Providing care and services to LGBT+ older adults: It’s a process and a journey


A rainbow flag near the entrance to your organization is great, but it’s not enough.


To truly be an organization that is sensitive to and provides a spectrum of services to older LGBT+ adults takes a lot of commitment and ongoing work.
Whenever your clientele consists of older adults, you’re dealing not only with issues of homophobia, heterosexism, transphobia, and other isms related to identity — but of ageism. 

Unfortunately, ageism exists not only in mainstream society, but even in the LGBT+ world.

If you’re really committed to providing person-centered care, then you as a practitioner and an organization need to become inclusive, competent, and affirming of LGBT+ older adults and their families. Keep in mind that just because LGBT+ older adults, and LGBT+ people in your organization, aren’t out, doesn’t mean they don’t exist.

This work takes time and is multifaceted. What you’re working against is most people’s lack of education, deep-seated internalized prejudice, stigma, and a long history of discrimination and harm by institutions including medical, legal, and religious.

It is understandable that LGBT+ older adults would choose not to disclose their sexual orientation and/or gender identity to service providers because of legitimate concerns of being mistreated or even harmed.

Doing this work, which includes better and open communication between care provider and client for the sake of optimum person-centered care, will also result in a healthier and more responsive organization. And as the Baby Boomers become older adults, many more out and proud, you’ll be ready to provide appropriate services for them.

There are several things to do to get started. Acknowledging and affirming that older people have sexuality is an important place to begin.  

Then, start having conversations about sexuality and gender, incorporating precise, normalizing language including “sexual orientation,” “gender identity,” “lesbian,” “gay,” “bisexual,” “transgender,” and “cisgender.” Talk openly about the existence of older LGBT+ adults.  Keep in  mind that you might be working with LGBT+ colleagues, or they may have LGBT+ family members – or you, yourself, may be LGBT+, and understand first hand challenges LGBT+ people have had, and continue, to face.  

Straight professionals who are aware of and sensitive to LGBT+ issues can play an essential role in providing and affirming a supportive environment for their LGBT+ colleagues and clients. Straight and/or cisgender allies, your support and involvement in this work can make a huge difference.

But individuals can only go so far without the enthusiastic, sincere support from the leadership of any organization.  The leadership needs to be clear that it does not tolerate discrimination of sexual and gender minorities in terms of both services provided and employment, and is committed, with time and financial resources, to evolving into an inclusive, affirming, and competent organization.  

Another component of this work involves assessing your organization’s policies and forms beginning with nondiscrimination policies for staff and clients. Make sure they include the phrases “sexual orientation” and “gender identity.” Intake forms should provide opportunities for self-disclosure of sexual orientation, gender identity, sex assigned at birth, name and pronouns used, and relationship history beyond the three options of married, single, or divorced. Inclusive bathroom signage, such as “all-gender bathroom” is important.

Acknowledging and celebrating Pride Month in June and LGBT History Month in October can provide additional opportunities for learning. A task force to assist in these efforts can be helpful.

Finally, doing this work, ideally on an ongoing basis, requires training and education in sexual-orientation and gender-identity with a focus on LGBT+ older adult experiences, needs and concerns for all employees, from the top down.  The goal?  Open-hearted, healing encounters — not based on assumptions or judgments – in which meaningful connections and growth can occur.

Rabbi Erica Steelman, MAHL, MPP, is Director of LGBT+ Initiatives and Staff Chaplain for Abramson Senior Care.