LGBTQ Resident Services Overview
Due to a lifetime of discrimination and stigma, LGBTQ people living in long-term care communities may not feel comfortable being themselves. They may be concerned about treatment from staff or other residents. They may be uncertain if they can attend programming and be welcomed to be their full, authentic self; they may worry about whether or not they can room with their same-sex significant other, spouse or domestic partner. They may want information about their sexual orientation and gender identity and expressions kept confidential out of fear of reprisal from others.
A 2018 AARP report surveyed LGBTQ people ages 45 and up and found that 60% were concerned about their future treatment in long-term care:
- 67% concerned about neglect
- 62% concerned about abuse
- 61% concerned about limited access to services
- 60% concerned about verbal or physical harassment
It’s vitally important and necessary for long-term care communities to put safeguards into place which will support LGBTQ residents to age with dignity, safety and in good health.
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.
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.
Within senior services, “person-centered planning” and/or care, is considered a best practice - one which seeks to involve the whole person in selecting services and supports that will best serve the individual. One of the most critical components of the process is that it be directed by the person receiving the support.
Furthermore, 1987 federal nursing home law requires nursing homes to protect and promote the rights of each resident - emphasizing the “individual dignity and self-determination in the provision of long-term care.” [The National Long-Term Care Ombudsman Resource Center]. Additionally, Residents Rights require that residents have the right to participate in their own care, including “the right to be informed about care and treatment, participate in their own assessment and care planning and make decisions regarding their treatment, including health care choices related to gender transition.”
For long-term care communities providing health and medical services, person-centered planning and/or care should incorporate all important aspects of one’s identity, including a resident’s sexual orientation, gender identity/expression, race, religion and other important cultural and identity characteristics, as well as special conditions such as HIV and/or Dementia. Person centered planning and/or care should incorporate the fullness of one’s being in service planning.
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.
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 criteria is met 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.
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.
Sharing information about and participating in recognizing LGBTQ days of significance sends a message of LGBTQ-inclusion to all people engaged in long-term care communities: LGBTQ residents, staff, volunteers and non-LGBTQ residents. It also provides opportunities for LGBTQ residents to engage in activities that may more personally resonate with them. There are a number of well-known and nationally-recognized events and dates throughout the year. LGBTQ Nation has a long list of annual days of significance, including some of the more well-known following dates/months:
- March 31: International Day of Transgender Visibility
- May 22: Harvey Milk Day
- June: LGBTQ Pride Month
- September 23: Bisexuality Day
- October: LGBTQ History Month
- October 11: National Coming Out Day
- November 20: Transgender Day of Remembrance
- December 1: World AIDS Day
According to a 2018 AARP survey of LGBTQ older adults, up to 73% of respondents are concerned about having access to LGBTQ-specific senior services. Most people indicate they are most concerned about the potential quality of care in long-term care communities and lack of access to LGBTQ-inclusive services there. This is important because not all service providers will be knowledgeable about the needs of LGBTQ individuals nor know the best ways to provide those services. Long-term care communities serve an important role in being able to provide culturally responsive and relevant referrals for their residents.
Creating a list of LGBTQ-affirming referrals can be a challenging task, one which can include vetting potential referral sources and the extent to which they have LGBTQ-inclusive policies in writing and procedures in action. The LEI considers it a best practice for long-term care communities to keep a list of LGBTQ-inclusive referral sources or connect residents to local organizations who maintain current LGBTQ-inclusive referral lists such as members of the SAGE Affiliates Network or your local Area Agency on Aging.
Below are some examples LGBTQ-inclusive referral lists used by long-term care communities created in by and in partnership with SAGE affiliates and Area Agencies on Aging who have created inclusive referral guides.
Examples from SAGE Affiliates:
Examples from Area Agencies on Aging (AAA):