Michael Adams explains how facilities can become more LGBTQ+ inclusive.
Michael Adams

Moving into a long-term care community is a significant life change and requires several factors when deciding where to live. When the time comes for extra support while aging, everyone deserves to feel welcome and safe accessing long-term care. 

However, this is not the case for many LGBTQ+ elders, who make up 5% of people living in long-term care communities. Due to a lifetime of discrimination and continued fear, many older LGBTQ+ people feel unsafe being themselves when seeking care. Per a recent AARP study, more than 60% of those surveyed were concerned about how they would be treated in a long-term care setting. 

Since the 2021 Long-Term Care Equality Index found that only 18% of the 60 communities reviewed with enumerated non-discrimination policies were LGBTQ+ inclusive, long-term facilities need to ensure they’re creating a welcoming and inclusive environment for all elders. Here’s how.

Implementing anti-discriminatory policies

A long-term care community’s dedication to LGBTQ+ inclusivity must be rooted in inclusive policies and practices. One policy to include would be a nondiscrimination resident policy, which takes a stance against unfair treatment of LGBTQ+ people. This is essential because over half of U.S. states do not have discrimination protections based on sexual orientation and gender identity.

Another critical step is an equal visitation policy, which guarantees a resident’s right to see any visitor of their choosing. Since many LGBTQ+ elders rely on “families of choice,” this may include friends, former partners, and other LGBTQ+ community members. These relationships are often not recognized and given the same rights as spouses or blood relatives.

Also, long-term care communities need to adopt inclusive rooming policies that recognize LGBTQ+ people’s need to feel safe and respected where they live and receive care. This rooming policy makes sure LGBTQ+ people receive equal treatment regardless of sexual orientation and gender identity.

Creating LGBTQ+- friendly environments 

Long-term communities can implement foundational policies to promote an inclusive environment, including: 

  • Support LGBTQ+ groups: Long-term care facilities should engage with the LGBTQ+ community and support its activities. Engaging with LGBTQ+ people and being involved in their causes shows that a long-term care community wants to be LGBTQ+-inclusive.
  • Inclusive programs/facilities for LGBTQ+ elders: An inclusive environment is vital for LGBTQ+ people to feel safe, comfortable, and supported in long-term care. Among other things, this means that people are encouraged to use the restroom that matches their gender identity rather than their sex assigned at birth or legal sex. And those residents are welcome to participate in events and programs in ways that respect their relationships and gender identifies.
  • Acknowledge LGBTQ+ identities: Make sure LGBTQ+ identities are included on intake forms and registration forms for new residents of a community by asking about sexual orientation, gender identity and pronouns. Gender-neutral options for the power of attorney, spouse or partner, or visitors are also important for acknowledging LGBTQ+ identities.

Cultural competency training 

When surveyed, 9 out of 10 LGBTQ+ people feared discrimination in care settings if providers knew their sexual orientation or gender identity, which is why cultural competency training is so vital in creating more LGBTQ-welcoming communities. This training will help arm staff members with the best practices to support elders to age successfully as their authentic selves.

According to AARP, 88% of LGBTQ+ older adults say they feel more comfortable with long-term care services if they know the staff is trained explicitly about the needs of LGBTQ+ patients. Research also shows that when staff members are trained on how to care for LGBTQ+ older adults, they’re more accepting of LGBTQ+ identities and better prepared to provide care.

The need for federal protections

While there’s been an increase in LGBTQ+ support and protections over the years, the fear and repercussions of the lack of anti-discrimination laws in more than half the country are still real.

Currently, there is no federal civil rights law for LGBTQ+ people. Without comprehensive federal-level protections, half of all LGBTQ+ older adults in the U.S. live in a state where they can be legally denied access to housing, services and other public accommodations. In addition, 34%  of all LGBTQ+ older adults fear they’ll have to hide their identity to access housing. 

Since LGBTQ+ people lack consistent anti-discrimination protections, institutions such as long-term care communities must adopt policies so that LGBTQ+ residents and employees are protected and aren’t living in fear.


With LGBTQ+ older adults in the U.S. expected to grow to around 7 million by 2030, elders entering long-term care shouldn’t have to fear the outcome of being their true selves. At SAGE, we hope that all long-term care housing providers want LGBTQ+ residents to feel comfortable and safe in their community. With the appropriate policies, training and inclusivity within care centers, LGBTQ+ elders can receive the care and support they need and deserve.

Michael Adams is the chief executive officer of SAGE, the world’s largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) older people.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.