In Face of Anti-LGBTQ+ Extremism, 200 Senior Living Communities Commit to LGBTQ+ Inclusion, Participating in Inaugural Long Term Care Equality Index (LEI) by HRC Foundation and SAGE

90 percent of participants updated resident and employee non-discrimination policies to include protections based on sexual orientation and gender identity – compared to only 18 percent of communities that were researched in the 2021 LEI

Showing work to be done, only 5 percent have abuse and neglect policies that explicitly protect LGBTQ+ residents; 7 percent have policies outlining procedures aimed at eliminating bias and insensitivity toward transgender residents


WASHINGTON Today, SAGE, the world’s largest organization dedicated to improving the lives of LGBTQ+ elders and the Human Rights Campaign (HRC) Foundation, the educational arm of the nation’s largest lesbian, gay, bisexual, transgender and queer (LGBTQ+) civil rights organization, released the 2023 Long Term Care Equality Index (LEI). This year, 200 long-term care communities across 34 states participated in the LEI, with 75 percent of participating communities earning either the High Performer or Leader designation. Recent news about a senior living facility in Boston vandalized with hate speech, as well as a story of a 79-year-old transgender woman who was discriminated against by a nursing home in Maine, highlight the need to support LGBTQ+ elders.

Many older LGBTQ+ people are fearful of living their authentic selves or faced with outright discrimination against them and their families simply because of who they are. In a study by AARP, 76 percent of older LGBTQ+ people expressed concern about having adequate social support to rely on as they age. The same study found that 73 percent of LGBTQ+ older people do not have access to LGBTQ+-specific services for older people. In response, SAGE and the HRC Foundation’s Health & Aging program created the LEI – the only-of-its-kind benchmarking tool promoting LGBTQ+ inclusive policies and practices in long-term care and senior housing communities. The tool also formally recognizes those communities that lead the field in LGBTQ+ inclusion.

“One of the biggest concerns facing older LGBTQ+ people is their future – especially when finding welcoming and inclusive places to live and receive care in their later years,” said SAGE CEO Michael Adams. Today, nearly 200 long-term care communities nationwide demonstrate their commitment to LGBTQ+ elders with their pledge to the LEI. The LEI is a powerful tool that helps ensure that LGBTQ+ elders get the respectful care they deserve as they age. This is essential for all LGBTQ+ older people, but the need is especially acute for LGBTQ+ elders of color, transgender older adults, and LGBTQ+ elders living in rural areas, who often face even greater challenges. SAGE is proud to work with the Human Rights Campaign Foundation on this vital initiative so that LGBTQ+ elders can age with the dignity and respect they deserve.”

“With anti-LGBTQ+ extremism on the rise, it is more important than ever to create safer spaces for LGBTQ+ people and that includes the places we age. It’s powerful to see more than 200 communities come together with HRC and SAGE to deliver on values of inclusion and equity,” said Kelley Robinson, President of the Human Rights Campaign. “Our older LGBTQ+ community – the ones whose shoulders we stand on – are so often forgotten, and they deserve more from all of us. The participation in our first-ever LEI is a huge step forward in uplifting and protecting the needs and rights of our elders. And we aren’t done – we look forward to seeing expanded participation in the LEI in years to come.”

Highlights from the report include:

  • 90% of LEI Participants documented that they include both “sexual orientation” and “gender identity” in their employment non-discrimination policy.
    • In the 2021 LEI, only 36% of communities published an enumerated employment non-discrimination policy that included both “sexual orientation” and “gender identity” in the policy.
  • On the question of equal visitation policy: 95% of the LEI participants for which this question was applicable documented that they have written equal visitation policies in place.
  • 84% of LEI participants met the staff training requirement by having 80% or more of key executives either complete the LEI Executive Briefing training module or training provided by SAGECare as part of their platinum-level SAGECare credential.
  • Percentage of LEI participants that have inclusive intake forms that collect the following data:
    • Chosen Name: 89%
    • Pronouns: 11%
    • Sexual Orientation: 55%
    • Gender Identity: 54%
    • Inclusive Relationship Options: 83%
  • Only 5% have an abuse and neglect policy that explicitly protects LGBTQ+ residents.
  • Only 7% have a policy or policies that specifically outline procedures and practices aimed at eliminating bias and insensitivity, and ensuring appropriate, welcoming interactions with transgender residents.

By 2030, studies project the population of LGBTQ+ people over 50 to reach 7 million. LGBTQ+ people confront many of the same issues everyone else does when aging — from how to afford the rising costs of housing and healthcare to how to stay connected to loved ones. However, LGBTQ+ older people face additional burdens:

  • Being less likely to be partnered or have children, LGBTQ+ elders will often need to rely on paid long-term care services and support.
  • Stigmatization, lack of identity-affirming treatment, and experiences of discrimination and violence can lead to avoiding necessary services, chronic stress, and increased social isolation among older LGBTQ+ peoples.
  • Approximately 20 percent of LGBTQ+ elders are people of color who, as a group, face increased health disparities, higher levels of stigma and have experienced more LGBTQ-related discrimination than their white counterparts, leaving them more at risk of not seeking or receiving the services they need.

The LEI measures the following policy and practice areas as benchmarks of LGBTQ+ inclusion in senior housing settings:

  • Non-Discrimination and Staff Training
    • Ensuring legal protections for LGBTQ+ residents, visitors, and staff along with staff training is a critical step in laying down the foundation for inclusivity.
  • Resident Services & Support
    • This section of the LEI asks about policies and practices that demonstrate progress toward LGBTQ+ resident care and support.
  • Employee Benefits & Policies
    • LGBTQ+ employees, like LGBTQ+ residents, should receive equal treatment and access to health-related benefits and policies.
  • Resident & Community Engagement
    • This section of the LEI asks about best practices a community takes to publicly demonstrate its commitment to the LGBTQ+ community.

For more information on the LEI and to view the 2023 report, click here.


SAGE is the world’s largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) older people. Founded in 1978 and headquartered in New York City, SAGE offers supportive services and consumer resources to LGBTQ+ older people and their caregivers. SAGE also advocates for public policy changes that address the needs of LGBTQ+ elders, provides education and technical assistance for aging providers and LGBTQ+ community organizations through its National Resource Center on LGBTQ+ Aging, and cultural competency training through SAGECare. Learn more at

The Human Rights Campaign Foundation is the educational arm of the Human Rights Campaign (HRC), America’s largest civil rights organization working to achieve equality for lesbian, gay, bisexual, transgender and queer (LGBTQ+) people. Through its programs, the HRC Foundation seeks to make transformational change in the everyday lives of LGBTQ+ people, shedding light on inequity and deepening the public’s understanding of LGBTQ+ issues, with a clear focus on advancing transgender and racial justice. Its work has transformed the landscape for more than 15 million workers, 11 million students, 1 million clients in the adoption and foster care system and so much more. The HRC Foundation provides direct consultation and technical assistance to institutions and communities, driving the advancement of inclusive policies and practices; it builds the capacity of future leaders and allies through fellowship and training programs; and, with the firm belief that we are stronger working together, it forges partnerships with advocates in the U.S. and around the globe to increase our impact and shape the future of our work.