This Pride Month, Inclusion Is Inseparable from Quality Care

This Pride Month, PHI proudly recognizes the LGBTQ+ community and recommits to championing the conditions that allow every person to live, work, and age with dignity. Across the long-term care field, this shared commitment is vital. LGBTQ+ people are an essential part of the direct care workforce that makes this care possible, and a growing share of those who rely on it. Fostering supportive, equitable workplaces is inseparable from delivering quality care.

Direct care workers—personal care aides, home health aides, and nursing assistants—spend more one-on-one time with older adults and people with disabilities than almost anyone else in the care system. These workers often navigate the barriers documented across the labor market: research from the Williams Institute finds that roughly half of LGBTQ+ workers (many working in health and long-term care) report unfair treatment on the job at some point in their careers. Layered onto the low wages and limited benefits already common in direct care, these pressures make recruitment and retention harder in a field that can least afford to lose workers.

Direct care workers also serve a growing LGBTQ+ population. Nearly 3 million LGBTQ+ adults age 50 and older live in the United States today, a number projected to grow to around 7 million by 2030, and many will need long-term care—often after lifetimes in which stigma and discrimination contributed to higher rates of physical and behavioral health challenges. Many approach the very settings meant to support them with apprehension: in SAGE’s 2025 research, 87% of LGBTQ+ older adults report concern about finding LGBTQ+-inclusive long-term care. When people fear the places they depend on, their health and well-being suffer.

The current policy landscape adds urgency. State legislatures continue to consider a high volume of bills affecting LGBTQ+ rights—the American Civil Liberties Union tracked more than 600 such measures in 2025, with legislation still under consideration across dozens of states in 2026. These debates shape the climate in which LGBTQ+ workers decide whether to stay in their jobs, and in which LGBTQ+ residents and clients decide whether they can be open about who they are.

Practical roadmaps already exist. The Long-Term Care Equality Index, developed by the Human Rights Campaign and SAGE, helps care communities strengthen their non-discrimination policies, cultural competency training, equitable benefits, and engagement with LGBTQ+ communities. Protections that let workers bring their full selves to the job are part of what makes those jobs sustainable.

Additionally, PHI’s Direct Care Worker State Index, which scores all 50 states and D.C. on the policies and economic conditions that shape direct care jobs, has found that states without employment protections for LGBTQ+ workers were more likely to rank near the bottom for direct care outcomes overall.

This Pride Month, employers, state leaders, and long-term care champions have both a moral and practical reason to ensure that LGBTQ+ workers and care recipients find safety and belonging. Every person deserves to live, work, and age with dignity, regardless of sexual orientation or gender identity.