LGBTQ+ older adults have often spent a lifetime navigating stigma, discrimination, and exclusion—experiences that can significantly impact their well-being as they age. In long-term care settings, it’s essential that we provide environments that are not only safe but also affirming and respectful of every individual’s identity. By increasing awareness and strengthening cultural competency, care professionals can help ensure that LGBTQ+ residents receive the compassionate, inclusive support they deserve.

The Growing Population of LGBTQ+ Older Adults

An estimated 2.7 million U.S. adults over age 50 identify as LGBTQ+, and that number is projected to exceed 5 million by 2030 (National Institutes of Health). These individuals bring rich life experiences but often face significant disparities in health care access, social support, and economic security.

Decades of discrimination have led many LGBTQ+ older adults to avoid healthcare systems altogether. As the American Psychological Association notes, older LGBTQ+ adults are more likely to live alone, less likely to have children or caregivers, and more likely to report poor physical and mental health.

Unique Barriers in Long-Term Care Settings

While federal and state regulations prohibit discrimination, many LGBTQ+ elders continue to report mistreatment and exclusion in care settings. The LGBT Aging Center and the California Advocates for Nursing Home Reform (CANHR) document issues such as denial of care, refusal to acknowledge same-sex partners, and staff lacking training in LGBTQ+ cultural awareness.

A 2023 study in Geriatric Clinics revealed that 76.3% of LGBTQ+ older adults in the U.S. South would be more willing to use long-term care services if the care were provided by LGBTQ+ individuals or trained allies (Geriatric Clinics, 2023).

A New Standard: The Long-Term Care Equality Index

In response, the 2023 Long-Term Care Equality Index (LEI) from the Human Rights Campaign Foundation and SAGE has emerged as a powerful tool to benchmark and promote inclusive practices. Participating facilities are assessed on non-discrimination policies, staff training, resident services, and data collection. The 2023 LEI included 200 long-term care communities from 34 states, many of which are leading the way in LGBTQ+ inclusivity.

Actionable Steps for Inclusive Care

To move from compliance to compassion, long-term care providers must commit to cultural competence as an ongoing journey. The APA Division 44 and NYS Office for the Aging LGBTQ+ Resource Guide recommend:

• Training and Education: Regular staff training on LGBTQ+ issues and inclusive language.
• Inclusive Policies: Written non-discrimination statements and inclusive intake forms.
• Affirming Environments: Visual cues of support (e.g., rainbow flags, inclusive signage), gender-neutral bathrooms, and welcoming communication.
• Respect for Identity and Relationships: Honoring chosen family, pronouns, and gender identities.

Be the Difference: LGBTQ+ Sensitivity Training for Long-Term Care Professionals

To support this mission, CareerSmart Learning offers a dedicated course:
👉 LGBTQ+ Sensitivity Training for Long-Term Care Professionals (California Required)

Course Highlights:

• Designed to meet California’s training requirements for staff in skilled nursing and congregate living settings.
• Approved for 1.0 CE/contact hour for California RN, LVN, LPN, and CNA.
• Covers laws affecting LGBTQ+ individuals in long-term care, challenges faced by LGBTQ+ elders, and strategies to create a welcoming, inclusive environment.
• Features interactive elements and a final exam (with unlimited retakes).
• Certificates available immediately upon completion.

By completing this training, you are not only fulfilling a legal requirement—you’re taking a meaningful step toward improving the lives of LGBTQ+ older adults in your care.

Inclusive care starts with education, and every learner makes a difference.

References

American Psychological Association. (n.d.). LGBTQ+ aging. https://www.apa.org/pi/lgbt/resources/aging

APA Division 44: Society for the Psychology of Sexual Orientation and Gender Diversity. (n.d.). Aging and the LGBTQ+ population: A policy and advocacy guide. https://www.apadivisions.org/division-44/resources/advocacy/lgbt-aging.pdf

California Advocates for Nursing Home Reform (CANHR). (n.d.). LGBT resources. https://www.canhr.org/

Fredriksen-Goldsen, K. I., Kim, H.-J., Shiu, C., Goldsen, J., & Emlet, C. A. (2015). Successful aging among LGBT older adults: Physical and mental health-related quality of life by age group. The Gerontologist, 55(1), 154–168. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375167/

Geriatric Clinics. (2023). Meeting the health and social needs of LGBTQ+ older adults through Medicaid. Clinics in Geriatric Medicine, 39(2), 247–259. https://www.geriatric.theclinics.com/article/S0749-0690(23)00091-5/abstract

Human Rights Campaign Foundation & SAGE. (2023). 2023 Long-Term Care Equality Index. https://reports.hrc.org/2023-long-term-care-equality-index

LGBT Aging Center. (n.d.). Resources and education for LGBT aging. https://www.lgbtagingcenter.org/

New York State Office for the Aging. (2024). LGBTQ+ resource guide for older adults. https://aging.ny.gov/system/files/documents/2024/06/lgbtq-resource-guide-for-older-adults-2024.pdf