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Experts predict that as many as 4.7 million older lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults may need supportive care and services by the year 2030. While LGBTQ+ adults confront the same issues everyone else does when choosing aging services -- where to live, how to afford rising costs of housing and healthcare, and how to stay with loved ones -- the reality of life in long-term care for LGBTQ+ people can be drastically different from their non-LGBTQ+ peers. Stigmatization, lack of identity-affirming treatment and experiences of discrimination and violence can lead to avoiding necessary services, chronic stress and increased social isolation among LGBTQ+ older adults. Additionally, approximately 20 percent of LGBTQ+ older adults are people of color who as a group face increased health disparities, higher levels of stigma and have experienced more LGBTQ+ related discrimination than their white counterparts, leaving them more at risk of not seeking or receiving the services they need.

A recent national survey of LGBTQ+ older adults by AARP found that more than 60 percent of those surveyed were concerned about how they would be treated in a long-term care setting, including fear that they might be refused or receive limited care; be in danger of neglect or abuse; or face verbal or physical harassment. The same survey found that more than 80 percent of respondents would be more comfortable if long-term care communities took actions to intentionally affirm LGBTQ+ adults.

SAGE, the world’s largest and oldest organization dedicated to improving the lives of LGBTQ+ older people, and the Human Rights Campaign Foundation (HRCF), the educational arm of the nation’s largest civil rights organization working to achieve equality for LGBTQ+ people, are joining forces to launch the Long-Term Care Equality Index (LEI) to promote equitable and inclusive care for LGBTQ+ older people in residential long-term care communities.

SAGE and HRC Foundation believe that most long-term care communities do not want LGBTQ+ older adults to face discrimination or have to worry about the care that they will receive. But these communities may be unsure how to protect their LGBTQ+ residents from discrimination, provide them with optimal care and extend a warm welcome to allay their concerns. The LEI will encourage and help long-term care communities to adopt policies and practices that provide culturally competent and responsive care to LGBTQ+older adults.

Skilled nursing communities, often referred to as “nursing homes.” provide a wide range of health and personal care options. SNFs assist residents with activities of daily living, such as eating, bathing and getting dressed. This higher level of care includes 24-hour medical care, 3 meals a day, social activities, and rehabilitation services (e.g physical therapy, speech therapy).

Assisted living communities are for people who need help with daily care but not as involved as skilled nursing care. Assisted living residents typically live independently in their own apartment with on-site staff, housekeeping, security, social and recreational activities. There may be access to additional services (often for an additional fee) such as 3 meals a day, personal care assistance, and medication management.

Memory care communities provide long-term care services to individuals with cognitive decline and dementia. While memory care communities may offer similar services and support as assisted living communities, this housing type is staffed, structured, and equipped to meet the specific needs of individuals with dementia.

Independent living communities are age-restricted (~55+) communities. Housing options can vary from apartments, condos, townhomes and duplexes. These residential communities provide an active environment with scheduled activities and commonly provide amenities such as a fitness center, hair salon, on-site entertainment, and dining services. Some communities may provide housekeeping and linen services, security, and transportation.

Also known as Life Care communities or Continuing Care Retirement Communities (CCRCs) offer different levels of care in one location. Most Life Plan communities offer independent housing, assisted living, and skilled nursing care on a single campus. Where a resident lives depends on one’s necessary level of care. In a Life Plan community, if a resident in independent living experiences a change in health status they can move into the assisted living facility on site. If a resident in assisted living develops greater care needs, the resident is guaranteed placement in the skilled nursing community onsite.

Affordable Senior Housing, sometimes known as low-income senior housing, are 55+ communities supported by the U.S. Department of Housing and Urban Development (HUD) programs such as Section 202 and Section 8 Project-Based Rental assistance programs. Entry to these communities are income-based.

Hospice care is commonly administered to where a patient lives. A free-standing hospice residential facility is considered a patient's home and care is provided 24-hours a day. Free-standing hospice facilities offer an alternative route to care for those who do not have at-home caregivers to support their end-of-life journey.