Connect with us

National

New report outlines problems faced by LGBTQ+ nursing home residents

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

Published

on

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

Advertisement
FUND LGBTQ JOURNALISM
SIGN UP FOR E-BLAST

Congress

HRC president campaigns for Chris Pappas in NH

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

Published

on

Human Rights Campaign President Kelley Robinson speaks at the group's 2025 National Dinner in D.C. She campaigned for U.S. Rep. Chris Pappas (D-N.H.) in New Hampshire on Aug. 30, 2026. (Washington Blade photo by Michael Key)

Human Rights Campaign President Kelley Robinson on Sunday campaigned for U.S. Rep. Chris Pappas (D-N.H.) in New Hampshire.

Robinson traveled to Manchester, the state’s largest city, nine days before the Sept. 8 primary that will determine who will vie for retiring U.S. Sen. Jeanne Shaheen (D-N.H.)’s seat.

Former U.S. Sen. John E. Sununu, who represented New Hampshire in the U.S. Senate from 2003-2009, will face off against former U.S. Sen. Scott Brown, who represented Massachusetts in the U.S. Senate from 2010-2013, in the Republican primary.

Karishma Manzur is among the Democrats challenging Pappas.

A poll the University of New Hampshire Survey Center released on Aug. 26 shows Sununu is ahead of Brown. The same survey shows Pappas ahead of Manzur and his other Democratic challengers.

The UNH Survey Center poll shows 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.

Continue Reading

National

Milo Yiannopoulos deported to UK

ICE arrested far-right provocateur in New Orleans on Thursday

Published

on

Milo Yiannopoulos (Photo via Homeland Security @DHSgov/X account)

Editor’s note: The Department of Homeland Security on Saturday said Milo Yiannopoulos has been deported to the U.K.

U.S. Immigration and Customs Enforcement on Thursday arrested far-right provocateur Milo Yiannopoulos.

A DHS spokesperson in a statement sent to the Washington Blade said ICE arrested Yiannopoulos, who they described as “an illegal alien from the United Kingdom,” at Louis Armstrong New Orleans International Airport.

The DHS spokesperson said Yiannopoulos “legally entered the country” in New York on May 14, 2019.

“He chose to overstay his welcome in violation of our nation’s laws,” said the spokesperson.

The DHS spokesperson said an immigration judge on July 22 “issued a final order of removal” for Yiannopoulos “after failing to show up for his immigration hearing.” The Times-Picayune newspaper in New Orleans on Friday reported Yiannopoulos is being held at an ICE detention center in Alexandria, La., which is about 200 miles northwest of the Crescent City.

“He will remain in ICE custody pending removal,” said the DHS spokesperson.

Yiannopoulos has, among other things, repeatedly targeted transgender people and Muslims.

The American Conservative Union, which organizes the annual Conversative Political Action Conference, in 2017 disinvited Yiannopoulos from speaking at that year’s CPAC after a video in which he appeared to condone sex between adults and underage boys emerged. Yiannopoulos subsequently resigned from Breitbart News, a far-right news website, where he had been a senior editor.

Yiannopoulos later that year married his boyfriend in Hawaii. The far-right provocateur in 2021 claimed he was an “ex-gay.”

The Australian government in 2019 banned Yiannopoulos from entering the country “on character grounds.” Yiannopoulos was also banned from Facebook, Twitter (now X), and other social media platforms.

Milo Yiannopoulos speaks at a “Gays for Trump” event during the 2016 Republican National Convention in Cleveland. (Washington Blade file photo by Michael Key)

The Times-Picayune reported Yiannopoulos “most recently worked for” Ye, formerly known as Kanye West.

The controversial rapper is scheduled to perform in New Orleans on Friday.

Laura Loomer, a far-right conspiracy theorist who is close to President Donald Trump, has called for Yiannopoulos’s deportation. Loomer on Friday wrote on X that she “reported him to ICE and the FBI” after he “called for me to be assassinated.”

Continue Reading

California

San Francisco, long a queer safe haven, remains competitive for homebuyers

AI boom has boosted market as housing shortages continue

Published

on

San Francisco’s LGBTQ Castro neighborhood is seeing an uptick in home purchases, local real estate agents said. (Photo by Rick Gerharter)

LGBTQ people have a variety of housing options when they’re lucky enough to be able to afford property. In San Francisco – long considered a safe haven for the queer community – individual needs have to be weighed both against the city’s chronic housing shortage and a competitive but often lucrative job market.

After a lull of several years, the city’s real estate market has heated up in recent months, driven by the city’s economic recovery post-COVID lockdowns and the artificial intelligence boom.

For Rick Page, 68, and Anthony Farace, 57, both gay men, the job market was a top reason to move back to the city after they’d left the Bay Area five years ago.

Page said the couple had left behind a “huge home in a town called Oakhurst, on the way to Yosemite.” When moving back to San Francisco they wanted to balance suburban and downtown vibes, Farace said, leading them to settle in Diamond Heights, a tiny neighborhood built atop three hills above Noe Valley, that has suburban sensibilities but isn’t too far from downtown.

“In the summer it’s a little foggy but it’s nicer up here the rest of the time, and where it felt like you aren’t downtown where it’s just concrete and buildings,” Farace said. 

Added Page, “It sounds goofy, but if there’s a tsunami, it won’t get all the way up here.”

Page said that in the spring the couple initially bought a relatively small studio in Diamond Heights. But they found that it didn’t meet their needs and purchased a second studio unit nearby that did. They closed on the larger condo unit in October.

“It just didn’t have any kind of patio or outdoor thing for the dog,” Page said of their first studio, “so we saw something upgraded with a kitchen redone, nice hardwood floors, a fireplace, a sunny patio, so it was much nicer. We bought that one, now we have to figure out what to do with the first one.”

The first unit was $450,000 and the second $520,000, they stated.

The couple also mentioned a lack of some of the downtown, South of Market, and Mission District street disorder that garnered negative headlines in the past several years. The couple also noted that Diamond Heights is more affordable than traditionally high-priced Russian Hill, which is closer to downtown. 

Nevertheless, “The employment, the social life is better” in San Francisco, Page added. 

Federal data shows many LGBTQ people want to own a home.

Fannie Mae, the government sponsored enterprise that buys home loans, does have some LGBT data, according to research from 2023 that was published in 2024. The data is the result of sexual orientation and gender identity identifiers in the National Housing Survey. It did not ask about queer representation.

According to the report, 8.6% of respondents identified as lesbian, gay, bisexual, and transgender – similar to the U.S. Census Bureau’s Household Pulse Survey. The survey included responses from a weighted total of 12,363 people 18 years and older, with a weighted total of 1,059 identifying as LGBT.

The research found the LGBT homeownership rate to be 46%, which is much lower than the overall U.S. homeownership rate of 65%.

The latest available data from The Urban Institute reveals that the homeownership rate for individuals identifying as LGBTQ+ stands at 51%, in contrast to 71% for those who identify as both straight and cisgender. According to the U.S. Census Bureau, at least 1.3 million same-sex couples reside in the U.S., meaning a significant number of LGBTQ people in this country do not own their own homes.

In San Francisco, the Diamond Heights neighborhood is just a half-hour walk from the Castro, and even shorter on the bus. 

Charlie Mader is a gay man who has been a Realtor in San Francisco for “just under 25 years,” with a particular emphasis on Diamond Heights, the Castro, and Noe Valley. He said that while many LGBTQ people want to live relatively close to a queer neighborhood, such as the Castro, “It’s not like it used to be.”

Even in spite of a recent backlash to LGBTQ equality in the mid-2020s, leading to a number of federal policies largely targeting transgender and gender-nonconforming people, Mader said that since marriage equality, “You hear ‘There’s no need for us to live together in a gay ghetto,’ and we’re interspersed throughout the community and the country.”

Marriage equality became legal in California in June 2013, two years before the U.S. Supreme Court made same-sex unions legal nationwide in 2015.

Mader said marriage equality helped incentivize more LGBTQ home-buying due to an old Clinton administration tax law that gave married couples favorable tax incentives versus single homebuyers. 

But even within the City-by-the-Bay, the distinction between neighborhoods is not as stark.

“I hear the Mission is just as gay as the Castro is, and the food is better,” Mader said. “I can’t argue with that.”

Angel Carney, a lesbian Realtor, has also been in the Castro area for decades. She said the threshold of home ownership there has risen dramatically. 

“When I first started,” which was in 2002, she said, “I had teachers, I had nurses, I had a doctor … It was diverse in terms of who was buying. Everybody had a way to get into the market.”

Now, “with tech, they blew out everybody,” she added, saying first-time homebuyers are sometimes competing with tech employees making six-figure salaries from their early 20s due to their economic opportunities.

Carney said that even so, “It’s mostly a two-income household who’s buying in the Castro,” largely people in their 30s.

“LGBTQ is more of a rarity,” she added. “I’ve seen more non-LGBTQ, I would say, couples buying in the Castro.”

One reason is because while it is such an iconic epicenter of the LGBTQ community, it is “definitely a transit hub, and it’s geographically central, so if you work on the Peninsula, you go over Diamond Street and you’re on [Highway] 280. You can get to BART, to the airport, it definitely is transit centric for work, for traveling, if you’re a tech worker.”

Understanding that unhoused people are often part of San Francisco neighborhoods such as the Castro is also a factor, Mader said. 

“Because gays are so tolerant, it draws a magnet for people who you know are distressed and so you see more antisocial behavior, begging on the street, people just getting high because they know they can get away with it,” he said. That can impact people’s desire to buy a forever home in one neighborhood or another.

Indeed, the Castro has experienced fewer open-air drug scenes than other parts of the city, such as Sixth Street or the Civic Center Plaza, which are both near the downtown core. Such activity has, however, remained a persistent complaint of Castro merchants. In early December, Sophie Marie, a legislative aide to gay Board of Supervisors President Rafael Mandelman, who represents the neighborhood as District 8 supervisor, noted that “a lot” of unhoused people have recently moved into the Castro as they leave South of Market and Civic Center amid an increase in law enforcement activity and attention from city government there.

The Castro is among those neighborhoods seeing building height limits increased as a result of Mayor Daniel Lurie’s family zoning plan that, after much rancor, passed the Board of Supervisors for the final time on December 9. The plan is intended to increase the city’s housing stock to meet state housing goals.

San Francisco’s median home sale price rose nearly 6% to $1.85 million, its highest amount since 2022, earlier this year, as the San Francisco Standard reported.  

Mader said that nonetheless, “There are empty condos everywhere for sale,” and that market is down 20% from its peak.

“Right now I’m selling for $625,000 – I’ve sold for $100,000 more than that,” Mader noted.

Carney agreed that condos are very available right now.

“If you’re thinking about entering the market, think about condos,” she advised. “When interest rates go down, prices will go up, so get in now on a condo. People say they’re waiting for the market to drop – well, the market dropped on condos. Those are a great buy right now.”

The Fannie Mae data showed that homeownership aspirations are high among LGBT consumers, with 83% saying they “would like to buy at some point” or “continue to own,” the report stated. This share is comparable to non-LGBT consumers, the report stated. LGBT consumers also believe there are more obstacles to owning a home than their non-LGBT peers.

Those obstacles include that over 70% of LGBT respondents said it was difficult to get a home mortgage today, compared to only 55% of non-LGBT respondents, according to the research. LGBT consumers were more concerned about closing costs, credit score or history, current debt, and insufficient income for monthly payments.

The Federal Reserve on December 10 lowered interest rates for the third time this year. The recent reduction was by a quarter of a percentage point, as the New York Times reported. The new range is between 3.25% to 3.75%. But CNBC noted that mortgage rates may remain higher because they are less impacted by the Fed. The average rate for a 30-year, fixed-rate mortgage is currently about 6.35%, the network reported December 10.

Nationally, the real estate market is dealing with the same uncertainty as the rest of the economy, now almost one year into President Donald Trump’s second term.

“Everyone is afraid of another Trump recession,” Mader said. “People are not buying houses especially in places like Florida, where they’re having all kinds of issues with insurance.”
Florida is the nation’s most expensive state for home insurance due to natural disasters like hurricanes. 

California is also experiencing insurance issues, particularly in areas prone to wildfires, as the San Francisco Chronicle reported. Most of the Bay Area is not as affected as other parts of the state, though insurance premiums are rising for home insurance.

Not everyone wants to live in a big city. 

Mark Kliem, who’s part of the LGBTQ Real Estate Alliance, focuses on the North Bay, encompassing Solano, Napa, and Sonoma counties. 

“Consumers can contact the alliance no matter where they live and connect with the nearest LGBTQ agent close to their area whether they are buyers or sellers,” Kliem, who is gay, said.
Kliem lives in the Solano County city of Vallejo, where the real estate market took a dive during the Great Recession.

“A lot of investors swooped in and bought up as many of those places as they could, so there was a lot of investing in property through that, and a lot of flippers,” he said, referring to people who buy a property, fix it up, and then sell it for a profit.

Now, the area is one of the country’s hottest real estate markets, he said, because it’s near San Francisco, has warmer weather and is more affordable long-term.

“It’s a good place location wise – we’re on a bay, we have a ferry service to downtown San Francisco. We don’t have BART, so it’s a little problematic to get to the nearest BART, but our weather gets even warmer, less fog, than Oakland. Throughout the year, it’s a five-degree difference from San Francisco.”

Ultimately, the Golden State and the Bay Area in particular are poised to remain competitive for buyers of all sexual orientations and gender identity – despite the fact that that leads to so many barriers to entry. Gay Realtor Anthony Waite, 30, explained why.

“A lot of people who moved to Austin, Texas [during the COVID pandemic lockdowns] said there’s not a lot to do,” Waite said. “In San Francisco, you could find something to do every single corner every hour, day and night. Texas doesn’t offer that.”

(Editor’s note: This article was originally published by the Bay Area Reporter and is part of a national initiative exploring how geography, policy, and local conditions influence access to opportunity. Find more stories at economicopportunitylab.com .)

Continue Reading

Popular