LGBTQ+ Resident Services and Supports

It is imperative that senior housing communities establish standard protocols to ensure that a resident’s expressed name and pronoun are used in record-keeping and in interactions with staff, volunteers, residents, and visitors.

For transgender individuals, the name and gender that appears on a legal state identification card, social security card, financial accounts, health insurance, and healthcare records may differ from the resident’s expressed/preferred name and gender. Communities must develop procedures for maintaining any legal naming obligations while also ensuring that only a resident's expressed name and gender pronoun are reflected in day-to-day internal operations and interactions. This includes activity rosters, service requests, room nameplates, and every place in which a resident’s name is used unless there is a legal requirement to do otherwise.

To receive credit for the LEI, a community must:
-Upload a copy of an intake/admission form(s) that includes fields for "preferred/chosen name" and "pronouns" 

If information is captured in EHR, upload a screenshot of "dummy" resident chart

Example:
 

Electronic Health Record with Fields for Preferred Name and Pronouns

It’s considered a best practice by many industry standards to provide opportunities to gather information about an individual’s sexual orientation and gender identity/expression in order to ensure affirming and culturally responsive services. The National Resource Center on LGBTQ+ Aging has produced some of the most well-known documentation that explores how communities can ask and track this information during move-in interviews with new residents:

Inclusive Questions for LGBT Older Adults: A Practical Guide to Collecting Data on Sexual Orientation and Gender Identity by SAGE

Questions about Sexual Orientation and Gender Identity in Aging Services - Resource by SAGE

To receive credit for the LEI, a community must:
-Upload a copy of an intake/admission form(s) that includes fields for "sexual orientation," and "gender identity"
 

If information is captured in EHR, upload a screenshot of "dummy" resident chart

Example:

Sexual Orientation: Do you think of yourself as: □Lesbian or gay, □Straight or heterosexual, □Bisexual , □Something else, □Prefer not to answer

Gender Identity: Are you (Mark all that apply):
□Female, □Male, □Transgender, non-binary, or another gender
 

2-Part Gender Identity: 1. Sex at birth: □Male, □Female
2. Current Gender Identity: □Male, □Female, □Transgender Male, □Transgender Female, □Non-Binary, □Something else, □Prefer not to answer

Electronic Health Record with Fields for Sexual Orientation and Gender Identity

Forms are often the first indicator to LGBTQ+ people about the extent to which an organization is inclusive of LGBTQ+ people. Including gender-neutral options for identifying important family members, friends, and emergency contacts is not only a positive signal of inclusion, it also provides staff with important information about the important people in a resident’s life.

To receive credit in the LEI, a community must:
-Upload a copy of an intake form or related document that has gender-neutral relationship options

Example:

What is your current relationship status? (check all that apply)
□ Single, □ Never Married, □ Married, □ In a Civil Union, □ Separated, □ Divorced, □ Widowed, □ Living with a Partner, □ Prefer Not to Answer

The federal government requires that all long-term care communities receiving medicaid or medicare funding ensure that residents have the right to be “free from abuse (by any individual, including other residents)” and that communities must “develop and implement policies and procedures that prohibit mistreatment of residents and investigate allegations of abuse.”

And yet research indicates LGBTQ+ older adults do experience abuse and discrimination in long-term care settings. In one recent study, Stories from the Field, LGBTQ+ older adults shared their stories of living in various long-term care settings. Patients reported abuse, neglect, discrimination, harassment, refusal of care / services, abrupt discharges, visitation restrictions and denials of basic care. “Altogether, 328 people reported 853 instances of mistreatment,” according to the report. LGBTQ+ older adult concerns also vary by race and ethnicity. A 2018 AARP report on the needs of LGBTQ+ older adults found that 37% black and 25% of latino LGBTQ+ older adults are very concerned about abuse in long-term care, as compared to 19% of white LGBTQ+ individuals.

Because federal guidelines only protect skilled nursing community residents and those living in communities receiving Medicaid or Medicare funding, experts advocate the same protections for all LGBTQ+ older adults living in long-term care, including assisted living and independent living. When long-term care communities explicitly state protection from abuse for LGBTQ+ residents, they provide a critical safety net for residents and clear guidance to employees about expectations.

To receive credit in the LEI, a community must:
-Upload a copy of the neglect and abuse policy
-Have a policy that includes the terms "sexual orientation" and "gender identity or expression" (just "gender identity" is okay)

Education is a key component in making impactful policy change. Ensure that staff understand residents are protected from discrimination based on sexual orientation and gender identity. This explanation can be offered via in-person staff training, staff onboarding, or hosted on an intranet for staff to access.

To receive credit in the LEI, a community must:
-Describe and attach at least one example of how you communicate the inclusive neglect and abuse policy (e.g. training slides, internal memo, etc.)

Residents have the right to voice grievances to their community or other agencies that hear grievances without discrimination or reprisal.

To receive credit in the LEI, a community must:
-Provide at least one example of how the grievance process is communicated to residents
-Have a process that provides 2 different ways to communicate a concern (such as a phone number to the facility’s Ombudsman, an online form, elder abuse hotline, etc.)

LGBTQ+ people may have strong reasons to maintain their privacy and may prefer not to share their sexual orientation and gender identity/expression unless absolutely necessary. Due to a lifetime of discrimination and stigma, LGBTQ+ people may not feel comfortable being “out.” They may be concerned about treatment from staff or other residents and prefer to keep information about their sexual orientation and gender identity/expression private. This may change over time as they develop relationships within the long-term community, or they may choose to keep this information private. Additionally, they might not be “out” to certain friends and/or family members such as brothers or sisters, grown children, and grandchildren. Sometimes coming out to loved ones can have repercussions and so it’s important that resident privacy in this regard be protected and that disclosures are made only with permission or when necessary to perform job duties.

To receive credit in the LEI, a community must:
-Upload a confidentiality policy
-Policy includes the terms "sexual orientation," "gender identity," "gender transition history/transgender status," and "HIV status"

Experiencing and expressing intimacy with a loved one is an important part of human social relationships and healthy aging. One’s home should be a place of safety and privacy and include the space and autonomy to experience and express intimacy with loved ones.

However, in some communities, older adult sexuality is a taboo subject - even for those who are heterosexual - making this subject an even more difficult one to broach for those who are gay, lesbian, or bisexual. This is especially important for some members of the LGBTQ+ community who are less likely to have an identified long-term partner. A 2018 AARP survey of LGBTQ+ community members found that gay men are more likely to live alone and tend to be less socially connected than lesbians or gender-expansive individuals. Providing safe spaces to connect is critical.

This criterion is meant to ensure that those policies are applied equitably to all residents and are inclusive and take into consideration one’s sexual orientation and gender identity/expression.

To receive credit in the LEI, a community must:
-Must upload a copy of a sexual expression policy or like-document that addresses residents’ right to sexual expression
-Includes inclusive relationship type language (spouse/partner) and/or explicitly includes protections based on “sexual orientation” and “gender identity”

Example:
Policies and Procedures Concerning Sexual Expression at Hebrew Home at Riverdale

Residents have a right to choice. This may mean having the ability to choose one's roommate. It is important that any rules or guidelines set forth by the community impact LGBTQ+ residents and non-LGBTQ+ residents equally.

To receive credit in the LEI, a community must:
-Upload a rooming policy
-Policy includes one or more following: "roommate of choice" language; same-sex spouse/partner protections; protection from discrimination based on sexual orientation and gender identity

Example:
The room assignment policy from United Church Homes includes a non-discrimination statement, as well as "roommate of choice" language.

There are a number of well-known and nationally recognized LGBTQ+ events and dates throughout the year. Explore GLAAD's LGBTQ+ Community Calendar to see the number of days and months observed, celebrated, and honored by the LGBTQ community. Examples include:

• March: Bisexual Health Awareness Month
• March 31: International Day of Transgender Visibility
• April 26: Lesbian Visibility Day
• May 17: International Day Against Homophobia, Transphobia, and Biphobia
• September 18: National HIV/AIDS & Aging Awareness Day
• October: LGBTQ+ History Month
• October 11: National Coming Out Day
• November 20: Transgender Day of Remembrance
• December 1: World AIDS Day

To receive credit in the LEI, a community must:
-Host an event or commemorate a day of significance for residents
-Describe the event and upload any relevant items (e.g. photos, flyers, etc.)
*Event must have occurred since 01/01/2023

Example:
Flyer. During Pride Month (June), Woodand Pond at New Paltz hosted multiple events in partnership with their local LGBTQ+ center.

The LEI considers it best practice for senior housing communities to have a list of local LGBTQ+ inclusive resources available for residents. This list can include contact information for the local LGBTQ+ center, LGBTQ+ inclusive places of worship, etc.

To receive credit in the LEI, a community must:
-Upload a document of local LGBTQ+ inclusive resources that is shared with residents

Examples

Organizations can use this template to share LGBTQ+ resources local to your specific area. Customize the list as needed and share with residents by posting in common areas or sharing on your organization's website.

To find local LGBTQ+ friendly resources, search the following:

• LGBTQ+ Centers: https://www.lgbtqcenters.org/LGBTCenters
• Affirming Christian Church Directory: https://www.gaychurch.org/
• Keshet Equality Directory (LGBTQ+ inclusive synagogues, rabbis, and other Jewish services) - https://www.keshetonline.org/r...
• SAGECollab - Find LGBTQ+ Aging Partners: https://www.sageusa.org/what-w...
• SAGECare LGBTQ+ Culturally Competent Providers: https://sageusa.care/sagecare-...
• SAGE x HearMe - On-demand mental health support for LGBTQ+ elders: https://www.sageusa.org/hearme/