Health & Medicine

Here’s why Meals on Wheels is asking elderly Californians about their LGBT status

Sacramento State volunteers fill meals trays with ingredients for Meals on Wheels as part of a “working spring break” in 2011.
Sacramento State volunteers fill meals trays with ingredients for Meals on Wheels as part of a “working spring break” in 2011. Sacramento Bee file

Carol Alexander received a phone call from Sacramento County’s Meals on Wheels program last Friday, and it wasn’t her usual case worker.

Alexander, 83, said she was hit with a barrage of about a half-dozen questions she considered invasive or unnecessary: What is your sex? Do you still associate with your gender? Are you heterosexual? Are you white or Hispanic?

“I was in shock. I took offense to that,” she said.

Alexander, who is white, said she didn’t understand why the surveyor asked whether she was Hispanic but not about any other race.

And the string of questions relating to sexual orientation and transgender status irritated her.

“I’m ticked off. Why do they ask an 83-year-old this?”

Alexander said the caller told her new federal law necessitated these questions, but as local Meals on Wheels Program Director David Morikawa explained, it’s actually a direct response to new state legislation.

Morikawa said a new California law requires meal-delivery services to issue sexual and gender minorities (SGM) survey questions, potentially to any and all of the program’s recipients. It had already surveyed participants about ethnicity.

But response from the participants is voluntary and won’t affect their service from the nonprofit organization.

“She doesn’t have to answer that,” Morikawa said.

As outlined in Assembly Bill 959, signed by Gov. Jerry Brown in October 2015, and AB 677, signed last October, California’s LGBT Disparities Reduction Act went into effect July 1 this year.

Its first provisions call for four state departments, including the Department of Aging, to gather demographic data regarding sexual orientation and gender identity during the course of conducting surveys on ancestry or ethnic origin.

AB 959, penned by David Chiu, D-San Francisco, cites studies on same-sex couple poverty, hate crimes and health disparities as ample reason to collect widespread demographic data on the groups. LGBT populations have been found to have higher risk of cancer, mental illness, substance abuse and other adverse health conditions, Chiu explained.

“It is in the best interests of the state to respect, embrace, and understand the full diversity of its residents and to collect accurate data to effectively implement and deliver critical state services and programs,” the bill reads.

The departments of Health Care Services, Public Health and Social Services are the other three with the legislation taking effect this year.

Seven additional agencies are due to adopt the policy by July 1: the Department of Education, Department of Fair Employment and Housing, Department of Industrial Relations, Commission on Teacher Credentialing, Labor and Workforce Development Agency, Employment Training Panel and Employment Development Department (excluding the unemployment insurance program).

Many LGBT advocates nationwide have pushed for such survey questions to be voluntarily posed to citizens, seniors or otherwise, to facilitate better demographic data sets.

The issue has grown complicated over the past year or so, particularly when examined at the federal level.

Programs like Meals on Wheels receive a mix of local, state and federal funding. The federal funds come from the U.S. Department of Health and Human Services’ Administration for Community Living, which designated $226 million nationwide toward “home-delivered nutrition services” for fiscal 2018. The Older Americans Act of 1965 created the Administration on Aging, which now falls under the ACL’s umbrella.

Support services are provided and coordinated to single- or multi-county geographic areas known as Area Agencies on Aging (AAAs). These are local public or private nonprofits designated at the state level, according to ACL’s website.

On its website, the National Association of Area Agencies on Aging says it consists of 622 of these AAAs. Among them is Agency on Aging Area 4, which is a partner of Meals on Wheels Sacramento.

The ACL collects performance and demographic data via annual, nationwide surveys issued to Older Americans Act participants selected from a random sample pool containing about half of the 622 AAAs. Unclear is which years, if any, the Sacramento-area agency was included in that pool.

Sexual and gender minorities-related questions were included in the nationwide survey from 2014 to 2016, but the Trump administration removed them from a draft of last year’s survey, the Associated Press reported in March 2017. Sexual orientation questions were amended back into the survey last June after the ACL received critical comments from 89 organizations, as stated in a Federal Register notice.

But the new survey draft still omitted gender identity questions, and ACL received more complaints – this time from 62 organizations and 15 individuals, as stated in a September 2017 register notice.

Finally, in March of this year, yet another Federal Register notice published by ACL announced plans to overhaul the national survey.

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The surveys in 2014 to 2016 asked questions including, “Which of the following best represents how you think of yourself?” with options for gay or lesbian, straight, bisexual, “refused,” “don’t know” or “something else,” according to the U.S. Centers for Medicare and Medicaid Services. “Something else” redirected to a follow-up question, with options for queer, trisexual, omnisexual, pansexual, transgender, transsexual, unlabeled, refusal to answer and an “other” option for identities not listed.

Those questions and answer options appear much more encompassing than the SGM questions found in the full report on an older national survey. The 2005 questionnaire simply calls for one’s gender and includes an all-caps instruction to the surveyor: “DON’T ASK IF OBVIOUS.”

The topic is under debate nationwide. A bill calling for the LGBT Data Inclusion Act, “requiring the collection of voluntary, self-disclosed information on sexual orientation and gender identity in certain surveys, and for other purposes,” was introduced to the U.S. Senate last July by Tammy Baldwin, D-Wis., with no legislative action taken on it since.

On Sunday, The New York Times reported the Trump administration is considering a narrow definition of gender that would effectively leave transgender people “defined out of existence.” That definition would “define sex as either male or female, unchangeable, and determined by the genitals that a person is born with,” The Times wrote, based on a review of an HHS memo draft.

It’s a topic of hot debate. LGBT advocates continue to fight a spectrum of battles ranging from voluntary survey questions to the federally mandated definition of transgender.

But Alexander, the Citrus Heights octogenarian who said she recently suffered a stroke, said she found the recent survey so offensive, she has considered leaving the Meals on Wheels program entirely.

“These are stupid,” she said of the questions. “It just blows my mind that they have to do this.”

Meals on Wheels by ACC Senior Services started serving Sacramento County and western Placer County in 2010. With 5,660 annual participants (2,387 getting home delivery, the rest getting meal site service), the organization estimates it serves about 500,000 meals a year in the region. More than 500 volunteers help serve and deliver hot and frozen food.

“We just want to make sure we’re representing the people that are in our community,” said Morikawa, the program director.