EDITOR’S NOTE: The number and identities of the skilled nursing members on the Human Right Commission’s list have been updated.

More than 1 million Americans already over 65 identify as lesbian, gay, bisexual or trans, but many in the generation behind them worry that now widely-accepted label may still make it difficult to find long-term care as they age.

More than 60% of LGBT adults surveyed by AARP recently say they’re worried that a long term care facility might refuse or provide them limited care.

They also fear neglect or abuse at the hands of their caregivers, according to AARP’s “Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans.

Though many physician practices and hospitals are now being recognized for their inclusive care, nursing homes — with their intimate involvement in residents’ day-to-lives and policies that can even determine who they room with — are not always seen as leaders on this issue.

The Human Rights Commission’s 2018 Health Equity Index evaluates more than 1,600 healthcare facilities on policies and practices dedicated to equitable treatment and inclusion of LGBTQ patients, visitors and employees. Many companies self-submit data, seeking an honor they can share with potential patients.

Just six skilled nursing facilities — Willowcrest Skilled Nursing and Rehabilitation Center, and five skilled nursing facilities at NYC Health + Hospitals: Gouverneur, Coler, Carter, McKinney and Sea View — made HRC’s 2018 list.

AARP’s survey found that 76% of LGBT adults were anxious about having adequate family or social support in the years ahead.

Gay men surveyed were more likely than lesbians to be single, live alone and have smaller support systems, which may put them at higher risk for isolation as they age. Transgender adults also report smaller support systems and are at an increased risk of isolation, while bisexuals are least likely to be “out” within health systems and might intentionally hide their sexual preference.

“LGBT adults want welcoming long-term care facilities designed for them,” Nii-Quartelai Quartey, Ed.D., AARP Senior Advisor and LGBT Liaison, told McKnight’s. “This means LGBT-trained providers advertising they provide LGBT friendly services, displaying LGBT-welcoming signage online and offline, and hiring openly-LGBT staff.”

Quartey points to a partnership with SAGE Cares, which provides culturally competent training. SAGECare credentialed providers can help meet the needs of a large and growing LGBT senior population, Quartey said.

More than 80% of AARP survey respondents said they would feel more comfortable with providers who are specifically trained in LGBT patient needs (88%), use advertising to highlight LGBT-friendly services (86%), have some staff members who are LGBT themselves (85%) or display LGBT-welcoming signs or symbols in their facilities and online (82%).

“Facilities that are doing a good job can do an even better job by having a presence in their local LGBT community at Pride Festivals and by investing in LGBT community-based organizations serving LGBT older adults including but not limited to local LGBT centers,” Quartey said.

The United Church of Christ’s Beatitudes Campus in Phoenix is a supportive campus and a leader on aging issues in the LGBT community.

But senior vice president of resident services David Ragan told an Arizona radio station there aren’t many other long-term care facilities in the Phoenix area that are openly friendly toward LGBT residents.

“That’s the ultimate fear,” Ragan said.”You could experience abandonment or judgment that you have no control over.”