Approximately 2.3% of Americans 50 and older (2.7 million people) self-identify as LGBTQ+, according to 2023 research from the Williams Institute at UCLA. As the number of openly LGBTQ+ seniors continues to grow in the U.S., the senior living and long-term care industries must address a pressing responsibility: to provide housing and care environments that are not only safe and respectful but also affirming of older adults’ diverse identities.

Many people in the LGBTQ+ community have faced a lifetime of discrimination and may enter care settings with valid concerns about being forced to conceal their true identity, treated unequally, or denied culturally competent and sensitive services. In response, some senior living and care providers are making meaningful strides toward creating inclusive, equitable spaces, but the journey toward full equality for the LGBTQ+ community is not yet complete, as highlighted by a recent report.

Equitable senior living and care for LGBTQ+ older adults

The biennial Long‑Term Care Equality Index (LEI) is a pioneering national benchmarking program assessing LGBTQ+ inclusivity in senior housing and long-term care communities. Sponsored by the Human Rights Campaign (HRC) Foundation in partnership with Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE), the LEI for 2025 includes data from 274 care facilities across 33 states (including the District of Columbia) that voluntarily took part in the survey and analysis.

Among participating communities, 31 attained LEI’s top-tier “LGBTQ+ Long-Term Care Equality Leader” designation, and 44 earned the “High Performer” designation. In all, over a quarter of participating communities (27%) attained either the Leader or High Performer designation. Additionally, 145 communities (53%) achieved “Equality Builder” status for demonstrating comprehensive LGBTQ+ initiatives.

>> Related: Working Toward Equal Access in LGBT Senior Living

A closer look at LGBTQ+ senior living and care

As with prior surveys from 2021 and 2023, the 2025 LEI evaluated participating senior living and care providers across four core pillars:

Non-discrimination and staff training

The 2025 study found that regular staff training on LGBTQ+ aging and respectful care is widely adopted as a standard practice in many of the participating communities. Additionally, 99% of communities now include both sexual orientation and gender identity protections in their resident nondiscrimination policies, up from 90% in 2023 and just 18% in 2021.

Importantly, for communities with visitation policies — typically communities that provide any type of care services (e.g., assisted living, nursing homes, or continuing care retirement communities [CCRCs or life plan communities]) — 95% have written equal visitation policies in place. This is significant since visitation by non-spouses has been (and continues to be) restricted by some care communities and hospitals.

Resident services and support

A growing number of senior living and care providers work in collaboration with LGBTQ+ community organizations to design culturally competent services for their residents, according to the 2025 LEI. Work remains to be done on this pillar, however.

For instance, the study found that only 1 in 3 (34%) communities have a rooming policy that is inclusive of same-sex couples. The study also found that while 39% include sexual orientation and gender identity in their confidentiality policy, 36% have LGBTQ+-specific resources available for residents, and 35% have an abuse and neglect policy that explicitly protects LGBTQ+ residents, just 8% have an LGBTQ+-inclusive sexual expression policy in place.

Furthermore, only 14% of participating communities have specific policies and procedures in place to deter prejudice and insensitivity, and ensure positive employee interactions with transgender residents.

Employee benefits and policies

Across industries, inclusive employee benefits, such as domestic partner coverage and gender-affirming healthcare, are increasingly standard and help encourage a diverse workforce. In senior living and care, diversity is bolstered by non-discrimination protections extended to staff as well as residents, though here again, there is work still to be done.

The 2025 LEI study found that 91% of participating communities have an employee diversity and inclusion office, council, or working group that specifically embraces LGBTQ+ diversity. However, only 5% have LGBTQ+-targeted employee recruiting efforts.

When it comes to employee benefits, an impressive 97% allow employees to take time off following the death of a same-sex domestic partner or their partner’s immediate family. More than half (53%) provide “FMLA-equivalent benefits,” enabling employees to take leave in order to care for a same-sex partner or the children of a same-sex partner, regardless of biological or adoptive status.

But there is room for improvement: While 83% do offer transgender-inclusive healthcare benefits to their employees, only 8% have written gender transition guidelines. Furthermore, only 11% of communities offer healthcare benefits to benefits-eligible employees’ domestic partners.

Resident and community engagement

As with many areas of life, transparency builds trust. The LEI survey found that leading senior living and care providers engage publicly with LGBTQ+ older adults and their families in a number of ways, like through signage, outreach, Pride events, and partnerships with HRC, SAGE, and other local LGBTQ+ groups, though many organizations could still do more.

For example, roughly a quarter of communities consult with external LGBTQ+ organizations to evaluate and address LGBTQ+ needs or apprehensions (27%) and/or took part in/supported LGBTQ+ events in their area (28%). However, only 8% proactively developed LGBTQ+-inclusive marketing or advertising campaigns.

Even among those that promoted their inclusivity, the LEI report observed that, “it was not uncommon to find that a senior housing community would include LGBTQ+ visual symbols like a Pride flag on their website to indicate that they were inclusive, yet upon review of their non-discrimination policies, we found that they had not been updated to be LGBTQ+-inclusive.”

>> Related: Single and Childless: Many Baby Boomers Must Prepare to Age Alone

Improvement for LGBTQ+ older adults … with more to go

Overall, the 2025 LEI report shows progress within the senior living and care industry with regard to their LGBTQ+ policies and procedures, including non-discrimination policies, standardized training, and improved cultural competency across many care sites. Such steps help reduce fear and stigma, and promote trust within LGBTQ+ communities.

Of note, there was also a 37% increase in voluntary LEI survey participation for 2025, highlighting expanded awareness and adoption within the industry. But despite this overall momentum, significant gaps clearly remain in providing truly inclusive senior living and care for LGBTQ+ older adults, as well as for LGBTQ+ employees of those communities. For instance:

  • Participation in the LEI is still largely concentrated in urban areas, skewing the data and leaving rural and underserved regions behind.
  • Transgender elders and LGBTQ+ people of color often face compounded discrimination, underscoring the need for intersectional policies and targeted staff training.
  • Accountability is an ongoing concern since few communities track or publish data to ensure that inclusion policies are being meaningfully applied.

>> Related: Why Diversity in Senior Living Matters

The future of LGBTQ+ senior living and care

From staff training and policy reform to expanding legal protections and community outreach, the senior living and care industry is beginning to reckon with the unique needs of LGBTQ+ seniors. The LEI survey shows many organizations exploring how to meet LGBTQ+ residents with dignity and care.

Despite these gains, many LGBTQ+ seniors and their loved ones continue to fear discrimination, often feeling pressure to hide their identities. Until all older adults feel safe and free to be who they are, the senior living and care industry as a whole must continue to promote greater outreach, visibility, and public affirmation of the inclusive values that are essential to building a sense of security, creating trust, and ensuring equitable care for LGBTQ+ older adults.

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