There are approximately three million lesbian, gay, bisexual, and transgender (LGBT) adults over the age of 50 in the United States (SAGE & National Resource Center on LGBT+ Aging, 2021), and that number is expected to grow to around 7 million by 2030. Home healthcare clinicians can only benefit from understanding some of the unique circumstances the LGBT older adult population faces, such as increased physical and mental illness, healthcare neglect, discrimination, social isolation, increased caregiver burden, financial difficulties, housing discrimination, and decreased public assistance. In fact, 82% of older LGBT adults report experiencing at least one instance of victimization in their lifetime, such as threats, harassment, or physical assault.

There is a greater risk of physical and mental illness in the LGBT population. This is due in part to fear of discrimination from healthcare providers. Forty-six percent of LGBT older adults report being denied healthcare or provided inferior healthcare because of their gender/sexual identity (Candrian & Cloyes, 2021). LGBT adults also have increased rates of disabilities (41% in LGBT older adults comparted to 35% in heterosexual older adults), higher smoking rates (over 50% higher than the general population), excessive alcohol consumption, and increased suicidal thoughts and attempts (SAGE, 2021).

Caregiving often looks different in the LGBT community compared with the general population due to social isolation. Many LGBT adults do not have traditional family systems or legally recognized relationships, which can increase the risk for social isolation and its consequences, such as loneliness and poor physical health (Candrian & Cloyes, 2021). Research suggests the health risks of prolonged isolation are equivalent to smoking 15 cigarettes a day (SAGE, 2021). Nontraditional family units cause LGBT people to become caregivers at a higher rate than their non-LGBT peers. About 21% of LGBT people have provided care to friends, compared with about 6% of non-LGBT adults (SAGE, 2021). This increase in caregiving can result in caregiver burnout.

Financial strain and housing discrimination also play a role in LGBT older adult care. One-third of LGBT older adults live at or below 200% of the federal poverty level (SAGE, 2021). Due to fear of discrimination, LGBT older adults are less likely to reach out to senior centers, meal programs, and other services (SAGE, 2021). Additionally, housing discrimination is frequent, as there are typically no laws prohibiting housing discrimination on the basis of sexual orientation and/or gender identity (SAGE, 2021).

It is important for home healthcare clinicians to be sensitive to all patients, but also be aware that some patients may be LGBT adults (and not disclose their status) and have more significant needs than originally anticipated. Clinicians must consider how to respectfully and sensitively invite patients to share their LGBT status. All involved should pay special attention to being inclusive and implementing a holistic care plan, while ensuring the patient's safety. A thorough assessment can help determine physical and mental health needs/concerns, being sure to consider the increased rate of disability, smoking, alcohol use, suicidal thoughts and ideations, and potential insufficient healthcare. Educate caregivers about caregiver burnout and self-care. A referral to a social worker is indicated for financial assistance, meal programs, access to senior centers, respite care, and housing-especially recommendations for LGBT-friendly accommodations.

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