The Promise and the Reality: LGBTQ+ Elder Care in massachusetts

Massachusetts, often lauded for its progressive stance, faces a stark reality: its groundbreaking LGBTQ+ elder care law is struggling to deliver on its promise. This law, designed to safeguard vulnerable LGBTQ+ seniors in assisted living and long-term care facilities, mandates specific staff training to ensure sensitive and informed care. Tho, recent data paints a concerning picture of a significant gap between the law’s intent and its practical implementation.

Since 2022,the Executive Office of Aging & Independence (AGE) has cited 48 assisted living residences for failing to adequately train their staff on LGBTQ+ care,as required by law. Alarmingly, two facilities were cited for “repeat non-compliance,” prompting regulators to order a complete retraining of all staff members at those locations. This raises serious questions about the commitment of some facilities to providing inclusive and respectful care for LGBTQ+ elders, highlighting a potential systemic issue within the state’s elder care system.

The scope of the Problem: Understanding the Numbers

The issue extends beyond mere compliance figures. An estimated 3.6 percent of Massachusetts residents aged 65 and older identify as LGBT or another sexual identity. According to a forthcoming analysis by The Fenway Institute and Boston Indicators,this translates to approximately 47,000 older adults in the state. These individuals, many of whom lived through decades of discrimination and stigma, deserve to age with dignity and respect, free from the fear of further marginalization.

Paul Glass, cofounder and program coordinator of LGBTQ+ Elders of Color, emphasizes the persistent challenges: “When there is someone who is LGBTQ, even though they are not treated badly, they are isolated by the residents and sometimes by personnel. It tends to be a very uncomfortable situation becuase we can mandate training for the personnel, but we can’t mandate it for the residents.” This highlights the complex interplay of systemic training failures and deeply ingrained societal biases, a challenge that requires a multifaceted approach.

The Training Mandate: What’s Required and What’s Missing

The state-mandated training is a free,one-time,pre-recorded online course.It covers the history of LGBTQ+ discrimination and rights and presents potential scenarios caregivers might encounter while interacting with LGBTQ+ residents. It also offers practical tips,such as using inclusive language like “partner” or “spouse” instead of gender-specific terms. While this training is a crucial first step,many advocates argue that it’s insufficient to create a truly inclusive surroundings. The one-size-fits-all approach fails to address the diverse needs and experiences within the LGBTQ+ community.

One advocate, Mitchell, believes that many administrators are taking a “mechanical” approach to the training, doing only the bare minimum required. This raises concerns about the depth of understanding and empathy fostered by the current training model.Is it truly changing hearts and minds, or simply checking a box? The lack of ongoing, interactive training leaves room for implicit biases to persist and potentially impact the quality of care provided.

Beyond Compliance: Examples of Best practices

Fortunately, some facilities are going above and beyond the basic requirements. Broad Reach Healthcare in Chatham, for exmaple, holds annual live group discussions with staff and residents around Gay Pride month. These discussions explore topics such as how to respond to an adult child who comes out as gay,fostering a more proactive and inclusive environment. This approach encourages open dialog and helps to break down stereotypes and misconceptions.

Bill Bogdanovich, president and chief executive of Broad Reach Healthcare, launched the training in 2018 with a public screening of the film “Gen Silent.” This powerful documentary follows the lives of six LGBTQ+ seniors in the Boston area who must decide whether to hide their sexuality to survive in the long-term health care system. “We still use that film from time to time and with residents,” Bogdanovich explains. “It’s as much about educating residents as staff, and it’s about people’s rights not just from staff but from roommates and people living in the same shared environments.” This holistic approach, involving both staff and residents, is crucial for creating a truly inclusive community.

Hebrew Senior Life, with facilities in Canton and Dedham, has also implemented innovative programs. Since 2018, chaplains in training have created LGBTQ+-related programming and activities for residents, families, and staff, in addition to providing staff training. Miriam Priven, the program’s newest resident chaplain, emphasizes the importance of asking open-ended questions to avoid making assumptions about residents’ relationships. “People don’t think of a 90-year-old grandma as a lesbian,” Priven notes. “But more people are surviving to an old age. So it’s really significant our long-term care facilities are well prepared to embrace our communities, cause we are coming.” This proactive approach to inclusivity ensures that LGBTQ+ seniors feel welcomed and respected.

The Need for Enforcement and Cultural Change

The experiences of LGBTQ+ elders highlight the urgent need for more robust enforcement of the existing law and a broader cultural shift within elder care facilities. As McGuire,a health professor at Northeastern University and former top executive in the state’s health and human services administration,points out,”The law is only meaningful in terms of what the enforcement is.” She adds, “A shift in culture takes a long time. And it has to have a deliberateness about it that’s not just there’s a law and you have to take some online training where you click through.” this underscores the importance of accountability and ongoing commitment to creating a truly inclusive environment.

The fear of retribution often prevents older residents and their families from filing official complaints, making it even more critical for regulators to proactively monitor and enforce compliance. This includes conducting regular audits, providing ongoing training and support for staff, and creating a culture of accountability within facilities. Without these measures, the law risks becoming a symbolic gesture rather than a meaningful safeguard for LGBTQ+ elders.

Looking Ahead: Policy Recommendations and Future Directions

To ensure that LGBTQ+ elders receive the care and respect they deserve, Massachusetts needs to take a multi-pronged approach:

• Strengthen Enforcement: Increase the frequency and rigor of audits of assisted living and long-term care facilities to ensure compliance with the LGBTQ+ training mandate.
• enhance Training Programs: Move beyond the one-time online course and implement ongoing, interactive training programs that address implicit biases and promote cultural competency.
• Empower residents: Create safe and confidential channels for residents and their families to report instances of discrimination or mistreatment without fear of retaliation.
• Promote Best Practices: Share prosperous models,like those implemented by Broad Reach Healthcare and Hebrew Senior Life,to encourage other facilities to adopt more inclusive practices.
• Address Systemic Issues: Advocate for policies that address the broader social and economic factors that contribute to the vulnerability of LGBTQ+ elders, such as housing insecurity and healthcare disparities.

By taking these steps, Massachusetts can move closer to fulfilling the promise of its groundbreaking LGBTQ+ elder care law and ensuring that all seniors can age with dignity and respect.The state’s commitment to inclusivity must extend beyond legislation and translate into tangible improvements in the lives of its LGBTQ+ elders.