be more informed, their community's needs.

KB:                 Right. And I think with research, if you really break it down, you're just giving a voice to people.

JF:                   Yeah.

KB:                 You're just collecting information, drawing conclusions and telling, especially with qualitative information. Um, it's just an, it's just storytelling in a way.

JF:                   Exactly. Exactly. And so you're putting a voice, you know, you're basically documenting in some way peoples experiences and their stories. Right.

KB:                 With those 20 individuals, what did you, what were some conclusions that were drawn or, or I guess I should back up. What were some of, uh, questions that were presented to these individuals?

JF:                   So it focused a lot on life. I wanted to know about childhood, relationship status, educational experiences, so really driven by sort of like a life course perspective. So I wanted to know like a structural factors that might have impacted their life. So things like education and economics and family, housing. Yes, exactly. Like all of the like formative stuff as well as you know, I wanted to talk about what was there, you know, coming out or kind of identity, experiences with their identity. So we dived into that. Uh, when they move to the bay area, what that was like a bit about experiences with discrimination, which there were incredible, like I was blown away. So these were people that were 60 and older. So you know, 40 years ago, maybe less people were being thrown in jail for being gay or identity, identifying as a, you know, a gender minority as well as some of those individuals were ostracized by the LGBTQ community. They weren't allowed to go to the gay bar. They weren't embraced by, you know, other groups. And then we learned of many, some of the Trans individuals that I had interviewed talked about like their family, not allowing them to be a part of, you know, if you want to come for the holidays you need to wear your boy clothes. Just experiences like that that I was just like, ahh, to hear, you know, to not be welcomed throughout, you know, a large part of your life as part of your family. So we touched on those experiences. I dived into some of what I wanted to learn about was even around victimization and trauma, which had to be a very careful, not everyone wanted to go there, which was fine. And obviously all of this was kept very confidential, de-identified, no one would know who they were. I changed, you know, the names of people, even events that they would list I would change the exact details so no one would be able to directly link what was said to them. But yeah, I was blown away, honestly. And not actually even drove one of the unique pieces and some of my work has started to look into the health needs of intersex adult. I was blown away. I interviewed two intersex older adults and I was just, the challenges, the trauma, the life adversity, issues with housing issues, with relationships, uh, not being welcomed into the LGBTQ community even. I was like, wow, more needs to happen.

KB:                 For some intersex individuals, they are literally discriminated against as soon as they are born.

JF:                   Exactly. Exactly. Yeah. So that's prompted me actually to, we have a, you'll learn, people will probably be thinking, ah, man, this guy has a lot of different projects, but I partnered with Interact advocates for intersex youth. We roll out one of the, first, it was a study looking at the health needs of intersex adult. Uh, so 205 people completed a survey that we developed with community members, with actual intersex people, uh, so that we could start to inform the medical community about the needs of intersex people. So it was, I mean we ask questions from health concerns, quality of life, mental how, but one of the big focuses of this survey was to look at healthcare experiences. Uh, how, how often are they having educate their health care provider on how to provide competent care? Right. Almost all the time, I think it was close to like 80%, right? We're saying like, I have to educate my healthcare provider on my needs or the fact of being a, many people need to have hormone therapy to stay healthy. And so they've often had to advocate on behalf of themselves in ways that just some of us would find impossible.

KB:                 And as somebody who went through a medical training program you're taught all about the pathophysiology, the clinical impression, the medical treatment

JF:                   Uh huh

KB:                 So it's there.

JF:                   Yeah.

KB:                 So what's the problem?

JF:                   Well, I think it's larger societal

KB:                 Stigma.

JF:                   It's discrimination. If we really just want to call it what it is, you're discriminating against a, a minority, uh, you know, gender or sexual minority and you are not going to give them the health care that they need. You're going to basically decide what they

KB:                 Right

JF:                   ...without completely, and I'm not saying every, every health care provider does that

KB:                 Of course,

JF:                   But I think it's more mainstream than we realize and so there's a need to really make some changes and that's what we're hoping to do with Interact. And I'm also working with a medical Suegee Tamar-Mattis who has done a lot of advocacy in this area, but now really wants to make an impact research wise, thinking about the health and health care needs of Intersex people. So we're starting to do some of that work

KB:                 Sounds like have going on, which is incredible because all the things you're doing, in many respects have never been done before.

JF:                   Yeah.

KB:                 Or they've been done maybe in smaller quantities and smaller population groups.

JF:                   Hmm.

KB:                 I'm curious, when you publish the qualitative study for the 20 aging individuals, do you publish? All of...

JF:                   It hasn't been published yet!

KB:                 Oh, okay. Okay. <LAUGHS>

JF:                   I presented on it a bit. I published on some similar areas, but we're in the process of getting that one published. We're going to probably send it to... A lot of the focus was on risk for dementia or Alzheimer's disease. So we're probably going to send it to one of the dementia journals.

KB:                 Can you share some conclusions or is that confidential?

JF:                   Yeah, sure. I mean what we basically found were, you know, people are concerned about dementia risk and their memory. Uh, there were a lot of the talks of that. There's also an interest in doing preventative behaviors, so that may be being more engaged in activities, doing cognitive stimulating, kind of like a luminosity or one of those kind of, you know, doing crossword puzzles or doing something that's, you know, brain games. So there was an interest in that. There's an interest in improving health so many talked about nutrition and thinking about aspects that are going to help their heart but also their brain. So there were talks on that. There was, what was unique was that many hadn't planned for what might happen. <DOG WHIMPERING> And so we talked quite a bit about the need for advanced care directives. Are you hearing my dog cry?

KB:                 I'm hearing the dog cry.

JF:                   Okay. I will. Tuna get over it.

KB:                 <LAUGHS> It's all good. There's room for tuna and the interview.

JF:                   Yeah, come on. Tuna. There's little tuna.

KB:                 Awwww, Hi Tuna. So cute. So I am curious to know if you know with your experience kind of evolving into this specific specialty, were there particular differences in the LGBTQI aging population compared to prior research that you've done with non-LGBTQI aging populations?

JF:                   I think what's unique is, Honestly, what I had studied a lot around was like access to social resources. And what really stood out to me is that there are a lot of deficits for LGBTQI seniors and access to social resources. So this includes things like, we think of it, you know, the academic term is like social support. So LGBTQI seniors are off, you know, most of them were single, did not have a partner. I would say a more than 90% of the ones that I interviewed and that was not a requirement to participate. So this was just me purposively like recruiting just diverse seniors who met the age requirement and no one had a partner pretty much

KB:                 Which is very different than the average population.

JF:                   Yes.

KB:                 Or the general population.

JF:                   Exactly. Very different. Income limitations were pretty huge. There were some that had more financial means, but on average many had a very fixed and income fitting into the you like that social support piece. Many did not have a very strong like support network. So if they had a health problem, if they needed a ride to the doctor, right. These were struggles! Uh, that I don't think other, you know, non LGBTQI have as much of a problem with they can rely on, you know, we do have in the U.S. a huge issue with like these nuclear families where they're spread all out throughout the U.S. but for even LGBTQI seniors, they didn't even have family members that necessarily they could rely on, they don't have children often to help them. And if their children lived in the city, they couldn't, like the piece with, uh, family members were like in the city, it was like they couldn't rely even on their children if they were in the city to necessarily help out. So I thought that was, you know, those really stood out as sort of these gaps for the community, especially as they're getting older and may need more help. They don't have it, they don't have resources. So that's why I've started working with community partners like Open House who is meeting that gap for LGBTQI seniors.

KB:                 So what does open house do to manage that gap?

JF:                   So Open House is, it's a nonprofit organization in San Francisco. It is led by Karyn Skultety, who is, uh, uh, has a doctorate in psychology and they focus on, one of their main missions is around providing housing to LGBTQ seniors. But they do even more than that there. They provide community programming. They can help seniors find resources, whether that's economic or social. Uh, they can link them to health services. They have a large team, they have social workers that are doing care management. One of the unique pieces that Open House is doing in the city is around housing. So they have 55 Laguna, which is the first LGBTQ inclusive housing that's affordable for LGBTQ seniors in the city. And it's very close to the Castro as well as conveniently located. It's right down the street from San Francisco's LGBT Center. They also have access to grocery stores nearby. So it's very conveniently located and the exciting news is that they're opening their second high rise in 2019, uh, 95 Laguna or the Marcy Edelman and Jeanette. It's, a, named after the founders, uh, Marcy Edelman and I have to get Jeanette's last name (Gurevitch), but uh, it's named after them. They were, uh, basically a psychologist and a social worker that were focusing, you know, many years ago on the needs of LGBTQ seniors and their work has just been extended to now, there's a nonprofit, you know, that's really meeting these needs. But soon they're going to have over a, you know, a hundred units for LGBTQ seniors to live in so it's really amazing. I'm doing more work with them that we're actually working on a with On Lok. So On Lok is a nonprofit in the city that provides services to older adults. Uh, their history was initially working with the Chinese community, provide care to aging individuals and their families through adult day social programs and also what we call P.A.C.E: Program for All Inclusive Care for the Elderly. And uh, so now they're partnering with Open House and I'm working with them as well, doing some doing a needs assessment to learn about how can we develop one of the first adult day social programs for LGBTQ seniors.

KB:                 Can you expand a little bit on the importance or the correlation between the aging LGBT and housing crisis?

JF:                   So what we're seeing is, you know, there's this common, and I think society needs to really think about where this is coming from, but there's this common thought that LGBTQ seniors are better off than their non-LGBTQ counterparts. This thought that like they make more income because they didn't have children. This thought that maybe they have more education and this is really a huge bias. And one, we know that the most well representative members of the community are gay men and typically gay, white men, right? And that doesn't reflect everyone's experience. And so what we're actually finding is, as I said, there's these huge gaps in the social resources for LGBTQ seniors, including white gay men. So it is not, you know, this stereotype or kind of perception is not, does not apply to everyone. Um, and it's probably just a few and some of the bias in recruitment and research in the past. But what we've seen is that are LGBTQ seniors have major income limitations. Many of them may be on disability or are, you know, not working any longer and have to rely on social security, which the amount that they receive is very little, especially when you think that most LGBTQ people move to urban environments because of the acceptibility, um, the opportunity to find others that were like minded or more open minded. Right. And so this is a history of sort of, if we think about LGBTQ rights and some of the historical aspects that our communities faced: the aids epidemic and some of the other, you know, fighting for rights and where trans people could feel safe, they move to urban environments. And this is where they built their chosen families and all of their support networks. And what we're seeing across the nation, you know, they, they talk historically about, there was this, they call it like white flight: this history of a very affluent, you know, individuals leaving cities because they wanted to move to the suburbs. Well those with less for like, well this is a great opportunity for us to move to the urban environments because it's going to be affordable. And so there's sort of this history now of well now people want to move back to cities. Um, and so this has caused the cost of housing to skyrocket,

KB:                 Especially in San Francisco.

JF:                   Especially in San Francisco, also New York City.

KB:                 And in LA too. We're having lots of problems.

JF:                   We're even seeing it in place at small places like Portland

KB:                 ...and Denver,

JF:                   Denver.

KB:                 Austin, yeah.

JF:                   Yeah. Everyone wants to be back in the city. There's this maybe realization of one. I think everyone having cars as an aid computes impossible. So everyone wants to live closer to work. This has caused the cost of housing and urban settings to increase in a way that is like insane. And guess who's taking some of the brunt of it are, you know, the people that were living in cities that, you know, a long time ago, uh, when there was this, you know, so this includes LGBTQ seniors, especially those in San Francisco and New York, LA, some of the larger cities. We're having problems with landlords evicting people because they know they can charge more rent. People are on very fixed incomes, they also have health challenges. They don't have the support they need to age in place. And so this is causing major challenges

KB:                 And rent controlled apartments are being sold or passed down to families and they're selling them for a gagillion dollars

JF:                   Or this airbnb movement where people are like, I'm going to kick you out and now put my apartment on airbnb because I can make you know, four times the amount of money that are, I was making. So, you know, with all of this, and I think also tech, you know, with the, you know, the rise in tech and tech moving to urban environments, especially San Francisco, that it's caused, you know, a lot of these challenges for allowing, especially LGBTQ seniors to age in place and stay in their communities. So we had to think of solutions to help make sure that they're not forced to leave.

KB:                 Well, it's great to know that there's people doing the work and, and you're doing the work and you're partnering with people who are doing the little work, which is incredible. Are there any challenges that you've faced pursuing this particular type of research?

JF:                   There are, you know, especially in, so I had already mentioned that there was this bias and I think that was coming from some of my experiences, basically saying that lgbt, they couldn't see why LGBTQ seniors would be considered a disadvantage group. So I had to do a lot, lot of educating. Even my colleagues, you know, had this bias that basically LGBTQ people were white gay men with, you know, what do we call it, this terminology "DINKS": double income, no kids, right?

KB:                 I just learned this. I guess I'm a little behind the time, but now I like I'm hearing it everywhere.

JF:                   That was the common misperception that that's what the community was like and why do they need any help? And that bias was really hard. And I think a lot of people still think this, you know, across the nation. So part of what we've had to do is educate them that that's not the case. And that's what maybe you see in the media or those who are getting a lot of the attention. But not everyone is Neil Patrick Harris, you know, and living it up and you know, has more resources than the average individual.

KB:                 People also don't realize that individuals that survived the AIDS and HIV crisis, their goal at the time was to survive.

JF:                   Yes.

KB:                 Whether you are a positive or negative and the people that did survive weren't thinking about their retirement or their 401K or their life 30 years down the road.

JF:                   Yeah.

KB:                 Because they just needed to worry about today

JF:                   And people don't know about some of the economic things for this unity as well. So what for many individuals living with HIV, uh, they were especially at least here in San Francisco because of discrimination and such people couldn't work. So many of them were eligible for disability and so they'd been living on disability. Well, what happens when they turn 65 and some, you know, depending on what the rules are for social security, they then have to go on social security because of entitlement based on age. And it's much less than what people were getting with disability. So now, as they're getting older, you know, they've been become accustomed to a certain amount of money they were getting monthly, which is still not very much. And then even, you know, three to $400 decrease in your benefits is huge! That may be your food for the month or that may be part of your rent. So then it, you know, for those individuals it makes it even more impossible to age in place and stay, you know, where they want to be.

KB:                 What are some uplifting, positive stories that maybe you can share with the listeners?

JF:                   Well, I had met him like I've met these trail blazers, right? And these trailblazers, I mean I've met people that are, you know, resilient, overcoming challenges in a way that they've, they've stayed healthy, they've overcome it, they fought for the rights of others, they're educating, they're helping each other. So the example would be, I've done some qualitative work as well at Open House's 55 Laguna theirfirst LGBTQ senior high rise. And what we're seeing is like we're rebuilding community. There was a, an example, one of the, the people living at 55 Laguna fell and broke their hip and a typical place they may become extremely, you know, living in their own independent apartment in the city, they likely would become very isolated and may not be able to care for themselves; get food, be able to, you know, maintain hygiene and even some of the daily things we need to do that we take for granted. Like doing your own laundry or cleaning your apartment. So we saw at 55 Laguna just from interviewing people the whole floor came around and supported this person. They were bringing meals. If they made dinner, they made an extra plate for this person. They would stop by when they were going to the grocery store and be like, what do you need? How can we help you? Providing, you know, of emotional support, stopping in and just spending some time with this person, seeing how they're doing, you know? And then there's just the advocacy work; getting to work with community members that are, I mean, making very little income wise and in one of the most expensive cities in America. Right. And they're helping LGBTQ seniors every day to make their life better. So to get to just know some of the people at open house like Karyn Skultety, Michelle Alcedo, Ariel, Jesse, Sylvia, these are just a few of, you know, getting to meet some of these amazing people that are changing the lives of LGBTQ seniors. I, as I said, it's so important. I'm not alone in doing this work and so that to me is probably the most rewarding. I'm meeting like LGBTQ seniors that volunteer at the front desk and are helping the community, answering phones, directing people to resources, 95 Laguna just actually their lotteries coming, they're revealing the results on Tuesday and the number of volunteers that were helping LGBTQ seniors sign up for the housing lottery... I was just like alright, we, we are going to help our community. There are people that are committed volunteering their time to help LGBTQ seniors. And I have a picture, also a group had donated, 90, over 90 present, uh, at the holidays to isolated LGBTQ seniors. It was like incredible.

KB:                 What a beautiful thing.

JF:                   Yeah. It's, it's just been like each, you know, each day I work in this area, I'm like, this is what I'm supposed to be doing. This is like, not only personally rewarding, but to even have a little, you know, a small opportunity to make an impact in the lives of a community that I respect, that I am grateful everyday for what they've done for us. Uh, around LGBTQ rights. I've met some of the trans women that were at the Compton's cafeteria, you know, fighting for trans Rights in San Francisco. I've met, you know, people that have been, that knew Harvey Milk and were there during, you know, the LGBTQ movement in San Francisco. I'm just like, ah, this is amazing to get to even talk to one of these people. Um, so I hope that more and more LGBTQ people my age and younger start to realize how much this community has done for us and the importance of learning from our elders, but also really respecting them and being grateful that they've made an impact on changing laws, helping...I wouldn't be able to study LGBTQ health right now if it wasn't for what they had done.

KB:                 And it's beautiful to see that you're dedicating your studies and career to this particular group; I would imagine, never expecting to be where you are today based on where you started.

JF:                   Oh no! I didn't think that this would be... you know, but I didn't get her alone. You know, it's a, I'm at the UCSF School of Nursing. I've had an amazing mentor, Julene Johnson who, um, she's the Associate Dean of Research and I'm at the Institute for Health and Aging. And then I'm affiliated with like the Institute for Health Policy Studies. I'm a member of the faculty on a group, it's called Health Force that does training for health care professionals. I'm a member of a HRSA funded health workforce research center on longterm care. So I'm get to work with amazing colleagues like Joanne Spetz, who's one of the experts in the economics of nursing and the nursing workforce. I'm a scholar with our clinical and translational science institute. Now I'm working, I'm a volunteer researcher at Kaiser Division of Research plus, I've already talked about the Center for Aging and Diverse Communities and the Claude Pepper Center at UCSF. You know, I've talked a little bit about researchers not being supportive of the area, but on it, you know, me listing off seven or eight groups that I'm affiliated with, shows like there, there's a lot of support and I think that, yeah, it's happening and I, and I think it'll continue to happen.

KB:                 Can you describe a network of maybe other researchers doing similar work to you, maybe in other areas of the country or the world?

JF:                   So one of the big groups, at least in aging, is the Gerontological Society of America has a, what they call the Rainbow Research Group. And so this is a group of people in the field of Gerontology that are all doing, you know, work in this space. It's been just like amazing to get to, ahh, work with these people. There's also the American Society on Aging has a group that does work, LGBT Aging Issues Network. We're actually inviting, uh, speakers from other institutions. So for instance, we're going to have Ilan. Meyer from UCLA is Williams Institute.

KB:                 Awesome!

JF:                   Yeah. So Ilan's is going to come and actually give a talk on his work in Minority Stress and understanding, you know, for LGBTQ people or how minority stress in a sense gets under the skin and impacts health. So we'll have that. Um, I'm also a part of, so there's the National Institute on Aging has a group focused on broader disparities for minority populations and this is open to people with terminal degrees that are doing research. So they are probably a professor in some sort of doing research and it's called the Butler William Scholars Program and it focuses on minority aging. And I, I've been a scholar in the past with that.

KB:                 So it sounds like there's a lot of research and opportunities kind of coming up.

JF:                   There are, there's actually like the, what I think some of this created was like the National Institutes of health has a sexual and gender minority, a research program. and so it's led by Karen Parker, who's a researcher at the NIH that's also helping to create a network of researchers focused on LGBTQ health. So we have that work happening. Uh, and actually there's going to be a regional workshop, uh, in LA at UCLA in like late February. They haven't announced the open call. Um, but I'll definitely make sure to send that to you so you could share with people that are interested in research and wanting to learn more. Yeah, I'm giving a talk on how to, as a junior person, how did I get my career started in LGBTQ health? So...

KB:                 Excellent. So I think a lot of people assume you have to be a researcher or a scientist or in academia to participate in research. What can the community do to be involved in such research?

JF:                   I think it's like looking for oppor... So one of the groups I also work with is the Pride Study. So it's the Pride Study, I think it's dot org. It's actually an online platform focused on really learning about the needs of Lgbtq people. And then another national effort is the All of Us Study, which is focused on everyone. Um, but we're really encouraging LGBTQ and gender nonconforming individual to consider being a part of that. It's a larger focus actually with the Affordable Care Act that helped to make this happen where we're trying to learn about the needs of everyone and using some precision medicine efforts so that we can start learning what type of care works well for LGBTQ people. What are some of the health concerns as well as maybe some of the potential treatments that might be ideal for our community. So I would definitely encourage, you know, if you're interested in research getting involved in either the Pride Study or the All of Us Study. I also think it's volunteering, whether that's volunteering to help researchers or volunteering to do work in the community with LGBTQ people, whether that's youth or older adults or people that maybe have more challenges. But being a part of that will help, you know, improve the lives of our community, but also can be very rewarding.

KB:                 That's amazing. And I appreciate all the work you're doing. I always like to end the interview by asking the person why they feel like their job is important.

JF:                   Why do I feel like my job is important? Let me think. I mean for me it's like such a like personally rewarding career to have, but I think why it's important, especially with what I'm doing in aging is like the system of the... we have seen for LGBTQ people, especially those that are older, that they've been made invisible. And this happens from both their own community but also, you know, broader society. So my hope is that my work will make our LGBTQ seniors more visible, but also to help educate healthcare professionals, researchers, the public about this community and their needs and ways that we should be helping to improve their lives. Whether it's advocating for new policies, advocating for better care, advocating for training, or you know, even as I've said, some of the basic living needs, so advocating to ensure that we have affordable and inclusive housing. So I'm, you know, really hoping the, this work, um, helps in some way to do that.

***END INTERVIEW***

***CONCLUSION: KB ONLY***

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