Where Does Glenda Go? Policy Visibility and Structural Vulnerability: LGBTQ+ Older Adults in Long-Term Care

Older lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults are more likely to live alone and less likely to have traditional family support, increasing reliance on long-term care (LTC). In Alabama, where legal protections remain limited, uncertainty persists regarding whether LTC facilities provide affirming environments. Guided by a community-academic partnership, we conducted a desk review of 52 LTC facility websites in central Alabama using the Human Rights Campaign and SAGE Long-Term Care Equality Index framework and interviewed administrators in nursing, human resources, and leadership roles. Only six facilities publicly included LGBTQ+-inclusive policies, limited to employee nondiscrimination; none had inclusive visitation policies. Although some facilities reported resident nondiscrimination policies, none explicitly referenced LGBTQ+ residents. Administrators frequently expressed uncertainty but indicated openness to improvement. These findings highlight policy visibility gaps and suggest that strengthening nondiscrimination language through peer support and grassroots advocacy may advance equity for LGBTQ+ older adults in LTC settings.