Announced officially last month, the Human Rights Campaign Foundation, the educational arm of the LGBTQ+ civil rights advocacy organization HRC, and SAGE, the world’s largest and oldest organization dedicated to improving the lives of LGBTQ+ older adults, joined forces in a partnership aimed at helping LGBTQ+ elders across the country. The inaugural project taken on by these groups is the Long-Term Care Equality Index: a nationwide assessment intended to rate the quality of life LGBTQ+ people have in long-term elder care facilities.
“All too often, LGBTQ+ elders do not receive the care and support they deserve,” said HRC President Chad Griffin. “With experts predicting that as many as 4.7 million LGBTQ+ elders will be seeking care and services by the year 2030, the time to act is now. It is incumbent on us to ensure that all LGBTQ+ elders are treated with dignity and respect, and HRC is proud to join with SAGE in this historic effort to fundamentally improve the experiences of LGBTQ+ older adults as they seek long-term care and services.”
The LEI in Four Steps
As it stands, there remains a lot of work to be done before the LEI is fully completed, but it will operate similarly to an existing index, said Tari Hanneman, director of HRC Foundation’s Health Equality Program.
“I think the LEI will probably be closest to the Health Care Equality Index,” she said. “We’ll be looking at some fairly similar kinds of criteria, so making sure that an area has LGBTQ+-inclusive non-discrimination both for their residents, visitors if applicable and their employees — that’s key — and then foundational is having some training. And that’s one of the strengths that SAGE really brings to the table, they have a great training program that’s really working with a lot of long-term care providers so that training really helps bring those policies to life.”
Kat LaTosch founded LaTosch Consulting, an organization that aids non-profits in expanding diversity, equity, and inclusion, has been doing work on LGBTQ+-inclusive senior services since 2013 and will serve as the Michigan project manager for the LEI. She outlined that the LEI will focus specifically on long-term care providers in institutional areas meaning assisted living, independent living, nursing care, and hospice and will be a great metric for assessing if a particular organization is the correct fit for a potential LGBTQ+ resident’s needs.
“We’re talking those specific areas because they’re already somewhat regulated and so we can make better inroads that way. But yes, ultimately, if I’m an aging LGBTQ+ person and I’m looking for a place that’s not going to discriminate against me and has gone through some practices and put those in place to ensure that there are protections for me, I’ll be able to check them out on this guide, I’ll be able to go to this website and see a directory of listings in my area, that’s the goal,” she said.
For organizations interested in testing their inclusivity, LaTosch said the first step is to sign the Commitment to Caring pledge put forth jointly by both organizations to show “that they’re going to make a commitment to go through the process and become inclusive organizations.”
“Once they sign the pledge or the endorsement, then they’ll have an opportunity — and this is in the development phases — of taking a self-assessment,” LaTosch said. “Someone from the agency can go through a checklist and check off to what extent their services are LGBTQ+-inclusive. Once they get that assessment, they’ll also learn how well they fare on that and they’ll receive best practices and guidance on how to improve.”
Then, the first round of institutional changes, if any, should begin. LaTosch emphasized that the results from this process are intentionally private and that both HRC and SAGE will play a role in helping organizations that opt into the service raise their scores.
“Once they’ve completed that, they’ll be ready to make some improvements and then they can take the actual index which will rank their organization,” she said. “So, our approach is very much one that is educational and supportive and helpful by providing best practices by providing guides and tools and resources.”
Regarding Southeast Michigan specifically, LaTosch said she’s observed a general willingness to participate from the currently existing elder care facilities.
“Additionally, our rainbow resource guide now has tons of referrals, all of which have pledged a commitment to care for LGBTQ+ older adults and agreed to treat them with dignity and respect and not discriminate,” she said. “So that’s a good combination in Metro Detroit.”
And statewide, the results look promising, too. Of the 16 LGBTQ+ care facilities in Michigan, six have already partnered with SAGE and HRC and three have started their own work — meaning that already more than half the state is interested in fostering positive relationships with the LGBTQ+ community.
“I think the LEI will provide an added encouragement for more companies to do that, more private services because now they’re saying, ‘This isn’t just Michigan, there are states across the country that are doing this.’ It’s really to help push that wave of forward movement ahead,” she said.
Fear of Discrimination is a Lasting Concern
Perhaps one of the starkest examples of the necessity for an accurate LGBTQ+ elder care index is in the rates of anxiety and fear that elders have about their quality of life when they retire to a senior living community. According to a study updated in 2018 by The National Long-Term Care Ombudsman Resource Center, an organization devoted to providing support, technical assistance and training to long-term care facilities across the U.S. — roughly 10.1 million Americans identify as LGBTQ+. Of that number, nearly a third of those who were in the age bracket of 52 and older “had significant concerns about discrimination as they age and there are reports that LGBTQ+ older adults encounter violations of their rights when seeking long-term care services and supports.”
The study went on to say that a challenge of identifying rights violations traces back to the fact that incidents of abuse are often “unreported and unidentified.”
“However, a majority of individuals responding to a survey (578 of the 649 respondents or 89 percent) felt that staff would discriminate against an LGBTQ+ elder who was out of the closet,” read the study. “Additionally, negative treatment, including verbal and physical harassment, by other residents was the most commonly reported problem by respondents in this study.”
Anna Wahrman is the SAGE senior digital content manager. She said those fears can sometimes become a reality, with reports of adults who have been out of the closet for decades forced to reject their LGBTQ+ identities.
“As the boomers age — and everyone else — they’ve been out of the closet and they’ve lived their lives out of the closet and it’s really hard to go back in. And, really, we know stories where people have faced definitely discrimination, sometimes even violence from [that],” Wahrman said. “I would just point out sort of an existential threat at the moment which is the religious freedom bills that are happening and 85 percent of long-term care facilities are religiously affiliated which is an insane statistic. So, it’s more important than ever that we do highlight those who are inclusive and have non-discrimination policies in place for residents.”
Hanneman said that as the LEI develops into its final stages, there will be some challenges that both SAGE and HRC will need to tackle.
“One of the biggest difficulties is that this is going to be a voluntary survey, so a long-term care facility would have to opt-in to participate and agree to answer questions about their policies and practices, agree to provide us with copies of those policies and practices so that we could verify in some way that they’re doing it,” she said. “It’s going to take a lot of outreach to get these facilities to opt in and then we’re still probably only going to be serving a fraction.”
The second issue will be in ensuring that organizations are meeting the standards set out for them.
“You can have great policies in place, but if you don’t have that training and all of your caregivers are not being fully inclusive, you could have a bad incident because of one person,” Hanneman said. “And so, making sure that these communities are really living up to these policies and practices and that they have trained their staff in a way so that, you know, everybody feels welcome and included, that’s something that is a lot harder to measure and capture in that experience on the ground because we’re not there.”
To combat these roadblocks, however, HRC and SAGE are working on putting together an advisory council “on folks from the field, folks from the aging, long-term care services sector as well as some LGBTQ+ aging advocates,” Hanneman said.
“So they will help us form this process,” she said. “We’re very excited about that and we’re making sure we’re listening to their voices as we develop this.”
To find out more about the Long-Term Care Equality Index visit thelei.org.
