LGBTQ+ Inclusion and Belonging in Direct Care
Pride Month 2025, which draws to a close on Monday, has highlighted evolving challenges faced by LGBTQ+ Americans. The federal Administration’s engagement in Pride Month has ranged from silence to erasure. Anti-LGBTQ+ legislation is reaching unprecedented levels, with over 500 such bills introduced in state legislatures this year alone. The need for inclusive, supportive long-term care environments has never been more urgent.
PHI acknowledges and celebrates the contributions of LGBTQ+ direct care workers while condemning the mounting challenges they face in both their personal lives and at work.
LGBTQ+ direct care workers experience workplace discrimination at alarming rates. Nearly half of LGBTQ+ U.S. workers answering an August 2024 survey reported unfair treatment because of their sexual orientation or gender identity. Many remain closeted at work to avoid harassment (50.4% are not out to their current supervisor), while those who are out are three times more likely to report discrimination. For direct care workers, such challenges are compounded by the poor job quality that pervades direct care work, characterized by low wages, limited benefits, and inadequate career advancement opportunities that are faced by almost all direct care workers.
At the same time, the LGBTQ+ older adult population is experiencing rapid growth. Approximately 3 million LGBTQ+ individuals age 50 and older currently reside in the United States, with numbers expected to more than double by 2030. Many of these individuals will require long-term care services, yet they fear they will face discrimination in care settings. Alarmingly, 64% of LGBTQ+ older people are concerned about their ability to access needed services as they age, and 87% are concerned about finding LGBTQ+ inclusive long-term care.
Furthermore, one in three LGBTQ+ people are individuals with disabilities, compared to one in four among the general population. These individuals face compounded discrimination that creates even greater barriers to quality care and economic security.
In an environment where inclusive policies and protections are increasingly under scrutiny, PHI believes that supporting LGBTQ+ workers and care recipients isn’t just the right thing to do—it’s essential for building a strong, sustainable care workforce.
This Pride Month, we call on long-term care leaders, policymakers, and employers to take concrete action: implement comprehensive non-discrimination policies, provide LGBTQ+ cultural competency training, ensure equitable benefits and advancement opportunities, and publicly commit to creating inclusive environments where all workers and care recipients can thrive.
