Examining LGBTQ+ policies and training in long-term care communities

One man pushes another man in a wheelchair outside of a building.

In the U.S., LGBTQ+ elders are at greater risk for poor treatment and other disparities in nursing homes and assisted living facilities compared to their straight peers. A first-of-its-kind University of Minnesota School of Public Health study seeks to improve the health and safety of LGBTQ+ adults receiving long-term services and supports (LTSS) nationally by examining the efficacy of LGBTQ+ explicit policies and training in Minnesota. 

The study is led by Associate Professor Tetyana Shippee, an expert in long-term care quality, and Professor Simon Rosser, an expert in LGBTQ+ health. Rajean Moone, faculty director of Long-Term Care Administration in the U’s College of Continuing and Professional Studies, also plays a key role.

“Most LTSS staff receive no training in how to care for LGBTQ+ people,” says Shippee. “While two states have mandated all LTSS facilities receive training in LGBTQ+ care, there are no evidence-based training programs in such care.”

LGBTQ+ older adults are significantly less likely than heterosexual older adults to have family members to provide care, and more likely to need residential LTSS. Additionally, up to 400,000 LGBTQ+ older adults in the U.S. have cognitive impairment, including people living with Alzheimer’s disease and Alzheimer’s disease related dementia (AD/ADRD). 

Yet, LGBTQ+ older adults are five times less likely to access health care and social services. Recent exposés have documented the risk of violence, abuse, and discrimination toward LGBTQ+ people in LTSS care.

“Most (81%) LGBTQ+ older adults fear entering LTSS because of potential discrimination,” says Rosser. “Many LGBTQ+ people in LTSS retreat back into the closet out of fear for safety. This may be even worse for those with AD/ADRD. Rural LTSS are a particular concern because of higher rates of hostility to LGBTQ+ clients.”

The study, funded by the National Institute on Aging, will evaluate the efficacy of LGBTQ+ explicit policies and LGBTQ+ responsive care training on how care is delivered in long-term care facilities throughout Minnesota. The researchers plan to conduct a statewide policy review to quantify the number and proportion of LTSS facilities that have explicit policies regarding LGBTQ+ care, with particular attention to policies related to AD/ADRD. 

The scientists will also evaluate how well an online training program they are creating works in preparing staff to serve LGBTQ+ residents. Development of the training program is being led by Moone, who is also associate director of education at the Center for Healthy Aging and Innovation.

“Our study will produce findings that will shine a light on what policies, if any, protect or harm LGBTQ+ people in LTSS facilities,” says Shippee. “It will also determine how well the online training stands up to its in-person counterpart.”

This study is a University-community collaboration with Rainbow Health, Minnesota’s largest LGBTQ+ service organization. The researchers will be working closely with Rainbow Health to develop the training curriculum and deliver it to LTSS agencies across Minnesota.