LGBTQ+ Resident Services and Supports

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 long-term care 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

It is imperative that long-term care 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 name and gender. Long-term care 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 "chosen name," "pronouns," "sexual orientation," and "gender identity"

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

Forms are often the first indicator to LGBTQ+ people about the extent to which an organization or long-term care community 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 what names and pronouns to use in discussing 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 for identifying spouse/partner, emergency contact, and durable power of attorney as applicable

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.)

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

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

To receive credit in the LEI, a community must:
-Describe the event and upload any relevant items (e.g. photos, flyers, etc.)
*Event must have occurred since 01/01/2021

Example:
Woodand Plaza hosted multiple events celebrating LGBTQ+ Pride month. The community partnered with their local LGBTQ+ center. Here is a flyer advertising two events.

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.

To receive credit in the LEI, a community must:
-Share either a weblink or upload a document showing where and how residents will find LGBTQ+ affirming resources shared by the community

Examples:
Examples from SAGE Affiliates:
Rainbow Resource Guide by SAGE Metro Detroit

Examples from Area Agencies on Aging (AAA):
Michigan, Region 11 AAA LGBTQ Resource Guide

Michigan, Region 8 AAA LGBTQ Resource Guide