Approximately 2.3% of Americans aged 50 and older—about 2.7 million people—now self-identify as LGBTQ+, according to 2023 research from the Williams Institute at UCLA. As the number of openly LGBTQ+ older adults grows, senior living and long-term care providers face a vital responsibility: to offer housing and care that are not only safe and respectful but also affirming of diverse identities.
Many LGBTQ+ older adults have experienced a lifetime of discrimination and may enter care settings with legitimate fears of being asked to hide who they are, treated unequally, or denied culturally competent services. Some providers have made meaningful progress toward inclusivity, but the path to full equity remains incomplete, as a recent national benchmarking report shows.
Equitable senior living and care for LGBTQ+ older adults
The biennial Long‑Term Care Equality Index (LEI) is a national benchmarking program that evaluates LGBTQ+ inclusivity in senior housing and long-term care communities. Sponsored by the Human Rights Campaign Foundation in partnership with SAGE (Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders), the 2025 LEI includes data from 274 care communities across 33 states and the District of Columbia that voluntarily participated in the survey.
Among participating communities, 31 achieved the LEI’s top-tier “LGBTQ+ Long-Term Care Equality Leader” designation, while 44 earned “High Performer” status. In total, more than a quarter of participating communities (27%) received either the Leader or High Performer designation. Another 145 communities (53%) were recognized as “Equality Builders” for demonstrating broad LGBTQ+ initiatives.
A closer look at LGBTQ+ senior living and care
Like previous LEI cycles, the 2025 survey assessed communities across four core pillars:
Non-discrimination and staff training
The 2025 LEI found that regular staff training on LGBTQ+ aging and respectful care is increasingly common. Notably, 99% of participating communities now include both sexual orientation and gender identity protections in resident nondiscrimination policies—up from 90% in 2023 and just 18% in 2021.
For communities with formal visitation policies—typically those offering assisted living, nursing care, or life plan services—95% have written equal visitation policies. This is important because some care settings and hospitals have historically restricted visitation for non-spousal partners or chosen family.
Resident services and support
More providers are partnering with LGBTQ+ organizations to develop culturally competent resident services, but gaps persist. Only about one in three communities (34%) have rooming policies inclusive of same-sex couples. While 39% include sexual orientation and gender identity in confidentiality policies, only 36% offer LGBTQ+-specific resources and 35% have abuse and neglect policies that explicitly protect LGBTQ+ residents. Just 8% maintain an LGBTQ+-inclusive sexual expression policy.
Specific policies to prevent prejudice and ensure respectful interactions with transgender residents are rare: only 14% of communities reported having such measures in place.
Employee benefits and policies
Inclusive employee benefits—like domestic partner coverage and gender-affirming care—help attract and retain diverse staff. The 2025 LEI found that 91% of participating communities maintain an employee diversity and inclusion office, council, or working group that explicitly embraces LGBTQ+ diversity. However, only 5% reported targeted LGBTQ+ recruiting efforts.
On benefits, 97% allow employees to take time off after the death of a same-sex domestic partner or their partner’s immediate family. More than half (53%) provide FMLA-equivalent leave for employees caring for a same-sex partner or their partner’s children. Yet only 83% offer transgender-inclusive healthcare benefits, just 8% have written gender transition guidelines, and only 11% extend healthcare benefits to domestic partners of benefits-eligible employees.
Resident and community engagement
Transparency and visible outreach help build trust. Leading providers engage publicly with LGBTQ+ older adults and families through signage, outreach, Pride events, and partnerships with national and local LGBTQ+ organizations, but many communities still fall short.
Only about a quarter consult external LGBTQ+ organizations to assess needs (27%) or participate in local LGBTQ+ events (28%), and just 8% developed proactive LGBTQ+-inclusive marketing campaigns. The LEI also noted cases where communities displayed inclusive imagery—such as Pride symbols—but had not updated their nondiscrimination policies to match.
Improvement for LGBTQ+ older adults … with more to go
The 2025 LEI shows clear progress across the industry: more communities have nondiscrimination policies, standardized training, and growing cultural competency. These steps reduce fear, combat stigma, and help build trust with LGBTQ+ elders and their families. The report also records a 37% increase in voluntary LEI participation in 2025, signaling wider awareness and adoption.
Despite momentum, important gaps remain. Participation in the LEI is concentrated in urban areas, leaving rural and underserved regions with fewer inclusive options. Transgender elders and LGBTQ+ people of color face compounded barriers that require intersectional policies and targeted training. Accountability remains a concern, as few communities track or publish outcomes demonstrating that inclusion policies are meaningfully applied.
The future of LGBTQ+ senior living and care
From staff training and policy reform to stronger legal protections and community outreach, the senior living and care sector is beginning to address the unique needs of LGBTQ+ seniors. Many organizations are exploring ways to meet residents with dignity and respect, yet many LGBTQ+ older adults and their loved ones continue to fear discrimination and feel pressure to hide their identities.
To ensure all older adults can age openly and securely, the industry must continue expanding outreach, increasing visibility, and affirming inclusive values. Ongoing efforts toward equitable policies, improved staff training, and transparent practices will be essential to build trust, promote safety, and deliver truly inclusive care for LGBTQ+ older adults.