LGBTQ Caregiver

Mental Health Services Needed to Treat Emotional Distress During the Pandemic

By Dr. Marcy Adelman–

Jan is a 71-year-old lesbian and a diabetic. She lives alone and prides herself on her independence. She is quick to tell you she is a happily retired jack of all trades and now an aspiring photographer. Pre-pandemic she enjoyed doing portraits but COVID-19 and shelter in place (CSIP) put the portraits on hold. She is concerned that diabetes and her compromised immune system put her at greater risk for COVID-19.

From March to May, Jan rarely left her apartment. By mid-May she found herself feeling stressed and out of sorts. She told me for the San Francisco Bay Times, “It was like I was anxious all the time but I didn’t know about what. I was tired no matter how much I slept. I just didn’t feel right.”

In early June she decided she needed to do something new. “I thought, if I don’t get the hell out of this apartment, I am going to go crazy,” she explained. Now, most days Jan can be found on long solitary hikes in the surrounding San Francisco Bay Area countryside taking photographs of birds, redwoods, reservoirs and flowers. I asked Jan how that was working out for her and she replied, “For the most part, that tiredness and anxiety and feeling out of sorts has gone. I can get that way from time to time, but it isn’t an everyday thing anymore.”

Jan isn’t alone in feeling stressed and anxious. The impact on the mental health of older adults living in the time of COVID-19 and shelter in place has been well documented. In a recent Kaiser study, one in four adults age 65+ reported anxiety or depression during the early months of the pandemic compared to one in 10 older adults in a pre-COVID study. Sometimes a simple intervention can help people feel better and less stressed, such as in Jan’s situation, but for many others who are experiencing more severe emotional distress, telehealth counseling with a licensed therapist may be the treatment of choice.

These are stressful times, what with the social and physical limitations imposed on our daily lives, the isolation of sheltering in place, the threat of ourselves or our loved ones being infected and killed by the deadly virus, the loss of jobs or fear of losing our jobs or our homes, and, finally, the heartbreaking loss of family and friends to the virus. Pandemic mental health research tells us that CSIP stress is a common experience regardless of age, race, ethnicity, or gender. But studies also have reported elevated levels of emotional distress in certain populations and communities, especially those communities disproportionately affected by the pandemic, such as older adult women; people with a previous history of anxiety, depression, or post-traumatic stress disorder (PTSD); and Black, Indigenous, Latinx and people of color (BILPOC).

There are currently no studies on the impact of CSIP on the mental health of LGBTQ+ older adults. But in a previous “Aging in Community” column
(, San Francisco LGBTQ+ senior service providers vividly described the initial distressing impact of the pandemic on the communities they serve—communities that lived through decades of oppression and trauma and now lack the mental health services to assist them through this difficult time.

During CSIP, women have reported higher rates of depression then men. Older adult women are more likely than older adult men to have poor health and to live in poverty. These two factors, poor health and economic insecurity, are related to increased levels of emotional distress. The pandemic has further exacerbated these gender differences.

Studies have reported that people with previous histories of psychological distress, in particular low- and moderate-income older adults, were vulnerable to being triggered during the initial stage of the pandemic. At first little was known about the virus—how long the emergency would last, how long we would be asked to socially isolate ourselves and wear a mask, and which experts to listen to. Our lives were disrupted and delayed through no fault of our own, and every day, more and more people were dying. It is a measure of resiliency that given the chaos, uncertainty, and danger, more people weren’t pushed beyond their limits. Older adults with economic, housing, and/or food insecurities and a previous history of anxiety, depression, or PTSD are more vulnerable to CSIP stress.

CDC data reports that BILPOC communities have been disproportionately affected by CSIP. Black, Indigenous and Latinx communities have experienced the highest rates of infections, hospitalizations, and deaths. These communities are at greater risk for severity of illness than white communities due to longstanding health disparities. BILPOC communities have higher rates of diabetes, cardiovascular disease, and other chronic illnesses than white communities. Historically, these communities have been underserved and underfunded due to systemic racism and economic injustice.

The loss of beloved family members and friends and the increased risk of infection has weighed heavily on the BILPOC communities. Understandably, surveys have reported significantly elevated rates of emotional distress, such as grief, loss, anxiety, depression, and trauma.

We can do something about this mental health crisis. We need to see more accessible, affordable, and culturally informed mental health services for all older adults, but especially women, low to moderate income older adults, and underserved communities, such as the BILPOC and LGBTQ+ communities. State and local governments and philanthropic organizations need to fund senior-centric, coordinated mental health programs and services to those most impacted by CSIP: low- and moderate-income women, and BILPOC and LGBTQ+ communities.


Dr. Marcy Adelman, a psychologist and LGBTQ+ longevity advocate and policy adviser, oversees the Aging in Community column. She serves on the California Commission on Aging, the Governor’s Alzheimer’s Prevention and Preparedness Task Force, the Board of the Alzheimer’s Association of Northern California, and the San Francisco Dignity Fund Oversight and Advisory Committee. She is the Co-Founder of Openhouse, the only San Francisco nonprofit exclusively focused on the health and well-being of LGBTQ+ older adults.

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I-Ally Announces Support for LGBTQ Caregivers

Millennial family caregivers are now over ⅓ of ‘sandwich caregivers.’ When I learned this, I also learned that we are the most diverse population of multigenerational caregivers to rise to majority status. Even more reason for us to break molds, I thought. Even more reason for a paradigm shift in the way our society talks about caregiving. Of course, LGBTQ people have always been family caregivers. Nothing about that is new. What is new is maybe now folks are more inclined to be openly gay and therefore identify themselves as such to the census-taker. A huge part of what emboldens our generation is a rejection of older methods—, a rejection of being forced to choose ‘male’ or ‘female’ or ‘gay’ or ‘straight’ when none of those is correct. A fierce energy propels us to buck systems that are no longer relevant and are even harmful.

However, generations before us have fought famously too. And, they have suffered famously. Imagine not being able to even BE your loved one’s caregiver because, even though you’ve been together 30 years, you’ve no legal right to even see them in the hospital? You have no say in what happens and you get no support.

Ultimately, all I can conclude is that navigating the healthcare system is a horror show for anyone, and even worse for many. Navigating being a caregiver? Precarious, full of grief, love, the best days and the worst days. The only way we will get through any of it is to help each other, support each other, and enrich our community. That’s why I-Ally is ecstatic to be a partner and supporter and friend to LGBTQ Caregiving.


Written by Lucinda Koza 

Founder + CEO


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What is Caregiver Burnout?

Caregiver burnout—also known as caregiver stress or caregiver syndrome—was first described by the American psychologist Herbert Freudenberger in 1974. The mental health professional worked in a clinic for drug addicts in New York and observed that most of the volunteers at the clinic had a progressive loss of energy, leading to exhaustion, symptoms of anxiety and depression, as well as lack of motivation at work and aggressiveness with patients after a year of working.

This is a disorder with serious implications both physically and psychologically. Caregivers are at risk of experiencing episodes of stress of varying intensity. The stress of caregivers is higher than that of other professions, due to the fact that they are largely faced with pain and human suffering on a daily basis.

To prevent caregiver burnout before it’s too late, here are some symptoms to watch out for:

  • Physical symptoms such as tiredness or muscle aches
  • Emotional lability or sudden mood swings
  • Sleep problems or weight gain
  • Chronic fatigue
  • Isolation
  • Frustration
  • Cognitive difficulties: memory problems, attention, etc.

Caregivers, whether family members or professionals, play the role of primary caregiver for a dependent person, and are usually given the responsibility of coping with whatever the situation requires. This is particularly true among Hispanic women, who are often the heart of their homes. In a cultural context, Latinas grow up being cared for by women, and grow up to fulfill that role with subsequent generations.

Therefore, it is necessary to recognize the need to watch over caregivers, regardless of their sex, so that they can enjoy an optimal state of health while carrying out their work. It’s important that they are able to develop in other areas of their lives outside of caregiving. NHCOA directs all its efforts to improve the quality of life of older adults, their families, and caregivers, and through spaces such as our seminar “Caring for the Caregiver”, we seek to create awareness about the importance of caring for all the people who are dedicated to this noble and important work, as well as giving them the tools so that they can carry out this work without sacrificing their mental and physical health.



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