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Gender-Affirming Service and Supports
Overview
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
Transgender and gender-expansive people face enormous challenges when entering community settings. They face elevated levels of discrimination and harassment, both from staff, volunteers, other residents and even the friends and family of staff, volunteers and other residents. It is critically important that all long-term care communities display a zero-tolerance environment for any displays of transgender bias.
Having policies that outline proper protocols creates conditions where transgender residents can feel safe and be supported in long-term care communities, while also setting clear expectations for staff, volunteers and other residents.
To receive credit for the LEI, a community must:
-Must provide an official written official policy (or policies) or procedure(s) which cover at least 3 of the policies listed below:
These include:
- Recording of the resident's name and pronouns in move-in/registration records (regardless of legal change)
- Correct use of resident's name and pronouns when interacting with and referring to the resident (regardless of legal change)
- Guidelines for room assignments for transgender residents
- Restroom policy states residents have the right to use the bathroom facilities that correspond with their gender identity
- Access to programs/activities that align with one's gender identity (e.g. a transgender woman can attend a women's day outing)
- Access to items that assist gender presentation (i.e. ensuring that no resident is denied to wear or be dressed in clothing, accessories, or cosmetics that are permitted for any other resident regardless of gender or gender identity)
- Addressing potential problems with insurance/billing claims related to gender-affirming care
- Preventing interruption to and supporting the right of residents to seek gender-affirming medical and behavioral healthcare such as hormone therapy
- Compliance with privacy laws
Resources:
Guide: Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies by HRC Foundation, Lambda Legal, and the LGBT Rights Committee of the New York City Bar Association.
Article: Ask HRC: When Patients Object to Transgender Roommates By ECRI - an independent nonprofit organization improving the safety, quality, and cost-effectiveness of care across all healthcare settings worldwide
Template Policy: We have created a template policy available for organizations to use in creating their own policy for welcoming interactions with transgender residents. Note that this is a basic starter template - be sure to customize as needed with specific information relevant to your organization.
Jersey City Medical Center - Room Assignment Policy (pg 4) Example of Rooming policy and procedures (from a hospital system) for room placement and issues that may pop up.
Bathroom safety is a paramount concern among transgender and gender-expansive individuals. According to the National Center for Transgender Equality. A majority (53%) of transgender people report experiencing verbal harassment or disrespect in a place of public accommodation and 8% percent report being physically attacked or assaulted in places of public accommodation.
59% of transgender people say they have avoided bathrooms in the last year because they were afraid of problems, such as being confronted by others;
12% of transgender people report that they have been harassed, attacked, or sexually assaulted in a bathroom in the last year
And although some claim that expanded bathroom access will result in safety risks to women and girls, a 2018 study from the Williams Institute found no link between gender-inclusive bathrooms and safety. The research showed that reports of these incidents are extremely rare. The real risk is non-inclusive bathrooms. Reports of attacks on transgender people in restrooms are much more highly prevalent and present a serious safety risk to transgender and gender-expansive people.
Because of the growing recognition of this safety precaution, many organizations and businesses across the country have adopted gender-inclusive bathroom policies and procedures.
To receive credit in the LEI, a community must:
-Provide the number of gender neutral bathrooms in public areas
-Upload a sample of the signage for one of the bathrooms
Example:
"All Gender" bathroom signage