The fight for LGBTQ rights in this nation was ignited by six days of violent protesting during the June 1969 Stonewall riots. Fifty years later, there are still many battlegrounds for equality left.

Due to lingering discrimination and disparities in healthcare, many older LGBTQ adults face uncertainty and lack of adequate care when they are most vulnerable and in need. There are an estimated 1.5 million LGBTQ people age 65 and older in the United States, according to Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE). As this population ages and becomes more infirm, they will need to rely on the help of long-term care facilities. However, LGBTQ seniors living in skilled nursing care face unique challenges that threaten their overall wellbeing. As the population of older LGBTQ adults is expected to rise in coming decades, these challenges must be addressed by long-term care professionals to ensure that their facilities are safe and welcoming to all residents.

Discrimination and mistreatment

Research has shown that one of the most significant concerns many older LGBTQ people have about living in long-term care is the freedom to openly share their identity. These seniors may feel like they have to live “in the closet” for a number of reasons such as past discrimination, fear of abuse or neglect, feelings of vulnerability or lack of a supportive environment. For some LGBTQ adults in long-term care, their worries are not unwarranted. SAGE collaborated with several other organizations on a 2009-2010 study of LGBTQ adults living in long-term care. Nearly half of the 769 respondents reported abuse or mistreatment of LGBTQ residents. Mistreatment reported by the survey included refusal of admission or re-admission, restriction of visitors, refusal to acknowledge medical Power of Attorney of spouse or partner, staff refusal to provide basic care or medical treatment, refusal to refer to transgender residents by preferred name or gender pronoun and harassment.

Protection for all

As part of the spirit of Resident Rights, all long-term care facilities have a responsibility to promote fairness and dignity for all residents. Providers and their staff must be united in efforts to cultivate an environment that is respectful and free from discrimination and harassment. One of the most important steps in ensuring LGBTQ adults are adequately protected by Resident Rights is to overcome denial about the possibility of having residents that are LGBTQ. Assumptions should never be made about residents’ sexual orientations or identities. Facility operators must always be open to the possibility of a wide range of diversity among their resident population. By raising awareness among staff about the special concerns of serving LGBTQ residents, skilled nursing facilities have an opportunity to promote inclusiveness and establish goals for protecting all residents.

Policies, especially those that address Resident Rights, should have language that is inclusive of sex, sexual orientation and gender identity or expression. Facilities should also review their admissions forms to ensure that they have language that is inclusive to same-sex spouses and partners. Additionally, facility operators can perform self-assessments of their culture and quality of care to determine if there are discrimination concerns or areas that need improvement. Most importantly, it should be established among staff, visitors and residents that discrimination, abuse and harassment of any kind are a violation of Resident Rights and will not be tolerated.

Culturally competent care

Training for providing culturally competent care is an important part of cultivating a respectful environment. As part of the SAGE National LGBT Housing Initiative, the organization offers some guidance on increasing LGBTQ cultural competence. SAGE recommends that training include discussion of appropriate terminology, history of the LGBTQ experience and unique culture of LGBTQ adults. This information can be obtained at agencies such as the National Resource Center on LGBT Aging and the U.S. Department of Health and Human Services’ Administration on Aging.

To show dignity and respect for all LGBTQ people, the National Resource Center on LGBT Aging suggests asking about residents’ sexual orientation, gender identity and preferred gender pronoun in a safe and confidential manner. These questions could possibly be added to admissions materials or residents could be asked during private, dignified conversations. However, the organization also cautions that sexual orientation and gender identity are just two aspects of a person’s background and that facility operators and staff need to recognize that LGBTQ adults have diverse experiences and interests and they should not be generalized or only defined by their sexual orientation or identity.

Finally, facilities should be intentional in affirming their commitment to the rights of all residents and a culturally-inclusive environment. Resident Rights and anti-discrimination policies need to be posted in the facility in highly visible areas as well as on the company website. Ongoing monitoring systems for discrimination or mistreatment should be put in place that include safe and confidential ways for residents and staff to report incidents. In addition to culturally competent care training, staff must be made to feel comfortable in having honest, yet respectful conversations about how to provide unbiased care and address discrimination among residents or co-workers. Above all, long-term care communities should not only recognize the existence of diversity among residents, but welcome it.  

Teri R. Sumbry is the communications and public relations specialist for The Compliance Store.