SAGE Uses an Advocacy Agenda to Confront Structural Ageism and Ableism for LGBTQ+ Elders


SAGE, the country’s largest and oldest organization dedicated to improving the lives of LGBTQ+ elders, offers a range of supportive services that play a key role in informing and supporting SAGE’s growing policy advocacy strategy. Formed with a focus on LGBTQ+ elders, SAGE’s policy advocacy focuses on addressing the structural challenges to dignified aging engendered by ableism and ageism. The article includes examples of how to form coalitions with grassroots organizers in the service of advocating for elders from marginalized groups, especially the LGBTQ+ community and people with disabilities.

Key Words:

ableism, advocacy, ageism, disability, grassroots, LGBTQ+


SAGE is the country’s largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) elders. SAGE offers supportive services and consumer resources to LGBTQ+ elders and their caregivers, LGBTQ+-competent services through New York City’s first LGBTQ+-affirming elder housing developments, education and technical assistance for aging service providers and LGBTQ+ organizations through its National Resource Center on LGBT Aging, and cultural competency training through SAGECare. These programs allow SAGE to provide a range of services for LGBTQ+ elders across the country, and they play a key role in informing and supporting our growing policy advocacy strategy.

Before joining SAGE, I worked as a policy aide for the U.S. Senate Special Committee on Aging, where I collaborated with countless nonprofits and advocacy groups fighting to create change for their constituencies. Now, working for SAGE, I find myself on the other side of the table, helping to expand and formulate an advocacy strategy that will create long-term policy results. My time in the U.S. Senate, and with SAGE, helped expose me to a range of advocacy agendas and strategies. While there may not be one clear approach that works for every group or community, there are fundamental challenges of structural discrimination that almost every marginalized community must confront. The long and complex history of discrimination in this country can make it difficult to fully comprehend the intersecting biases facing a community. However, finding strength in diversity, and discovering the community’s external and internal intersecting interests, can form a strong base from which to build a powerful policy-advocacy agenda.

Structural Ageism and Ableism in the LGBTQ+ Community

There’s a long history behind the structural barriers in our society that continue to create challenges for older people and people with disabilities. These range from failing to provide reasonable accommodations so an individual can work, or failing to provide access to long-term services and supports that allow an individual to live independently in the community of their choice. When older LGBTQ+ people or people with a disability require specialized support services, complex medical treatment, or reasonable accommodations, failure to make those as accessible as possible can create a seemingly insurmountable barrier to health and independence.

At SAGE, one of the ways we work to embrace diversity and intersectionality is by finding ways to combat how ageism and ableism impact our community. LGBTQ+ older people and LGBTQ+ people with disabilities must navigate the same ageist and ableist structures as their non-LGBTQ+ peers, but they must do so while also navigating the rising tide of anti-LGBTQ+ violence and discrimination.

Understanding what exactly is meant when people discuss the challenges of structural ageism or ableism may seem confusing, but this is nothing compared to the real-life consequences that are inflicted upon older people and those in the disability community due to the complex way these institutional forms of discrimination are rooted in our society.

‘SAGE begins its fight with the powerful understanding that LGBTQ+ older people must secure a seat at the table.’

A report from the World Health Organization (2021) found that “often people fail to recognize the existence of such institutional ageism because the rules, norms and practices of the institution are long-standing, have become ritualized and are seen as normal.”

Similarly, a report from The New England Journal of Medicine found that “people with disabilities face substantial inequities … ranging from education and employment, to housing and transportation, to access to broadband and other technologies. They also experience inequities in health care quality and access stemming from physical, attitudinal, and communication barriers; inadequate professional training in legal obligations and the needs of people with disabilities; and inadequate knowledge regarding, and reimbursement for, accommodations” (Valdez & Swenor, 2023).

SAGE’s goal is not only to confront these complex discriminatory structures, but to do so via an intersectional lens through which we understand and value the experiences and needs of LGBTQ+ elders. This has become even more difficult now with the alarming rise of anti-LGBTQ+ laws across the country, a rise that requires SAGE not only to continue providing culturally competent services, but also to find ways to strengthen its fight against multiple forms of discrimination through a robust state and national advocacy strategy.

Nothing About Us, Without Us

SAGE begins its fight with the powerful understanding that LGBTQ+ older people must secure a seat at the table. This literal seat at the table is grounded in the spirit of “nothing about us without us,” and is part of SAGE’s core values. SAGE is working to confront the barriers of ageism and ableism but doing so from the older LGBTQ+ perspective. There are no shortage of organizations and advocates fighting for the rights of older people and those in the disability community. However, for years both aging and disability policy routinely failed to consider the needs of LGBTQ+ people. When planning to address housing instability, food insecurity, or access to healthcare, there was no thought given to how to ensure the needs of LGBTQ+ older people were met.

‘When embraced as partners and supported in the frontline advocacy work they do every day, grassroots groups are indispensable.’

The tragic consequences of LGBTQ+ discrimination have forced some older adults to hide their identity in order to access services, which has rarely been addressed. The barriers our nation has put in place to access necessary and lifesaving medical care and services often mean that older people and people with disabilities do not have the luxury of simply finding another medical provider. Structural barriers, such as cost or lack of affordable transportation, can mean that if the medical provider in their area is not accepting of the LGBTQ+ community, LGBTQ+ elders and people with disabilities have little choice but to go back in the closet to access the services they need.

Only relatively recently, thanks to decades of activism, has public policy started to incorporate and respond to the needs of the older LGBTQ+ community. This is possible because members of the community ensured their voices were heard when and where policy was being formed that would impact them. There are many issues and challenges SAGE works to address through its policy advocacy, but our overarching goal focuses on amplifying the voices of LGBTQ+ elders and ensuring the seat at the table they fought so hard to achieve cannot be taken away.

Putting Words to Action

A seat at the policy table is key but overcoming the barriers of structural ageism and ableism faced by the LGBTQ+ community requires far more action. It’s important to make sure that the seat is a permanent position of influence and garners the respect that will help to shape and inform policy for years to come, not a token nod to the community. As such, a concrete strategy and clear goals are needed to ensure that the seat at the table is not wasted, and is genuinely “nothing about us without us.”

Start with Your Strengths

For SAGE, we begin with our strength as a service provider and an advocacy organization. SAGE arose from a need for LGBTQ+ elders in New York City to have access to safe and culturally competent services and has since grown into a nationwide leader on LGBTQ+ aging with growing international ties. Discrimination and fear barred many LGBTQ+ elders from accessing care from traditional providers, so SAGE found a way to help provide that care or educate providers to do it themselves.

SAGE’s strength lies in the fact that as a national organization, working with a nationwide network of state and local partners, it can provide or connect individuals to services in the community. These direct links to the individuals being served and local advocates working on their behalf allows SAGE to work with LGBTQ+ elders to uplift their voices and concerns all the way to policymakers in Washington, DC.

Embrace Diversity and Build Partnerships

The individuals SAGE serves, like many throughout the nation, are not defined by a single identity or community. SAGE began with a focus on LGBTQ+ elders, but within that community individuals have countless experiences and life stories that help to shape how they will age. Just as there are multiple ways to understand an individual and community, there are often multiple ways to approach policy and advocacy that can help broaden support. Policy important to one community will likely impact other groups and organizations not directly tied to a mission.

We have seen this in SAGE’s work with aging, housing, and HIV groups. These relationships can provide an opportunity to expand partnerships into new areas, allowing community and organizations to work together, learn from one another, and address limits and blind spots. SAGE is strongest when it is partnering with, supporting, and learning from organizations that are serving and led by diverse communities. A broader coalition also will help strengthen the importance of the issues SAGE advocates for to policymakers, proving these are not isolated issues facing just one community. The more voices calling for change, the harder they are to ignore.

Strengthen Grassroots

Strong relationships between policymakers and advocacy organizations are important, but there is nothing like being able to bring a groundswell of grassroots support to advocate for one issue. Through a network of state partners SAGE strives to support local groups across the country, and in turn build a strong coalition to advocate for change on the national level. This network not only helps inform SAGE’s national strategy, but also provides a powerful tool to influence elected leaders. SAGE has experience advocating for change on both the national level and the state level in New York, and in both areas the importance of supporting and listening to our LGBTQ+ elders and grassroots advocates is clear. The work of full-time paid advocates is an important tool, but one that should support and compliment the work of grassroots activists and lived experience of our elders. Grassroots groups are often the organizations most closely connected to and representative of the communities being impacted. They understand firsthand how the debates in Washington will impact the lives of people on the ground. When embraced as partners and supported in the frontline advocacy work they do every day, grassroots groups are indispensable.


Unfortunately, there are few easy fixes to taking down the challenges and barriers facing LGBTQ+ elders in the United States. Members of the community will face a lifetime of homophobia and transphobia, and then learn to confront the problems of structural ageism and ableism that continue to challenge millions of people every year. Of course, this is only made worse for LGBTQ+ elders of color and trans elders, who now find themselves facing increasing hostility. But, by recognizing that we live in interconnected communities, where needs and interests often overlap, we can ensure our advocacy strategy is similarly interconnected. The barriers of discrimination are not isolated, they easily work across whatever communities they need to succeed, and neither should our policy strategy isolate itself.

SAGE could not succeed in its mission by solely working to end LGBTQ+ discrimination and leaving in place the barriers faced by the larger aging and disability community. As daunting and complex as the challenges seem, they provide the basis for uniting around policy goals and achieving success. The barriers are too large for any one community to tackle on its own. But together we can create a blueprint for bringing them down.

Josh Dubensky is the Housing Policy Advocate Associate at SAGE. He is based in Washington, DC.

Photo credit: Shutterstock/Wirestock Creators



Valdez, R. S. & Swenor, B. K. (2023, May 18). Structural ableism—Essential steps for abolishing disability injustice. New England Journal of Medicine, 388(20), 1827–1829.

World Health Organization. (2021). Global report on ageism.