Human Rights Campaign and SAGE Release First Edition of the Long-Term Care Equality Index

The Long-Term Care Equality Index (LEI) is the first-ever nationwide assessment of LGBTQ+ inclusivity and inclusion at long-term care communities in the U.S. 

WASHINGTON, D.C. – Today, the Human Rights Campaign (HRC) Foundation, the educational arm of the nation’s largest lesbian, gay, bisexual, transgender and queer (LGBTQ+) civil rights organization, and SAGE, the world’s largest and oldest organization dedicated to improving the lives of LGBTQ+ older adults, released the first edition of the Long-Term Care Equality Index (LEI). This national benchmarking tool evaluates long-term care communities based on the equity and inclusion of their LGBTQ+ residents and patients. This initial report does not score long-term care communities, but instead includes research data on how many long-term care communities currently have LGBTQ+-inclusive policies, and lays out how organizations can participate in the LEI and improve their policies.

Despite significant progress, LGBTQ+ people lack basic legal protections in states across the country, including consistent and explicit anti-discrimination protections. Without these protections, long-term care communities must adopt their own LGBTQ+ non-discrimination policies to protect their residents and employees. However, the HRC Foundation and SAGE’s research found that that is rarely the case. Of the long-term care communities where enumerated residential non-discrimination policies existed, only 18% had an LGBTQ+-inclusive non-discrimination policy. Of the long-term care communities where enumerated employee non-discrimination policies were found, only 36% had an LGBTQ+-inclusive non-discrimination policy.

“Long-term care is an essential part of assisting and providing for LGBTQ+ people as they age. The Human Rights Campaign Foundation is proud to partner with SAGE on the Long-Term Care Equality Index (LEI), a new benchmarking tool set to fundamentally change the inclusivity of long-term care,” said Human Rights Campaign President Alphonso David. “As this report makes clear, finding inclusive long-term care communities can be especially challenging for LGBTQ+ older adults, and that more long-term care communities need to take the lead on LGBTQ+ inclusion. Together, the Human Rights Campaign Foundation and SAGE will continue working to ensure that LGBTQ+ people at all stages of life have safe and equitable access to inclusive long-term care.”

“Equitable and inclusive care in residential long-term care communities is vital for LGBTQ+ elders to thrive in their later years,” said Michael Adams, CEO of SAGE. “The Long-Term Care Equality Index (LEI) is designed to both assess a facility’s current services, and assist them in adopting policies that promote culturally competent care. We at SAGE are proud to partner with the HRC Foundation on this crucial tool for both our LGBTQ+ pioneers and the many facilities that serve them.”

The invisibility of LGBTQ+ elders, many of whom remain closeted or return to the closet when they enter long-term care, has perpetuated the false perception that there is not a pressing need to make policy or practice changes to ensure that care communities are welcoming and inclusive of LGBTQ+ elders. However, more than 5% of people who live in long-term care communities are LGBTQ+. And for LGBTQ+ BIPOC community members, there is compounded fear of discrimination and inadequate care based not only on sexual orientation and gender identity, but also racial bias.

Many long-term care communities that want to welcome LGBTQ+ residents and patients may not know how to do so. The Long-Term Care Equality Index gives professionals, providers, older adults and care partners the tools for being LGBTQ+ inclusive, building on the decade-plus success of the HRC Foundation’s Healthcare Equality Index (HEI). The LEI will measure the following policy and practice areas as benchmarks of LGBTQ+ inclusion in long-term care settings:

  • Foundational Policies & Practices;
  • Resident Services & Support;
  • Employee Benefits & Policies; and
  • Resident & Community Engagement

As of the release of this initial report, there have been 78 “Commitment to Caring” pledges completed, which is the first step in the LEI and indicates long-term care communities’ intentions to adopt LGBTQ+ inclusive and culturally competent policies and practices. Additionally, there have been 49 self-assessments completed for 184 diverse long-term care communities, with 32 states represented. The next edition of the LEI will be released in 2023. Organizations can participate in the LEI by signing the “Commitment to Caring” pledge, taking the LEI self-assessment and planning for long-term LGBTQ+-inclusive goals after receiving a customized needs-assessment report.

To download the Long-Term Care Equality Index 2021, visit For more information about the LEI, visit


SAGE is the world’s largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual, and transgender (LGBTQ+) older people. Founded in 1978 and headquartered in New York City, SAGE is a national organization that 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. With staff located across the country, SAGE also coordinates SAGENet, a growing network of affiliates in the United States.


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, 600,000 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.