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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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LGBTQ community calls out Radio Korea over host’s homophobic comments

Station acknowledged controversy, but skirted accountability

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On Nov. 21st, Radio Korea CEO Michael Kim made an official video statement addressing the Nov. 3rd program. (Screen capture via Radio Korea/YouTube)

On Monday, Nov. 3, Radio Korea aired its regular morning talk show program, where one of its hosts, Julie An, discussed her lack of support for the LGBTQ community, citing her religious beliefs. She also went on to comment that gay people spread HIV and AIDS, and that conversation therapy — which has been linked to PTSD, suicidality, and depression — is a viable practice. Clips of this have since been taken down.

Radio Korea offers Korean language programming to engage local Korean American and Korean immigrant community members. Its reach is broad, as Los Angeles is home to the largest Korean population in the U.S, with over 300,000 residents. As An’s words echoed through the station’s airwaves, queer Korean community members took to social media to voice their concern, hurt, and anger.  

In a now-deleted Instagram post, attorney, activist, and former congressional candidate David Yung Ho Kim demanded accountability from the station. Writer and entertainer Nathan Ramos-Park made videos calling out Radio Korea and An, stating that her comments “embolden” people with misinformation, which has the ability to perpetuate “violence against queer people.”

Community health professional Gavin Kwon also worries about how comments like An’s increase stigma within the Korean immigrant community, which could lead to increased discrimination against queer people and their willingness to seek health care.  

Kwon, who works at a local clinic in Koreatown, told the Los Angeles Blade that comments like An’s prescribe being gay or queer as a “moral failure,” and that this commonly-held belief within the Korean immigrant community, particularly in older generations, strengthens the reticence and avoidance clients hold onto when asked about their gender or sexual orientation. 

“When you stigmatize a group, people don’t avoid the disease — they avoid care,” Kwon explained. “They avoid getting tested, avoid disclosing their status, and avoid talking openly with providers. Stigma pushes people into silence, and silence is the worst possible environment for managing any infectious disease.”

For weeks, Radio Korea did not offer a direct response to the public criticism. Its Instagram feed continued to be updated with shorts, featuring clips of its various hosts — including An. 

On Friday, Radio Korea CEO Michael Kim released an official statement on the station’s YouTube page. In this video, Michael Kim stated that An’s comments “included factual inaccuracies” and that the station “does not endorse or share the personal opinions expressed by individual hosts.” Michael Kim also stated that Radio Korea “welcomes members of the LGBT community to share their perspectives” in order to deepen understanding through dialogue. 

Afterwards, Michael Kim continued that though he acknowledges the “pain” felt by queer community members, he concluded: “I don’t think Radio Korea needs to apologize for what was said any more than Netflix should apologize for what Dave Chappelle says, or any more than Instagram or TikTok should apologize for what people say on their platforms.” 

Michael then offered a justification that An’s statements were “not part of a news report,” and that he was “disappointed” that David Yung Ho Kim, specifically, had been vocal about An’s comments. Michael Kim stated that he was the first person to interview David Yung Ho Kim in 2020 during his congressional campaign, and that he had provided the candidate a platform and opportunity to educate listeners about politics. 

“After all these years, the support Radio Korea has given him,” said Kim, “the support I personally gave him, even the support from other Radio Korea members who donated or even volunteered for him — he dishonestly tried to portray Radio Korea as being an anti-gay organization.”

Michael Kim went on to criticize David Yung Ho Kim’s purported “hurry to condemn others,” and also questioned if David has disowned his father, who he states is a pastor. “What kind of person is David Kim, and is this the kind of person we want in Congress?” Michael Kim asked viewers, noting that Koreatown is “only about three miles from Hollywood, and some people just like to perform.” 

At the end of the video, Michael Kim stated that his duty is to guard the legacy of the station. “My responsibility is to protect what was built before me and ensure that Radio Korea continues serving this community long after today’s momentary controversies disappear,” he said. 

For community members and advocates, this response was unsatisfactory. “The overall tone of the statement felt more defensive than accountable,” Kwon wrote to the Blade. “Instead of a sincere apology to the LGBTQ+ community that was harmed, the message shifts into personal grievances, political dynamics, and side explanations that don’t belong in an official response.”

Michael Kim’s portrayal of the criticism and calls to action by community members as a “momentary controversy” paints a clearer picture of the station’s stance — that the hurt felt and expressed by its queer community members is something that will simply pass until it is forgotten. An continues to be platformed at Radio Korea, and was posted on the station’s social media channels as recently as yesterday. The station has not outlined any other action since Michael Kim’s statement. 

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U.S. Military/Pentagon

Pentagon moves to break with Boy Scouts over LGBTQ and gender inclusion

Leaked memo shows Hegseth rejecting Scouting America’s shift toward broader inclusion

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Scouts for Equality march in the 2015 Capital Pride Parade. (Washington Blade file photo by Michael Key)

The Pentagon is preparing to sever its longstanding partnership with the Boy Scouts of America, now known as Scouting America.

In a draft memo to Congress obtained by NPR, Defense Secretary Pete Hegseth criticizes the organization for being “genderless” and for promoting diversity, equity, and inclusion.

“The organization once endorsed by President Theodore Roosevelt no longer supports the future of American boys,” Hegseth wrote, according to Defense Department sources.

Girls have been eligible to join Cub Scouts (grades K–5) since 2018, and since 2019 they have been able to join Scouts BSA troops and earn the organization’s highest rank of Eagle Scout.

A statement on the Scouting America website says the shift toward including girls stemmed from “an expanding demand to join the Boy Scouts” and a commitment to inclusivity. “Throughout the late 20th and early 21st centuries, it has undergone significant changes to become more inclusive of the adult staff and volunteers that drive its programming as well as of scouts and their families,” the organization says.

Part of that broader push included lifting its ban on openly gay members in 2014 and on openly gay adult leaders in 2015.

Once the Pentagon finalizes the break, the U.S. military will no longer provide medical and logistical support to the National Jamboree, the massive annual gathering of scouts in West Virginia that typically draws about 20,000 participants. The memo also states that the military will no longer allow scout troops to meet on U.S. or overseas installations, where many bases host active scout programs.

Hegseth’s memo outlines several justifications for the decision, arguing that Scouting America has strayed from its original mission to “cultivate masculine values” by fostering “gender confusion.” It also cites global conflicts and tightening defense budgets, claiming that deploying troops, doctors and vehicles to a 10-day youth event would “harm national security” by diverting resources from border operations and homeland defense.

“Scouting America has undergone a significant transformation,” the memo states. “It is no longer a meritocracy which holds its members accountable to meet high standards.”

The Pentagon declined NPR’s request for comment. A “War Department official” told the outlet that the memo was a “leaked document that we cannot authenticate and that may be pre-decisional.”

The leaked memo comes roughly one month after nearly every major journalism organization walked out of the Pentagon in protest of new rules requiring reporters to publish only “official” documents released by the department — effectively banning the use of leaked or unpublished materials.

President Donald Trump, who serves as the honorary head of Scouting America by virtue of his office, praised the Jamboree audience during his 2017 visit to West Virginia. “The United States has no better citizens than its Boy Scouts. No better,” he said, noting that 10 members of his Cabinet were former Scouts.

Hegseth was never a scout. He has said he grew up in a church-based youth group focused on memorizing Bible verses. As a Fox News host last year, he criticized the Scouts for changing their name and admitting girls.

“The Boy Scouts has been cratering itself for quite some time,” Hegseth said. “This is an institution the left didn’t control. They didn’t want to improve it. They wanted to destroy it or dilute it into something that stood for nothing.”

NBC News first reported in April that the Pentagon was considering ending the partnership, citing sources familiar with the discussions. In a statement to NBC at the time, Pentagon spokesman Sean Parnell said, “Secretary Hegseth and his Public Affairs team thoroughly review partnerships and engagements to ensure they align with the President’s agenda and advance our mission.”

The Scouting America organization has has long played a role in military recruiting. According to numbers provided by Scouting America, many as 20 percent of cadets and midshipmen at the various service academies are Eagle Scouts. Enlistees who have earned the Eagle rank also receive advanced entry-level rank and higher pay — a practice that would end under the proposed changes.

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The White House

Trans workers take White House to court over bathroom policy

Federal lawsuit filed Thursday

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Protesters outside of House Speaker Mike Johnson's (R-La.) office in the Cannon House Office Building last year protesting a similar bathroom ban. (Washington Blade photo by Christopher Kane)

Democracy Forward and the American Civil Liberties Union, two organizations focused on protecting Americans’ constitutional rights, filed a class-action lawsuit Thursday in federal court challenging the Trump-Vance administration’s bathroom ban policies.

The lawsuit, filed on behalf of LeAnne Withrow, a civilian employee of the Illinois National Guard, challenges the administration’s policy prohibiting transgender and intersex federal employees from using restrooms aligned with their gender. The policy claims that allowing trans people in bathrooms would “deprive [women assigned female at birth] of their dignity, safety, and well-being.”

The lawsuit responds to the executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” signed by President Donald Trump on his first day in office. It alleges that the order and its implementation violate Title VII of the Civil Rights Act of 1964, which prohibits sex discrimination in employment. In 2020, the U.S. Supreme Court ruled 6-3 that Title VII protects trans workers from discrimination based on sex.

Since its issuance, the executive order has faced widespread backlash from constitutional rights and LGBTQ advocacy groups for discriminating against trans and intersex people.

The lawsuit asserts that Withrow, along with numerous other trans and intersex federal employees, is forced to choose between performing her duties and being allowed to use the restroom safely.

“There is no credible evidence that allowing transgender people access to restrooms aligning with their gender identity jeopardizes the safety or privacy of non-transgender users,” the lawsuit states, directly challenging claims of safety risks.

Withrow detailed the daily impact of the policy in her statement included in the lawsuit.

“I want to help soldiers, families, veterans — and then I want to go home at the end of the day. At some point in between, I will probably need to use the bathroom,” she said.

The filing notes that Withrow takes extreme measures to avoid using the restroom, which the Cleveland Clinic reports most people need to use anywhere from 1–15 times per day depending on hydration.

“Ms. Withrow almost never eats breakfast, rarely eats lunch, and drinks less than the equivalent of one 17 oz. bottle of water at work on most days.”

In addition to withholding food and water, the policy subjects her to ongoing stress and fear:

“Ms. Withrow would feel unsafe, humiliated, and degraded using a men’s restroom … Individuals seeing her enter the men’s restroom might try to prevent her from doing so or physically harm her,” the lawsuit states. “The actions of defendants have caused Ms. Withrow to suffer physical and emotional distress and have limited her ability to effectively perform her job.”

“No one should have to choose between their career in service and their own dignity,” Withrow added. “I bring respect and honor to the work I do to support military families, and I hope the court will restore dignity to transgender people like me who serve this country every day.”

Withrow is a lead Military and Family Readiness Specialist and civilian employee of the Illinois National Guard. Previously, she served as a staff sergeant and has received multiple commendations, including the Illinois National Guard Abraham Lincoln Medal of Freedom.

The lawsuit cites the American Medical Association, the largest national association of physicians, which has stated that policies excluding trans individuals from facilities consistent with their gender identity have harmful effects on health, safety, and well-being.

“Policies excluding transgender individuals from facilities consistent with their gender identity have detrimental effects on the health, safety and well-being of those individuals,” the lawsuit states on page 32.

Advocates have condemned the policy since its signing in January and continue to push back against the administration. Leaders from ACLU-D.C., ACLU of Illinois, and Democracy Forward all provided comments on the lawsuit and the ongoing fight for trans rights.

“We cannot let the Trump administration target transgender people in the federal government or in public life,” said ACLU-D.C. Senior Staff Attorney Michael Perloff. “An executive order micromanaging which bathroom civil servants use is discrimination, plain and simple, and must be stopped.”

“It is absurd that in her home state of Illinois, LeAnne can use any other restroom consistent with her gender — other than the ones controlled by the federal government,” said Michelle Garcia, deputy legal director at the ACLU of Illinois. “The Trump administration’s reckless policies are discriminatory and must be reversed.”

“This policy is hateful bigotry aimed at denying hardworking federal employees their basic dignity simply because they are transgender,” said Kaitlyn Golden, senior counsel at Democracy Forward. “It is only because of brave individuals like LeAnne that we can push back against this injustice. Democracy Forward is honored to work with our partners in this case and is eager to defeat this insidious effort to discriminate against transgender federal workers.”

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