• Karen McPhail

Creating Inclusive Care Communities and Providers

LGBT older adults often face many challenges when it comes to accessing care and finding care providers that will best support their needs.  I am always upset when I ask individuals at care communities if they are LGBT frien

dly and they simply state with a confused expression, "I think so."  I then inquire further about whether they have any openly out employees, any residents that identify at LGBT, or about how they celebrate diversity, train staff to be inclusive, etc?  The confused expression sadly remains and says it all, thus making me feel sad and disappointed as we are clearly still failing an entire generation of older adults.   Health care providers need to realize that the reality is that they are caring for and interacting with LGBT older adults on a daily basis!

For years the medical community has failed this population of older adults through a lack of understanding and training in LGBT health areas, and through at times cruel and inappropriate treatment for decades.  Looking back at history and not too far back sadly, LGBT older adults were labeled as having a mental disorder for the first several decades of many of their lives.  Some may have even been exposed to electroshock therapy, lobotomies, or even disfiguring surgeries including castration. In 1973, homosexuality was finally removed from the Diagnostic and Statistical Manual (DSM), and more recently, the DSM. stopped classifying transgender as a mental disorder.  Older adults deserve to be treated with compassion, dignity, empathy, and respect as they have been through so much in their lifetimes and have so much to contribute to care communities. 

All care communities and care providers should assume that they are caring for LGBT older adults and should do their best to ensure inclusive practices at all times.  LGBT older adults do not look different and may not even identify openly, but they are there and need to be able to rely upon, safe, and individualized care practices just as any other client or resident.  All older adults should feel safe, comfortable, and happy with their care community and providers!  LGBT older adults should have options to choose from in terms of access to care!

Below are some guidelines for creating an inclusive care community or organization:

1.  Service providers should always assume that they have LGBT clients or residents even if no one has openly identified as LGBT. Many LGBT older adults do not feel comfortable coming out when in a care community or to a provider; allow all aspects of communication and care be on their terms. 

2.  Ask your clients or residents about their sexual orientations and gender identities in a safe, relaxed, and of course confidential manner. Remember that while it is important to ask about sexual orientation and gender identity, along with all the other key aspects of care and services needed or preferred, LGBT individuals have significant histories of discrimination and negativity, which makes them fearful of health care providers and less willing to disclose aspects of their identities. Always ask open ended questions and do not force answering if individuals appear uncomfortable. If an individual looks upset or hesitant to answer a question, move on to the next question. Reassure the that this is on their terms with no pressure!

3. Look at your current activities and programming to see if it could be changed in any way to better accommodate LGBT clients / residents. Ensure that you support celebrations for all individuals and include open support for: LGBT Pride in June, LGBT National Coming out Day and LGBT History Month both in October, and National Transgender Day of Remembrance in November. Ensure that flyers, contracts, forms, and events state inclusive language always!  

In addition, for example, while bringing in a guest speaker such an elder care attorney, care manager,  or financial advisor be sure that they are using inclusive language and presenting information about LGBT topics of importance also such as legal inequalities, tax implications for same sex couples, or information on the tax deductibility of sex reassignment / transgender related surgery.

4.  Train staff properly on and correct pronoun usage for transgender individuals. Create a safe and inclusive environment in all aspects! Staff should always know and use the pronoun that their client or resident prefers!

5.    Respect gender identity when providing site segregated services. When services include shared rooms that are segregated by sex, the assignment of rooms should always be made based on the client’s gender identity, not their sex assigned at birth. Anything else is unacceptable!

6. Review your organizational policies, contracts, and definitions of family, make sure that they include a client’s family of choice, friends, partners and other people close to the individual as well as family or origin, biological family members or those related by marriage or kinship. Many LGBT older adults have preferred or chosen family rather than family of origin as contacts.

7. Promote diversity and inclusion, be sure that your community or organization’s board and leadership reflect diversity and inclusion of LGBT older adults. This message filters down in all organizations and starts at the top! Be inclusive in terms of race, ethnicity, gender, and other characteristics.

8. Create a welcoming and safe environment always. Tastefully display rainbow flags, rainbow colored items or “safe zone” signs within the community or agency to indicate LGBT support, and acceptance.

9.  Promote cultural competency training for staff members!  Ensure that all staff are trained on how to identify, address, and properly manage the needs of LGBT older adults as this is the key to making a care community or organization inclusive and welcoming for all! 

10. Treat everyone with empathy, dignity, respect, and kindness. Honor choices, wishes, and show empathy towards all individuals realizing that exclusion is hurtful and causes others pain.  This is often seen in dining within care communities! No one should ever be sitting alone to dine unless this is a stated preference, which staff should explore more from a social and emotional standpoint.

11.  Support a positive culture and environment at all times.  Promptly address and deter any negativity or hate speech in a direct, yet private, and polite manner.  Always explain that all residents / clients deserve to be treated with respect and kindness and to be given the opportunity to live authentically.  Hate speech is not permitted within the agency or care community!

12.  Never assume anything and remember that we are all more alike than we are different!  Be kind, be inclusive, be accepting, show empathy, and support all individuals to live on their terms!  


National Resource Center on LBGT Aging


Lambda Legal

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