Gender-Affirming Service and Supports

Produced by the HRC Foundation

This section is designed to familiarize long-term care communities with best practices to enhance care for transgender patients, who can face an exceptional degree of discrimination and harassment.

A 2011 report by the National Center for Transgender Equality and the National Gay and Lesbian Task Force documented discrimination toward transgender patients in care settings ranging from private doctors’ offices, to emergency rooms, to mental health clinics and drug treatment programs. Respondents reported being harassed by staff or other patients or even being physically abused while seeking care. Nearly one in four transgender women and one in five transgender men reported having been refused medical treatment because of they were transgender. Respondents who had lower incomes or were people of color reported higher rates of mistreatment.

Transgender older adults may feel they have particular reason to fear entering a nursing home because of potential discrimination, hostility, and violence from staff and other residents, and the possibility of receiving unequal care—yet health disparities and social isolation may put many at greater risk for requiring more intensive care. In a recent AARP report, 70% of transgender individuals were concerned they would need to hide their identity in long-term care and 75% were concerned that healthcare providers would not be sensitive to their needs. These fears are exacerbated for transgender people of color who face higher levels of discrimination than their white counterparts.

The federal Nursing Home Reform Act guarantees rights of privacy, dignity, autonomy, and freedom from restraint and abuse in facilities that accept Medicaid and Medicare. Facilities violate these rights when they refuse to respect the identities of residents, such as by refusing to permit or assist them in wearing clothing consistent with that identity; when they deny hormone medication or refuse to provide personal care because staff are uncomfortable with a resident’s body; when they isolate transgender residents; and when they fail to prevent routine harassment by residents or staff. Facility managers and even state officials might not recognize that such practices are illegal. Again, regulators could help by revising federal nursing home guidelines to clarify these rights.

For transgender and gender-expansive people, improving cultural competence for long-term care workers and administrators is a critical component of improving the services and supports they receive. The following section of questions targets key best practices designed to support transgender and gender-expansive residents.

LEI Survey Questions

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