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If my loved one is being mistreated in a nursing home because of his or her sexual or gender identity, what can I do about it?

Homophobia and transgender phobia can be expressed in a number of ways in a care facility, ranging from comments made directly to your loved one by other patients or staff to problems with the care that is or should be provided. Under the law, every nursing home resident has certain rights and protections and must be given a copy of these rights. For information about nursing home resident rights, see Nursing Home Residents’ Rights, a document excerpted from A Family Council Manual prepared by the Minnesota Alliance of Health Care Consumers.

Not surprisingly, nursing homes (also known as skilled nursing facilities or SNFs) and residential care facilities in general continue to struggle with the sex and sexuality of their residents, heterosexual or homosexual. Contrary to popular belief, many seniors maintain active sex lives and desire that does not go away with aging. This may particularly be an issue for a care receiver care who has dementia, and may be further complicated by the relationship between dementia, and other cognitive conditions and brain disorders, and lack of inhibition and self-regulation. Additionally, there are still no laws prohibiting discrimination against people based on sexual orientation in housing or public accommodation in 28 states. This number will no doubt change going forward.

If problems occur with a loved one in a nursing or residential facility, the first step is to determine whether the mistreatment is isolated or systemic: Is a particular health professional, aide, or other worker the source of the problem? Or is the person being harassed or mistreated by other residents? If the harassment is by another resident, possibly a roommate, request that your loved one be moved to another room or another part of the facility. If the problem stems from an individual worker, talk to the appropriate supervisor or administrator, explain the problem, and request another staff person to be assigned to assist your loved one. These requests should be friendly and followed up by descriptive letters to the persons with whom you speak. You will want to keep a record of your requests and the responses you receive. However, if problems persist, or if you determine that the homophobia is widespread and can’t be resolved by talking with the facility staff, you should contact your local Ombudsman Program.

Under federal law, each jurisdiction must maintain an Ombudsman Program. Each facility must have the contact information for reaching the Ombudsman posted in highly visible places. If you do not see this posted, contact the Office on Aging/Area Agency on Aging in the county in which the facility is located to get information about your local Ombudsman Program. Ombudsmen are usually very busy in their county, and you may have to exercise diligence to set an appointment. Once informed about the problem, the Ombudsman will visit to verify claims of mistreatment or abuse in licensed care facilities and help to mediate a resolution. Each facility’s local Ombudsman Program should also be responsive to caregivers who want to discuss their concerns about care in a licensed facility and should assist caregivers in determining whether a formal complaint should be filed. Formal complaints are made in writing. You can also report a problem directly to the state department (often the state Department of Health) that licenses and/or certifies skilled nursing facilities, residential care facilities, or board and care homes. If the problem rises to the level of elder abuse, be forewarned that lodging a formal complaint against a nursing home or other senior residential facility can become a long and difficult undertaking, often requiring attorneys and court time. Attorneys who handle elder abuse matters in nursing homes are highly specialized. Visit the National Center on Elder Abuse website (https://ncea.acl.gov/) for more information about concerns in assisted care and nursing facilities or at home.