Even now, at 81 and with her memory beginning to fade, Gloria Donadello recalls her painful brush with bigotry at an assisted-living center in Santa Fe, N.M. Sitting with those she considered friends, “people were laughing and making certain kinds of comments, and I told them, ‘Please don’t do that, because I’m gay.’” 

The result of her outspokenness, Ms. Donadello said, was swift and merciless. “Everyone looked horrified,” she said. No longer included in conversation or welcome at meals, she plunged into depression. Medication did not help. With her emotional health deteriorating, Ms. Donadello moved into an adult community nearby that caters to gay men and lesbians. 

“I felt like I was a pariah,” she said, settled in her new home. “For me, it was a choice between life and death.” 

Elderly gay people like Ms. Donadello, living in nursing homes or assisted-living centers or receiving home care, increasingly report that they have been disrespected, shunned or mistreated in ways that range from hurtful to deadly, even leading some to commit suicide.

Some have seen their partners and friends insulted or isolated. Others live in fear of the day when they are dependent on strangers for the most personal care. That dread alone can be damaging, physically and emotionally, say geriatric doctors, psychiatrists and social workers.
 
The plight of the gay elderly has been taken up by a generation of gay men and lesbians, concerned about their own futures, who have begun a national drive to educate care providers about the social isolation, even outright discrimination, that lesbian, gay, bisexual and transgender clients face. 

Several solutions are emerging. In Boston, New York, Chicago, Atlanta and other urban centers, so-called L.G.B.T. Aging Projects are springing up, to train long-term care providers. At the same time, there is a move to separate care, with the comfort of the familiar. 

In the Boston suburbs, the Chelsea Jewish Nursing Home will break ground in December for a complex that includes a unit for the gay and lesbian elderly. And Stonewall Communities in Boston has begun selling homes designed for older gay people with support services similar to assisted-living centers. There are also openly gay geriatric case managers who can guide clients to compassionate services. 

“Many times gay people avoid seeking help at all because of their fears about how they’ll be treated,” said David Aronstein, president of Stonewall Communities. “Unless they see affirming actions, they’ll assume the worst.”
Homophobia directed at the elderly has many faces. 

Home health aides must be reminded not to wear gloves at inappropriate times, for example while opening the front door or making the bed, when there is no evidence of H.I.V. infection, said Joe Collura, a nurse at the largest home care agency in Greenwich Village. 

A lesbian checking into a double room at a Chicago rehabilitation center was greeted by a roommate yelling, “Get the man out of here!” The lesbian patient, Renae Ogletree, summoned a friend to take her elsewhere. 

Sometimes tragedy results. In one nursing home, an openly gay man, without family or friends, was recently moved off his floor to quiet the protests of other residents and their families. He was given a room among patients with severe disabilities or dementia. The home called upon Amber Hollibaugh, now a senior strategist at the National Gay and Lesbian Task Force and the author of the first training curriculum for nursing homes. Ms. Hollibaugh assured the 79-year-old man that a more humane solution would be found, but he hanged himself, Ms. Hollibaugh said. She was unwilling to identify the nursing home or even its East Coast city, because she still consults there, among other places.
While this outcome is exceedingly rare, moving gay residents to placate others is common, said Dr. Melinda Lantz, chief of geriatric psychiatry at Beth Israel Medical Center in New York, who spent 13 years in a similar post at the Jewish Home and Hospital Lifecare System. “When you’re stuck and have to move someone because they’re being ganged up on, you put them with people who are very confused,” Dr. Lantz said. “That’s a terrible nuts-and-bolts reality.”

The most common reaction, in a generation accustomed to being in the closet, is a retreat back to the invisibility that was necessary for most of their lives, when homosexuality was considered both a crime and a mental illness. A partner is identified as a brother. No pictures or gay-themed books are left around. 

Elderly heterosexuals also suffer the indignities of old age, but not to the same extent, Dr. Lantz said. “There is something special about having to hide this part of your identity at a time when your entire identity is threatened,” she said. “That’s a faster pathway to depression, failure to thrive and even premature death.”

The movement to improve conditions for the gay elderly is driven by demographics. There are an estimated 2.4 million gay, lesbian or bisexual Americans over the age of 55, said Gary Gates, a senior research fellow at the Williams Institute at the University of California, Los Angeles. That estimate was extrapolated by Dr. Gates using census data that counts only same-sex couples along with other government data that counts both single and coupled gay people. Among those in same-sex couples, the number of gay men and women over 55 has almost doubled from 2000 to 2006, Dr. Gates said, to 416,000, from 222,000.

California is the only state with a law saying the gay elderly have special needs, like other members of minority groups. A new law encourages training for employees and contractors who work with the elderly and permits state financing of projects like gay senior centers. 

Federal law provides no antidiscrimination protections to gay people. Twenty states explicitly outlaw such discrimination in housing and public accommodations. But no civil rights claims have been made by gay residents of nursing homes, according to the Lambda Legal Defense Fund, which litigates and monitors such cases. Potential plaintiffs, the organization says, are too frail or frightened to bring action.

The problem is compounded, experts say, because most of the gay elderly do not declare their identity, and institutions rarely make an effort to find out who they are to prepare staff members and residents for what may be an unfamiliar situation.

So that is where Lisa Krinsky, the director of the L.G.B.T. Aging Project in Massachusetts, begins her “cultural competency” training sessions, including one last month at North Shore Elder Services in Danvers. 

Admissions forms for long-term care have boxes to check for marital status and next of kin. But none of the boxes match the circumstances of gay men or lesbians. Ms. Krinsky suggested follow-up questions like “Who is important in your life?” 

In the last two years, Ms. Krinsky has trained more than 2,000 employees of agencies serving the elderly across Massachusetts. She presents them with common problems and nudges them toward solutions. 

A gay man fired his home health aide. Did the case manager ask why? The patient might be receiving unwanted Bible readings from someone who thinks homosexuality is a sin. What about a lesbian at an assisted-living center refusing visitors? Maybe she is afraid that her friends’ appearance will give her away to fellow residents. 

“We need to be open and sensitive,” Ms. Krinsky said, “but not wrap them in a rainbow flag and make them march in a parade.” 

Some of the gay elderly chose openness as the quickest and most painless way of finding compassionate care. That is the case for Bruce Steiner, 76, of Sudbury, Mass., whose 71-year-old partner, Jim Anthony, has had Alzheimer’s disease for more than a decade and can no longer feed himself or speak. 

Mr. Steiner is resisting a nursing home for Mr. Anthony, even after several hospitalizations last year. The care had been uneven, Mr. Steiner said, and it was unclear whether homosexuality was a factor. But Mr. Steiner decided to take no chances and hired a gay case manager who helped him “do some filtering.” 

They selected a home care agency with a reputation for treating gay clients well. Preparing for an unknown future, Mr. Steiner also visited several nursing homes, “giving them the opportunity to encourage or discourage me.” His favorite “is one run by the Carmelite sisters, of all things, because they had a sense of humor.”

They are the exception, not the rule.

Jalna Perry, a 77-year-old lesbian and psychiatrist in Boston, is out, she said, but does not broadcast the fact, which would feel unnatural to someone of her generation. Dr. Perry, who uses a wheelchair, has spent time in assisted-living centers and nursing homes. There, she said, her guard was up all the time. 

Dr. Perry came out to a few other residents in the assisted-living center — artsy, professional women who she figured would accept her. But even with them, she said, “You don’t talk about gay things.” Mostly, she kept to herself. “You size people up,” Dr. Perry said. “You know the activities person is a lesbian; that’s a quick read.” 

Trickier was an aide who was gentle with others but surly and heavy-handed when helping Dr. Perry with personal tasks. Did the aide suspect and disapprove? With a male nurse who was gay, Dr. Perry said she felt “extremely comfortable.” 

“Except for that nurse, I was very lonely,” she said. “It would have been nice if someone else was out among the residents.”

Such loneliness is a source of dread to the members of the Prime Timers, a Boston social group for older gay men. Among the regulars, who meet for lunch once a week, are Emile Dufour, 70, a former priest, and Fred Riley, 75, who has a 30-year heterosexual marriage behind him. The pair have been together for two decades and married in 2004. But their default position, should they need nursing care, will be to hide their gayness, as they did for half a lifetime, rather than face slurs and whispers.

“As strong as I am today,” Mr. Riley said, “when I’m at the gate of the nursing home, the closet door is going to slam shut behind me.”

Dan Frosch contributed reporting