Prevalence of sexual and gender minority affirmative policies in long-term care facilities in Minnesota

Background and Objectives: Sexual and gender minority (SGM) older adults are more likely to use long-term care (LTC) than their cisgender, heterosexual counterparts. However, LTC settings may lack SGM-affirming policies necessary for inclusive care. This study analyzed the prevalence of SGM-affirming policies in nursing homes (NH) and assisted living facilities (ALF) in Minnesota and examined differences across facility characteristics. Research Design and Methods: A survey was conducted across 165 NH and 266 ALF in Minnesota. Facilities were assessed by their explicit inclusion of 28 SGM-affirmative policies, like nondiscrimination and training policies, with a mean index score calculated to determine the overall prevalence of affirming policies. Differences by facility type (NH vs. ALF), location (rural vs. urban), ownership (non-profit vs. for-profit), and religious affiliation (religious vs. secular) were assessed in multinomial logistic regression. Latent class analysis compared lower (n = 244) and higher (n = 153) performers across facility characteristics. Results: Across LTC facilities, there was an average of 11.30 SGM-affirming policies out of 28 policies assessed. Lower performing facilities reported fewer SGM-affirming policies (mean = 7.34) than higher performing facilities (mean = 17.24). No significant differences in policy prevalence were found between NH and ALF; between rural and urban facilities or by ownership status. However, striving facilities were more likely to be secular than religious. Discussion and Implications: The prevalence of SGM-affirming policies was distributed binomially, suggesting facilities fall within two categories (lower performers and high performers). Efforts should focus on adopting SGM-affirmative policies across all LTC facilities to ensure equitable and inclusive care for SGM older adults.