Skip to Content

Alternative Living Arrangements for Older Adults

By

Daniel B. Kaplan

, PhD, LICSW, Adelphi University School of Social Work;


Barbara J. Berkman

, DSW, PhD, Columbia University School of Social Work

Last full review/revision Mar 2021| Content last modified Mar 2021

Living arrangements and relationships that do not involve living with a spouse, with an adult child, or alone are fairly common among older adults. For example, a substantial proportion of older people who never married, are divorced, or are widowed have long-standing and close relationships with siblings, friends, and partners. Understanding the nature of these relationships helps practitioners plan care that is in keeping with a patient’s wishes.

Consideration of the homosexual or transgender older adult

About 6 to 10% of the US population are estimated to be lesbian, gay, bisexual, or transgender (LGBT), including as many as 2.7 million people over age 50 and 1.1 million people over age 65. People of color comprise 20% of LGBT older adults. One-third of LGBT older adults are living at or below 200% of the federal poverty level, including 40% of LGBT adults over age 80 and 48% of those who identify as transgender.

In addition to high rates of poverty and lifetimes of discrimination and oppression, older people in a homosexual relationship face special caregiving challenges. The health care system may not be aware of their sexual preference or gender identity, may not recognize their partner as having a role in caregiving decisions or as being part of the patient’s family, and may not provide services that are appropriate for their circumstances. For example, an unmarried partner may not have legal standing in decision making for a cognitively impaired patient and may not be able to share a room in a nursing home or other congregate living setting.

Health care practitioners should ask questions about partners and marital status or living arrangements, and try to accommodate patient preferences. Instead of relying on standardized intake questions that force patients to choose from a limited set of gender categories or marital status, health providers should ask open-ended questions such as "Who are the people who are most important in your life?" and "How do you identify in terms of gender and sexual identity?" Health providers should refer to patients with their preferred gender pronouns and, when possible, include in healthcare discussions the closely related people identified by patients, regardless of their legal relationship.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • Understanding Issues Facing LGBT Older Adults: Prepared by the Movement Advancement Project (MAP) and SAGE, explains the unique needs and experiences of LGBT older adults

Copyright © 2021 Merck & Co., Inc., known as MSD outside of the US, Kenilworth, New Jersey, USA. All rights reserved. Merck Manual Disclaimer