“I couldn’t go back and change it for my friend, but we could start thinking much more proactively about this,” Paasche-Orlow said.

With gay marriage legal nationwide and organizations such as The LGBT Aging Project, a nonprofit that advocates for equal access to life-prolonging services, in operation for more than a decade, Americans should theoretically be living in a golden age for LGBT seniors. Yet the LGBT Aging Center’s survey found that only 22 percent of respondents felt they could be open about their sexual identities with health-care staff. Almost 90 percent predicted that staff members would discriminate based on their sexual orientations or gender identities. And 43 percent reported instances of mistreatment. Meanwhile, few elder-care providers have services directly targeted at helping them.

To deal with this problem, Paasche-Orlow decided to integrate LGBT-focused programs into her work as the director of Religious and Chaplaincy Services at Hebrew SeniorLife, a Harvard-affiliated organization that provides health care to more than 3,000 Boston-area elders. Paasche-Orlow’s programs range from sensitivity training to bringing in LGBT youth from local high schools to spend time with residents.

Although the residents are grateful for the programs, community members such as Mimi Katz acknowledge there’s still a long way to go. Katz, who came out as a lesbian in 1968, lives in a Hebrew SeniorLife facility in Brookline, Massachusetts. She says that one of the major problems today’s elders must contend with is unspoken homophobia. “In the more liberal Brookline kind of setting, nobody is going to be overtly homophobic,” she said. “It’s the same thing as racism. Nobody wants to think of themselves as a racist, but then somebody will say, of one of the black aides, ‘Oh, she’s so well-spoken.’ That kind of thing. Or somebody will say to me, about a woman whose child is gay, ‘Oh, the heartache she goes through.’”

Katz can’t help but be exasperated when these moments occur. “It’s like, ‘Hello!’” she said.

In terms of concrete activities offered by Hebrew SeniorLife, Katz was especially appreciative of her community’s screening of the 2010 documentary Gen Silent, which follows the stories of six LGBT senior citizens who must navigate the intricacies of a long-term care system that is unsupportive of LGBT individuals. But Katz believes what will ultimately benefit LGBT elders the most is staff training. “The only way to deal with it is by example,” Katz said.

According to Paasche-Orlow, most care providers and staff members would never knowingly discriminate against someone because of their sexual identity. But that doesn’t mean LGBT seniors feel like they can be themselves. There’s a difference, Paasche-Orlow acknowledged, between wanting to provide a safe environment and actually providing one. “What we know about the whole field of cultural competency is that, unless I really understand the person I’m serving, I’m going to provide them with what I personally would like, or what I think they need.”