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
Top 10 LGBTQ national news stories of 2025
Trump, Supreme Court mount cruel attacks against trans community
President Trump’s anti-LGBTQ agenda dominated national news in 2025, particularly his cruel attacks on trans Americans. Here are our picks for the top 10 LGBTQ news stories the Blade covered in 2025.
10. Trump grants clemency to George Santos
President Donald Trump granted clemency to disgraced former Long Island Rep. George Santos. Santos was sentenced to 87 months in federal prison after pleading guilty to wire fraud and aggravated identity theft and had served just 84 days of his more than seven-year sentence. He lied to both the DOJ and the House Ethics Committee, including about his work and education history, and committed campaign finance fraud.
9. U.S. Olympics bans trans women athletes
The United States Supreme Court decided in 2025 to take up two cases — Little v. Hecox and West Virginia v. B.P.J.— both of which concern the rights of transgender athletes to participate on sports teams. The cases challenge state laws under the Equal Protection Clause of the 14th Amendment, which prevents states from offering separate boys’ and girls’ sports teams based on biological sex determined at birth. Both cases are set to be heard in January 2026. The developments follow a decision by the United States Olympic & Paralympic Committee to change eligibility rules to prohibit transgender women from competing in women’s sporting events on behalf of the United States, following Trump’s Executive Order 14201, “Keeping Men Out of Women’s Sports.”
8. FDA approves new twice-yearly HIV prevention drug
The U.S. Food and Drug Administration on June 18 approved a newly developed HIV/AIDS prevention drug that needs to be taken only twice a year, with one injection every six months. The new drug, lenacapavir, is being sold under the brand name Yeztugo by pharmaceutical company Gilead Sciences. According to trial data, 99.9 percent of participants who received Yeztugo remained HIV negative. This emerging technology comes amid direct cuts to HIV/AIDS research measures by the Trump–Vance administration, particularly targeting international HIV efforts such as PEPFAR.
7. LGBTQ people ‘erased’ from gov’t reports
Politico reported in March that the Trump–Vance administration is slashing the State Department’s annual human rights report, cutting sections related to the rights of women, people with disabilities, the LGBTQ+ community, and more. Members of Congress objected to the removal of the subsection on “Acts of Violence, Criminalization, and Other Abuses Based on Sexual Orientation, Gender Identity or Expression, or Sex Characteristics (SOGIESC)” from the State Department’s Annual Country Reports on Human Rights Practices.
In a Sept. 9 letter to Secretary of State Marco Rubio, U.S. Reps. Robert Garcia (D-Calif.), Julie Johnson (D-Texas), and Sarah McBride (D-Del.) urged the department to restore the information or ensure it is integrated throughout each report, noting that the reports serve as key evidence for asylum seekers, attorneys, judges, and advocates assessing human rights conditions and protection claims worldwide.
6. Trump admin redefines ‘sex’ in all HHS programs
The Trump administration canceled more than $800 million in research into the health of sexual and gender minority groups. More than half of the National Institutes of Health grants scrapped through early May involved studies of cancers and viruses that disproportionately affect LGBTQ people.
The administration is also pushing to end gender-affirming care for transgender youth, according to a new proposal from the Department of Health and Human Services, NPR reported. The administration is considering blocking all Medicaid and Medicare funding for services at hospitals that provide pediatric gender-affirming care. “These rules would be a significant escalation in the Trump administration’s attack on access to transgender health care,” said Katie Keith, director of the Center for Health Policy and Law at Georgetown University.
5. FBI plans to label trans people as ‘violent extremists’
The Human Rights Campaign, Transgender Law Center, Equality Federation, GLAAD, PFLAG, and the Southern Poverty Law Center condemned reports that the FBI, in coordination with the Heritage Foundation, may be working to designate transgender people as “violent extremists.” The concerns followed a report earlier this month by independent journalist Ken Klippenstein, who cited two anonymous national security officials saying the FBI is considering treating transgender subjects as a subset of a new threat category.
That classification—originally created under the Biden administration as “Anti-Authority and Anti-Government Violent Extremists” (AGAAVE) — was first applied to Jan. 6 rioters and other right-wing extremists. Advocates said the proposal appears to stem from the false claim that the assassination of Charlie Kirk was committed by a transgender person.
4. Pentagon targets LGBTQ service members
Acting in agreement with the growing anti-LGBTQ sentiment from the Trump administration, during a televised speech to U.S. military leaders at Marine Corps Base Quantico in late September, Defense Secretary Pete Hegseth denounced past military leadership for being too “woke,” citing DEI initiatives and LGBTQ inclusion within the Department of Defense. During the 45-minute address, Hegseth criticized inclusive policies and announced forthcoming directives, saying they would ensure combat requirements “return to the highest male standard only.”
Since 2016, a Navy replenishment oiler had borne the name of gay rights icon Harvey Milk, who served in the Navy during the Korean War and was separated from service under other than honorable conditions due to his sexuality before later becoming one of the first openly LGBTQ candidates elected to public office. In June 2025, the ship was renamed USNS Oscar V. Peterson.
The U.S. Air Force also announced that transgender service members who have served between 15 and 18 years would be denied early retirement and instead separated from the military without benefits. Transgender troops will be given the option of accepting a lump-sum payout offered to junior service members or being removed from service.
In February, the Pentagon said it would draft and submit procedures to identify transgender service members and begin discharging them from the military within 30 days.
3. Trump blames Democrats, trans people for gov’t shutdown
Republicans failed to reach an agreement with Democrats and blamed them for the government shutdown, while Democrats pointed to Republicans for cutting health care tax credits, a move they said would result in millions of people paying significantly higher monthly insurance premiums next year. In the White House press briefing room, a video of Democrats discussing past government shutdowns played on a loop as the president continued to blame the Democratic Party and “woke” issues, including transgender people.
“A lot of good can come from shutdowns. We can get rid of a lot of things. They’d be Democrat things,” Trump said the night before the shutdown. “They want open borders. Men playing in women’s sports. They want transgender for everybody.”
2. Supreme Court joins attacks on LGBTQ Americans
The U.S. Supreme Court issued multiple rulings this year affecting LGBTQ people. In Mahmoud v. Taylor (6–3), it ruled that public schools must give parents advance notice and the option to opt children out of lessons on gender or sexuality that conflict with their religious beliefs. The case arose after Montgomery County, Md., schools added LGBTQ-inclusive storybooks to the elementary curriculum.
In June, the court upheld Tennessee’s ban on gender-affirming care for transgender minors, protecting similar laws in more than 20 states. Lawmakers and advocates criticized the ruling, and a coalition of seven medical associations warned it strips families of the right to direct their own health care.
The Court also allowed the Trump administration to enforce a ban on transgender military personnel and to implement a policy blocking passports with “X” gender markers, with the federal government recognizing only male and female designations.
1. Trump inaugurated for second time
President Donald Trump became the 47th president after winning Wisconsin, securing 277 of the 270 electoral votes needed. His guidebook, Project 2025, outlined the Republican Party’s goals under his new leadership, with a particular focus on opposing transgender rights.
Trump nominated openly gay hedge fund executive Scott Bessent as U.S. Treasury Secretary, a role he eventually assumed. Bessent became the highest-ranking openly gay U.S. government official in American history.
Honorable mention: The war on rainbow crosswalks escalates around the country
Florida Gov. Ron DeSantis (R) ordered state transportation officials to remove a rainbow-colored crosswalk in Orlando next to the Pulse gay nightclub, where 49 mostly LGBTQ people were killed in a 2016 mass shooting. The move follows a July 1, 2025, announcement by U.S. Transportation Secretary Sean Duffy that, with support from President Trump, the department adopted a “nationwide roadway safety initiative” that political observers say could be used to require cities and states to remove rainbow street crosswalks.
Federal Government
Holiday week brings setbacks for Trump-Vance trans agenda
Federal courts begin to deliver end-of-year responses to lawsuits involving federal transgender healthcare policy.
While many Americans took the week of Christmas to rest and relax, LGBTQ politics in the U.S. continued to shift. This week’s short recap of federal updates highlights two major blows to the Trump-Vance administration’s efforts to restrict gender-affirming care for minors.
19 states sue RFK Jr. to end gender-affirming care ban
New York Attorney General Letitia James announced on Tuesday that the NYAG’s office, along with 18 other states (and the District of Columbia), filed a lawsuit to stop U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. from restricting gender-affirming care for minors.
In the press release, Attorney General James stressed that the push by the Trump-Vance administration’s crusade against the transgender community — specifically transgender youth — is a “clear overreach by the federal government” and relies on conservative and medically unvalidated practices to “punish providers who adhere to well-established, evidence-based care” that support gender-affirming care.
“At the core of this so-called declaration are real people: young people who need care, parents trying to support their children, and doctors who are simply following the best medical evidence available,” said Attorney General James. “Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors’ offices. My office will always stand up for New Yorkers’ health, dignity, and right to make medical decisions free from intimidation.”
The lawsuit is a direct response to HHS’ Dec. 18 announcement that it will pursue regulatory changes that would make gender-affirming health care for transgender children more difficult, if not impossible, to access. It would also restrict federal funding for any hospital that does not comply with the directive. KFF, an independent source for health policy research, polling, and journalism, found that in 2023 federal funding covered nearly 45% of total spending on hospital care in the U.S.
The HHS directive stems directly from President Donald Trump’s Jan. 28 Executive Order, Protecting Children From Chemical and Surgical Mutilation, which formally establishes U.S. opposition to gender-affirming care and pledges to end federal funding for such treatments.
The American Medical Association, the nation’s largest and most influential physician organization, has repeatedly opposed measures like the one pushed by President Trump’s administration that restrict access to trans health care.
“The AMA supports public and private health insurance coverage for treatment of gender dysphoria and opposes the denial of health insurance based on sexual orientation or gender identity,” a statement on the AMA’s website reads. “Improving access to gender-affirming care is an important means of improving health outcomes for the transgender population.”
The lawsuit also names Oregon, Washington, California, Colorado, Connecticut, Delaware, the District of Columbia, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Mexico, Pennsylvania, Rhode Island, Vermont, and Wisconsin as having joined New York in the push against restricting gender-affirming care.
At the HHS news conference last Thursday, Jim O’Neill, deputy secretary of the department, asserted, “Men are men. Men can never become women. Women are women. Women can never become men.”
DOJ stopped from gaining health care records of trans youth
U.S. District Judge Cathy Bissoon blocked an attempt by the Department of Justice (DOJ) to gain “personally identifiable information about those minor transgender patients” from the University of Pittsburgh Medical Center (UPMC), saying the DOJ’s efforts “fly in the face of the Supreme Court.”
Journalist Chris Geidner originally reported the news on Dec. 25, highlighting that the Western District of Pennsylvania judge’s decision is a major blow to the Trump-Vance administration’s agenda to curtail transgender rights.
“[T]his Court joins the others in finding that the government’s demand for deeply private and personal patient information carries more than a whiff of ill intent,” Bissoon wrote in her ruling. “This is apparent from its rhetoric.”
Bissoon cited the DOJ’s “incendiary characterization” of trans youth care on the DOJ website as proof, which calls the practice politically motivated rather than medically sound and seeks to “…mutilate children in the service of a warped ideology.” This is despite the fact that a majority of gender-affirming care has nothing to do with surgery.
In United States v. Skrmetti, the Supreme Court ruled along party lines that states — namely Tennessee — have the right to pass legislation that can prohibit certain medical treatments for transgender minors, saying the law is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment because it does not involve suspect categories like race, national origin, alienage, and religion, which would require the government to show the law serves a compelling interest and is narrowly tailored, sending decision-making power back to the states.
“The government cannot pick and choose the aspects of Skrmetti to honor, and which to ignore,” Judge Bissoon added.
The government argued unsuccessfully that the parents of the children whose records would have been made available to the DOJ “lacked standing” because the subpoena was directed at UPMC and that they did not respond in a timely manner. Bissoon rejected the timeliness argument in particular as “disingenuous.”
Bissoon, who was nominated to the bench by then-President Obama, is at least the fourth judge to reject the DOJ’s attempted intrusion into the health care of trans youth according to Geidner.
A Wider Bridge on Friday announced it will shut down at the end of the month.
The group that “mobilizes the LGBTQ community to fight antisemitism and support Israel and its LGBTQ community” in a letter to supporters said financial challenges prompted the decision.
“After 15 years of building bridges between LGBTQ communities in North America and Israel, A Wider Bridge has made the difficult decision to wind down operations as of Dec. 31, 2025,” it reads.
“This decision comes after challenging financial realities despite our best efforts to secure sustainable funding. We deeply appreciate our supporters and partners who made this work possible.”
Arthur Slepian founded A Wider Bridge in 2010.
The organization in 2016 organized a reception at the National LGBTQ Task Force’s Creating Change Conference in Chicago that was to have featured to Israeli activists. More than 200 people who protested against A Wider Bridge forced the event’s cancellation.
A Wider Bridge in 2024 urged the Capital Pride Alliance and other Pride organizers to ensure Jewish people can safely participate in their events in response to an increase in antisemitic attacks after Hamas militants attacked Israel on Oct. 7, 2023.
The Jewish Telegraphic Agency reported authorities in Vermont late last year charged Ethan Felson, who was A Wider Bridge’s then-executive director, with lewd and lascivious conduct after alleged sexual misconduct against a museum employee. Rabbi Denise Eger succeeded Felson as A Wider Bridge’s interim executive director.
A Wider Bridge in June honored U.S. Rep. Debbie Wasserman Schultz (D-Fla.) at its Pride event that took place at the Capital Jewish Museum in D.C. The event took place 15 days after a gunman killed two Israeli Embassy employees — Yaron Lischinsky and Sarah Milgrim — as they were leaving an event at the museum.
“Though we are winding down, this is not a time to back down. We recognize the deep importance of our mission and work amid attacks on Jewish people and LGBTQ people – and LGBTQ Jews at the intersection,” said A Wider Bridge in its letter. “Our board members remain committed to showing up in their individual capacities to represent queer Jews across diverse spaces — and we know our partners and supporters will continue to do the same.”
Editor’s note: Washington Blade International News Editor Michael K. Lavers traveled to Israel and Palestine with A Wider Bridge in 2016.
