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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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National

Man charged in Mall of America shooting plot inspired by Pulse massacre: report

Suspect exchanged hundreds of messages, pledged loyalty to ISIS

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The U.S. Department of Justice charged Sheikhdoon Abdullahi Mohamud with planning a crime of terrorism.

The U.S. Department of Justice charged Sheikhdoon Abdullahi Mohamud, 18, of Richfield, Minn., on Oct. 7 with one count of knowingly receiving a firearm and ammunition in order to commit a federal crime of terrorism. Mohamud allegedly planned to carry out a mass-casualty attack in support of ISIS, inspired in part by the Pulse nightclub massacre that took place on June 12, 2016 when then-29-year-old Omar Mateen murdered 49 people and wounded 58 – one of the deadliest mass shootings in U.S. history, and the deadliest targeting the LGBTQ+ community. 

According to a DOJ statement release, Mohamud was arrested on Oct. 6 by the FBI, which had arranged to sell him an AK-47 assault rifle, magazines, and ammunition through an undercover FBI employee. Mohamud was arrested shortly after paying $600 in cash and taking possession of those items; he reaffirmed his intention to shoot people at the Mall of America during the transaction.

“Mohamud allegedly sought to carry out a mass-casualty shooting at the Mall of America, expressing a desire to emulate some of the most horrific ISIS-inspired attacks in the United States, including the atrocities at Pulse Nightclub and 2025 New Year’s Day attack in New Orleans,” said Assistant Attorney General for National Security John A. Eisenberg in the statement by the DOJ. “The National Security Division will continue to work closely with the FBI and Joint Terrorism Task Force to track down and prosecute ISIS-inspired terrorists in the United States.”

According to the complaint, beginning on or about December 2024, Mohamud had exchanged hundreds of messages through multiple social media and messaging apps with a confidential source, and expressed a desire to travel to Somalia to join a designated foreign terrorist organization to fight on their behalf.

The defendant stated many times that if he was unable to travel overseas because of a lack of funds, he planned to carry out a mass-casualty event in Minnesota in support of ISIS. 

According to the DOJ, “In July 2026, Mohamud sent messages discussing his intent to carry out a mass-casualty shooting attack at the Mall of America because he claimed it was owned by Jews. He wrote that [he] wanted to kill 30 to 60 people so no one would go there.”

“During the course of his communications, Mohamud stated that he wanted to commit an attack similar to those of the Pulse Nightclub mass-shooting in Orlando, the Bondi Beach mass-shooting in Australia, and the New Year’s Day vehicle-ramming attack in New Orleans.”

This case is being prosecuted by Trial Attorney Ryan White of the National Security Division’s Counterterrorism Section and Assistant U.S. Attorney Benjamin Bejar for the District of Minnesota.

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California

Calif. GOP gubernatorial candidate ad ‘disgusting attempt to exploit lesbian intimacy’

Activists, anti-LGBTQ religious leaders criticized Steve Hilton spot

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(Screenshot of Steven Hilton ad)

Two women sit on a bed, a Pride flag hanging behind them. One is nervous; the other tells her to be calm and that she’ll do “all the work.” The music swells. The two hold hands and —  fill out a ballot voting for Steve Hilton? 

This is the new advertisement from the Hilton gubernatorial campaign that is drawing rebuke from both sides of the aisle, but for very different reasons. 

Jorge Reyes Salinas, the communications director at Equality California, said the ad was an insult to the queer community. 

“This ad is a disgusting attempt to exploit lesbian intimacy for political attention,” he said. The advertisement plays on media tropes that Salinas says “reduce lesbian and bisexual women … to sexual entertainment,” rather than showing them as well-rounded characters. “Any group of the LGBTQ+ community deserves the same dignity and respect as everyone else,” he said. 

The ad is truly hyper-sexualized. It ends with one woman telling the other, “Now lick it.” The two pause and stare before she reveals an envelope to send the ballot, and large text pops up saying, “Just try it!”  

Salinas characterized the ad as a desperate attempt to get attention from a candidate who is trailing far behind in the polls in heavily Democratic California. The Democratic candidate Xavier Becerra, who is endorsed by Equality California, holds a 25-point lead over Hilton according to recent polling by the UC Berkeley Institute of Governmental Studies. 

Conservatives have also criticized the ad.

Influential evangelical Pastor Jack Hibbs thought the ad was distasteful and said, “lesbianism among college girls and some high school girls that right now is an actual pandemic of social ill.” Republican attorney general candidate Michael Gates said it undermines “the sanctity of the relationship between parents and their children.” This criticism is rather confusing because although the ad features two relatively young women, they both appear to be adults, not minors. 

“The comments from Pastor Jack Hibbs should be criticized because there is nothing wrong with two women being attracted to each other,” Salinas said. “We’re calling out the ad’s stereotypes, while also rejecting the homophobia in the response to it … by other Republicans.” 

The backlash from Hilton’s own party and supporters shows that an advertisement full of queer innuendo was ill-considered, considering the national GOP’s attacks on LGBTQ people in recent years. Hilton himself has been campaigning against transgender girls and women competing in school sports and using locker rooms that correspond with their gender identity. This context might be why Hilton’s political base responded to the ad just as poorly as the liberal voters he was attempting to court. 

Hilton says the ad is part of a new series rolling out before Election Day, showing stereotypical California liberal archetypes voting for Hilton. He claims these ads are authentically filmed with real actors, as opposed to being A.I. generated, like many of his previous ads. One other advertisement has been released so far by the campaign showing a man at a spiritual retreat also being swayed to vote for Hilton, although it is notably absent of sexual innuendo.

Caleb Kaufman is a California Local News Fellow placed with the Los Angeles Blade. The California Local News Fellowship is a state-funded initiative to support and strengthen local news reporting. Learn more about it at fellowships.journalism.berkeley.edu/cafellows.

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2026 Midterm Elections

Trump uses anti-trans slur against Democratic Senate candidate

President mocked Annie Andrews

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President Donald Trump (Washington Blade photo by Michael Key)

President Donald Trump used an anti-trans slur against Democratic South Carolina Senate candidate Annie Andrews on Monday as he sought to rally support for Republicans in the state’s Senate race.

In a post on Truth Social, Trump attacked Andrews three times, referring to her as “trannie” while promoting U.S. Sen. Darline Graham (R-S.C.)’s campaign.

Andrews is running against Graham for a Senate seat in the solidly Republican state.

Earlier this year, Graham was specially appointed to the seat following the death of her brother, Lindsey Graham, who represented South Carolina in the Senate from 2003 to 2026.

Andrews, the Democratic nominee from the state, is a pediatrician that lives in Charleston with her three children. She told NBC News that she will “work with anyone to put South Carolina first.”

“As a mom and a pediatrician, I’m in this race to fight for my patients, my three kids, and South Carolina,” Andrews said, adding that “lowering costs and making life better for families across our state is going to take all of us working together.”

Andrews used the attention from the president’s attack to emphasize what she described as a focus on policy issues rather than the culture wars that have dominated much of the political debate.

“If you care more about your bills than the politics in Washington, this campaign is for you,” she added.

Trump’s remarks have drawn criticism from leaders on both sides of the aisle.

Senate Minority Leader Chuck Schumer (D-N.Y.) condemned Trump’s words Monday night on social media, calling his attacks on Andrews “despicable.”

“Annie Andrews is a mom and pediatrician who’s always put her community first — and she’s exactly who South Carolina needs representing them in the Senate,” Schumer said on X.

Former South Carolina Gov. David Beasley, a Republican, also criticized the president’s attack on Andrews, urging voters to “reject politics based on division and hate.”

“This is abhorrent. Elections don’t have to be about cruelty and lies. South Carolina deserves better,” Beasley wrote Monday night on X.

South Carolina has not elected a Democratic senator in nearly three decades.

Andrews’s campaign website does not mention her positions on LGBTQ issues.

The Washington Blade reached out to Andrews’s campaign for comment on Trump’s attack and her positions on transgender rights but did not hear back by time of publication.

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