Dannie Ceseña was already 30 years old when he met the woman who would become his mother.
Ceseña, a young transgender man in conservative Orange County, Calif., was at odds with his family and community. His parents saw his sexuality and gender identity as sin. “It was hard to reconcile my sexual orientation, trying to make my family happy, and trying to make the church happy,” says Ceseña. “It became too much for me.” At times, he was suicidal.
Seeking community, he joined the Orange County LGBTQ center and organized its first ever trans pride event. At that event he met Yvette Cervantes, who had been brought there by her oldest son, who is transgender. On the spot, Ceseña drafted Cervantes to join the group’s new transgender health committee.
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Cervantes, who has five children, became a parental figure to many young people around the center. (She jokes that her preferred pronoun is “mom.”) But something stronger grew between her and Ceseña. When Ceseña mentioned that he had almost no relationship with his parents, she volunteered to step up. “Yvette said, ‘You’re my kid,’” he says now. “You might not have parents anymore, but you have a mother in me.”
During the next years, she proved she really meant it. She was always there to listen to him vent about work, offer advice, celebrate small triumphs. And tease him. A lot. He teases her back. “We became mom and kid — if he had a bad day and had anxiety, he texts,” she says. “I say breathe, and joke about the situation to get him moving and laughing.”
“She pulls me out when I lose myself inside myself,” he says.
They created what people in the LGBTQ community call a “family of choice” — ties that go beyond biology.
But when Ceseña needed his new mom most of all, she couldn’t be there. That’s because in the eyes of the law, Cervantes and Ceseña’s relationship didn’t count, even though they are closer than many people with bonds of blood.
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A shift in thinking
In 2021, Ceseña was recovering at home from surgery when he started feeling worse. The incision turned rashy red and started bleeding again. At the hospital they said he had sepsis, a potentially fatal reaction to infection. He was all alone, woozy, and scared — but Cervantes couldn’t take time off work to be with him.
California state law protects workers who need to take time off for caregiving, ensuring their jobs will still be there when they return. But until last year, the law covered only spouses, in-laws, and biological relatives like siblings or grandparents. If you needed to care for your ex-spouse, your best friend, or your boyfriend, your employer wasn’t required to let you go.
Cervantes was stuck. She did her best, calling and texting every hour, watching Ceseña’s dogs, organizing a brigade of home-cooked meals once he got home. “She knew how alone I felt, that I was trying to be brave through it,” says Ceseña. “It drove her crazy that she couldn’t be there.”
This year, California joined five other states in expanding its definition of who counts for caregiving. Its new law covers anyone with “the equivalent of a family relationship.” People with relationships like the one Ceseña and Cervantes have are now allowed to take unpaid leave or paid sick leave for caregiving. A follow-up bill making its way through the state legislature this summer would also allow them to tap into the paid temporary disability leave program that most employees in the state pay into and are eligible for.
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These changes in California are part of a shift in thinking about what counts as family — not just in the LGBTQ community but more broadly.
“The idea is that it’s not using a strict formulation about blood or legal relationships but who is actually providing care for each other based on loving relationships,” says Julia Parish, an attorney with Legal Aid at Work, one of the cosponsors of the California bill.
The changes are coming quickly. New Jersey was the first to pass a paid-leave rule for chosen family, in 2019. Oregon passed similar changes that will take effect in September. Colorado’s begin in January 2024. Maine’s legislature passed such a rule in June, which the governor is expected to sign.
A Massachusetts law passed in 2018 protects caregiving for people in a broad range of relationships — including grandparents and grandchildren, siblings, parents, children, in-laws, spouses, and those in several kinds of domestic relationships — although advocates are interested in expanding the categories further, says Elizabeth Whiteway, senior attorney at Greater Boston Legal Services.
The new laws reflect the new reality of American family. Less than 20 percent of us live in a nuclear family unit, according to US Census Bureau numbers. Among younger people, the shift is more dramatic. Less than 45 percent of those in their 20s and 30s live in any family group at all, a far higher proportion than other generations at that age.
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The new rules also reflect the fact that caregiving has never been only an obligation to blood relatives. Sometimes it is a choice driven by love and loyalty or social bonds.
“It underscores the need to think about how we define ‘caregiver’ and who benefits from policies at the federal level and in the private sector,” says Jason Resendez, CEO of the National Alliance for Caregiving, a nonprofit based in Washington, D.C. “I think that’s only going to grow.”
In LGBTQ communities in particular it’s a longstanding reality: friends, lovers, and ex-partners stepping up to care for each other. It dates back decades, to the last major pandemic: HIV.
Pitching in for one another
In the worst years of the AIDS crisis, Hernán Poza worked for New York City’s Department of Health as the director of a clinic in Manhattan’s Chelsea neighborhood that provided anonymous testing for HIV. During those dark days, there were no good treatments. Fear of and hostility toward gay people were intense. People who were HIV-positive and sick often relied on friends because there were few other places to turn for help.
Many of the clinic staff were also HIV-positive or had partners with the virus, so coworkers pitched in for one another when someone needed leave for caregiving. “We weren’t officially family, but we were close,” Poza says. “We put that into action.” Poza’s own partner had AIDS, and he wanted to be at his side while he was dying. But because domestic partnerships and legally recognized gay marriage didn’t exist back then, he could not use family leave. He was lucky that his supervisors allowed him to use his sick days and take unpaid leave.
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Terrible as it was, the AIDS crisis brought people together, says Brian de Vries, a retired San Francisco State University gerontologist who lived through those years in that city. “Many gay men themselves were sick,” says de Vries. “The sick were caring for the sick.” Lesbians often jumped in to shoulder caregiving duties, and “I still get goose bumps” thinking of those acts of selflessness, de Vries remembers. At other times, help took shape as a care corps — a network of people collectively helping a friend.
To some degree, that history lives on today. Gays, lesbians, and other sexual minorities are twice as likely to rely on friends rather than blood relatives during a health crisis. In one survey of working LGBTQ people, 63 percent said a friend or “chosen family” member had asked for help with health needs. Of the roughly 4 million LGBTQ caregivers, about 10 percent of them are taking care of people other than family, according to data from the National Alliance for Caregiving.
The reasons vary. Sometimes biological family isn’t in the picture anymore, as in Ceseña’s case. LGBTQ people are less likely to be married and less likely to have children than others. On top of that, many are wary of social support services, for fear of discrimination.
Creating families of choice could be a wise approach for those in need of all kinds of care today, suggests Kristin Cloyes, professor at the Oregon Health & Science University School of Nursing. As care responsibilities become increasingly intense and long-lasting, the old stereotype in which one person relies on a single caregiver is unrealistic. The more fluid, dynamic relationships in LGBTQ communities that draw upon a broad web of connections can create a stronger safety net.
Juggling obligations
Nationally, many citizens have few or no workplace protections for caregiving, even for biological family. New Jersey Senator Cory Booker has twice introduced a federal bill that would prohibit workplace discrimination against caregivers. It recognizes connections that are “the equivalent of a family relationship.” The bill has not advanced.
Lacking solid job protections, caregivers juggle work and care obligations. More than 60 percent of caregivers overall are employed, according to National Alliance for Caregiving data. LGBTQ caregivers, who are somewhat younger on average, are even more likely to be working. They are also less likely than others to have any paid leave.
There isn’t much research on this population, but a few studies suggest they may have a tougher time of it than others. Surveys conducted by University of Nevada Las Vegas professor Jason Flatt and colleagues find that sexual and gender minority caregivers are even more likely to struggle with the problems that many caregivers face: depression, stress, isolation, financial strain, and chronic disease. Recognizing the added difficulty and the need, two social workers created the digital LGBTQ Caregiver Center and launched an online support group.
National advocacy groups like A Better Balance and Family Values at Work are coordinating campaigns in New Mexico, New Hampshire, and New York to create or broaden rules for paid family and medical leave that covers more inclusive definitions of families. In California, the bill to expand paid-leave eligibility is now waiting for its next hearing on Aug. 14. Ceseña and Cervantes are campaigning to pass it, urging lawmakers to recognize what they see as a home truth: “You don’t have to give to birth to someone to be a parent,” says Cervantes. “A parent is someone who is there for you.”
Kat McGowan is a freelance writer in California focused on caregiving. She received support for her reporting from the Alicia Patterson Foundation.