LGBT Older Adults in Long-Term Care Facilities

Based on the concerns outlined by individuals in this survey, we also believe that LGBT elders and those who care for them would be helped greatly by increased awareness of the protections in the Nursing Home Reform Act, as well as by a wide array of federal, state, and local regulations that could better support the rights of assisted livin residents, specifically those who are LGBT older adults.

According to a recent report, Improving the Lives of LGBT Older Adults (March 2010), LGBT elders are more likely to be single, childless, estranged from their biological family, and reliant on families of choice, such as friends and other loved ones.

Without traditional support systems in place, many LGBT elders end up relying on nursing homes or other institutions providing long-term care.  Yet little information is available about the opinions and experiences of LGBT older adults in these settings. This report is the result of a survey undertaken by six organizations seeking to better understand the experiences of LGBT older adults in long-term care settings.

The survey also sought to capture personal comments that describe some of the varied experiences of LGBT older adults, their loved ones, and the providers who care for them. A majority, for example, believed that staff would discriminate against an LGBT elder who was open about his or her sexual orientation. More than half felt that staff would abuse or neglect an LGBT elder and other residents.

However, the most significant results of the survey are expressed in the hundreds of comments submitted, ranging from reports of staff harassment to staff refusals to provide basic services or care. Altogether, 328 people reported 853 instances of
mistreatment. Instances were reported by those identifying themselves as LGBT older adults, family members, friends, social service providers, legal services providers, or other interested individuals.

Some of these comments point to possible violations of federal nursing home law, as noted in the section “Legal Rights of LGBT Residents,” while others signify that far more training and awareness by staff is needed. Additionally, policymakers would be well advised to consider the wide array of policy remedies that could be enacted to better support LGBT elders and the institutions where they reside and receive services. Based in large part on these comments, the recommendations made in this report are directed toward policymakers and consumers as well as long-term care providers.

Quotes from Survey Respondents:

Within the next two weeks, I will be going into assisted living. Due to my financial situation, I will have to share a room with another man. The thought of going back into a closet is making me ill. Frankly, I’m afraid of telling anyone that I’m gay. —Anonymous, 73 years old, Sylmar, CA

Of the 289 service providers who answered the survey, 247 felt that LGBT older adults were not safe coming out or were not sure that they should come out. I’ve not known anyone in a facility who has stated their alternative sexual orientation, which says a lot in itself. —Katheryn J. C., 49 years old, MSW, Dept. of Social Services, Ashland, VA


I lived in a very rural, conservative state as a lesbian for 25 years and then transitioned from female to male. LGBT elders in (state withheld by request) are forced to remain hidden, and when placed in long-term care facilities, become even further isolated. I have done training for long-term care staff and administrators in this state, but most feel that there are no LGBT residents in their facilities. —Sam (last name withheld by request), 51 years old

This story illustrates the theme of many comments:

Two friends of mine, Vera and Zayda, had been together for 58 years. When Vera’s Alzheimer’s became too much, Zayda moved her to an assisted living facility. Zayda could barely trust family or neighbors with the truth, let alone strangers, so she and Vera became “sisters.” Much later, after Vera’s death, Zayda needed to move into an assisted living facility herself. She had many, many photos of the love of her life, but dared not display them in her new home. The other residents would talk about husbands, children and grandchildren, but she felt too vulnerable to tell the truth. Zayda was in hiding and terribly isolated. —Nina L., Carlsbad, CA

Some respondents developed an unspoken understanding with staff. Several individuals offered comments like this one:

My partner was in a nursing home for 10 years until she passed away. I visited several times a week. We have never mentioned our relationship though I think everyone except perhaps the direct care workers figured it out. They do have a big picture of the two of us together hanging on the wall.

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