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.”