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Review

Reliance, Support, and Caregiving Among Married LGBTQ+ Americans: Spousal and Family Relationships

1
Department of Psychology, Clark University, Worcester, MA 01610-1477, USA
2
Independent Researcher, Amherst, MA 01002, USA
3
School of Law, UCLA, Los Angeles, CA 90095, USA
*
Author to whom correspondence should be addressed.
Soc. Sci. 2025, 14(10), 605; https://doi.org/10.3390/socsci14100605 (registering DOI)
Submission received: 5 August 2025 / Revised: 6 October 2025 / Accepted: 7 October 2025 / Published: 13 October 2025
(This article belongs to the Special Issue Intimate Relationships in Diverse Social and Cultural Contexts)

Abstract

When LGBTQ+ people get married, they enter into a union that promises mutual reliance and caregiving, such as in the event of financial need or health care crisis. This mixed-methods study explores how 484 married LGBTQ+ individuals in the United States (192 cisgender men, 186 cisgender women, 106 trans/nonbinary) (a) negotiate disability (38% of couples) and illness in the context of unpaid and paid labor divisions, (b) provide care for each other, and (c) receive support from family in the face of health or financial needs. Findings revealed diversity in the ways that disability and illness shaped household and paid labor, underscoring how flexibility enabled couples to adapt to changes and highlighting the role of marriage in providing security amidst changes. Logistic regression models examining predictors of family support during health or financial crises revealed that participants in couples in which at least one partner (a) had a disability and/or (b) was a partner’s caregiver had greater odds of reporting receiving help in a health care crisis. Participants who were lower income, younger, and perceived their partners’ families as becoming more accepting after marrying had greater odds of reporting financial help from family. Additionally, disability interacted with gender such that those with a disability in female or trans couples were more likely to report financial help than those without, while the reverse was true for male couples. Participants describe multiple forms of family support, revealing the key role of family support during times of crisis and need.

1. Introduction

1.1. Marriage, Mutual Reliance, and Support

Marriage arguably increases individuals’ access to emotional, material, and symbolic resources, which may impact health (Karney et al. 2024). That is, couples pool resources when they marry, potentially contributing to less stress and greater well-being (Coontz 2005). LGBTQ+ people in the United States (U.S.) have historically not had access to marriage, depriving them of the resources and protections associated with marriage (Goldberg 2024; Karney et al. 2024). Ten years ago, federal marriage equality became a reality in the U.S., enabling all same-sex couples to marry their partners regardless of their state of residence. Access to marriage provides partners with greater protections (e.g., legal protections) as well as access to shared benefits, such as health insurance, which may be especially important to couples with health issues and/or as they age; and, marriage may also facilitate other, less visible, types of instrumental support such as caregiving and family support (Badgett et al. 2025). In turn, when LGBTQ+ people get married, they not only enter into a union that promises mutual reliance and caregiving (i.e., til death do us part), but also, by virtue of marriage, may theoretically have access to a broader range and number of resources insomuch as now they have two extended families to rely on, such as in the event of financial need or health care crisis (Goldberg 2024). Indeed, although LGBTQ+ people face challenges with respect to family acceptance and support, marriage may act as a legal and symbolic conferral of legitimacy and societal acceptance, encouraging families to affirm—and offer support to—same-sex couples (Badgett et al. 2025; Leitch and Greif 2022; Ocobock 2013).

1.2. The Significance of Mutual Reliance for Vulnerable Married People

A key dimension of marriage is spousal provision of caregiving, particularly instrumental care work, during times of poor health, injury, or illness (Umberson et al. 2017). When married people encounter or deal with vulnerabilities such as health challenges or disability, this may complicate the mutual dependency that is so frequently highlighted as a hallmark of marriage (Coontz 2005). Health issues, for example, may make it difficult for married couples to share both paid and unpaid labor as well as to exchange emotional support (Cannon and Cavanaugh 1998). Research with married heterosexual couples providing mutual care to each other for different health issues found that couples adapted their day-to-day routines to accommodate each other’s different health issues and shifting health statuses—interdependence that was challenging, especially when both individuals were unwell (Nimmon et al. 2018). Married couples where one or both partners have health challenges and/or provide caregiving to each other can ideally rely on outsiders, such as family of origin, for help and support, especially when they have limited resources (Cannon and Cavanaugh 1998; Nimmon et al. 2018). Greater social network support may help to buffer the stresses and strains associated with one spouse’s chronic health issues (Revenson and Majerovitz 1991), and, in general, being able to rely on outsiders for help can offset and minimize the stress associated with care and support giving in marriage (Ray 2006).
Married same-sex couples may, especially as they age, encounter poor health, injury, or illness, which places new demands on both partners as they adapt to their new circumstances (Umberson et al. 2017). Of note is that same-sex couples share both paid and unpaid forms of labor more equally than heterosexual couples (e.g., Fischer 2024; Goldberg 2013; Goldberg et al. 2012), and a similar trend towards egalitarianism also appears to be present in couples in which one or both partners are trans (Tornello 2020). Partners in same-sex couples are also more likely to be caregivers for their partners than partners in different-sex couples (Morgan et al. 2023), and the likelihood of mutual caregiving (i.e., giving and receiving care in a mutual reciprocal arrangement) may be greater among same-sex couples than in heterosexual couples (Anderson and Flatt 2018; Knauer 2016). Interestingly, across all types of couples (different-sex, female same-sex, and male same-sex), women appear to be more likely to perform this type of work than men, likely because of gendered expectations and associations (Savage and Barringer 2023; Umberson et al. 2017). Further, women in both same- and different-sex relationships seem to be more likely to construct illness as necessitating intensive care work, whereas men generally downplay illness and provide less care work when their spouses are ill (Umberson et al. 2016); although, survey data also suggest that while women across all couple types tend to provide and receive more instrumental care compared to men, women married to women provide and receive the most instrumental care (Umberson et al. 2017).
Issues of support, reliance, and caregiving may be especially relevant for LGBTQ+ people insomuch as they appear to be more likely to have a disability than non-LGBTQ+ people, where disability refers to conditions that impair the body or mind and makes it more difficult to do certain activities or functions of daily living (Human Rights Campaign 2025). According to 2020 national survey data, about 36% of LGBTQ+ people reported a disability, versus 24% of non-LGBTQ+ people, with cognitive disabilities being the most common type (Human Rights Campaign 2025), although slightly lower rates of disabilities among LGBTQ+ people have also been reported (e.g., between one-quarter and one-third; Fredriksen-Goldsen et al. 2012). Further, LGBTQ+ older adults (i.e., 50+ years) appear to be at greater risk of chronic health conditions, cognitive impairments, and poorer general physical and mental health, than non-LGBTQ+ older adults (Fredriksen-Goldsen et al. 2017), possibly also dealing with an earlier age of onset of these challenges (Fredriksen-Goldsen et al. 2012), leading to greater lifetime emotional, relational, economic, and health care related burdens. LGBTQ+ status may also interact with race in impacting risk for disability: in Los Angeles County in California, for example, over half (53%) of LBTQ Latinas reported a disability, about double the rate of disability among adults overall in the county (27%), including non-LGBTQ Latinas (29%) and non-GBTQ White men (22%) (Williams Institute 2025). Finally, national survey data indicate that trans people have a higher probability of reporting a disability than cisgender people—a 39% chance at age 55, nearly twice the rate of their cisgender counterparts (Smith-Johnson 2022). Trans people may be at especially high risk for certain types of disabilities, such as developmental disabilities (Mulcahy et al. 2022).
Marriage may have particular benefits for LGBTQ+ couples who suffer from health or aging related issues. Goldsen et al. (2017) found that legally married older LGBTQ+ people reported superior quality of life and more economic and social resources than their unmarried partnered counterparts. In one study, all same-sex couples interviewed reported that marriage had positively impacted their health due to the support and caring they provided to one another (Peak et al. 2021). Marital partners make a promise to commit to each other “through sickness and in health”, and marriage may therefore offer unique relational (in addition to instrumental) benefits (Peak et al. 2021). In turn, given the inevitability of age-related illness, injury, and decline, the likelihood of fluctuating health needs and physical limitations over the adult life course, and the possibility of illness and/or disability before older age, LGBTQ+ married couples may face the need for unexpected adaptations and adjustments in labor divisions and support provision, as well as the possibility of (at least temporary) caregiving responsibilities for one another. The legal protections, symbolic meaning, and support resources that are associated with marriage may therefore benefit LGBTQ+ people and their partners as they face health and aging issues.

1.3. Marriage, LGBTQ+ People, and Family Support

Marriage has been a reality in the U.S. for less than two decades, with Massachusetts becoming the first state to enact marriage equality in 2003, and federal marriage equality has been a reality for only a decade, since the landmark Supreme Court case of Obergefell v. Hodges. Research has established that material, emotional, and symbolic benefits associated with marriage have key consequences for LGBTQ+ people’s lives, benefiting their economic and relationship stability, mental health, and physical health (Badgett et al. 2025; Karney et al. 2024). Married LGBTQ+ people may experience an enhanced sense of security regarding financial (e.g., taxes) and legal (e.g., hospital visitation) benefits, as well as increased social acceptance from others, including their families of origin (Badgett et al. 2025; Drabble et al. 2021; Ogolsky et al. 2019).
Indeed, marriage equality has helped to validate LGBTQ+ identities and legitimize same-sex relationships, potentially enhancing acceptance and support from family. Same-sex couples have been found to rely more on family and less on friends in the wake of marriage equality (Karney et al. 2024; Ogolsky et al. 2019), and, in turn, family support is associated with better physical and mental health (Drabble et al. 2022). Studies comparing same-sex couples in legally recognized relationships (civil unions, marriages) with those who lack legal recognition for their relationships have also found higher levels of closeness to family of origin among the former group (Karney et al. 2024; Solomon et al. 2004). Married same-sex couples surveyed in Massachusetts believed that marriage increased family of origin’s acceptance of the relationship, acceptance of the spouse, and acceptance of their sexual orientation (Ramos et al. 2009). Notably, however, other research suggests that while some LGBTQ+ people perceived their marriage as meaningfully impacting their families’ ability to accept and provide support to them, others felt that the decision to marry created more strain or rejection from family, who saw marriage as a step too far (it was too visible; it challenged their religious notions of marriage; Ocobock 2013).
Family support, in turn, is widely regarded as contributing positively to health outcomes, such as through the provision of both instrumental and emotional resources (Chum et al. 2021; Karney et al. 2024), including offering financial help during times of need or crisis (Baland et al. 2016). And, although support from friends and family of choice is also valued, the distinct benefits of family support are clear from a number of studies. For example, some research has found that family support is more strongly related to aspects of psychological health than friend support (Acoba 2024) and LGBTQ+ people are more likely to designate members of family of origin as beneficiaries (e.g., in their wills) than family of choice (Robinson 2022). Yet many LGBTQ+ adults, particularly those who are aging, have health issues, and/or disabilities, report not receiving enough support from family (Hawthorne et al. 2020).

1.4. Theoretical Framework

This investigation is informed by a structural stigma framework (Hatzenbuehler 2016), where structural stigma is defined as “societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized” (Hatzenbuehler 2016, p. 1). Given that structural stigma creates oppressive environments that lead to minority stress, this study is also informed by a minority stress model, which aims to explain the processes and mechanisms by which stigmatized people respond to their environment, including experiences and expectations of discrimination and marginalization, internalization of stigma, and coping (Meyer 2003; Meyer et al. 2011). This model can be broadened to consider individual-based resilience (focused on personal agency) and community-level resilience (focused on connection to community and access to social resources and support) that may help to mitigate the adverse effects of stress, and even promote thriving amid adversity (Meyer 2015).
Given that the experiences and impacts of structural stigma may not be felt the same for all members of a given marginalized group (Rao et al. 2020), this study is also informed by an intersectionality framework, which provides a lens for understanding how different social identities intersect to shape vulnerability to oppressive contexts (Bowleg et al. 2003; Crenshaw 1991). LGBTQ+ people with less privilege—for example, related to disability, gender identity, social class, or race—may be more vulnerable to the negative impacts of structural stigma, possibly leading to greater minority stress (Price et al. 2023; Rao et al. 2020). LGBTQ+ people with disabilities, for example, encounter more discrimination in many settings, which may contribute to greater minority stress, and, ultimately, higher levels of mental health challenges such as anxiety (Eliason et al. 2015). Yet intersectional frameworks also encourage us to consider how intersecting social identities may also be associated with different forms of resilience that can help buffer the effects of stress and reduced well-being (McConnell et al. 2018; Meyer 2015). For example, highly educated and financially stable LGBTQ+ people with health challenges or disabilities may be able to circumvent or minimize some impacts of structural stigma, thus protecting their well-being (Kempapidis et al. 2023). Access to support, such as family of origin support—which may be especially important for vulnerable LGBTQ+ people, such as those with limited incomes, disabilities, and/or minoritized gender identities—may play an especially important role in mitigating stress (Jackson Levin et al. 2020; Milton and Knutson 2023).

1.5. The Current Study

The current study focuses on LGBTQ+ married people in the U.S. Given the elevated rates of disabilities in the LGBTQ+ community, as well as the higher likelihood of caregiving need in this community, as well as the possibility that marriage may usher in important sources of support and assistance from family of origin, the current study examines the specific intersections of health, caregiving, and support in the context of marriage. Also, amid very little attention to trans people in the literature on marriage (but see Liu and Wilkinson 2017), we attend to experiences across different types of couples, including cisgender (cis) women couples, cis men couples, and couples where one or both partners identify as trans—but all of whom indicated that they were in a same-sex marriage, an inclusion criterion for this study.
The current study draws data from a survey of 484 LGBTQ+ Americans in same-sex marriages: 39.1% cis men couples, 32.2% cis women couples, and 28.7% couples in which one or both partners were trans. Participants, on average, were in their current relationships for over 16 years and married for over nine years, and 60% had been married after the Supreme Court’s 2016 decision in Obergefell v. Hodges, which brought marriage equality to all 50 U.S. states. In addition to facilitating mutual reliance between partners, marriage also enabled couples to access support from two families, or sets of in-laws, such as in a health care crisis or during times of financial instability. This study focuses on their experiences of caregiving, support, and family reliance, particularly in the context of financial need and health care challenges.

1.6. Research Questions

The current mixed-methods study focuses on four research questions that explore the interrelationships among mutual reliance, reliance on family, and marriage:
(1) At a descriptive level, to what extent do members of married same-sex couples face disability and rely on each other for caregiving in the face of disability or illness?
(2) At a qualitative level, how do members of married same-sex couples adapt to short- or long-term changes in health and ability (e.g., in terms of dividing paid and unpaid labor?)
(3) At a quantitative level, what predicts whether members of married same-sex couples rely on their families for support? Are those who are disabled, providing caregiving for one another, and/or low income more likely rely on their families for financial and health related support? And how is family acceptance related to support?
(4) At a qualitative level, how do members of married same-sex couples who rely on their families for support perceive this support (e.g., what functions does it serve)? For those who do not rely on their families for support, how do they explain this?

2. Method

2.1. Procedure

This mixed-methods study uses data from 484 LGBTQ+ married American individuals, who were surveyed about their perspectives on marriage equality, and how their lives were impacted by marriage. Some prior data from this dataset was previously published; see Goldberg and Smith (2025). The Community Marketing and Insights’ (CMI) LGBTQ research panel was used to recruit participants. CMI’s 50,000 person LGBTQ research panel was developed over 20 years via partnerships with over 100 LGBTQ+ organizations, media, and events in the U.S. This study recruited individual participants from known panel members in a same-sex legal marriage, including trans/nonbinary individuals who identified themselves as being in a same-sex marriage.
The survey, which was hosted on the online platform Qualtrics, included closed- and open-ended questions, including demographic items and questions about marriage. Questions were informed by prior research, theory, and input from scholars with relevant expertise. In constructing questions, effort was made to balance our desire for thorough assessment of domains of interest with our awareness of the need for conciseness and brevity in order to prevent participant fatigue. Social scientists and legal and policy scholars reviewed the survey instrument for clarity and accessibility.

2.2. Sample

The full study sample was N = 589, but our sample included only the 484 participants who were currently married and characterized this marriage as a same-sex marriage. Divorced and widowed individuals, and individuals who were not in what they viewed as a same-sex marriage were excluded. See Table 1 for details on race, religion, income, and geographic region.
Most participants were married once, to their current partner (n = 462, 95.5%), and had been in their relationships with these partners for a mean of 16.63 years (Mdn = 14.00, SD = 10.61). At the time that they were married legally, they had been in their relationships for a mean of 9.1 years (Mdn = 6.0, SD = 8.5). Most (n = 350, 72.3%) were married in their state, 118 (24.4%) in a different state, and 16 (3.3%) in a different country. About when they first married their partner, most (n = 431, 89.0%) said this marriage was legal in the state they were married.
Most participants were cisgender (cis) men (n = 192, 39.7%) and cis women (n = 186, 38.4%). Smaller numbers were trans (n = 45, 9.3%) and nonbinary (n = 61, 12.6%). Participants’ spouses were mostly cis men (n = 199, 41.1%) and cis women (n = 215, 44.4%). Smaller numbers were trans (n = 26, 5.4%) and nonbinary (n = 44, 9.1%). Most were in cis men couples (n = 189, 39.1%) or cis women couples (n = 156, 32.2%); the remaining couples comprised a cis person and a trans/nonbinary person (n = 101, 20.1%) or two trans/nonbinary people (n = 38, 7.9%). Therefore, 189 (39.1%) couples were cis men couples, 156 (32.2%) were cis women couples, and 139 (28.7%) were couples in which one or both individuals were trans.
Both participants’ and their spouses’ mean age was 48.0 years (SD = 14.0). Almost half of participants were of color, including biracial/multiracial (n = 235, 48.6%); 249 (51.4%) were White only. More than two-thirds of participants’ spouses were White only (n = 342, 70.7%); 142 spouses (29.3%) were of color.
In terms of highest level of education, 1 (0.2%) had less than high school, 32 (6.6%) had a high school diploma or GED, 158 (32.6%) had some college/an associate’s degree, 178 (36.8%) had a college degree, 81 (16.7%) had a master’s, and 34 (7.0%) had a PhD/MD/JD. Fifteen (3.1%) identified themselves as lower-class, 125 (25.8%) as working-class, 246 (50.8%) as middle-class, 89 (18.4%) as upper middle-class, 3 (0.6%) as upper-class, and 6 (1.2%) endorsed “something else”. Regarding employment, 258 (53.3%) worked full-time, and 51 (10.5%) worked part-time. Sixty-six (13.6%) were retired, and 14 (2.9%) did not work due to disability. A total of 132 (27.3%) participants had a disability, and 126 (26.0%) had spouses with a disability. In more than one-third of couples (n = 185, 38.2%), participants and/or their spouses had a disability.
Regarding parenthood, 148 participants (30.6%) were parents; in turn, 50 (10.3%) had one child, 59 (12.2%) had two, and 39 (8.1%) had three or more children. Thirty-three (6.8%) had children <6 years, 48 (9.9%) had children 6–18 years, and 95 (19.6%) had children 18+ years.
Participants lived in all 50 states plus Washington DC, with >2.5% in California (11.4%), Texas (7.9%), New York (6.4%), Florida (6.0%), Georgia (4.9%), North Carolina (3.9%), Illinois (3.7%), Massachusetts (3.3%), Michigan (3.3%), Pennsylvania (2.9%), Wisconsin (2.9%), and Tennessee (2.7%). Most lived in urban (n = 198, 40.9%) or suburban (n = 191, 39.5%) areas; 62 (12.8%) resided in a rural community and 33 (6.8%) said “something else” (e.g., small town).

2.3. Measures

2.3.1. Outcomes

Family Financial Support. Participants answered Yes (1), No (0), or N/A (not applicable) to the statement: “At least one of our families of origin has given us money.” Of the 484 participants, 415 (85.7%) indicated that financial need was applicable to them; and, of those in need, 159 (38.3%) had relied on their families for financial support.
Family Support in a Health Care Crisis. Participants answered Yes (1), No (0), or N/A to the statement: “At least one of our families of origin has helped us during a health care crisis.” Of the 484 participants, 333 (68.8%) indicated that a health care crisis was applicable to them; and, of those in need, 189 (43.2%) had relied on their families for health care support.

2.3.2. Predictors

Age. Participants’ age, in years, was included as a predictor.
Couple Type. Couple type was coded dichotomously as cis men couple, cis women couple, or couple with at least one trans partner (0, 1).
Family Income. Income was coded as 1 = <$50K, 2 = $50K–$100K, 3 = $101K–$150K, 4 = $151K–$200K, 5 = $201K–$250K, and 6 = >$250K.
Presence of Children < 18. Participants were asked whether or not they had children under the age of 18, children 18+ years, or no children. This item was recoded whereby 1 = children < 18 and 0 = no children < 18.
Disability Status. Individuals were asked: “Do you have a disability?” This item was coded such that 1 = has disability and 0 = does not have a disability. Participants were also asked this question about their partner. A variable was created to capture the presence of disability in the union, such that 1 = participant or partner has disability and 0 = neither has a disability. Participants reported disabilities related to illness (e.g., cancer), degenerative disease (e.g., multiple sclerosis, Parkinson’s disease), injury (e.g., spinal cord injury) and mental health (major depression, obsessive–compulsive disorder).
Caregiver Status. Individuals were asked: “Are you a caregiver for your partner?” This item was coded such that 1 = caregiver and 0 = not a caregiver. They were also asked, “Is your partner a caregiver for you?” This item was coded in the same way. A variable was created to capture the presence of disability in the partnership, such that 1 = participant and/or partner is a caregiver for each other, and 0 = neither is a caregiver for the other.
Family Support, Own Family and Partner’s Family. Participants were asked, “Since you got married, what changes, if any, have you experienced changes in acceptance from any of the following people or groups?” Among the groups listed were “my immediate family of origin” and “partner’s immediate family of origin.” Response options were: increased acceptance; no change; and decreased acceptance. This was recoded such that 1 = increased acceptance, and 0 = no change or decreased acceptance. In the sample, 25.2% reported increased acceptance from their own family, and 42.1% reported increased acceptance from their partner’s family. (Using the original coding, 69.9% reported no change in acceptance from their own family, and 4.9% reported decreased acceptance; 52.7% reported no change in acceptance from their partner’s family, and 5.2% reported decreased acceptance.)

2.4. Open-Ended Questions

A range of open-ended questions were examined and responses analyzed to gain insight into the intersections among marriage, disability, caregiving, labor, and family support. The following questions are among those we used in our analysis.
Within Couple Support: (a) Do you see yourselves as specializing labor-wise (e.g., one does more housework/child care, and one works more)? Please explain. If yes: How did this arrangement come about? (b) Did marriage affect your life planning—for example, in terms of where to live, moving, working, earning income, saving, and planning for the future? Please explain. (c) Did marriage provide some stability to your relationship? How? Please explain.
Support from Family of Origin: (d) Do you/your partner rely on each other’s family of origin (e.g., in times of crisis, such as financial or health care needs?) Please explain. (e) Please elaborate on your response (yes, no, or n/a to these questions: At least one of our families of origin has given us money; At least one of our families has helped us during a health care crisis).

2.5. Data Analysis

This study uses a mixed-method design, which is especially useful in exploring complex and/or understudied social issues, to generate a more complete, nuanced understanding of phenomena (Mason 2006; Suitor and Gilligan 2022). Our quantitative approach enables us to investigate general patterns in the data and associations between variables, while our qualitative approach offers depth and meaning to the quantitative findings, as well as unearthing findings that may be infrequent but offer new insights (Charmaz 2006; Mason 2006). Some of our open-ended questions were fairly focused or mapped closely onto the quantitative data, while others were more general, seeking to understand participants’ perspectives in their own words. Our decision to focus on the interrelationships of health and disability, labor and caregiving, and family support, in the context of marriage, was informed by our observation of connections across multiple quantitative and qualitative questions in our dataset. Our goal was to shed insight on several complex, understudied areas in the context of contemporary LGBTQ+ married people.

2.5.1. Quantitative Analysis

We fit logistic regression models to examine which demographic, need or vulnerability related, and/or family related characteristics predicted (a) family financial help (n = 415) and (b) family help in a health care crisis (n = 333), in the subsamples of participants that reported needing such help. Individual variables (i.e., age), couple variables (i.e., type of couple: cis women couple, cis men couple, couple with at least one trans partner; family income; presence of children < 18; at least one partner has a disability; at least one partner is a caregiver for the other) and family variables (i.e., my family’s acceptance increased after marriage; my partner’s family’s acceptance increased after marriage) were entered as predictors. To examine differences between couple types, initial regression models included cis women couple and cis men couple as predictors; thus, couples with at least one trans partner was the default. Models were refit replacing cis men couples with trans couples, such that cis men couples were the default category, and testing for differences between cis women couples and cis men couples. We also examined interactions between disability and couple gender. To interpret interactions, we examined the predicted probabilities for all possible values of the predictors of interest, while holding all other predictors constant at their mean. Variables were checked for multicollinearity based on VIF scores, and residuals were checked for normal distribution.

2.5.2. Qualitative Content Analysis

Responses to the open-ended survey portions ranged from one sentence of text to almost one page of text, with most respondents providing 2–5 sentence responses. We used qualitative content analysis (Krippendorff 2004) to examine the open-ended responses. Content analysis is a standard method for examining open-ended responses to survey questions, and can generate new insights and understanding through the process of systematically identifying, coding, and categorizing primary patterns, or themes. Through rigorous exploration and classification of qualitative data, we developed a coding system to organize the data (Bogdan and Biklen 2007).
For this paper, our analysis focused on participants’ responses to the open-ended questions described earlier, which center on the intersections among disability, caregiving, and family. The first author first read all open-ended responses to gain familiarity with the data, including overarching themes in responses (Goldberg and Allen 2015). Then, through line-by-line coding, the first author labeled phrases relevant to the primary domains of interest (e.g., housework contributions increased or decreased). These codes were abstracted under larger categories and subcategories (e.g., disability caused reallocation of paid and unpaid work), which were positioned in relation to each other such that connective links were established to meaningfully capture participants’ responses. A coding scheme was produced and reapplied, such that all data were recoded according to the scheme (Goldberg and Allen 2015).
To strengthen the credibility of the analysis, a student research assistant served as an auditor and analyzed a random selection of open-ended responses, reading about 1 out of 10 respondents’ data, as a basic “check” on primary themes. Minor discrepancies were discussed with the first author, which led the author to make minor modifications to the coding scheme. The second author provided further feedback about the finalized coding structure. This resulted in minor changes, such that several sections were rearranged for clarity, cohesion, and flow.
In reporting quotes, we provide descriptive details about participants—namely, gender identity, sexual orientation, disability, race, and age. Names are pseudonyms.

3. Results

3.1. Descriptive Data on Disabilities, Physical Challenges, and Caregiving (Question 1)

Participants were asked about whether or not they or their partner had any disabilities, and ways that they had provided caregiving for their partners and/or their partners had provided caregiving for them. See Table 2. Over one-fourth of participants (27.3%) reported they had a disability and over one-fourth (26.0%) reported that their partner had a disability. Just one partner had a disability in in 23.1% of couples (n = 112) and both partners had a disability in 15.1% of couples (n = 28). In terms of caregiving, 14.5% of participants were caregivers for their partner and 12.4% said their partners were caregivers for them. More specifically, one partner was a caregiver in 10.3% of couples and both partners cared for each other in 5.8% of couples. Given research highlighting the gendered nature of caregiving in same-sex couples, we conducted chi square analyses to determine whether there were differences in disabilities and caregiving across couple types. There were indeed differences in the presence of disabilities, X2 (2, 484) = 42.04, p < 0.001, such that, according to follow up chi square analyses, trans couples were more likely to report a disability compared to cis women couples (59.7% vs. 35.3%), X2 (1, 295) = 17.66, p < 0.001, and cis men couples (24.9%), X2 (1, 328) = 40.65, p < 0.001. Cis women couples were more likely to report a disability than cis men couples, X2 (1, 345) = 4.43, p = 0.024. There were also differences across couples in caregiver status, X2 (2, 484) = 8.69, p = 0.013, such that trans couples were more likely to report that one or both partners were caregivers for each other than cis men couples (28.7% vs. 15.1%), X2 (1, 328) = 8.70, p = 0.003, but not cis women couples (21.1%). There were no significant differences between cis men and cis women in caregiver likelihood.
Among the 70 individuals (14.5% of the sample) who said that they were a caregiver for their partners, 64 of them (91%) said that their partners had disabilities. Likewise, of the 60 who said their partners were caregivers for them, 57 (95%) said they had disabilities. Another way to consider these data is that among the 126 whose partners had disabilities, 64 (50.8%)—that is, half—were caregivers for them, and among the 132 who had disabilities themselves, 43.2% said their partners were caregivers to them. See Table 3.
Table 3. Disability and Caregiving, Considered Together (N = 484).
Table 3. Disability and Caregiving, Considered Together (N = 484).
Are You a Caregiver for Your Partner?
YesNoN/A, No Partner DisabilityTotal
Is your partner living with a disability?Yes64620126
No6148204358
Total 70210204484
Is your partner a caregiver to you?
YesNoN/A, no disabilityTotal
Do you have a disability?Yes57750132
No3173176352
Total 60248176484
Participants also reported on their level of difficulty with specific activities. See Table 4. Cognitive challenges (i.e., concentrating or remembering) were the most frequently reported difficulty, for both self and partner, in the full sample.
Table 4. Difficulty with Specific Activities: Self and Partner (N = 484).
Table 4. Difficulty with Specific Activities: Self and Partner (N = 484).
Some DifficultyA Lot of DifficultyCannot DoAny Difficulty (Some, a Lot, Can’t Do)
MYSELF
Seeing, even if wearing glasses121 (25.0%)11 (2.3%)1 (0.2%)133 (27.5%)
Hearing, even if wearing hearing aids65 (13.4%)5 (1.0%)2 (0.4%)72 (14.8%)
Walking or climbing stairs95 (19.6%)23 (4.8%)2 (0.4%)122 (25.2%)
Concentrating or remembering123 (25.2%)30 (6.2%)0 (0%)153 (31.6%)
Self-care, such as washing or dressing41 (8.5%) 6 (1.2%)1 (0.2%)48 (9.9%)
Communication (understanding or being understood)41 (8.5%)4 (0.8%)0 (0%)45 (9.3%)
PARTNER
Seeing, even if wearing glasses116 (24.0%)20 (4.1%)1 (0.2%)127 (26.2%)
Hearing, even if wearing hearing aids67 (13.8%)10 (2.1%)0 (0%)77 (15.9%)
Walking or climbing stairs78 (16.1%)26 (5.4%)3 (0.6%)107 (22.1%)
Concentrating or remembering102 (21.1%)30 (6.2%)2 (0.4%)133 (27.5%)
Self-care, such as washing or dressing33 (6.8%)5 (1.0%)0 (0%)38 (7.9%)
Communication (understanding or being understood)47 (9.7%)5 (1.0%)0 (0%)52 (10.7%)
Of interest was whether those with disabilities tended to report certain types of challenges (e.g., cognitive issues) versus others (e.g., physical challenges, such as walking and self-care; communication issues). We did not assess the intersection of disability and eyesight issues, given the large percentage of Americans (at least three quarters) who wear some type of corrective eyewear or lenses (van Dam 2023).
Among the 132 participants with a disability, more than two-thirds (n = 87, 66%) reported cognitive issues, such as difficulty with memory and concentrating; almost two-thirds (n = 82, 62%) reported mobility challenges (e.g., climbing stairs); almost one-third (n = 40, 30.0%) reported hearing difficulties; over one-quarter (n = 38, 28.8%) reported difficulties with self-care; and over one-quarter (n = 35, 26.5%) reported difficulties with communication. Of the 126 whose partners had a disability, almost two-thirds (n = 81, 64.5%) reported that they had cognitive difficulties; over half (n = 70, 55.6%) reported mobility challenges; almost one-third (n = 41, 32.5%) reported hearing difficulties; over one-quarter (n = 36, 28.8%) reported communication difficulties; and over one-quarter (n = 32, 25.4%) reported self-care difficulties.

3.2. Adaptation in the Face of Health Challenges and Disability (Question 2)

In the context of an open-ended question about the division of labor in their families, including paid and unpaid work, participants often offered insights that highlighted how the division of responsibilities and chores were not only dictated by work hours, schedule, and flexibility but also by dimensions related to health, wellness, and physical ability. The latter category, then, emerged as a salient source of information related to how couples adapted when one or both partners had health challenges. In turn, the qualitative data were mined for themes related to (a) health and disability, (b) adaptation and flexibility, and (c) the division of labor (housework, paid work, and caregiving). The data also highlighted how marriage itself made a difference (e.g., in terms of enabling couples to adapt and shift their work and family lives) (Warner and Adams 2015).

3.2.1. Long-Term Shifts in Labor Allocation Due to Illness/Disability

In response to our open-ended question regarding specialization in the division of labor, about one-fifth of participants detailed how they or their partner had chronic health issues or physical disabilities (e.g., cancer, multiple sclerosis, hearing loss) that caused a renegotiation of paid and unpaid labor. In some cases, one partner’s health or disability challenges led to reduced paid work hours (and increased responsibility for unpaid labor) and a corresponding increase in their partner’s paid work hours. Thus, in some circumstances, the partner with the disability or chronic health challenges took on more of the housework and child care because their partner was forced to be the primary or only earner. Steve, a 48-year-old White cis gay man with a disability, shared, “My disabilities now keep me home bound and in bed a lot. However, my energies are on clerical needs, housework, and my special needs adult child’s care. He goes out to work, runs the errands, makes the phone calls, and all else that I cannot do.” Marcus, a 34-year-old White cis gay man with a disability, said, “My husband is more a worker and I specialize more in the home. This is due to some mental health issues that I was experiencing over time, and thankfully we have been able to make it work out financially. My husband was supportive of this decision.”
In other cases, one partner’s disability or health challenges caused a renegotiation of unpaid work only, such that they took on less physically demanding or time intensive tasks. “I do what I can do when I can, but I help plan and manage,” shared Rex, a 34-year-old Latinx nonbinary queer participant who had several physical disabilities, highlighting how they sought to contribute where possible amid their limitations. Trevor, a 36-year-old White bisexual trans man with a cis woman partner, said, “I am disabled so I do ‘lighter’ household tasks like cooking all meals, dusting, laundry, and my spouse does the more physically involved tasks like shopping, vacuuming, etc. This changes depending on my pain levels from week to week.” Jamie, a 30-year-old Black nonbinary queer participant with a nonbinary partner, said, “I do less labor-intensive housework because of my chronic illnesses and chronic pain. My spouse takes on more of the physical labor chores… and I do more of the chores that require less physical strength and ability.” In a few cases, one partner’s illness or disability meant that one partner took on the bulk of paid and unpaid work. Henry, a 63-year-old White cis gay man partnered with a cis man, stated, “My husband is totally disabled, so I have to do all the household tasks.”
For those whose health challenges developed or intensified more gradually, there was time to shift to a different arrangement. Alison, a 32-year-old Latina cis lesbian, whose partner was nonbinary, shared:
My spouse works outside the home, while I am fully disabled and stay at home. There are tasks that I do that are accommodated due to my limitations. My spouse takes on whatever else I’m unable to do. We discussed all of this very heavily when my disability began to worsen, and then when they had to start working out of the house again.
Of note is that some participants acknowledged that their current arrangements were less than ideal but were necessary (i.e., “part of life”). Some spoke to their preference for a more egalitarian or fair division of labor but accepted that this was not possible due to current disabilities or health circumstances. Likewise, some participants hoped for more equality in the future (“As our child grows and my mental health changes we plan to rebalance towards a slightly less specialized labor-sharing arrangement”). Nicole, a 33-year-old White pansexual cis woman with a nonbinary partner, stated:
Our roles have changed since my partner’s disability. They used to do most/all cooking, and we shared housework. I’ve always had the more demanding job. I grocery shop and do all the bills/mental work of keeping our lives together since the disability. I do almost everything and my partner helps with housework and cleaning when able. It was not a choice we made—rather forced upon us by life. We would both prefer [it] more balanced.
Situations where both partners had disabilities or health challenges required flexibility and periods of (re)negotiation. Elana, a 31-year-old Latina cis lesbian with a nonbinary partner, said:
We specialize in terms of who does which housework tasks, and we’ve traded off who does more overall housework based on our changing health conditions, as we both have chronic illness. Some of this has been through necessity (e.g., acute injuries/illnesses mean one partner has to suddenly step up in certain areas), but we try to discuss as much as possible, and we’ve done couples counseling at various points to help us make informed and loving decisions about what the home care workload should look like for each of us.

3.2.2. Temporary Shifts and Adaptation Due to Health Crises

Other participants shared how they and/or their partners had dealt with health issues that necessitated temporary changes in chore allocation. For example, due to a back injury, Connor, a 39-year-old White trans queer participant partnered with a cis woman, took over “more finances and logistics, food shopping and cooking,” leaving it to their partner to do more “physical labor” during their period of recovery. Monica, a 65-year-old multiracial queer trans woman partnered with a cis woman, said, “We shared housework and child care until recently when a stroke debilitated my partner and left her unable to do as much.” Shawn, a 31-year-old White nonbinary queer participant partnered with a cis woman, shared, “We tend to fluctuate who does more of the household work based on our mental health, rather than work-work.” Thus, participants highlighted flexibility and adaptability to short-term shifts in the allocation of labor as well.

3.2.3. Marriage, Mutual Reliance, Labor Allocation, and Disability

Some participants spoke to how marriage itself shaped how they experienced and adapted to their partner’s illness or disability, often underscoring how the gravity of the commitment they had made became clear when their partner became disabled. Izzie, a 33-year-old White cis pansexual woman with a nonbinary partner, said, “My partner went through a disabling injury four years after we married. It changed everything—travel plans, life plans, investment plans. I am honoring our ‘in sickness and in health’ vows, but it is hard having to completely reshape what you thought life would look like because of something out of your control.”
Indeed, participants highlighted the challenging reality of being married to a person with a disability, particularly in terms of being both physically responsible for and financially intertwined with them. Marriage meant “having to consider [their partners’] health concerns.” Gavin, a 47-year-old White cis man partnered with a cis man, shared, “I have to work more due to my spouse’s disability than if I had married a non-disabled person.” Nadia, a 35-year-old White cis queer woman with a nonbinary partner, said, “Being married to someone who is now disabled was not something I had planned. The other partner can derail your life/plans… nobody ever talks about that. I am now the sole income earner and the pressure is immense.” For a few participants, caregiving for their partners became their job. Henry, a 63-year-old White cis gay man, said, “I do not have a regular job now due to my caretaking responsibilities for my husband. I am paid a stipend through the aging/disabled waiver program which is considered part time.”
Several disabled participants highlighted how marriage, and specifically their ability to rely on their spouse, had benefited them in terms of their overall health and well-being. Addressing the financial benefits, Cass, a 27-year-old White nonbinary queer participant partnered with a trans woman, said, “I am able to work only once a week in a job I enjoy, being financially supported by my wife. I would likely not be able to financially support myself by working because of disability (not legally recognized).” These participants were also aware of how marriage offered other forms of security, such as relational stability. Particularly for those with chronic health issues, marriage provided them with a sense of relationship “insurance” as they anticipated an uncertain future. Kasey, a 32-year-old White cis lesbian with a nonbinary partner, stated, “Being diagnosed with an incurable disease, marrying my wife meant we would be there for each other no matter how my MS progresses. I’m hopeful for many more stable years, but I know if things take a turn, my spouse is right there with me.”
Many participants without health issues or disabilities recognized the benefits of marriage as they aged. To them, a benefit of marriage was knowing they had protections in place for both partners as they grew older, particularly in the event that one or both of them become ill or died. Suzie, a 61-year-old biracial (Black/White) cis lesbian with a cis woman partner, said, “As we are both getting older and dealing with some individual health issues, marriage means we have the right to hospital visitation, will planning, etc.” Toby, a 65-year-old White nonbinary participant partnered with a trans woman, said, “Because I am older than my spouse, I have made plans for her to be taken care of if and when I die, including will and estate, and life insurance.” Likewise, many participants with and without health issues, highlighted the specific health care benefits of marriage vis a vis shared insurance. KK, a 35-year-old White nonbinary queer participant partnered with a cis woman, said, “I have an expensive chronic illness and so does my wife, it is crucial for us to be able to share health insurance.”

3.3. Reliance on Family and In-Laws: Quantitative Analysis (Question 3)

In addition to facilitating mutual reliance between partners, marriage also meant that the couple had two families—or sets of in-laws—that they could rely upon. Of couples who found the need applicable to them (n = 415 for financial need, n = 333 for health care crisis), 61.7% had relied upon their families for financial support, and 43.2% reported that their families had helped out during a health crisis. See Table 5.
A logistic regression was conducted to determine whether age, income, presence of a disability (in self or partner) or caregiver status (being a caregiver for one’s partner or having one’s partner be a caregiver for oneself), increased family acceptance after marriage, and gender (cis men couple, cis women couple, couple in which either partner is trans) predicted receiving help (if needed) financially or during a health care crisis.

3.3.1. Predicting Financial Help for Those in Need

In predicting receiving financial support, among those who reported needing such support (n = 415), we found that participants had 0.17 times lower odds of receiving financial help for each higher level of income (with 5 levels), and participants had 0.04 times lower odds for every additional year of age. See Table 6. Participants who perceived their partners’ families as becoming more accepting when they got married had 0.77 times greater odds of receiving financial help than those who did not. Finally, participants in trans couples had greater odds of reporting financial help than those in cis men couples. Follow-up analyses, however, showed an interaction between gender and disability. While they revealed the same pattern of findings for income, age and acceptance, there were significant interactions for both disability x trans couple and disability x cis women couple when cis men couple was the default variable, but only disability x cis men couple when cis women couple was the default variable (and with no significant main effects for gender). Examining the predicted probabilities revealed that individuals in couples with disabilities who were also in cis women (0.69) or trans (0.83) couples were more likely to receive financial help than those without disabilities (0.56 and 0.68, respectively), whereas those in cis men couples with disabilities were less likely to report financial help (0.46) than those without (0.63).

3.3.2. Predicting Help in a Health Care Crisis

In predicting receiving help in a health care crisis among those needing such help (n = 333), we found that participants who reported a disability in themselves or their partner had 0.89 times greater odds of reporting receiving help in a health care crisis than those who did not, while those who reported that they or their partners were caregivers to each other, had 1.01 times greater odds than those who did not. See Table 6. Additionally, there were marginally significant associations (i.e., 0.05 < p < 0.10), such that those who were younger were somewhat more likely to report help from family in a health care crisis (p = 0.058), and those who were in cis women couples were somewhat more likely than those in cis men couples to report help from family during a health care crisis (p = 0.097).

3.4. Meaning of Family Support: Qualitative Analysis (Question 4)

Participants elaborated on the type of help they received from family in open-ended responses, which provide a more nuanced understanding of the range and meaning of the support they received with respect to financial and health care needs. Their responses also revealed that they relied on family for other types of instrumental support (e.g., transportation, pet care) and emotional support (e.g., advice).

3.4.1. Financial Support

Participants who relied on family for financial support gave many examples of how their families had supported them, primarily in the realm of helping them to afford basic daily expenses in times of financial strain (e.g., job loss), as well as assistance with medical expenses, education, and the purchase of homes or vehicles. Some shared how their families had provided financial assistance to them as a couple over an extended period of time (e.g., with rent, groceries, car insurance, or pet costs). Participants often suggested that this support was crucial in helping them to avoid a crisis, such as being evicted or losing their home. Henry, a 63-year-old White cis gay man who was partnered with a cis man with a disability, said, “We went through a tough time during COVID. My stepmother and brother kept us afloat and kept our house out of foreclosure.” Kari, a 34-year-old biracial (Latina/White) cis lesbian with a disability who was partnered with a cis woman, shared, “We’ve been in situations where we’ve needed serious help to stop actions like evictions, car repossession, and getting utilities turned back on, from happening.” Other participants noted how their family’s financial support with major household repairs (e.g., new roof) had enabled them to avert financial crisis.
Some respondents detailed how their families and/or their partners’ families had provided them with financial support to buy a home—sometimes in the form of a loan, and other times in the form of a gift. Celine, a 29-year-old biracial (Black/White) pansexual cis woman with a cis woman partner, said, “My aunt let us borrow $13,000 for the down payment of our house.” Laura, a 45-year-old queer cis woman with a nonbinary partner, said, “My mother helped with our down payment for our house and also paid for our wedding reception. I know we could fall back on both sets of parents if needed for help.” Other participants detailed how their families had assisted them with buying a car (e.g., after a major accident) and with moving/relocation.
Some family members also assisted with medical bills and expenses (e.g., surgeries, hospital stays, expensive dental work). Others detailed their families’ financial assistance with education (“My family is providing support for me while I’m in my graduate program”) or careers, such as investing in their partner’s business or a joint business enterprise (“Both our families of origin have helped financially with helping get our business off the ground”).

3.4.2. Health Care Crisis

Many participants elaborated on how their families helped out during health care crises. Sometimes these were sudden events like heart attacks, strokes, or car accidents, which necessitated immediate caregiving support. In other cases, health care crises took the form of diagnoses (e.g., brain cancer) that necessitated emotional support in the short term and caregiving support in the longer term, such as during ongoing treatment. They also shared how families had contributed during and after major surgeries, such as hip replacement. Patricia, a 48-year-old Latina cis lesbian with a cis woman partner, shared, “My wife had a hysterectomy a few years ago and she wanted my mom’s help. My mom flew in from out of state to take care of her. My mom is a nurse and I pass out at the sight of blood so I am not handy in these situations.” Some trans participants specifically shared how their own or their partners’ families helped out after top surgery. Significant here was the fact that several participants detailed how in-laws provided this type of support (“my mother-in-law assisted me when I had top surgery”).
Sometimes the support families provided was less in the realm of caregiving and more in the realm of transportation and pet care during a health care crisis. Jessie, 39-year-old White cis lesbian whose cis woman partner had a disability, shared, “My wife was pretty sick a while back and was hospitalized for a long period. Both of our families helped with things like pet care and they also threw a spaghetti dinner for her to help pay our bills.”

3.4.3. Instrumental Support

Participants also detailed a variety of forms of instrumental support that their families or their partners’ families provided, including child care, laundry, and even assisting with the visa application process. Brianna, a 32-year-old White cis lesbian with a cis woman partner, stated, “Grandparents watch the kids every other Friday. They also pet sit/walk the dog. And our dads also do house repairs, electric, heating, plumbing, etc.” Andrea, a 43-year-old Black cis lesbian with a disability who was partnered with a woman, shared, “My parents are extremely helpful when it comes to childcare. Also, my mother-in-law is a financial planner who helps us manage our finances and the kids’ college fund.”

3.4.4. Emotional Support

Many participants detailed how they relied on their families for emotional support, including advice (for example, “on life stuff like housing, saving, business stuff, car troubles, etc.”), as well as love and empathy. Corey, a 33-year-old White cis gay woman partnered with a woman, said, “We’re very close and connected with my wife’s sister, husband, and child, and we’ve been connected at this level since the start of COVID… They are our main and closest support network, [and] second to them are my dad and stepmom.” Thus, for this participant, and others, marriage—sometimes in combination with various environmental and situational pressures such as those introduced by COVID-19—facilitated the strengthening of relationships in ways that had profound and seemingly mutually beneficial and reciprocal effects.

3.4.5. Multiple Forms of Support

Many participants identified multiple ways that their families of origin provided support to them, including “providing financial assistance during a period of unemployment, help with medical appointments for medical issues, and emotional support”). Lee, a 52-year-old White asexual trans man with a disability, whose partner was a trans man, said, “His parents help out in times of crisis, and we rent from them.” Lucy, a 40-year-old White cis lesbian with a cis woman partner, said, “My family has helped us emotionally through some hard times dealing with a sick child. They also helped financially, helped get us a car when we moved, and let us stay with them for several months when we moved.”
Sometimes families provided different forms of support. Jake, a 28-year-old White cis gay man partnered with a cis man, shared, “My family has been very generous financially to us. His family lives closer to us than mine, and provides family support as well as resources.” Ash, a 29-year-old White nonbinary queer participant with a nonbinary partner, both with disabilities, said, “My partner’s family gave us money when we needed extra for an unexpected grad school expense, and my mother came up to care for me after surgery.” Such examples highlight how social support from family operated as an informal and much needed safety net, reflecting how for some, legal kinship resulted in greater social capital that served to ease stress and promote well-being. Felicia, a 31-year-old Latina cis lesbian with a nonbinary partner, shared:
My family has offered a lot of financial support, whether through actual money gifts/loans or just advice and guidance, in response to health crises that affected our ability to work. My wife’s family has given monetary gifts on occasion, but they are not a true source of support in that regard; we would not ask them for financial help if we had any other option, given their attitudes toward money in general. We have relied on both families for emotional… support, especially my partner’s sibling and his spouse, who live close by.

3.4.6. Not Leaning on Family

For those who stated they did not lean on families of origin for various needs (financial, emotional, etc.), the primary reason given was self-sufficiency and self-reliance: they did not need to, they relied on each other, they were independent, and even saw themselves as “the most responsible and financially secure people in both of our immediate families.” This theme was especially salient among cis men participants. As Andy, a 35-year-old Asian cis gay man partnered with a cis man, said, “We are self-reliant and do not ask immediate family for assistance in any type of matters.”
Some also noted that their families were not financially well-off, and this deterred them from considering them as a source of potential monetary support specifically. Javier, a 42-year-old Latino cis gay man partnered with a cis man, shared, “We both come from humble, working-class families... and we don’t carry a tradition in our family to overextend financially for each other, since we all have bills to pay; classic working-class Hispanic story.” Holly, a 32-year-old White queer trans woman partnered with a cis woman, said, “My mother struggles to keep herself afloat, and has no resources available to help even if we needed them.”
Some said that they were estranged from their families (e.g., their families had rejected them), their families were emotionally dysfunctional, or they were simply not close to them. In turn, they did not look to their families for emotional, instrumental, or financial support. Marsha, a 64-year-old White cis woman partnered with a cis woman with a disability, said, “We are fairly estranged from our families of origin because they are jerks basically.” Several said that their families’ rejection had intensified since one partner’s gender transition or since they got married. In other cases, family of origin was simply absent: they had a small family and/or most family members had passed away. In a few cases, participants shared that their families simply lived very far away and thus were not a reliable source of instrumental or emotional support.
Significantly, some participants offered the caveat that while they did not rely on their families, their families relied on them, particularly for financial support (“We’ve purchased them cars, loaned them money, etc.”). Darcy, a 44-year-old biracial (Black/White) cis lesbian with a cis woman partner, both of whom had disabilities, said, “My wife’s parents are elderly and rely on us, and her siblings are awful but she/we help them when we can.” Cam, a 33-year-old cis Latino gay man with a cis man partner, said, “We have surpassed our families’ level of class, and we financially assist them.”
Some participants pointed specifically to marriage as facilitating their current level of stability, which in turn enabled them to support their families financially and with regard to caregiving. Brian, a 40-year-old White cis gay man with a cis man partner, said, “I feel much more settled. The stability of [marriage] has given me a strong foundation to support my family members when they are struggling.” DJ, a 31-year-old White queer trans man partnered with a trans man, said, “Being married has made us consider more how we as a couple will care for our elderly parents together in the future.”

4. Discussion

The current study focused on the interrelationships of health and disability, labor and caregiving, and family reliance and support, in the context of marriage, among contemporary LGBTQ+ married people. Our particular focus on the couple and family dynamics of LGBTQ+ married people with disabilities is important, given the potential health protective properties of marriage (Karney et al. 2024) and the fact that LGBTQ+ people with disabilities are recognized as having unique risks and vulnerabilities due to their intersecting statuses, including heightened risk of discrimination and potential for unmet health care needs (United Nations Office of the High Commissioner for Human Rights 2023), which places them at particular risk for minority stress (Kempapidis et al. 2023)
We documented somewhat lower rates of disabilities in our sample (27%) compared to some prior surveys of LGBTQ+ adults (Human Rights Campaign 2025, but see Fredriksen-Goldsen et al. 2012), which may in part reflect their marital status, a potentially protective factor. Between half and two-thirds of those with disabilities or whose partner had disabilities reported cognitive or mobility issues, which are indeed the most common types of disabilities in the U.S. (Centers for Disease Control and Prevention 2025), and, between one-quarter and one-third of those with disabilities or whose partners had disabilities reported hearing, self-care, and communication issues. Relatively low numbers of participants were caregivers (12%) or had partners who were caregivers for them (14.5%)—yet even in the absence of caregiving responsibilities, managing one’s own and/or one’s partner’s disability can be stressful and challenging, making it difficult to share paid and unpaid labor as well as to lean on each other for mutual emotional support (Cannon and Cavanaugh 1998).
Amid some work exploring how married heterosexual couples adapted their day-to-day routines to accommodate each other’s health issues and shifting health statuses (Nimmon et al. 2018), we were interested in how married LGBTQ+ couples described their division of labor vis a vis disability and health issues, especially since LGBTQ+ couples both value and often enact egalitarian arrangements (Fischer 2024; Goldberg 2013; Goldberg et al. 2012). We hoped to gain insight into changes in the division of labor in response to health care issues, especially since, given queer people’s preference for equity (Goldberg 2013), such adaptations might be particularly stressful. Interestingly, we documented a pattern whereby for some cases, the partner with health issues or disabilities took on more domestic labor because they were forced to stay home, requiring their partners to take on the lion’s share of paid work. In other cases, disability or health issues prompted a reallocation of specific tasks such that the disabled partner took on fewer, less demanding, or more flexible tasks. Although such changes were not always ideal, they were typically accepted as “necessary” and some hoped to reestablish a more equal chore division in the future. Significantly, too, some participants shared how they had made short-term changes to chore allocation in response to health crises, including strokes and mental health challenges.
Such patterns are notably consistent with the ethos of flexibility that studies have captured among LGBTQ+ people during other key times of transition and heightened stress. During the transition to parenthood, for example, LGBTQ+ new parents often describe making shifts to their paid work lives, taking turns staying home with the child, and both partners cutting back on work hours to accommodate child care (Goldberg 2013; Richardson et al. 2012); such patterns are not found among heterosexual couples, who tend to become more specialized and traditional in their roles during this transition (Goldberg 2013). Thus, the flexibility LGBTQ+ people display in renegotiating the division of labor may be especially adaptive during times of crisis, such as health care crises, enhancing their ability to adjust and maintain positive relationships. Significant, too, is that LGBTQ+ participants recognized the role of marriage in fostering mutual reliance and stability, especially amid aging and disability, emphasizing how legal marriage facilitated mutual commitment, access to health insurance, and ability to plan for a shared future (e.g., via wills and powers of attorney; Badgett et al. 2025). Notably, however, while participants with disabilities voiced relief about the added protections of marriage, participants whose partners had disabilities sometimes articulated feeling an enhanced sense of responsibility vis a vis their partners, underscoring the “both/and” nature of marital commitment.
Of interest, too, was how LGBTQ+ married people relied on each other’s families for resources, especially financial and health care related support—resources that can reduce the stress associated with care and support-giving in marriage (Ray 2006) as well as offset the harm posed by anti-LGBTQ laws and sentiment in broader society (Wang et al. 2022). Alongside the fact that marriage may increase commitment—which is protective for disabled people but may be challenging for their spouses, if caregiving needs are high, as we saw in the qualitative data—we were interested in the degree to which participants relied on their family and in-laws for support, and predictors of reliance. We found that 62% had relied on their families for financial support, and 43% had relied on their families for support during a health care crisis. Even though analyses were limited to those who expressed a need for financial help, lower-income individuals were more likely to rely on family for financial support. This was also true of younger individuals, reflecting the heavy reliance of contemporary young adults on their parents in the U.S.: in 2024, just 16% of young adults 18 to 24 were completely financially independent, and just 44% of those ages 25 to 29 were completely independent, versus two-thirds of those 30 to 34 (Pew Research Center 2024). Younger LGBTQ+ people face unique challenges in establishing financial independence from their families: like their cis heterosexual counterparts, they have fewer years of education, work experience, and accumulated resources—but, unlike them, they navigate the consequences of coming out and being out with their families (Ghosh 2020). Such dynamics—of financial dependence and potential rejection—could have implications for newly married LGBTQ+ couples, whose families may have had less time to adjust to and accept their sexuality/gender identity than families of older LGBTQ+ people. Also, older participants may have been less likely to rely on family for financial help not only because they were more established in their jobs and lives, but also because they had fewer living relatives to rely on.
We also found that participants who viewed their in-laws as becoming more accepting post-marriage were more likely to report receiving financial help from them, extending prior work suggesting that marriage may increase family acceptance (Ocobock 2013; Ramos et al. 2009) and further establishing that such acceptance may come with monetary support that may benefit LGBTQ+ married couples and families. Of course, in that we did not ask about or control for initial level of family acceptance, our index of increased family acceptance is imperfect, and our findings may simply reflect that families who were previously unsupportive, and thus had more room to improve, used family support as a symbol or signal of this new acceptance.
Interestingly, we found evidence that the likelihood the presence of a disability would be related to increased financial support varied according to gender. While participants in trans couples and women in cis women couples who had disabilities or whose partners had disabilities were more likely to report financial support from family, men in cis men couples who had disabilities or whose partners did were less likely to do so. In explaining this finding, it is notable that cis gay men were especially likely to emphasize their general and financial self-reliance and independence from family in the qualitative data, perhaps reflecting larger gendered patterns in support giving and receiving more broadly (Umberson et al. 2017), but also suggesting that, in the presence of personal crisis (e.g., a disability), they may be especially unlikely to ask for or accept help from family. Some prior research suggests that gay men in midlife may have weaker ties to parents as compared to heterosexual men (Fischer and Kalmijn 2021), preferring to “rely on themselves” for various forms of support (Shippy et al. 2004), and relying less on family for financial support (and more on chosen family) than lesbian women (Frost et al. 2016), pointing to how the intersection of masculine norms and anticipated and internalized homophobia may be especially disadvantageous to gay men in times of crisis (Seidler et al. 2016). Further, it has been suggested that, compared to sexual minority men, sexual minority women maintain closer ties with family due to gendered expectations related to caregiving, such that family members expect women, but not men, to care for them as they age (Fredriksen-Goldsen 1999; Hawthorne et al. 2020), an area that future research can explore. Finally, amid evidence that trans people often lack family support, and such support is related to well-being (Lampis et al. 2023), the fact that trans people’s families were more likely to step in compared to those of cis men is notable, and suggests that marriage may play an especially protective role for vulnerable trans people and their partners.
In predicting reliance on family in a health care crisis, we found that those who reported a disability in themselves or their partner, and those who reported that they or their partners were caregivers to each other, were more likely to report receiving family help in a health care crisis. Perhaps couples in which one partner is a caregiver, in particular, have objectively higher needs vis-a-vis health care; or, their need is more visible and/or is seemingly more legitimate to warrant offerings of support. Our finding that, at least in this sample, LGBTQ+ married couples with caregiving responsibilities are able to benefit from additional outside support from family is significant, given that partners in same-sex couples are more likely to be caregivers for their partners than partners in different-sex couples (Morgan et al. 2023), and same-sex couples are more likely to be characterized by mutual caregiving (Anderson and Flatt 2018; Knauer 2016).
Several findings did not reach full significance, but were nevertheless reported due to the exploratory nature of our work, which we hope will inspire future research. Younger participants were somewhat more likely than older participants to report relying on family during a health care crisis, and those who were in cis women couples were somewhat more likely than those in cis men couples to report help from family during a health care crisis. Indeed, women partnered with women appear to provide and receive the most instrumental or practical care, as compared to men partnered with men and men-women partners (Umberson et al. 2017). The fact that they receive the most instrumental support from family when dealing with a health care crisis may reflect broader gendered interactions (e.g., in terms of how women maintain their relationships with family) or other dynamics (e.g., their financial need; their physical proximity to family; their closeness to family) that can be explored in future work.
The qualitative data revealed key insights into the types and meaning of financial and health care related support that participants received from family. Many participants highlighted how family members had helped them to avoid financial crisis by chipping in with daily expenses and major purchases that they would otherwise have been unable to manage, especially amid job loss, underscoring the central role of extended kin in many married people’s economic security and stability (Baland et al. 2016). Likewise, in some cases, family members’ financial support had enabled them to advance in their careers, thus elevating their social and financial status. Regarding health care crises, participants described a range of ways that their families and their partners’ families had supported them, including supporting them after surgery, helping with pet and child care, and driving them to medical appointments. Participants, too, outlined a range of other ways that family had provided aid to them, which encompassed instrumental and emotional support. Primary reasons for not leaning on family included self-reliance (especially among cis men) and lack of familial resources, highlighting how, even among LGBTQ+ married couples, lack of reliance may reflect factors other than familial rejection, and may even represent forms of resilience. Further, some participants noted that their family or their partner’s family relied on them for help, indicating how more established or settled couples may be more of a resource for their families (i.e., resources go in the other direction; Baland et al. 2016; de Vries 2014).

Limitations and Future Directions

This study’s findings must be interpreted within the U.S. cultural context. The history, meaning, and function of marriage for LGBTQ+ people, as well as relevant processes such as family support and acceptance, are inevitably shaped by the broader national and cultural context; indeed, in cultures where LGBTQ+ identities are highly stigmatized, marriage might not necessarily yield the same shifts in family support (see Flores 2021; Ghosh 2020, 2024). Likewise, we did not attend to the role of LGBTQ+ individuals’ cultural background, migration histories, or immigration status in the context of marriage: future work might explore how such factors shape both kinship norms as well as family and support experiences (Ghosh 2024).
We did not collect data from couples, but individuals. Our participants’ partners may have had different experiences and perceptions that, if considered, may have yielded different results, such as in the domain of family support. Future work in this area should consider the potential benefits of a dyadic approach to data collection (Kenny et al. 2006; Smith et al. 2020) to understanding the differing and potentially interacting effects of both partners’ reports of characteristics, attitudes, and behaviors. We also did not inquire about family of origin economic resources or financial stability, making it difficult to determine whether their provision of resources to participants and their partners was related to their own ability to do so. When people marry, they theoretically have access to more financial capital, yet this really only applies to those who marry partners with at least some financial means (Thomas et al. 2017).
We did not ask about specific disabilities and/or whether they were diagnosed by a health provider; indeed, our index of disability was a one-item, subjective question. Our single-item measure also did not enable us to account for the potentially very different realities and impacts of a diverse array of disabilities, which, as we saw in the qualitative data, ranged from serious mental health issues to significant physical impairment. Future work should consider varying types of, and levels of impairment related to, different disabilities. Family assistance for financial and health needs was also assessed with single-item questions that did not address degree or duration of assistance. Using continuous measures of support that take into account the degree (and duration) of support would increase the power to test predictors. Likewise, a more refined and nuanced set of questions probing support would enable researchers to differentiate between the provision of different levels and types of support: indeed, the provision of resources to avoid eviction is different in meaning and urgency than offering funds to help with a business venture.
As noted earlier, our findings did not take family members’ initial level of acceptance into account when considering whether they increased or not. Our finding that participants were less likely to see their own family as increasing in acceptance than their partners could reflect that they viewed their own families as already more accepting/they had less room to “grow.” Future work can better tease apart overall level of support versus change in support—although of note is that in this study, we were specifically interested in whether the increase in acceptance associated with marriage was predictive of support-giving. Future work, too, can tease apart the role, function, and composition of social network support more fully. For example, we did not examine support from friends versus family: some prior work found that for major support needs, such as borrowing money, heterosexual people and lesbian/bisexual women relied more on family, while gay/bisexual men relied more on friends (Frost et al. 2016; Shippy et al. 2004).

5. Conclusions and Implications

Our findings point to some of the ways in which marriage may matter for LGBTQ+ people, particularly those with disabilities and health care needs. Of note are our qualitative findings highlighting flexibility, adaptation, and stress in the face of health challenges. LGBTQ+ people may especially benefit from marriage during aging or health care crises, insomuch as they can depend on the relational security, health insurance, and legal protections linked to marriage.
Further, our findings offer new insights related to marriage, family, and support for LGBTQ+ people. Across multiple generations, LGBTQ+ people have relied not only on partners but also friends for support, including caregiving help, in the case of disability or illness. Leaning on members of the queer community was, and is, especially important in the context of limited support from family of origin (Fredriksen-Goldsen 2018). LGBTQ+ people have historically relied on family of choice (Knauer 2016; Weston 1997), converting friends to kin when faced with family of origin rejection, exclusion, and weak ties (Allen et al. 2011). Yet family of origin, when available, can certainly be a powerful source of support. Through the bonds of marriage, LGBTQ+ people may come to have two families, or sets of in-laws, that they can rely upon. The possibility that marriage may lead to greater acceptance by family members of LGBTQ+ people, potentially transforming tenuous relationships into formally recognized and stable kinship ties, builds on prior work—but extends it by suggesting that increased acceptance may be associated with financial help, a powerful source of support that has the potential to offset various forms of social-structural stress. Moreover, our qualitative data highlight ways that LGBTQ+ married people and their partners lean on family for a wide array of instrumental needs.
To the extent that LGBTQ+ married spouses can lean on their families of origin for assistance—not only in relation to health care crises but also for financial support, child care and other types of instrumental support, and emotional support—this may have significant beneficial consequences for emotional, relational, and family well-being. The ability to depend on one’s family of origin, or one’s partner’s family of origin, in times of need, can reduce stress associated with housing, health, and overall stability, and solidify intergenerational bonds. In this way, marriage has the potential to facilitate shifts in LGBTQ+ people’s family relationships that have powerful cascading effects, mitigating the impacts of structural inequities, reducing stress, and promoting individual and family well-being.
Our findings have a number of practical implications. First, they suggest that individuals in same-sex couples may benefit from the legal support and recognition that marriage provides—but also, tax credits for family care, health care costs, and so on, should ideally be extended to support more forms of dependent care, including from non-kin, to ensure greater flexibility and freedom in supporting both the people who need care and the people who provide it. Second, our findings highlight the need for national surveys that address disability and caregiving to incorporate questions about sexual orientation and gender identity in order to address more fully the ways these different identities and statuses intersect. Finally, based on our findings, clinicians and service providers who work with LGBTQ+ people, particularly those who are older and/or have disabilities, should address (a) issues of family acceptance and possible reconnection when safe and appropriate; (b) development and fostering of friendship and community networks (c) perceptions of self-reliance among LGBTQ+ people that may be adaptive in some contexts, but may be impeding well-being in others; and (d) caretaking needs and demands alongside the provision of LGBTQ+-affirming resources to support couples and families.

Author Contributions

Conceptualization, A.E.G. and B.S.; methodology, A.E.G. and B.S.; software, A.E.G. and J.Z.S.; validation, A.E.G. and J.Z.S.; formal analysis, A.E.G. and J.Z.S.; investigation, A.E.G.; resources, A.E.G. and B.S.; data curation, A.E.G. and J.Z.S.; writing—original draft preparation, A.E.G.; writing—review and editing, J.Z.S. and B.S.; visualization, A.E.G. and J.Z.S.; supervision, A.E.G.; project administration, A.E.G.; funding acquisition, A.E.G. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by grants from Freedom for All Americans and The Williams Institute at UCLA, awarded to the first author.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Clark University (protocol code #526 on 15 November 2023).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflict of interest.

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Table 1. Select Demographic Details (N = 484).
Table 1. Select Demographic Details (N = 484).
VariableM, SDN, %
Participant race a
  White334 (69.0%)
  Black/African American87 (18.0%)
  Hispanic73 (15.1%)
  Latino/a/x51 (10.5%)
  Asian40 (8.3%)
  American Indian/Alaska Native25 (5.2%)
  Native Hawaiian 6 (1.2%)
  Something else (e.g., Caribbean, Chicana, Middle
  Eastern)
18 (3.7%)
Religion
  Nothing in particular 170 (35.1%)
  Atheist 77 (15.9%)
  Agnostic 64 (13.2%)
  Protestant 58 (11.6%)
  Roman Catholic 36 (7.4%)
  Jewish 12 (2.5%)
  Buddhist 7 (1.4%)
  Something else (e.g., Baptist, Lutheran, Spiritual) 60 (12.9%)
Personal Income
  Under $25K/year 78 (16.1%)
  $25K–$50K 125 (25.8%)
  $51K–$75K 123 (25.4%)
  $76K–$100K 67 (13.8%)
  $101K–$125K 37 (7.6%)
  $126K–$150K 18 (3.7%)
  Over $150K 36 (7.4%)
Region of the U.S.
  South 146 (30.2%)
  Midwest 138 (28.5%)
  West Coast 111 (22.9%)
  East Coast 88 (18.2%)
a Participants could indicate more than one; thus, numbers add up to more than 100.
Table 2. Disability and Caregiving, Considered Separately (N = 484).
Table 2. Disability and Caregiving, Considered Separately (N = 484).
YesNoN/A, No Disability or Caregiving Need
Are you living with a disability?132 (27.3%)352 (72.7%)
Is your partner living with a disability?126 (26.0%)358 (74.0%)
Is your partner a caregiver for you?60 (12.4%)248 (51.2%)176 (36.4%)
Are you a caregiver for your partner?70 (14.5%)210 (43.4%)204 (42.1%)
Note: See Table 3 for disability status and caregiving considered together.
Table 5. Support from Family of Origin (N = 484).
Table 5. Support from Family of Origin (N = 484).
YesNoN/A
At least one of our families of origin has given us money256 (52.9%)159 (32.9%)69 (14.3%)
At least one of our families of origin has helped us during a health care crisis144 (29.8%)189 (39.0%)151 (31.2%)
Table 6. Logistic Regressions Predicting Family Help in Response to Financial or Health Need.
Table 6. Logistic Regressions Predicting Family Help in Response to Financial or Health Need.
Helped in Response to
Financial Need (n = 415)
Helped in Response to Financial Need
with Interactions
(n = 415)
Family Helped in Health Care Crisis
(n = 333)
BSEWaldExp (B)BSEWaldExp (B)BSEWaldExp (B)
Family income−0.18 * 0.085.300.83−0.20 * 0.086.070.820.0110.090.021.01
Age in years−0.04 *** 0.00922.760.96−0.040.00922.300.96−0.02 + 0.0093.600.98
Any children < 18−0.230.320.520.80−0.180.320.320.83−0.320.330.990.72
Trans couple0.82 *0.345.892.280.200.450.191.220.55 + 0.342.621.74
Cis woman couple0.110.250.181.11−0.310.311.010.740.49 +0.292.761.63
Either has disability0.120.300.151.13−0.700.432.800.480.64 * 0.314.271.89
Either is caregiver0.250.360.491.280.250.370.451.280.70 * 0.354.072.01
Increased family acceptance (mine)0.370.291.611.450.420.301.981.520.360.301.451.43
Increased family acceptance (partner)0.57 * 0.255.271.770.57 * 0.255.141.770.290.261.261.34
Disability × trans--------1.53 * 0.450.191.22--------
Disability × woman--------−0.310.311.010.74--------
Constant2.43 *** 0.5718.35--2.73 ***0.5921.21---−0.460.610.56--
Model statisticsχ2(9) = 71.11 ***;
McFadden R2 = 0.13
χ2(11) = 79.10 ***;
McFadden R2 = 0.14
χ2(9) = 43.15 ***;
McFadden R2 = 0.09
Note: For gender, default is cis man couple. + p < 0.10. * p < 0.05. *** p < 0.001.
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MDPI and ACS Style

Goldberg, A.E.; Smith, J.Z.; Sears, B. Reliance, Support, and Caregiving Among Married LGBTQ+ Americans: Spousal and Family Relationships. Soc. Sci. 2025, 14, 605. https://doi.org/10.3390/socsci14100605

AMA Style

Goldberg AE, Smith JZ, Sears B. Reliance, Support, and Caregiving Among Married LGBTQ+ Americans: Spousal and Family Relationships. Social Sciences. 2025; 14(10):605. https://doi.org/10.3390/socsci14100605

Chicago/Turabian Style

Goldberg, Abbie E., JuliAnna Z. Smith, and Brad Sears. 2025. "Reliance, Support, and Caregiving Among Married LGBTQ+ Americans: Spousal and Family Relationships" Social Sciences 14, no. 10: 605. https://doi.org/10.3390/socsci14100605

APA Style

Goldberg, A. E., Smith, J. Z., & Sears, B. (2025). Reliance, Support, and Caregiving Among Married LGBTQ+ Americans: Spousal and Family Relationships. Social Sciences, 14(10), 605. https://doi.org/10.3390/socsci14100605

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