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Why Long-Term Care Must Champion LGBTQ+ Inclusion

June 11, 2024

Pride Month, a time to celebrate the LGBTQ+ community, presents a crucial opportunity for long-term care leaders to reflect on their role in creating inclusive environments for workers and care recipients. With a rapidly aging LGBTQ+ population facing unique challenges and a surge in discriminatory legislation, the imperative to act has never been stronger.

Approximately 2.4 million LGBTQ+ individuals age 65 and older currently reside in the United States. These numbers are expected to nearly double by 2040. Many LGBTQ+ older adults require long-term care with a disproportionate burden of physical and mental health issues, the result of a lifetime of stigma and discrimination. They often encounter unwelcoming or hostile environments that compound their hardships. In fact, an AARP study found that more than half of LGBTQ+ older adults fear they will face discrimination in long-term care settings.

For the one in three LGBTQ+ individuals who have at least one disability, compared to one in four non-LGBTQ+ individuals, the intersecting forces of homophobia, transphobia, and ableism lead to severe consequences. According to the Human Rights Campaign, disabled LGBTQ+ people are also more likely to face adverse economic outcomes, such as poverty, due to earning less for equal work, facing higher unemployment or lacking access to inclusive workplace benefits.

LGBTQ+ direct care workers also face pervasive workplace discrimination and harassment. In a recent study, nearly half of LGBTQ+ workers have experienced unfair treatment at work at some point in their lives, including being fired, not hired, or harassed because of their sexual orientation or gender identity. Many avoid discrimination by not being out at work – 50.4% are not out to their current supervisor. Those out to at least some at work were 3 times more likely to report discrimination. For transgender workers, the rates of discrimination are even higher. These challenges, exacerbated by poor job quality pervasive in direct care work, demand targeted support from long-term care leaders, such as inclusive policies, benefits, and training.

The urgency of this moment is underscored by the record number of anti-LGBTQ+ bills introduced in state legislatures this year. As of May 31st, 515 such bills have been proposed, surpassing the combined total of 324 bills introduced between 2018 and 2021. These measures aim to restrict access to accurate identification documents, healthcare, and free speech, making it even harder for LGBTQ+ individuals to thrive in long-term care settings.

The Long-Term Care Equality Index, developed by the Human Rights Campaign and SAGE, provides a roadmap for leaders committed to LGBTQ+ inclusion. The index measures communities’ non-discrimination policies, cultural competency training, equitable benefits, and public engagement with LGBTQ+ communities. In its inaugural year, 200 long-term care communities across 34 states participated in the index, demonstrating a growing commitment to equality. By participating in future iterations of the index or adopting its principles, long-term care leaders can tangibly demonstrate their support for LGBTQ+ residents and workers.

PHI’s Direct Care Worker State Index—which scores and ranks all 50 states and D.C. based on policies that support direct care workers and economic outcomes—draws on these resources and underscores the importance of employment protections for LGBTQ+ direct care workers. We find that 35 states plus D.C. have protections against LGBTQ+ employment discrimination based on sexual orientation, gender identity, or both by public and/or private employers. The 15 states that do not have such protections in place were significantly more likely to rank at or near the bottom overall for direct care worker outcomes overall in the Direct Care Worker State Index.

This Pride Month, state leaders, employers, and long-term care champions have a moral and practical responsibility to ensure safety and belonging for LGBTQ+ workers and care recipients. By championing inclusive policies, providing education, and publicly committing to equality, they can send a powerful message of acceptance and affirmation. As attacks on civil rights escalate, long-term care settings must become beacons of hope and resilience. Every person deserves to live, work, and age with dignity, regardless of their sexual orientation or gender identity.

Contributing Authors

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