MDS Alert

Making a concentrated effort toward inclusivity will help all residents feel at home — and can boost your bottom line as well.

If you don’t already have policies in place to make sure your facility is inclusive and welcoming to everyone —  now is the time to start. People of all sexualities are aging, and there’s a good chance you already have some lesbian, gay, bisexual, or transsexual (LGBT) individuals living in your facility, but there’s more you and your team members can do to make everyone really feel at home.

“The possibility of being forced to hide one’s identity as a condition of receiving care is a concern for just under half of lesbian, gay and bisexual respondents and for 70% of transgender and gender expansive respondents,” says Angela Houghton, a senior advisor of multicultural research at AARP, in her March 2018 piece “Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans.”

Beware: In the past few years, LGBT residents have sued facilities for discrimination and even abuse. Residents also point to harassment and social isolation in facilities as an ongoing problem.

Understand Your State’s Legislation

Some states, including California, have recently enacted legislation to emphasize protections for LGBT residents in nursing facilities.

Resource: You can check to see whether your state has any specific legislation that supports LGBT residents in nursing facilities via the National Resource Center on LGBT Aging, here: www.lgbtagingcenter.org/resources/area.cfm.

Many facilities that provide crucial long-term care to seniors have an affiliation with a faith-based organization and federal and state policymakers have recently enacted a spate of religious exemptions that may apply to even healthcare service providers. Various LGBT senior advocacy organizations generally urge all facilities to remember that resident care should come first, and note that individuals living in rural areas may not have many choices about their care providers — meaning that such facilities shoulder the burden of providing truly resident -centered care for all residents.

Remember: Despite the recent religious exemptions, federal antidiscrimination laws both specific to LGBT populations and couched within other larger legislation, such as the Affordable Care Act, prohibit discrimination and harassment of individuals as related to many factors, including age, gender, and sexuality.

Train Employees

Your team members certainly know their stuff, in terms of delivering medical care, but are they up to date on the most inclusive means of caring for and talking with people who identify as LGBT — in a healthcare setting?

National LGBT advocacy organizations like SAGE that are focused on aging individuals provide resources and even trainings to help facilities and employees increase their “cultural competency” for caring for LGBT individuals with the aim of eliminating discrimination and harassment. SAGE has a few specific branches, including SAGECARE, a training resource especially for personal service providers, which offers credentialing, CEUs, and other ways for facilities to learn how to best serve LGBT residents.

The Health Resources and Services Administration (HRSA), part of the U.S. Department of Health and Human Services, funded through a grant the development of the Nurses’ Health Education About LGBTQ Elders (HEALE) Curriculum. This curriculum is a six-hour training that is free for nurses (and some social workers) in your facility and includes the option of 1 CEU for each of the six one-hour modules. You can find out more about requesting a training here: www.nursesheale.org/order-training/#p=Modules+1-6+(English).

Fill Dearth of Caregivers

While your facility’s cultural sensitivity and inclusivity should be motivated by the desire to provide person-centered care, it’s worth noting how catering to LGBT residents can also boost your bottom line.

The LGBT senior population is expected to reach approximately 7 million individuals by 2030, according to SAGECARE.

Include LGBT Bill of Rights for Residents

California’s antidiscrimination law for LGBT-identifying residents in long-term care, which is formally titled “Lesbian, Gay, Bisexual, and Transgender Long-Term Care Facility Residents’ Bill of Rights” provides facilities with specific items to attend to in their welcoming and care of LGBT residents. Check out Los Angeles law firm Garcia, Artigliere & Medby’s summary of some of the elements of this “Bill of Rights,” below:

• “Facilities must refer to residents using the pronouns and names that residents prefer.
• “Facilities can’t discriminate against LGBT people when making decisions about admissions, discharges, evictions, or transfers. Specifically, facilities can’t discriminate on the basis of actual or perceived sexual identity, gender, gender identity, gender expression or HIV status.
• “Facilities also can’t discriminate on the basis of other residents’ anti-LGBT attitudes.
• “Nursing home staff must receive training in respecting LGBT seniors.
• “Facilities must post a notice of their anti-discrimi­nation policies.”

While these rights are law in California, they’re solid policy to implement in your facility, regardless of your location — especially if you want to provide genuinely patient-centered care, boost your bottom line, and avoid potential litigation.

“While 80% of the general population rely on legal- or blood-related family members for caregiving, LGBT people are twice as likely to live alone and four times less likely to have children. Their reliance on long-term care services is potentially steep. Yet, when surveyed, nearly 9 out of 10 people feared discrimination in long-term care settings if providers knew their sexual orientation or gender identities,” SAGECARE says on the FAQ section of their website.

Plus, aging individuals who identify as LGBT are keen to invest their money in care that they know will support and advocate for all aspects of their lives, especially their sexuality.

“The LGBT market today has a combined purchasing power of $830+ billion … [and] 72% of the LGBT market feel it is extremely/very important to buy from ‘gay-friendly’ companies,” SAGECARE says.

Bring LGBT Cultural Competency to Forefront

Once your facility has pursued necessary training and employees feel up to snuff about providing truly person-centered care to LGBT residents, your facility can highlight its knowledge and understanding in a few different ways.

The National Resource Center on LGBT Aging offers suggestions on intake questions designed to help facilities gather the information they need to eliminate assumptions about gender identity and sexuality and begin dialogue. Just make sure that when you’re asking questions like these, you emphasize that they’re not mandatory but do help you as a provider allocate resources, as well as helping individuals live authentically and emphasizing your facility’s commitment to person-centered care.

Self-identifying as a LGBT-affirming long-term care provider can go a long way in helping individuals feel safe, accepted, understood — and grateful to be in your care.

Resource: You can find the sample intake questions, along with explanations for the questions, here: https://issuu.com/lgbtagingcenter/docs/lgbt_affirming_intake.