some professionals and family caregivers to question whether raising the topic is really important or necessary. Are the services LGBT caregivers need truly different from those in the larger community?
In response, this chapter takes the position that until we live in a world where LGBT individuals no longer experience the discrimination and social isolation that create barriers to receiving competent care, we need to continue to educate ourselves and other service providers and researchers to develop increasing competence in our service provision to LGBT family caregivers. More specifically, we discuss key questions related to LGBT caregiver interventions, such as who are LGBT caregivers and what are the obstacles these caregivers face to service utilization? How can we engage members of the LGBT community with the services that we provide? How do we educate service providers to serve LGBT caregivers not merely out of increased awareness but also from ever-growing competence?
Most published accounts of LGBT caregiving are derived from the HIV/ AIDS caregiving literature, which delineates outcomes associated with the heroic response to the epidemic by the LGBT community and their supporters (e.g., Fredriksen, 1999; Wrubel & Folkman, 1997). In response to the need for valid data on emerging issues within the aging LGBT community, the New York Community Trust and the Sam Wilmer Funds awarded a grant in December 1999 to the Pride Senior Network to conduct a qualitative study of caregiving provided in the older LGBT New York City community and to determine the community's present and future needs. The study will explore questions such as, Can the LGBT community provide the support that caregivers themselves will need? Has the community suffered a degree of burnout due to the level of caregiving demanded by the HIV/AIDS epidemic? Hopefully, this investigation as well as future studies will add to the regrettably sparse research and clinical literature currently available. Moreover, we hope it augments this chapter's information, which is based on current literature drawn from multiple disciplines and integrated with our own clinical experiences and the clinical impressions of colleagues.
Finally, many of the challenges and responses presented here are drawn from LGBT-caregiver and clinician experiences with larger LGBT communities in cities like San Francisco, New York, Dallas, Los Angeles, and Phoenix, suggesting that obstacles and issues faced by LGBT caregivers in smaller cities and rural areas may be exacerbated by more limited resources and greater isolation. However, we must caution readers about the tendency to stereotype or overgeneralize in discussions of the LGBT community, just as with any minority group, and instead recognize and celebrate its diversity. Many LGBT persons experience great joy as well as hardships and obstacles, and the difficulties discussed in this chapter should not be read as necessary truths about members of the LGBT community. For example, though many LGBT persons are isolated from their birth families, one LGBT caregiver recently reminded his support group