Senior Living Industry Makes Some Progress On Lgbtq+ Inclusion, But Much More Action Needed

Editor’s note: WTWH Healthcare is pleased to announce the inaugural Prism Awards, honoring individuals and organizations that have demonstrated exemplary achievements in the areas of Diversity, Equity, Inclusion & Belonging (DEIB); Environmental Sustainability; and Social Stewardship. The deadline for award submissions is Nov. 30. 

Senior living operators must do much more than pay lip service to social causes if they hope to improve their operating models to be more inclusive for gay and trans older adults and workers.

Despite some progress in visibility and acceptance made in recent years, gay and trans people living in the U.S. still face a wall of adversity that takes multiple forms. At the same time, companies across the U.S. are retreating on diversity, equity and inclusion promises amid bad-faith backlash campaigns against DEI.

For LGBTQ+ people living in America in 2024, the road ahead will include many unique challenges. And senior living operators must be open and sensitive to those challenges – and more importantly, ready to take real action – if they hope to bring about true inclusion into their communities and workforces. Simply put, affirming words are not enough in 2024.

That said, some senior living operators and owners are stepping up to go beyond performative solidarity and increase inclusivity within their communities. This includes rewriting and updating anti-discrimination policies, seeking independent accreditation around workforce training and inclusivity, along with cultivating a workplace culture that allows LGBTQ staff and residents to feel represented and supported.

According to the 2023 Long Term Care Equality Index (LEI), many more organizations had codified gender and orientation-specific language in their non-discrimination policies in 2022 than in 2021.

At the center of many operators’ efforts is Services and Advocacy for LGBTQ+ Elders (SAGE), an advocacy organization that offers supportive services and consumer resources to LGBTQ+ older people and their caregivers. To date, the organization has helped senior living operators including Watermark Retirement Communities and Maplewood Senior Living and others to make their practices more inclusive.

According to SAGE Director of Marketing and Communications Bren Cole, senior living operators that take LGBTQ+ inclusion seriously are not only more empathetic and supportive, but also at an advantage when it comes to their business outcomes.

“Folks who make the business decisions in [senior living] are starting to understand that inclusivity is not just a nice thing to have, but it’s actually a business value-add,” Cole told Senior Housing News. “It makes them more appealing across the board and it increases the potential customer base.”

‘Not just lip service’

By 2030, LGBTQ+ adults over the age of 65 will number 7 million according to data shared by SAGE. At the same time, older adults in this cohort are less likely to have caregiver support, financial insecurity and face healthcare inequities.

Nearly all LGBTQ+ people surveyed by SAGE – 9 out of 10 – said they feared discrimination in senior care settings if providers knew their sexual orientation or gender identity. This marginalization of LGBTQ older adults can also lead to mental health challenges and exacerbate feelings of loneliness, anxiety and depression, SAGE reports.

With those trends in mind, operators including Watermark Retirement Communities, Maplewood Senior Living, Connie House have sought SAGE accreditation showing they are well-versed in LGBTQ+ issues and challenges. 

Maplewood’s latest development, Inspir Embassy Row in Washington, D.C. recently sought and received SAGE accreditation for its training efforts to bring more inclusion for LGBTQ older adults and staff.

Through the training, Maplewood staff learned about sensitivity awareness, using someone’s correct pronouns and the lived experience of LGBTQ older adults, according to Inspir Embassy Row General Manager Timothy Cox. That is especially important for Maplewood given the community’s location in Dupont Circle, Washington D.C.’s longtime gay neighborhood.

“The training gives us an opportunity to really have the sensitivity to approach individuals in a kind, caring way to have a better understanding of their history and how residents want to be approached,” Cox recently told SHN.

Watermark Retirement Communities CEO and President David Barnes remembers the moment nearly two decades ago that he knew Watermark needed to improve training for staff and include greater support in care operations for LGBTQ+ older adults.

“I remember the gentleman turned to me and said, ’You may or may not know it, you have people that are fearful [and] they’re not going to get the care they need because of a fear of being treated differently,’” Barnes said. “It just hit me to my core and it really stopped me in my tracks, and that’s what kicked it off.”

Today, Watermark maintains the platinum certification from SAGECare, meaning that at least 80% of staff are trained through a curriculum regarding cultural competency and inclusion. The operator’s Watermark Connect operating system includes ongoing training and review materials for staff.

But in order to move from implementing a more inclusive workplace culture, operators need “hardcore commitment” from staff to create real change from within, he said.

“Half of it is having the passion and commitment for change, and we have our own in-house training group that develops the pieces of this and it’s really powerful,” Barnes added. “We have to make sure that it’s not just lip service and we want to reduce or eliminate fear—that’s our mantra.”

Trans rights emerge as key area of operators to improve service, care

Transgender people of all ages in 2024 face a harrowing barrage of discrimination and hardship, from harassment in everyday situations and difficulties getting proper identification to targeted federal legislation and national political campaigns designed to belittle and exclude them.

There are about 1.3 million Americans who identify as transgender, nearly 172,000 of which are older adults, according to recent stats from the Williams Institute at the UCLA School of Law.

A recent study from the National Center for Transgender Equality found that a “significant proportion” of trans elders experience discrimination, harassment or outright denial of care. In fact, approximately one-third of transgender older adults rate their health as poor, and many are more likely to face depression or disability compared to their cisgender counterparts.

For many transgender folks, collective trauma and mistreatment within the greater health care spectrum is “magnified and compounded” as they age into older adulthood.

“There has been tension around the needs of trans communities and I think what is happening in society and the world at this moment because of the blatant attacks on trans rights,” said SAGE National LGBT Elder Housing Initiative Director Sydney Kopp-Richardson.

Given the adversity trans older adults face, the senior living industry must do much more to support them in particular.

Some in the industry are not mincing words when it comes to the lack of support in today’s senior living environment. Connie House, an assisted living community tailored for LGBTQ+ older adults in Oshkosh, Wisconsin, opened last year and is working to extend its reach to underserved older adults.

Connie House owner Allan Hendricks said he has yet to see “any evidence that trans elders are supported anywhere in this industry.”

To break through this barrier, Hendricks urged senior living providers to take concrete steps in workforce training, policy implementation and programming to “build a corporate culture that clearly defines” equal footing for LGBTQ+ residents and staff.

“The very first step I would recommend is looking up SAGECare and starting training of executives and staff,” Hendricks said.

Hinshaw and Culbertson Partner David Alfini, who helps senior living organizations with policy development and antidiscrimination efforts, said operators must take notice of the influx of LGBTQ+ older adults, specifically trans residents reaching the age of 65 and older.

Alfini said that when operators are aware of these issues, they are often receptive to making changes ranging from educating executives on the nuance needed to provide identity-affirming health care.

“What’s new is that we’re rewriting policies and procedures with transgender staff and transgender residents in mind, along with the ways we’re talking about training,” Alfini said. “They get it, and you can see the lightbulbs going off in their heads.”

This gets to the deep vulnerabilities facing transgender older adults in society, something Kopp-Richardson calls the “invisibility of trans elders as people” in today’s senior living environment.

“There’s definitely an increased awareness of that because of the culture shift and because of the latent rollback legislatively and socially on the rights of trans people generally,” Kopp Richardson added.

To increase inclusion efforts that adequately include transgender older adults, Cole notes that transgender elders have a “higher threshold for feeling safe,” with many being facing discrimination in seeking health care.

“The idea of later in life having to then enter into a system which would be a long term care facility or housing can be very frightening for them, and I think that the burden of proof of actual affirming environment really lays on the providers,” Cole added. “Trans folks often get lumped into the whole ‘LGBTQ’ acronym but the very specific needs of that aren’t always met.”

Cole called on senior living operators to consider taking new approaches to marketing efforts to help bring greater inclusivity into senior living communities. That includes having a website that displays supportive language or images that are LGBTQ-affirming, or having a well-defined nondiscrimination policy that includes gender identity and sexual orientation.

“It’s just little changes like that I think can really start opening doors for folks to have to feel more able to bring their whole selves into that space,” Cole said.

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