LGBTQ+ older adults fear discrimination in long-term care, need protections: study

Lesbian, gay, bisexual, transgender and queer residents in assisted living and other long-term care settings fear discrimination, necessitating a “dramatic, systematic change” to care to protect those residents and promote equitable healthcare, according to a new study from Rush University Medical Center.

“In [long-term care] settings, LGBTQ+ older adults are forced to navigate a healthcare system that assumes heteroseuxality and gender conformity amongst providers who are poorly trained to care for their specific needs,” according to the study, published in the journal Clinical Gerontologist.

The authors recommend increasing staff training, and revising forms and policies to ensure all sexual orientations and gender identities are protected.

Specifically, the authors recommend widespread staff training that exposes staff to lesbian and gay older adults, and includes education on all lesbian, gay, bisexual, transgender and queer older adults identities. Creating an environment conducive to LGBTQ+ residents’ safety, they wrote, means staff should acknowledge that “LGBTQ+ residents not only exist in long-term care settings, but are a heterogenous community with individual needs and desires.”

They added that it is up to leadership to enforce policies to prevent discrimination and encourage inclusivity.

The number of LGBTQ+ individuals aged 65 or more years worldwide is expected to be between 1.6 billion and 2 billion by 2050, according to the study authors. LGBTQ+ older adults are more likely to live alone, be socially isolated and have less family support, disproportionately leading to a reliance on long-term care, according to the authors. Without protective policies and practices, this population can be at risk for issues such as access to care and living arrangements.

Sherrill Wayland, director of national education initiatives for eldercare advocacy group SAGE, said it’s no surprise that many LGBTQ+ elders do not feel comfortable going into long-term care for fear of discrimination.

“Safe and welcoming long-term care communities require an intentional commitment to inclusivity and ongoing cultural awareness,” Wayland told McKnight’s Senior Living.

The Rush University Medical Center research team reviewed 20 studies related to caring for LGBTQ+ older adults in long-term care settings. Those studies showed an overall lack of knowledge among long-term care staff about their LGBTQ+ residents, as well as a lack of awareness of the challenges, stigmas and biases these older adults face in healthcare settings.

The authors noted that data confirms that their care in long-term care facilities can be “subpar, at times even damaging, forcing an entire generation back into the closet during a time of great need.”

Wayland said she supports the study’s recommendations for updating policies and procedures, being LGBTQ+-inclusive and providing ongoing opportunities for cultural competency training.

Wayland said SAGECare programs provide LGBTQ+ cultural competency training and credentialing to long-term care communities. The Long-term Care Equality Index, a joint program from SAFE and the Human Rights Campaign Foundation, is another resource that provides senior living and other long-term care providers with a self-assessment tool to evaluate the care being provided to LGBTQ+ older adults.

“We need to provide opportunities, like SAGECare and the LEI, to these facilities who are ready to ensure that older LGBTQ+ people can live their authentic lives and age with dignity and respect,” Wayland said. “In addition, passing the Equality Act would go a long way in ensuring that federal nondiscrimination protections are provided for LGBTQ+ elders and the entire LGBTQ+ community.”

This article was originally published in McKnights Senior Living News on August 16, 2021.