National
New report outlines problems faced by LGBTQ+ nursing home residents
Authors recommend supportive policies, training for nation’s 15,000 facilities
A recently published academic journal article by two University of Indiana researchers reports on problems faced by LGBTQ+ older adults living in the nation’s nursing homes and recommends actions nursing homes should take to ensure LGBTQ+ residents are treated equitably and without bias.
The article, entitled “Postacute Care and Long-Term Care for LGBTQ+ Older Adults,” was published Nov. 9 in the peer reviewed journal Clinics In Geriatric Medicine. It is co-authored by geriatric physician Jennifer L. Carnahan, a research scientist with the Regenstrief Institute, which is affiliated with Indiana University’s Center for Aging Research and Andrew C. Picket, an elder care researcher and assistant professor at Indiana University’s School of Public Health in Bloomington. Carnahan also serves as an assistant professor of medicine at the Indiana University School of Medicine.
“Cultivating an inclusive and LGBTQ+ culturally competent nursing home culture means that all staff and clinicians should receive training specific to working with this group and time should be allocated for this to reduce staff burden,” the article states.
It points out that while some older LGBTQ+ adults fear being forced into the closet while in a nursing home, “they also simultaneously fear unwanted disclosure of their sexual orientation or gender identity status, and their autonomy should be respected either way.”
The article says there are more than 15,000 nursing homes in the U.S. that provide rehabilitative and skilled nursing care to mostly older adults. It notes that nursing home residents fall into two distinct groups–post-acute care residents who often can return to their own home after recovering from an illness or injury; and long-term care residents who are no longer able to care for themselves. It says that among the long-term care residents in nursing homes, about 50% are living with dementia or another type of cognitive impairment.
According to the article, LGBTQ+ older adults “at a minimum have the same risk of dementia as the general U.S. population, and dementia increases the risk of nursing home admission.”
Among the article’s recommendations is that when new residents are being admitted to a nursing home, whether for short term or long term, “standard practice should be to ask sexual orientation and gender identity questions of every new resident along with other demographic identifiers.” Doing this “normalizes sexual and gender minority status” and can also “help to reduce the invisibility and health disparities” that LGBTQ+ nursing home residents experience.
“For transgender individuals, the personal care received in nursing homes can be supportive, as intended, or traumatic,” the article states. When nursing home staff provide assistance to transgender persons unable to care for themselves, “such as toileting or bathing, they may become newly aware of a resident’s transgender status,” the article says, adding, “If staff are not prepared for such an unintentional outing and how to react in a supportive manner, they may demonstrate microaggressions.” That type of biased reaction can be psychologically harmful for a transgender resident, the report states.
“We think about younger LGBTQ+ individuals and the challenges and risks of their lifestyles, but older adults in this population are often forgotten,” co-author Carnahan said in a statement. “They’ve experienced many health disparities. As these accumulate over a lifetime, we see the potential long-term ill effects of being from a marginalized population,” she says in the statement.
“More and more LGBTQ+ older adults are comfortable being out with their providers, while many living in nursing homes fear unwanted disclosure of their sexual orientation or gender identity status,” Carnahan says. “Their autonomy should be respected either way so they can age in an environment where they feel safe, where they feel comfortable and where they are able to live with dignity.”
The article points to a 2018 survey conducted by AARP, which advocates for people over the age of 50, that found most LGBTQ+ older adults, when considering entering a nursing home, “anticipate neglect, abuse, refusal of services, harassment, and being forced back into the closet.”
The article says this fear of abuse and stigmatization may be related to older LGBTQ+ adults’ experiencing anti-LGBTQ+ bias in their younger years.
“Health care workers across disciplines are not well trained in care for LGBTQ+ older adults,” the article says. “Stereotypes and inadequate knowledge of the LGBTQ+ population are not uncommon among those who care for older adults,” it says. And it says LGBTQ+ residents in nursing homes may also face stigmatization from other residents.
“Training programs that engage nursing home staff in LGBTQ+ cultural competency can remediate staff knowledge and ensure more equitable care,” the article stresses.
In addition to calling for better training, the article includes several other recommendations, including providing legal advice to LGBTQ+ nursing home residents on how best to assign the legal authority to make decisions about their care if they become incapacitated and unable to make those decisions for themselves.
Carnahan said in an interview with the Blade that obtaining legal advice about designating a trusted surrogate to make medical decisions for them if they are no longer able to do that is especially important for LGBTQ+ nursing home residents. In at least some cases, LGBTQ+ people are estranged from their biological families and may have chosen families, Carnahan points out. Without having assigned legal health care power of attorney to someone of their choosing, under the laws of most states, the biological family becomes the entity that a nursing home will go to in making these health-related decisions for all residents, including LGBTQ residents.
The article also provides a list of LGBTQ+-related resources for nursing homes and LGBTQ+ older adults considering entering a nursing home. Among the resources on this list is the Long-Term Care Equality Index prepared by the LGBTQ+ organizations Human Rights Campaign and SAGE, an LGBTQ+ elders advocacy organization. The Index is a document that identifies LGBTQ+-supportive facilities, including residential facilities and nursing homes.
SAGE, based in New York City, arranges for LGBTQ+-supportive training for older adult residential facilities across the country and designates facilities that SAGE believes are LGBTQ+ supportive as “SAGECare credentialed” facilities, which are listed in the Long-Term Care Equality Index.
“It is the case now that in almost all states there are one or more elder care facilities that have been trained throughout our SAGECare program,” SAGE CEO Michael Adams said in a recent interview. “But it’s nowhere near where it needs to be,” he said. “It needs to be that there are welcoming elder care facilities in every single community in this country” for LGBTQ+ elders.
The article by elder care researchers Carnahan and Picket reaffirms Adams’s claim that most U.S. nursing homes don’t have the type of LGBTQ+ supportive credentials advocated in the SAGECare program. The two stress in their article the need for all nursing homes to take steps to train their staff on LGBTQ competency issues.
“Yes, that’s what I would like to see,” Carnahan told the Blade. “I would like more nursing homes and assisted living and even senior communities to embrace cultural competency and embrace the SAGE designation,” she said.
Carnahan said a common impediment to nursing homes providing LGBTQ+-related training is it is sometimes difficult to set aside the time to do that because of the busy and often stressful work involved in operating a nursing home. “Working in a nursing home is very hard work. I’ve done it,” she said.
“What leadership really needs to do is to say this is important enough to me that I’m going to set aside a couple of hours where you don’t have critical duties and they just want you to participate in this cultural competency training,” Carnahan concludes. “And that’s what really needs to happen.”
The journal Clinics In Geriatric Medicine has a policy of not releasing articles it publishes to the public who are not paid subscribers to the journal until one year after an article has been published. Additional information about the topic of LGBTQ+ nursing home residents can be found on these sites from the Regenstrief Institute:
regenstrief.org/article/culturally-inclusive-care-lgbtq-nursing-home-residents/
regenstrief.org/article/carnahan-inclusive-long-term-care-video
National
Medical groups file lawsuit over Trump deletion of health information
Crucial datasets included LGBTQ, HIV resources
Nine private medical and public health advocacy organizations, including two from D.C., filed a lawsuit on May 20 in federal court in Seattle challenging what it calls the U.S. Department of Health and Human Services’s illegal deletion of dozens or more of its webpages containing health related information, including HIV information.
The lawsuit, filed in the United States District Court for the Western District of Washington, names as defendants Robert F. Kennedy Jr., secretary of the Department of Health and Human Services (HHS) and HHS itself, and several agencies operating under HHS and its directors, including the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration.
“This action challenges the widespread deletion of public health resources from federal agencies,” the lawsuit states. “Dozens (if not more) of taxpayer-funded webpages, databases, and other crucial resources have vanished since January 20, 2025, leaving doctors, nurses, researchers, and the public scrambling for information,” it says.
“These actions have undermined the longstanding, congressionally mandated regime; irreparably harmed Plaintiffs and others who rely on these federal resources; and put the nation’s public health infrastructure in unnecessary jeopardy,” the lawsuit continues.
It adds, “The removal of public health resources was apparently prompted by two recent executive orders – one focused on ‘gender ideology’ and the other targeting diversity, equity, and inclusion (‘DEI’) programs. Defendants implemented these executive orders in a haphazard manner that resulted in the deletion (inadvertent or otherwise) of health-related websites and databases, including information related to pregnancy risks, public health datasets, information about opioid-use disorder, and many other valuable resources.”
The lawsuit does not mention that it was President Donald Trump who issued the two executive orders in question.
A White House spokesperson couldn’t immediately be reached for comment on the lawsuit.
While not mentioning Trump by name, the lawsuit names as defendants in addition to HHS Secretary Robert Kennedy Jr., Matthew Buzzelli, acting director of the Centers for Disease Control and Prevention; Jay Bhattacharya, director of the National Institutes of Health; Martin Makary, commissioner of the Food and Drug Administration; Thomas Engels, administrator of the Health Resources and Services Administration; and Charles Ezell, acting director of the Office of Personnel Management.
The 44-page lawsuit complaint includes an addendum with a chart showing the titles or descriptions of 49 “affected resource” website pages that it says were deleted because of the executive orders. The chart shows that just four of the sites were restored after initially being deleted.
Of the 49 sites, 15 addressed LGBTQ-related health issues and six others addressed HIV issues, according to the chart.
“The unannounced and unprecedented deletion of these federal webpages and datasets came as a shock to the medical and scientific communities, which had come to rely on them to monitor and respond to disease outbreaks, assist physicians and other clinicians in daily care, and inform the public about a wide range of healthcare issues,” the lawsuit states.
“Health professionals, nonprofit organizations, and state and local authorities used the websites and datasets daily in care for their patients, to provide resources to their communities, and promote public health,” it says.
Jose Zuniga, president and CEO of the International Association of Providers of AIDS Care (IAPAC), one of the organizations that signed on as a plaintiff in the lawsuit, said in a statement that the deleted information from the HHS websites “includes essential information about LGBTQ+ health, gender and reproductive rights, clinical trial data, Mpox and other vaccine guidance and HIV prevention resources.”
Zuniga added, “IAPAC champions evidence-based, data-informed HIV responses and we reject ideologically driven efforts that undermine public health and erase marginalized communities.”
Lisa Amore, a spokesperson for Whitman-Walker Health, D.C.’s largest LGBTQ supportive health services provider, also expressed concern about the potential impact of the HHS website deletions.
“As the region’s leader in HIV care and prevention, Whitman-Walker Health relies on scientific data to help us drive our resources and measure our successes,” Amore said in response to a request for comment from the Washington Blade.
“The District of Columbia has made great strides in the fight against HIV,” Amore said. “But the removal of public facing information from the HHS website makes our collective work much harder and will set HIV care and prevention backward,” she said.
The lawsuit calls on the court to issue a declaratory judgement that the “deletion of public health webpages and resources is unlawful and invalid” and to issue a preliminary or permanent injunction ordering government officials named as defendants in the lawsuit “to restore the public health webpages and resources that have been deleted and to maintain their web domains in accordance with their statutory duties.”
It also calls on the court to require defendant government officials to “file a status report with the Court within twenty-four hours of entry of a preliminary injunction, and at regular intervals, thereafter, confirming compliance with these orders.”
The health organizations that joined the lawsuit as plaintiffs include the Washington State Medical Association, Washington State Nurses Association, Washington Chapter of the American Academy of Pediatrics, Academy Health, Association of Nurses in AIDS Care, Fast-Track Cities Institute, International Association of Providers of AIDS Care, National LGBT Cancer Network, and Vermont Medical Society.
The Fast-Track Cities Institute and International Association of Providers of AIDS Care are based in D.C.
U.S. Federal Courts
Federal judge scraps trans-inclusive workplace discrimination protections
Ruling appears to contradict US Supreme Court precedent
Judge Matthew Kacsmaryk of the U.S. District Court for the Northern District of Texas has struck down guidelines by the U.S. Equal Employment Opportunity Commission designed to protect against workplace harassment based on gender identity and sexual orientation.
The EEOC in April 2024 updated its guidelines to comply with the U.S. Supreme Court’s ruling in Bostock v. Clayton County (2020), which determined that discrimination against transgender people constituted sex-based discrimination as proscribed under Title VII of the Civil Rights Act of 1964.
To ensure compliance with the law, the agency recommended that employers honor their employees’ preferred pronouns while granting them access to bathrooms and allowing them to wear dress code-compliant clothing that aligns with their gender identities.
While the the guidelines are not legally binding, Kacsmaryk ruled that their issuance created “mandatory standards” exceeding the EEOC’s statutory authority that were “inconsistent with the text, history, and tradition of Title VII and recent Supreme Court precedent.”
“Title VII does not require employers or courts to blind themselves to the biological differences between men and women,” he wrote in the opinion.
The case, which was brought by the conservative think tank behind Project 2025, the Heritage Foundation, presents the greatest setback for LGBTQ inclusive workplace protections since President Donald Trump’s issuance of an executive order on the first day of his second term directing U.S. federal agencies to recognize only two genders as determined by birth sex.
Last month, top Democrats from both chambers of Congress reintroduced the Equality Act, which would codify LGBTQ-inclusive protections against discrimination into federal law, covering employment as well as areas like housing and jury service.
The White House
Trump travels to Middle East countries with death penalty for homosexuality
President traveled to Saudi Arabia, Qatar, and United Arab Emirates
Homosexuality remains punishable by death in two of the three Middle East countries that President Donald Trump visited last week.
Saudi Arabia and Qatar are among the handful of countries in which anyone found guilty of engaging in consensual same-sex sexual relations could face the death penalty.
Trump was in Saudi Arabia from May 13-14. He traveled to Qatar on May 14.
“The law prohibited consensual same-sex sexual conduct between men but did not explicitly prohibit same-sex sexual relations between women,” notes the State Department’s 2023 human rights report, referring specifically to Qatar’s criminalization law. “The law was not systematically enforced. A man convicted of having consensual same-sex sexual relations could receive a sentence of seven years in prison. Under sharia, homosexuality was punishable by death; there were no reports of executions for this reason.”
Trump on May 15 arrived in Abu Dhabi, the capital of the United Arab Emirates.
The State Department’s 2023 human rights report notes the “penalty for individuals who engaged in ‘consensual sodomy with a man'” in the country “was a minimum prison sentence of six months if the individual’s partner or guardian filed a complaint.”
“There were no known reports of arrests or prosecutions for consensual same-sex sexual conduct. LGBTQI+ identity, real or perceived, could be deemed an act against ‘decency or public morality,’ but there were no reports during the year of persons prosecuted under these provisions,” reads the report.
The report notes Emirati law also criminalizes “men who dressed as women or entered a place designated for women while ‘disguised’ as a woman.” Anyone found guilty could face up to a year in prison and a fine of up to 10,000 dirhams ($2,722.60.)
Trump returned to the U.S. on May 16.
The White House notes Trump during the trip secured more than $2 trillion “in investment agreements with Middle Eastern nations ($200 billion with the United Arab Emirates, $600 billion with Saudi Arabia, and $1.2 trillion with Qatar) for a more safe and prosperous future.”
Former President Joe Biden traveled to Saudi Arabia in 2022.
Saudi Arabia is scheduled to host the 2034 World Cup. The 2022 World Cup took place in Qatar.
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