Inaugural Long Term Care Equality Index reflects commitment to LGBTQ elder inclusion

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The Human Rights Campaign Foundation (HRCF) and SAGE, the largest organization that provides advocacy and services for LGBTQ elders, have released the first Long Term Care Equality Index (LEI). The LEI encourages LGBTQ+-inclusive policies and practices in long-term care and senior housing communities. 

“One of the biggest concerns facing older LGBTQ+ people is their future — especially when finding welcoming and inclusive places to live and receive care in their later years,” SAGE CEO Michael Adams said in a press release. “The LEI is a powerful tool that helps ensure that LGBTQ+ elders get the respectful care they deserve as they age. This is essential for all LGBTQ+ older people, but the need is especially acute for LGBTQ+ elders of color, transgender older adults, and LGBTQ+ elders living in rural areas, who often face even greater challenges.”

The LEI was born out of the results of an AARP study, which found that 76% of older LGBTQ people had concerns about whether they would have sufficient social support as they age. The report also showed that 73% of LGBTQ older people don’t have access to services specific to LGBTQ elders. 

The 2023 LEI includes data from 200 long-term care communities throughout 34 U.S. states, 75% of which earned the High Performer or Leader designation, meaning that they go beyond the basics and have implemented some of the policies and practices detailed in each criteria category.  

The report shows that 90% of LEI participants said that they include sexual orientation and gender identity in their employment nondiscrimination policy; 95% of participants to which the question applied said that they have written equal visitation policies and 84% of participants met the staff training requirement. The report also indicated that 89% of participants make a space for chosen name on intake forms; 11% make a space for pronouns; 55% have a section for sexual orientation; 54% for gender identity and 83% have an inclusive relationship option. 

“Providing care and services in a way that puts the person at the center is our number one priority, and the work being done by SAGE and HRCF aligns with our mission,” Marlena Montgomery, chief nursing officer at Villa Coronado and and LEI Equality Leader, said in this year’s LEI report. “Participating in the LEI program provides the structure, best practices and resources to be successful in our efforts to educate our workforce, update policies, increase awareness and provide a culture of love.”  

However, only 5% of LEI participants have an abuse and neglect policy that protects LGBTQ residents, and just 7% implemented policies that categorically detailed procedures and practices for removing bias and insensitivity and assuring kind interactions with trans residents. 

In terms of LGBTQ-inclusive employee benefits and policies, 14% of participants provide medical and comprehensive benefits to domestic partners of benefits-eligible employees; 79% offer bereavement leave following the death of a same-sex partner or their immediate family; 4% provide FMLA-equivalent benefits allowing employees to take family and medical leave to care for same-sex domestic partners and children of a same-sex partner; and 43% offer trans-inclusive healthcare benefits. 

As for resident and community engagement among LEI participants, 49% work with outside LGBTQ organizations or community members to gauge and address the needs of the LGBTQ community; 8% connect residents to LGBTQ community organizations; 84% participate in or support at least one LGBTQ-related event in their service area; and 77% engage in marketing or advertising inclusive of LGBTQ communities.

According to the LEI, although many of the issues facing aging LGBTQ communities overlap with the cishet population, LGBTQ elders are less likely to have a partner or children and need to depend on long-term care services and support. LGBTQ elders tend to experience stigmatization, a dearth of identity-affirming treatment, habitual stress and heightened social isolation, and discrimination and violence that can result in avoidance of services. Roughly 20% of LGBTQ elders are people of color, who as a group experience higher rates of health disparities, stigma and discrimination based on their LGBTQ identity, all of which increases their risk of avoiding and not receiving the services that they need as they age. 

The LEI has four objectives: to ensure foundational nondiscrimination protections for residents, visitors and staff and to provide cultural competency training on LGBTQ inclusion; to illustrate progress toward inclusion of LGBTQ resident care services and support; to cultivate an inclusive workplace by administering employee policies and benefits that are LGBTQ-inclusive; and to show engagement with and a public commitment to the LGBTQ community. 

“Our older LGBTQ+ community — the ones whose shoulders we stand on — are so often forgotten, and they deserve more from all of us,” HRC President Kelley Robinson said in a press release. “The participation in our first-ever LEI is a huge step forward in uplifting and protecting the needs and rights of our elders. And we aren’t done — we look forward to seeing expanded participation in the LEI in years to come.”