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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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Multi-billion-dollar 9/11 Victim Compensation Fund to continue until 2090

Married, same-sex partners are eligible for federal program

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The September 11th Victim Compensation Fund has awarded more than $18 billion to 77,000 9/11 victims and their families since 2011. (Photo by Anthony Correia/Bigstock)

As part of its commemoration of the 25th anniversary of the 9/11 terrorist attacks, the September 11th Victim Compensation Fund, a federally operated program, released information during the past week showing it has awarded more than $18 billion to over 77,000 9/11 victims and their families since 2011. 

Officials with what’s now referred to as the VCF point out that it was created to provide compensation to individuals or to a court-approved personal representative of a deceased individual who were present at one of the three sites where the hijacked jetliners crashed. 

Among those supported under the program are thousands of rescue workers, clean-up crews, and residents living near the World Trade Center Twin Towers destruction site who became ill, many of whom later died, by being exposed to the toxic fumes created by the fire and falling debris.

“Twenty-five years since that day, the September 11th Victim Compensation Fund has  served tens of thousands of victims and their families, and we continue to receive over 750 new claims each month — a clear indication of the ongoing importance of our mission,” said Allison Turkel, VCF’s leader, who holds the title of Special Master.

In a Sept. 2 briefing for the news media in advance of the 9/11 anniversary commemoration, Turkel pointed out that the VCF operation was upgraded and expanded by separate laws passed by Congress in 2011 and 2019, with the 2019 law signed by President Trump providing full funding to “pay all eligible claims and extended the filing deadline to Oct. 1, 2090.”

LGBTQ advocacy organizations in New York and nationwide have reported that during the time shortly after the 9/11 attacks same-sex surviving partners of 9/11 victims learned they were ineligible for compensation benefits because their same-sex relationships were not legally recognized.

Nicole Nava, a VCF spokesperson, told the Washington Blade that under long established VCF procedures, all applicants for benefit claims regarding a deceased person, whether same-sex or opposite sex, must be appointed as a Personal Representative of the deceased person by a state court. For D.C. residents, the probate division of the D.C. Superior Court appoints a Personal Representative.

“Claims for deceased victims (regardless of the cause of death) may be submitted only by the Personal Representative,” a statement on the VCF website says. “Each state has laws that define the process for appointment of the Personal Representative and the specific authority granted to that Personal Representative,” it says.

The Washington Blade couldn’t immediately determine the criteria for being approved as a Personal Representative by the D.C. Superior Court  and various state courts, including whether a same-sex survivor partner would be eligible for such an appointment. 

A spokesperson for the District of Columbia LGBTQ+ Bar Association, which includes many local attorneys who specialize in a wide range of specialized legal issues, couldn’t immediately be reached to find out if one or more of their members might be able to determine the same-sex partner eligibility for Personal Representative status.  

VCF spokesperson Navas pointed out that the VCF regulations initially did not allow a legally married same-sex partner survivor to receive benefits under the VCF program because the then existing U.S. Defense of Marriage Act, which denied federal recognition of same-sex marriage, prevented VCF from providing benefits to a same-sex partner survivor who had been married in their home state.

But Navas noted that the regulations changed in 2013 when the U.S. Supreme Court declared the Defense of Marriage Act unconstitutional and were further changed in 2015 when the Supreme Court legalized same-sex marriage nationwide. Based on those changes, legally married same-sex partner survivors since 2013 and currently have been and are fully eligible for the VCF benefits.  

The updated regulations would provide benefits to married same-sex partner 9/11 survivors in the states that legalized gay marriage beginning in 2004, when Massachusetts became the first state to legalize same-sex marriage. D.C. legalized same-sex marriage in 2009. 

In her news media briefing, VCF Special Master Turkel said detailed information about how best to file a claim for 9/11 victim compensation is available on the VCF website.

“Twenty-five years since the events of September 11th , 2001, we know it has become increasingly challenging for claimants to find documents needed to prove their presence at an eligible location, which is one of the key requirements to be eligible for compensation,” she said.

She was referring to the requirement that 9/11 surviving victims seeking a claim for support for injuries or illnesses related to the 9/11 attacks must prove they were present at the World Trade Center site, the Pentagon site, or the Shanksville, Pa. site where the hijacked jetliners crashed.

“Our team is committed to ensuring no claimant feels lost or overwhelmed when submitting a claim,” Turkel said at the briefing. “We have a great helpline with real live people who can answer or refer any questions that come in,” she added. “They engage in over 4,000 calls a month on average. We encourage folks to call 1-855-1555 with any questions.”

The VCF website, which has additional detailed information, can be accessed at www.vcf.gov

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Remembering the LGBTQ heroes of 9/11 terrorist attacks

25 years later, ‘the heartbreak remains strong’

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The scene near the collapsed towers on Sept. 11, 2001. (Photo by Anthony Correia/Bigstock)

Many in the LGBTQ community in the D.C. area and throughout the country were expected to join friends, co-workers, and family members this week in commemorating the 25th anniversary of the Sept. 11, 2001, terrorist attacks on the New York World Trade Center’s Twin Towers and on the Pentagon just outside D.C. as well as the jetliner hijacking that ended in a fatal crash in an open field in Shanksville, Pa.

A total of 2,996 people died in the 9/11 attacks, including 19 terrorists who hijacked four jetliners whose passengers included Americans and citizens of many other countries.

Activists involved with local and national LGBTQ advocacy organizations recall witnessing a coming together of LGBTQ people and their co-workers, neighbors, and family members to support one another during a time of unimaginable horror and grief.

Among those who lost their lives in the 9/11 terrorist attacks was American Airlines co-pilot David Charlebois, an out gay man and member of the Gay Pilots Association, who was on American Airlines Flight 77, which the terrorists crashed into the Pentagon.

The Pentagon on the morning of Sept. 11, 2001, approximately 10 minutes after terrorists flew American Airlines flight 77 into the building killing 184 people. (Screen capture via YouTube Archival news footage)

Also among the terrorist victims in the 9/11 attacks was gay public relations executive and rugby enthusiast Mark Bingham of San Francisco, who was among several passengers of the hijacked United Airlines jet who reportedly stormed the cockpit to regain control of the jetliner before one of the hijackers crashed the jet into the countryside in rural Pennsylvania.

The jet had taken off from Newark, N.J. with its destination being San Francisco. Investigators learned the hijackers turned the plane around and were heading to Washington, D.C., with plans to crash it into the White House or the U.S. Capitol.

The passengers, including Bingham, who stormed the cockpit and were among the 44 passengers and crew who lost their lives in the crash are credited by investigators and family members and friends with saving the lives of hundreds of others if the hijackers succeeded in crashing into the White House or Capitol.

Among the other LGBTQ people known to have lost their lives in the 9/11 attacks was Father Mychal Judge, 68, a gay Franciscan priest who served as a Catholic chaplain for the New York City Fire Department. According to the National Catholic Reporter, Judge rushed to the scene of the World Trade Center shortly before the Twin Towers collapsed. He was fatally struck by debris falling from the south tower while giving last rites to a fallen firefighter, the Catholic publication reported. 

“He was a decent, wonderful human being,” said New York gay journalist Andy Humm, who had interviewed Judge for LGBTQ-related stories prior to the 9/11 attacks. “I saw him at many demonstrations for gay and AIDS causes, showing up in his Franciscan monk’s cassock,” Humm told the Washington Blade five years ago at the time of the 9/11 20th anniversary. “And he was equally beloved by the fire department, there at every major fire tragedy in the city, lending moral support to firefighters,” Humm said.

Francis DeBernardo, executive director of New Ways Ministries, a Maryland-based LGBTQ Catholic group that advocates for LGBTQ supportive policies within the church, reported five years ago that his group was supporting an effort to call on the Catholic Church to officially recognize Fr. Judge as a saint by canonizing him. But DeBernardo told the Blade this week that those efforts failed to obtain the needed support from various Catholic entities, including the Franciscan Order of Friars Minors, of which Judge was affiliated, ending efforts to canonize Judge as a saint. 

DeBernardo has written a book about Judge’s life and legacy published in 2023 called “Mychal Judge:Take Me Where You Want Me to Go.” 

Among the other widely reported LGBTQ victims of the 9/11 terrorist attacks were a gay couple from California, Daniel Brandhorst and Ronald Gamboa, and their adopted son, David, who were among those who died aboard the United Airlines flight that crashed in Pennsylvania. The Los Angeles Times reported that Brandhorst, an attorney, and Gamboa, the manager of a Santa Monica Gap store, had adopted three-year-old David when he was an infant.

For many LGBTQ residents of New York and the D.C. area, the suffering over the loss of loved ones, including same-sex partners, was heightened a short time later when they learned they were initially ineligible for local and federal programs aimed at providing financial assistance to survivors of the 9/11 attack victims because same-sex couples were not legally recognized. 

At the urging of LGBTQ rights organizations, state and local officials in the New York and the D.C. area took steps to address the initial denial of financial support for surviving same-sex partners In programs under their control. Officials with a massive federal aid program for 9/11 survivors, however, said they did not have legal authority to authorize payments to same-sex partners. 

The officials, in the administration of then-President George W. Bush, said the best they could do would be to leave it up to local authorities to determine whether state probate laws would recognize a same-sex partner as a family member for eligibility in the federal aid program for 9/11 survivors, many of whom lived in states outside the New York and D.C. area.

Nicole Nava, a spokesperson for the September 11th Victim Compensation Fund, a federally funded program established to compensate for physical harm or death caused by the 9/11 terrorist attacks, including support for surviving family members, said she would inquire into whether same-sex surviving partners were being supported under that program in subsequent years in response to a request from the Washington Blade.

Jenny Pizer, an attorney for the LGBTQ litigation group Lambda Legal, which supported LGBTQ partner survivors of victims of the 9/11 attacks, said the information she and her organization had showed that many if not most of the LGBTQ partner survivors were unable to obtain the federal Victim Compensation Fund payment benefits that married heterosexual spouses obtained. She said she didn’t have a definitive answer on whether some LGBTQ surviving partners were compensated.

However, at least one case where an LGBTQ partner was compensated was reported by the Washington Post in a Jan. 22, 2003, news story about Peggy Neff, the lesbian partner of 18 years of Sheila Hein, 51, a civilian employee at the Pentagon, who was killed when the terrorist hijacked jetliner crashed into the Pentagon.

The Post reported that the Sept. 11 Victim Compensation Fund, under the leadership of its director, Kenneth Feinberg, approved an award of $557,390 for Neff in compensation for the loss of her partner. The Post story quoted a spokesperson for the Human Rights Campaign as saying, “It is our sincere hope that this signals that other gay families who have suffered the loss of a loved one will be treated similarly.”    

The compensation program, which is operated by the U.S. Department of Justice, remains in operation until 2090. The Blade will report on any additional similar awards for LGBTQ surviving partners if Nava provides such information.    

Events commemorating the 25th anniversary of the 9/11 attacks were scheduled to take place this week at memorial sites honoring the 9/11 victims located outside the Pentagon in Arlington, Va., at the site of the World Trade Center Twin Towers in New York City, and the site of the jetliner crash in Shanksville, Pa., which is operated by the U.S. National Park Service.

The U.S. Congress in 2017 and 2021 approved separate bills signed by President Donald Trump during his first term in office and President Joe Biden creating the Global War on Terrorism Memorial and its construction, to be built on the National Mall in Washington, D.C. that’s scheduled to be completed in 2028.     

The memorial, to be located near the Lincoln Memorial and Vietnam Veterans Memorial close to 23rd Street and Constitution Avenue, N.W., is intended to honor people who served and were lost in the wars and counterterrorism operations that followed the 9/11 attacks, including U.S. military operations in Iraq and Afghanistan.     

Longtime LGBTQ rights advocate Jay Fisette, who at the time of the 9/11 attacks held the elected position of chair of the Arlington County Board, which serves as the county’s governing body, was among the Arlington officials that came to the Pentagon’s grounds in Arlington to oversee efforts by firefighters to rescue Pentagon workers on the day of the attack. 

At an Oct. 7, 2001, 9/11 Day of Remembrance and Appreciation ceremony held in Arlington, Fisette expressed the views of many in the community in response to the 9/11 attacks.

“Tonight, our community gather as a family,” he told the gathering. “We gather in sorrow and in disbelief, in remembrance and appreciation,” he said. “But we come here, too, with resolve and pride. We come together as Arlingtonians who love our country, as Americans who love our country,” he said.

“Our enemies may hurt our bodies and destroy our buildings, but they will never defeat our determination to make this a world of peace and a community in which our children grow up safe and secure,” Fissette said. 

Although some of the same-sex partners of those killed in the 9/11 attacks faced obstacles in obtaining financial support through the federal 9/11 relief program, Tom Hay, the surviving partner of 14 years of American Airlines pilot David Charlebois was treated with respect and honor by American Airlines officials and colleagues at Charlebois’s funeral mass at D.C.’s St. Matthew Cathedral. 

More than a dozen uniformed company pilots and flight attendants attended the mass. And a press release issued by American Airlines mentioned Charlebois’s relationship with Hay and told how Hay stood with Charlebois when Charlebois advocated for equal rights for LGBTQ people in the airline industry through his involvement with the National Gay Pilots Association.

“David was an early member of the NGPA,” the American Airlines statement said. “His contribution helped ensure ongoing progress toward fairness and solidarity.” 

Activists in New York have said the 9/11 attacks drew attention to the need for legal protections for same-sex couples, including the need for recognition of same-sex marriage, which the U.S. Supreme Court legalized nationwide in its landmark ruling in 2015.

But LGBTQ advocates in New York pointed to the difficulties LGBTQ surviving partners faced when desperately seeking to find out if a partner had survived at the site of the World Trade Center attack where the Red Cross and other emergency relief agencies set up a station near the site of the attack. 

“Literally, gay people had to go there, turn around, go back home, and get some paperwork that spouses didn’t have to get to prove a relationship existed,” said Ross Levi, who at the time served as executive director of the New York LGBTQ advocacy group Empire State Pride Agenda.

“You were nervous and scared and sad and then you had to go through that,” Levi told the Blade in 2011 at the time of the 10-year anniversary of the 9/11 attacks. “And worse yet, other people turned them away, even with the paperwork, saying sorry you’re not a family according to our guidelines.”

Activists said New York City and New York State officials quickly recognized the inequities faced by same-sex partner survivors and took steps to change polices and laws to correct the situation. Among other things, New York’s then-Gov. George Pataki (R) issued an executive order in October 2001 that included surviving partners of gay and lesbian victims of the World Trade Center attacks in receiving full spousal benefits from the state’s Crime Victims Board.

In a separate development, the LGBTQ litigation group Lambda Legal, ESPA, the Human Rights Campaign, and other LGBTQ advocacy groups created the September 11 Gay & Lesbian Family Fund to provide some support to surviving same-sex partners who were ineligible for help from the federal relief fund program. 

“The terrorist attack on September 11th is a tragedy that touched every American, impacting people and families from all walks of life,” Jonathan Lovitz, the Human Rights Campaign’s Senior Vice President for Campaigns and Communications told the Blade in a statement this week.

“As in all moments in American history, LGBTQ+ Americans were there, and feel the impact of this day,” he said. “As we remember the lives lost 25 years later, the heartbreak remains strong and the work to ensure that every person can live safe from violence in this country continues.”

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2026 Midterm Elections

Chris Pappas wins NH Democratic Senate primary

Gay congressman running to succeed retiring U.S. Sen. Jeanne Shaheen

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U.S. Rep. Chris Pappas (D-N.H.) speaks at the LGBTQ+ Victory Fund's 2025 National Champagne Brunch in D.C. (Washington Blade photo by Michael Key)

New Hampshire Congressman Chris Pappas on Tuesday won the Democratic primary in the race to succeed retiring U.S. Sen. Jeanne Shaheen (D-N.H.) in the U.S. Senate.

Pappas defeated Karishma Manzur, who was his primary challenger, by a 61.8-36.1 percent margin.

The gay congressman will face off against former U.S. Sen. John E. Sununu, who defeated former U.S. Sen. Scott Brown in the Republican primary.

“Tonight’s victory sends a clear message that voters are looking for leaders who will fight for their rights, their freedoms, and to be treated with dignity and respect,” said Human Rights Campaign President Kelley Robinson in a statement. 

She campaigned for Pappas in Manchester, New Hampshire’s largest city, on Aug. 30.

“Chris Pappas has delivered results, stood up for equality, and showed up for the people he serves,” said Robinson in her statement. “HRC was proud to mobilize Equality Voters across New Hampshire to help power this win. We don’t have a second to waste between now and November. We look forward to continuing our work with Rep. Pappas as he drives toward victory in November so he can help return a pro-equality majority to the United States Senate.”

poll the University of New Hampshire Survey Center released on Aug. 26 showed Sununu ahead of Pappas by a 45-43 percent margin if they were to face off in the general election. The margin of error is +/-2.1 percent.

Pappas would become the first openly gay man elected to the U.S. Senate if he were to win in November.

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