‘Now it’s our turn’: Taking care of Callen-Lorde’s elder patients through a uniquely sensitive program

Before Callen-Lorde launched its elder care program, our patients often felt like they needed to decide between getting LGBTQ+ affirming care with us or getting elder-friendly care elsewhere. It was a difficult decision–one that Callen-Lorde didn’t want our community to have to make. 

Luckily, a generous grant from The Fan Fox & Leslie R. Samuels Foundation allowed us to begin our program a few years ago, create systems to assess older patients’ unique social, emotional and care needs and begin to care for New Yorkers in the entirety of their identity. 

As more Americans age—the population is expected to nearly double to about 84 million by 2030–healthcare providers are working to serve them more effectively. Our foundation funding is aligned with the growth of a movement to create Age Friendly Health Systems around the country. Championed by The John A. Hartford Foundation and the Institute for Healthcare Improvement, these spaces aim to follow evidence-based care models, cause no harm and promote what matters to older patients and their families. These principles of What Matters, Mentation, Mobility and Medication, or the 4Ms, are what our elder care program aims to help patients manage so they can live fulfilling lives.  

Caring for a vulnerable generation 

Callen-Lorde’s patient population has historically skewed younger – we lost a whole generation to AIDS – and older patients often left to seek more specialized care elsewhere to address their multifactorial needs. As we have grown capacity to better serve them, we are seeing a growing population of patients in their 60s and 70s wanting to get age friendly care that also affirms their LGBTQ+ identities.  

Because the population was slim, Callen-Lorde didn’t have the infrastructure in place to support these patients until recently. That provided the unique opportunity for clinical director of elder care Ryan Scanlon to build a program from the ground up. 

His first step includes clinic-wide cognitive and physical frailty assessments for patients 60 and older, which both helps establish a baseline for all aging patients and will help catch problems earlier so that interventions can be made sooner. Beyond the actual assessments, having a provider to talk to about what they’re experiencing–struggles with memory and subsequent fears of dementia being the most common–helps patients alleviate stress and anxiety, he said. 

If a patient needs care beyond what Callen-Lorde can provide, they are referred out to a network of supportive providers, like physical therapists or neuropsychologists, that we’re building. These referrals ensure that they get what they need in a timely manner. 

Ryan is also trying to build educational and social components into the program to help elders navigate and mitigate other aspects of growing older. Medicare can be tricky, he explained. Some people don’t have caregivers to check on them as they age, so new approaches to support are required. 

While providers can’t be patients’ friends, he said, they can use home visits to evaluate patients’ living conditions and connect them to resources if any home issues seem to be present. Ryan called home visits potential “gamechangers.” 

The program offerings already have a tangible impact. He recalled one patient who came into our Chelsea clinic recently with clear cognitive issues. Ryan assessed him using his aging assessment tool and found that the patient had marked cognitive decline and thus needed to be further evaluated for dementia by a neuropsychologist.  

At the time, Callen-Lorde could only refer a patient to such a specialist through its behavioral health program, so Ryan worked with Callen-Lorde’s referral team to develop a new pathway to getting patients connected to these highly specialized providers. The assessment, and the referral, ended up being crucial to the patient’s future health and well-being. 

Building for the future 

Ryan is doing vital work—and he is making plans to reach more people who would benefit from the program. He plans to train all staff to provide the gold standard for cognition assessments and interpret the data correctly with the goal of improved care. 

Additionally, he wants to build a curriculum with elder care staff and launch new social programs so that patients can feel more connected to their community. He mentioned that things have moved much faster since Chief Medical Officer Nejat Zeyneloglu came aboard. He is excited to see how Nejat’s leadership fosters new expansion going forward.  

Ryan is aware that the elder care team will have to constantly reevaluate and refine the program to make it work better for LGBTQ+ elders. He said he’s up for the task because making people feel seen within their own community, those who had previously felt invisible, is so gratifying. 

“When people over 65 hear that we’re doing something like this, taking the time to make a program for their needs and their care, there is so much gratitude and appreciation. It’s like they feel seen,” he said. “It’s really good to be able to give that to them—that sense of being cared for… they are our community’s elders and had to face social and political challenges that the younger generations cannot possibly fathom.  

They fought so hard for LGBTQ+ rights that we now see as givens. They suffered as a virus wiped out a generation of their friends, partners and lovers, but did not cower in the corner–they united and marched and protested until viable HIV treatments were released. They took care of us, and now it’s our turn–dare I say our duty–to take care them.”