Finding a long-term care community to meet a loved one’s particular needs is a challenge for any caregiver. Factor in the likelihood of getting turned away based on sexual orientation or gender identity, and an already emotional life transition becomes downright traumatic.
In 2021, the Human Rights Campaign reported only 18% of senior housing communities had policies that prohibited discrimination based on sexual orientation or gender identity. The entire state of Texas, for example, has just four long-term care communities with such policies in place.
“We know how hard it is to get into a long-term care community to begin with,” explained Elliot Sklar, PhD, associate professor at Nova Southeastern University in Fort Lauderdale, Florida. “Imagine if your list only includes four establishments.”
Still, those policies don’t appear to include educating health care lay workers about how to be more inclusive and make sure they don’t have prejudicial viewpoints that play out at work, he explained. A lack of acceptance sets up barriers to care that put LGBTQ seniors at risk of social isolation and unmet basic needs. An executive order to advance LGBTQ equality, issued by President Joe Biden on June 15, in honor of Pride Month, aims to change that.
The order directs the U.S. Department of Health and Human Services (HHS) to develop and publish a “Bill of Rights for LGBTQI+ Older Adults in long-term care communities.” The policy will outline the rights of LGBTQI+ seniors to ensure they’re understood and honored. It also enlists HHS to group these individuals with “populations of greatest social need” under the Older Americans Act and promotes expanded federal data collection on sexual orientation and gender identity—all measures to make sure LGBTQ seniors’ needs are being met.
Previously, under direction of the Trump administration, HHS removed questions about LGBTQ people from two vital surveys: the National Survey of Older Americans Act Participants, which annually measures how older adults receive social support and nutrition services under the Older Americans Act, and the Annual Program Performance Report for Centers for Independent Living, which assesses whether people of all ages with disabilities are properly receiving necessary services in their homes and communities.
“Removing LGBTQ measures from these surveys made it more challenging to know whether LGBTQ people, and LGBTQ older adults in particular, were experiencing barriers to access—a long-standing challenge,” Sklar explained.
While the Fair Housing Act prohibits denial of housing based on race, religion or sex discrimination, Sklar emphasized there’s no federal law that protects people based on sexual orientation or gender identity—which makes this executive order critical.
It’s one of two steps in the right direction, Sklar explained – this year also marked the first time a formal proclamation was made recognizing June as Pride Month – but there is much work still to be done.
“You can have a proclamation of rights but live in a world where there is also a social order,” he said. “When you have viewpoints in different parts of the country that are very anti-LGBTQ, it creates a challenge. This executive order doesn’t address the social realities, but it’s a good start.”
He believes it takes education and sensitization to eliminate discrimination, and commends the nonprofits SAGE and WellMed Charitable Foundation for the sensitivity trainings they conduct for health care workers.
A call to action to protect LGBTQ older adults
In light of the various anti-LGBTQ discriminatory bills proposed across the country by state and local lawmakers, Jennifer Henius, LCSW, founder of the nonprofit Caregiver Wellness Collective Inc., home of the LGBTQ Caregiver Center, would like to see Congress pass the Equality Act. The bill would amend the 1964 Civil Rights Act to prohibit discrimination based on sex, sexual orientation and gender identity.
“It would ensure much-needed civil rights protections to all LGBTQ Americans regardless of where they live across the country,” she said. “We see this as a critical and necessary step to providing consistent and explicit nondiscrimination protections that support the equality, dignity and overall well-being of LGBTQ people.”
A staunch advocate for the community, Henius’ nonprofit organization raises awareness of the unique challenges faced by LGBTQ caregivers, connects them to resources, offers support through its Facebook group, and hosts virtual yoga classes.
Although the executive order is an opportunity to improve the quality of life for the LGBTQ community and help them age with dignity, she said the effectiveness of the resulting policies will remain to be seen.
New concerns surface
Given the recent overturning of Roe v. Wade, Sklar said he’s concerned about the reversal of other rights, such as gay marriage, that are very significant to the LGBTQ community, especially as people age. On a federal level, marriage offers protections like the ability to access a survivor’s pension or Social Security benefits and coverage under the Family and Medical Leave Act.
“It’s a time for all of us to have a heightened awareness of the importance of the rights we have and that we need to maintain,” Sklar said. “That was in part the impetus for President Biden’s executive order. The community is under attack, and I think it’s very critical that he did what he did.”