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New report outlines problems faced by LGBTQ+ nursing home residents

Authors recommend supportive policies, training for nation’s 15,000 facilities

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A new study emphasizes the need for culturally competent care for LGBTQ+ people living in nursing homes.

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

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Federal Government

Trump-appointed EEOC leadership rescinds LGBTQ worker guidance

The EEOC voted to rescind its 2024 guidance, minimizing formally expanded protections for LGBTQ workers.

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Equal Employment Opportunity Commission seal, gay news, Washington Blade

The U.S. Equal Employment Opportunity Commission voted 2–1 to repeal its 2024 guidance, rolling back formally expanded protections for LGBTQ workers.

The EEOC, which is composed of five commissioners, is tasked with enforcing federal laws that make workplace discrimination illegal. Since President Donald Trump appointed two Republican commissioners last year — Andrea R. Lucas as chair in January and Brittany Panuccio in October — the commission’s majority has increasingly aligned its work with conservative priorities.

The commission updated its guidance in 2024 under then-President Joe Biden to expand protections to LGBTQ workers, particularly transgender workers — the most significant change to the agency’s harassment guidance in 25 years.

The directive, which spanned nearly 200 pages, outlined how employers may not discriminate against workers based on protected characteristics, including race, sex, religion, age, and disability as defined under federal law.

One issue of particular focus for Republicans was the guidance’s new section on gender identity and sexual orientation. Citing the 2020 U.S. Supreme Court’s Bostock v. Clayton County decision and other cases, the guidance included examples of prohibited conduct, such as the repeated and intentional use of a name or pronoun an individual no longer uses, and the denial of access to bathrooms consistent with a person’s gender identity.

Last year a federal judge in Texas had blocked that portion of the guidance, saying that finding was novel and was beyond the scope of the EEOC’s powers in issuing guidance.

The dissenting vote came from the commission’s sole Democratic member, Commissioner Kalpana Kotagal.

“There’s no reason to rescind the harassment guidance in its entirety,” Kotagal said Thursday. “Instead of adopting a thoughtful and surgical approach to excise the sections the majority disagrees with or suggest an alternative, the commission is throwing out the baby with the bathwater. Worse, it is doing so without public input.”

While this now rescinded EEOC guidance is not legally binding, it is widely considered a blueprint for how the commission will enforce anti-discrimination laws and is often cited by judges deciding novel legal issues. 

Multiple members of Congress released a joint statement condemning the agency’s decision to minimize worker protections, including U.S. Reps. Teresa Leger Fernández (D-N.M.), Grace Meng (D-N.Y.), Mark Takano (D-Calif.), Adriano Espaillat (D-N.Y.), and Yvette Clarke (D-N.Y.) The rescission follows the EEOC’s failure to respond to or engage with a November letter from Democratic Caucus leaders urging the agency to retain the guidance and protect women and vulnerable workers.

“The Equal Employment Opportunity Commission is supposed to protect vulnerable workers, including women, people of color, and LGBTQI+ workers, from discrimination on the job. Yet, since the start of her tenure, the EEOC chair has consistently undermined protections for women, people of color, and LGBTQI+ workers. Now, she is taking away guidance intended to protect workers from harassment on the job, including instructions on anti-harassment policies, training, and complaint processes — and doing so outside of the established rule-making process. When workers are sexually harassed, called racist slurs, or discriminated against at work, it harms our workforce and ultimately our economy. Workers can’t afford this — especially at a time of high costs, chaotic tariffs, and economic uncertainty. Women and vulnerable workers deserve so much better.”

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Minnesota

Lawyer representing Renee Good’s family speaks out

Antonio Romanucci condemned White House comments over Jan. 7 shooting

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Protesters in Haymarket, Va., protest against U.S. Immigration and Customs Enforcement after an ICE agent shot Renee Good to death in Minneapolis. (Washington Blade photo by Michael Key)

A U.S. Immigration and Customs Enforcement agent shot and killed Renee Good in Minneapolis on Jan. 7 as she attempted to drive away from law enforcement during a protest.

Since Good’s killing, ICE has faced national backlash over the excessive use of deadly force, prompting the Trump-Vance administration to double down on escalating enforcement measures in cities across the country.

The Washington Blade spoke with Antonio Romanucci, the attorney representing Good’s family following her death.

Romanucci said that Jonathan Ross — the ICE agent seen on video shooting Good — acted in an antagonizing manner, escalated the encounter in violation of ICE directives, and has not been held accountable as ICE and other federal agents continue to “ramp up” operations in Minnesota.

A day before the fatal shooting, the Department of Homeland Security began what it described as the largest immigration enforcement operation ever carried out by the agency, according to DHS’s own X post.

That escalation, Romanucci said, is critical context in understanding how Good was shot and why, so far, the agent who killed her has faced no consequences for killing a queer mother as she attempted to disengage from a confrontation.

“You have to look at this in the totality of the circumstances … One of the first things we need to look at is what was the mission here to begin with — with ICE coming into Minneapolis,” Romanucci told the Blade. “We knew the mission was to get the worst of the worst, and that was defined as finding illegal immigrants who had felony convictions. When you look at what happened on Jan. 7 with Renee and Rebecca [Good, Renee’s wife], certainly that was far from their mission, wasn’t it? What they really did was they killed a good woman — someone who was a mother, a daughter, a sister, a committed companion, an animal lover.”

Romanucci said finding and charging those responsible for Good’s death is now the focus of his work with her family.

“What our mission is now is to ensure that we achieve transparency, accountability, and justice … We aim to get it in front of, hopefully, a judge or a jury one day to make that determination.”

Those are three things Homeland Security Secretary Kristi Noem and DHS has outright rejected while smearing Good in the official record — including accusing her of being a “domestic terrorist” without evidence and standing by Ross, who Noem said acted in self-defense.

The version of events advanced by Noem and ICE has been widely contradicted by the volume of video footage of the shooting circulating online. Multiple angles show Good’s Honda Pilot parked diagonally in the street alongside other protesters attempting to block ICE agents from entering Richard E. Green Central Park Elementary School.

The videos show ICE officers approaching Good’s vehicle and ordering her to “get out of the car.” She then puts the car in reverse, backs up briefly, shifts into drive, and steers to the right — away from the officers.

The abundance of video evidence directly contradicts statements made by President Donald Trump, Noem, and other administration officials in interviews following Good’s death.

“The video shows that Renee told Jonathan Ross that ‘I’m not mad at you,’ so we know that her state of mind was one of peace,” Romanucci said. “She steered the car away from where he was standing, and we know that he was standing in front of the car. Reasonable police practices say that you do not stand in front of the car when there’s a driver behind the wheel. When you leave yourself with only the ability to use deadly force as an option to escape, that is not a reasonable police practice.”

An autopsy commissioned by Good’s family further supports that account, finding that her injuries were consistent with being shot from the direction of someone driving away.

The autopsy found three gunshot wounds: one to Good’s left forearm, one that struck her right breast without piercing major organs, and a third that entered the left side of her head near the temple and exited on the right side.

Romanucci said Ross not only placed himself directly in harm’s way, but then used deadly force after creating the conditions he claimed justified it — a move that violates DHS and ICE policy, according to former Assistant Homeland Security Secretary Juliette Kayyem.

“As a general rule, police officers and law enforcement do not shoot into moving cars, do not put themselves in front of cars, because those are things that are easily de-escalated,” Kayyem told PBS in a Jan. 8 interview.

“When he put himself in a situation of danger, the only way that he could get out of danger is by shooting her, because he felt himself in peril,” Romanucci said. “That is not a reasonable police practice when you leave yourself with only the ability to use deadly force as an option. That’s what happened here. That’s why we believe, based on what we’ve seen, that this case is unlawful and unconstitutional.”

Romanucci said he was appalled by how Trump and Noem described Good following her death.

“I will never use those words in describing our client and a loved one,” he said. “Those words, in my opinion, certainly do not apply to her, and they never should apply to her. I think the words, when they were used to describe her, were nearly slanderous … Renee Good driving her SUV at two miles per hour away from an ICE agent to move down the street is not an act of domestic terrorism at all.”

He added that his office has taken steps to preserve evidence in anticipation of potential civil litigation, even as the Justice Department has declined to open an investigation.

“We did issue a letter of preservation to the Department of Justice, Department of Homeland Security, and other agencies to ensure that any evidence that’s in their possession be not destroyed or altered or modified,” Romanucci said. “We’ve heard Todd Blanche say just in the last couple of days that they don’t believe that they need to investigate at all. So we’re going to be demanding that the car be returned to its rightful owner, because if there’s no investigation, then we want our property back.”

The lack of accountability for Ross — and the continued expansion of ICE operations — has fueled nationwide protests against federal law enforcement under the Trump-Vance administration.

“The response we’ve seen since Renee’s killing has been that ICE has ramped up its efforts even more,” Romanucci said. “There are now over 3,000 ICE agents in a city where there are only 600 police officers, which, in my opinion, is defined as an invasion of federal law enforcement officers into a city … When you see the government ramping up its efforts in the face of constitutional assembly, I think we need to be concerned.”

As of now, Romanucci said, there appears to be no meaningful accountability mechanism preventing ICE agents from continuing to patrol — and, in some cases, terrorize — the Minneapolis community.

“What we know is that none of these officers are getting disciplined for any of their wrongdoings,” he said. “The government is saying that none of their officers have acted in a wrongful manner, but that’s not what the courts are saying … Until they get disciplined for their wrongdoings, they will continue to act with impunity.”

When asked what the public should remember about Good, Romanucci emphasized that she was a real person — a mother, a wife, and a community member whose life was cut short. Her wife lost her partner, and three children lost a parent.

“I’d like the public to remember Renee about is the stories that Rebecca has to tell — how the two of them would share road trips together, how they loved to share home-cooked meals together, what a good mother she was, and what a community member she was trying to make herself into,” Romanucci said. “They were new to Minneapolis and were really trying to make themselves a home there because they thought they could have a better life. Given all of that, along with her personality of being one of peace and one of love and care, I think that’s what needs to be remembered about Renee.”

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The White House

Trump-Vance administration ‘has dismantled’ US foreign policy infrastructure

Current White House took office on Jan. 20, 2025

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President Donald Trump took office on Jan. 20, 2025. (Public domain photo courtesy of the White House's X page)

Jessica Stern, the former special U.S. envoy for the promotion of LGBTQ and intersex rights, on the eve of the first anniversary of the Trump-Vance administration said its foreign policy has “hurt people” around the world.

“The changes that they are making will take a long time to overturn and recover from,” she said on Jan. 14 during a virtual press conference the Alliance for Diplomacy and Justice, a group she co-founded, co-organized.

Amnesty International USA National Director of Government Relations and Advocacy Amanda Klasing, Human Rights Watch Deputy Washington Director Nicole Widdersheim, Human Rights First President Uzra Zeya, PEN America’s Jonathan Friedman, and Center for Reproductive Rights Senior Federal Policy Council Liz McCaman Taylor also participated in the press conference.

The Trump-Vance administration took office on Jan. 20, 2025.

The White House proceeded to dismantle the U.S. Agency for International Development, which funded LGBTQ and intersex rights organizations around the world.

Thousands of people on Feb. 5, 2025, gathered outside the U.S. Capitol to protest the Trump-Vance administration’s efforts to dismantle the U.S. Agency for International Development. (Courtesy photo)

Secretary of State Marco Rubio last March announced the State Department would administer the 17 percent of USAID contracts that had not been cancelled. Rubio issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during the U.S. foreign aid freeze the White House announced shortly after it took office.

The global LGBTQ and intersex rights movement has lost more than an estimated $50 million in funding because of the cuts. The Washington Blade has previously reported PEPFAR-funded programs in Kenya and other African countries have been forced to suspend services and even shut down.

Stern noted the State Department “has dismantled key parts of foreign policy infrastructure that enabled the United States to support democracy and human rights abroad” and its Bureau of Democracy, Human Rights, and Labor “has effectively been dismantled.” She also pointed out her former position and others — the Special Representative for Racial Equity and Justice, the Ambassador-at-Large for Global Women’s Issues, and the Ambassador-at-Large for Global Criminal Justice — “have all been eliminated.”

President Donald Trump on Jan. 7 issued a memorandum that said the U.S. will withdraw from the U.N. Entity for Gender Equality and the Empowerment of Women and more than 60 other U.N. and international entities.

Rubio in a Jan. 10 Substack post said UN Women failed “to define what a woman is.”

“At a time when we desperately need to support women — all women — this is yet another example of the weaponization of transgender people by the Trump administration,” said Stern.

US ‘conducting enforced disappearances’

The Jan. 14 press conference took place a week after a U.S. Immigration and Customs Enforcement agent killed Renee Good, a 37-year-old woman who left behind her wife and three children, in Minneapolis. American forces on Jan. 3 seized now former Venezuelan President Nicolás Maduro and his wife, Cilia Flores, at their home in Caracas, the Venezuelan capital, during an overnight operation. Trump also continues to insist the U.S. needs to gain control of Greenland.

Colombians protest against U.S. President Donald Trump in Plaza Bolívar in Bogotá, Colombia, on Jan. 7, 2026. (Washington Blade photo by Michael K. Lavers)

Widdersheim during the press conference noted the Trump-Vance administration last March sent 252 Venezuelans to El Salvador’s Terrorism Confinement Center, a maximum-security prison known by the Spanish acronym CECOT.

One of them, Andry Hernández Romero, is a gay asylum seeker who the White House claimed was a member of Tren de Aragua, a Venezuelan gang the Trump-Vance administration has designated as an “international terrorist organization.” Hernández upon his return to Venezuela last July said he suffered physical, sexual, and psychological abuse while at CECOT.

“In 2025 … the United States is conducting enforced disappearances,” said Widdersheim.

Zeya, who was Under Secretary of State for Civilian Security, Democracy, and Human Rights from 2021-2025, in response to the Blade’s question during the press conference said her group and other advocacy organizations have “got to keep doubling down in defense of the rule of law, to hold this administration to account.”

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