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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

DOJ seeks to dismiss some claims in gay FBI employee’s bias lawsuit

David Maltinsky was fired after displaying Pride flag at desk

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A gay FBI trainee was fired after displaying a Pride flag at his desk. (Washington Blade photo by Michael Key)

Attorneys for gay former FBI employee David Maltinsky, who was fired from his job as a non-agent employee at the FBI’s Los Angeles Field Office in October 2025 after more than 16 years of service for displaying an LGBTQ Pride flag at his workstation, filed court papers on July 15 opposing a motion by government attorneys to dismiss some but not all of the provisions in his unlawful discrimination lawsuit seeking to overturn the firing.

Maltinsky’s lawsuit, filed in federal court in D.C. on Nov. 19, 2025, states that FBI Director Kash Patel acted illegally by violating Maltinsky’s First Amendment constitutional rights and the U.S. Civil Rights Act of 1964 by ordering his firing on grounds that he “exercised poor judgement with an inappropriate display of political signage” by displaying the Pride flag.

The firing came at a time when Maltinsky successfully completed 16 weeks of the FBI’s 19-week training program at the FBI training academy in Quantico, Va. to become an FBI Special Agent, according to the lawsuit.

In addition to Patel, who took office as FBI director in February 2025 under the Trump administration, the lawsuit names as defendants the FBI itself, Acting U.S. Attorney General Todd Blanche, and the U.S. Department of Justice, which oversees the FBI.

“Defendants discriminated against Maltinsky for engaging in protected speech, for his sexual orientation, and for opposing discrimination – a clear and brazen violation of federal law and the Constitution,” the lawsuit states in an amended complaint filed May 5, 2026.

The Department of Justice, which is representing the FBI in its response to the lawsuit, did not immediately respond to a request from the Washington Blade for comment on the lawsuit and why it is seeking dismissal of some but not all of the lawsuit’s multiple allegations, including its claim that the firing violated Maltinsky’s First Amendment rights.

In its “Partial” motion filed on June 15, 2026, to dismiss some provisions in the lawsuit, the Justice Department through Assistant Attorney General Brett A. Shumate and Associate Branch Director Christopher Hall, stated that the lawsuit fails to provide sufficient evidence that Maltinsky was fired because he is gay.    

“The Amended Complaint contains no factual allegations that Director Patel or any other decisionmaker expressed hostility toward gay employees, relied on Plaintiff’s sexual orientation in making employment decisions, even knew Plaintiff’s sexual orientation or otherwise indicated that Plaintiff’s status as a gay man played any role in the challenged actions,” the motion states.

Based on that, among other things, the motion says the lawsuit’s claim that the firing violated the U.S. Civil Rights Act of 1964 should be dismissed. A 2020 U.S. Supreme Court decision ruled that the 1964 law bans employment discrimination based on sexual orientation and gender identity along with its other categories including race, religion, and gender.  

In its arguments that the decision to fire Maltinsky was illegal, unconstitutional, and unjust, the lawsuit’s amended complaint points out that FBI officials at the Los Angeles Field Office where Maltinsky worked presented the Pride flag to him and gave him full permission to display it at his workstation.  

“The FBI encouraged and honored Maltinsky’s work by awarding him the 2020 Director’s Award For Excellence-Outstanding Service in Diversity and Inclusion,” the lawsuit says. “In 2022, the Attorney General for the Department of Justice awarded Maltinsky the Attorney General’s Award for Equal Employment Opportunity, DOJ’s highest award for performance in support of the Equal Employment Program,” it says.

“In special recognition of Maltinsky’s efforts to improve the FBI, in June 2021 LAFO [Los Angeles Field Office] leadership entrusted to Maltinsky two Pride flags that had been flown from the flagpole located in front of the LAFO,” the lawsuit complaint continues. “Maltinsky displayed one of those flags at his workstation.”

Although the lawsuit doesn’t say so directly, all of that happened during the administration of President Joe Biden and previous FBI Director Christopher Wray, who held the director’s position from August 2017 to January 2025, when Donald Trump took office as president.

Nathaniel Zelinsky, one of the attorneys representing Maltinsky regarding the lawsuit, told the Blade that because the Justice Department did not contest the lawsuit’s First Amendment provisions, the case will move forward to the discovery stage, in which he and fellow attorneys can seek and obtain government documents, and most likely go to trial. He said that regardless of whether the judge approves the dismissal of the lawsuit provisions the government has asked for, the other provisions and the case as a whole  will continue.

“And those First Amendment claims are extremely serious,” he said. “The government, by its admission, fired David Maltinsky because they did not like the speech he displayed when he put up the Pride flag that was gifted to him by the FBI,” Zelinsky said. “The federal government cannot discriminate against its workers based on their speech.”      

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North Carolina

Authorities investigate officer-involved shooting outside Asheville gay bar

Incident took place near Shakey’s on Wednesday

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(Photo by chalabala/Bigstock)

An officer-involved shooting outside of a gay dive bar, Shakey’s, in downtown Asheville, N.C., left one man dead Wednesday.

The bar released a statement the following morning regarding the incident, stating that bar staff had asked a patron to leave earlier in the night citing concerning behavior. The bar said that later the man was spotted with a gun in the parking lot.

The bar proceeded to call 911, locked the doors to the establishment, and followed dispatcher instructions on how to keep patrons of the bar safe while officers arrived. These protocols included getting patrons away from the windows and staying low to the ground.

According to Shakey’s, shots were fired outside of the business. When the Asheville Police Department officers arrived, they fired back. The individual died from their injuries, according to the police.

“Because of everyone’s quick actions, cooperation, and concern for one another, every customer and every employee inside Shakey’s made it home safely. We are incredibly thankful,” Shakey’s said on their Instagram page. They thanked Asheville police, emergency dispatchers, EMS, and all first responders who were on scene.

On Thursday, a spokesperson for the North Carolina State Bureau of Investigation, Chad Flowers, stated that the suspect involved in the shooting was Arturo Castillo Palomar.

The Washington Blade reached out to the North Carolina State Bureau of Investigation for a comment regarding the possibility of the event being considered a hate crime. They said the issue is currently under investigation and that the findings would be turned over to the district attorney for review.

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Pentagon

Hegseth announces testosterone initiative as trans troop ban continues

SPARTA Pride criticized Pentagon policy

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Defense Secretary Pete Hegseth (Washington Blade photo by Michael Key)

The U.S. military will begin testing and treating service members with hormone therapy despite banning similar medical care for transgender service members.

Defense Secretary Pete Hegseth said Wednesday that troops ages 30 and older will be subject to annual testosterone screenings, while younger service members will have the option to voluntarily opt in. Some troops may then be recommended for hormone therapy, he explained in a video posted to social media.

“Under the supervision of our world-class medical professionals, warfighters age 30 and older are going to be tested annually as part of their periodic health assessment,” Hegseth said in a video posted to X, captioned “The High-T Department of War.”

This push to test testosterone levels, as the hormone is commonly referred to as “T,” runs counter to current medical guidelines. Physicians are generally advised to discuss testosterone therapy only with men who have symptoms consistent with low testosterone and documented low hormone levels on two separate blood tests.

Testosterone is a vital sex hormone that all humans naturally produce. It helps regulate muscle mass, bone density, and sex drive. In men, it is primarily produced in the testicles, while in women it is produced in the ovaries and adrenal glands.

Natural testosterone levels in men decline with age and have long been associated with issues such as erectile dysfunction, low libido, mood changes, and weight gain. However, experts continue to debate whether these conditions should routinely be treated with testosterone therapy.

Hegseth’s announcement aligns with other actions taken by the Trump-Vance administration — including efforts by Health Secretary Robert F. Kennedy Jr. — to make testosterone therapy more accessible for men, particularly those assigned male at birth.

Last month, the Food and Drug Administration proposed easing prescribing restrictions on testosterone gels, pills, patches, and injections following a December advisory panel that recommended reducing regulatory hurdles to expand access to testosterone therapy.

Currently, FDA labeling specifies that these medications are approved only for men with hypogonadism, a medical condition that causes abnormally low testosterone levels.

The announcement came as a shock to many LGBTQ advocates because Hegseth and the Defense Department have cited the use of hormone therapy by trans service members as justification for their dismissal under President Donald Trump’s 2025 executive order, “Prioritizing Military Excellence and Readiness.

The Pentagon continues to pursue implementation of the trans military ban as litigation proceeds. As a result, many trans service members have had their gender-affirming medical care halted, even as similar hormone therapy is now being expanded for cisgender service members. Under the executive order, the military currently disqualifies individuals diagnosed with gender dysphoria and has begun formal administrative separation proceedings for trans personnel.

SPARTA Pride, a nonpartisan nonprofit organization made up of trans service members, veterans, and their allies, issued a statement to the Washington Blade following Hegseth’s announcement.

“If hormone therapy helps warfighters perform at their best, then it cannot simultaneously be used as evidence that transgender service members are unfit to serve,” said Kara Corcoran, executive director of SPARTA Pride. “The same class of evidence-based medical treatment cannot be characterized as readiness-enhancing for one group and readiness-destroying for another.”

The legal fight over trans military service remains ongoing.

On June 1, the U.S. Court of Appeals for the D.C. Circuit ruled that trans service members already serving in the military could continue to do so, while allowing the armed services to continue refusing to enlist new trans recruits.

The Blade reached out to the Pentagon to ask why cisgender service members could receive hormone therapy while trans service members could not, but did not receive a response by the time of publication.

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