Human Rights Campaign and SAGE Release First Edition of the Long-Term Care Equality Index

by Madeleine Roberts

The Long-Term Care Equality Index (LEI) is the first-ever nationwide assessment of LGBTQ inclusivity and inclusion at long-term care communities in the U.S.

Today, the Human Rights Campaign (HRC) Foundation, the educational arm of the nation’s largest lesbian, gay, bisexual, transgender and queer (LGBTQ) civil rights organization, and SAGE, the world’s largest and oldest organization dedicated to improving the lives of LGBTQ older adults, released the first edition of the Long-Term Care Equality Index (LEI). This national benchmarking tool evaluates long-term care communities based on the equity and inclusion of their LGBTQ residents and patients. This initial report does not score long-term care communities, but instead includes research data on how many long-term care communities currently have LGBTQ-inclusive policies, and lays out how organizations can participate in the LEI and improve their policies.

Despite significant progress, LGBTQ people lack basic legal protections in states across the country, including consistent and explicit anti-discrimination protections. Without these protections, long-term care communities must adopt their own LGBTQ non-discrimination policies to protect their residents and employees. However, the HRC Foundation and SAGE’s research found that that is rarely the case. Of the long-term care communities where enumerated residential non-discrimination policies existed, only 18% had an LGBTQ-inclusive non-discrimination policy. Of the long-term care communities where enumerated employee non-discrimination policies were found, only 36% had an LGBTQ-inclusive non-discrimination policy.

Long-term care is an essential part of assisting and providing for LGBTQ people as they age. The Human Rights Campaign Foundation is proud to partner with SAGE on the Long-Term Care Equality Index (LEI), a new benchmarking tool set to fundamentally change the inclusivity of long-term care. As this report makes clear, finding inclusive long-term care communities can be especially challenging for LGBTQ older adults, and that more long-term care communities need to take the lead on LGBTQ inclusion. Together, the Human Rights Campaign Foundation and SAGE will continue working to ensure that LGBTQ people at all stages of life have safe and equitable access to inclusive long-term care.”

Alphonso David, Human Rights Campaign President

Equitable and inclusive care in residential long-term care communities is vital for LGBTQ elders to thrive in their later years. The Long-Term Care Equality Index (LEI) is designed to both assess a facility’s current services, and assist them in adopting policies that promote culturally competent care. We at SAGE are proud to partner with the HRC Foundation on this crucial tool for both our LGBTQ pioneers and the many facilities that serve them.”

Michael Adams, CEO of SAGE

The invisibility of LGBTQ elders, many of whom remain closeted or return to the closet when they enter long-term care, has perpetuated the false perception that there is not a pressing need to make policy or practice changes to ensure that care communities are welcoming and inclusive of LGBTQ elders. However, more than 5% of people who live in long-term care communities are LGBTQ. And for LGBTQ BIPOC community members, there is compounded fear of discrimination and inadequate care based not only on sexual orientation and gender identity, but also racial bias.

Many long-term care communities that want to welcome LGBTQ residents and patients may not know how to do so. The Long-Term Care Equality Index gives professionals, providers, older adults and care partners the tools for being LGBTQ inclusive, building on the decade-plus success of the HRC Foundation’s Healthcare Equality Index (HEI). The LEI will measure the following policy and practice areas as benchmarks of LGBTQ inclusion in long-term care settings:

  • Foundational Policies & Practices;
  • Resident Services & Support;
  • Employee Benefits & Policies; and
  • Resident & Community Engagement

As of the release of this initial report, there have been 78 “Commitment to Caring” pledges completed, which is the first step in the LEI and indicates long-term care communities’ intentions to adopt LGBTQ inclusive and culturally competent policies and practices. Additionally, there have been 49 self-assessments completed for 184 diverse long-term care communities, with 32 states represented. The next edition of the LEI will be released in 2023. Organizations can participate in the LEI by signing the “Commitment to Caring” pledge, taking the LEI self-assessment and planning for long-term LGBTQ-inclusive goals after receiving a customized needs-assessment report.

For more information about the LEI, visit

The Human Rights Campaign reports on news, events and resources of the Human Rights Campaign Foundation that are of interest to the general public and further our common mission to support the LGBTQ community.

Contact Us

To make a general inquiry, please visit our contact page. Members of the media can reach our press office at: (202) 572-8968 or email