An ongoing fear in the gay and lesbian community is that long-term care (LTC) facilities may not be sensitive to their needs. In the present study, 218 LTC staff members responded to one of three vignettes in which resident sexual contact was observed, with only the gender of the characters changing, to create different gender pairings. Results suggested that staff rated male-male and female-female pairings more negatively than heterosexual intimacy. Knowledge about older adult sexuality made little difference in staff ratings. However, staff attitudes were directly related to ratings of negative reaction and level of acceptability of same-gender sexuality.

Affirmative therapy is a type of psychotherapy used to validate and advocate for the needs of sexual and gender minority clients. Therapists use verbal and nonverbal means to demonstrate an affirming stance toward lesbian, gay, bisexual, and transgender (LGBT) clients. Although this therapeutic approach can be used with LGBT individuals across the lifespan, the case presented in this paper highlights the benefit of using this approach with older LGBT individuals. Discussion of the unique challenges faced by older LGBT people will be followed with an illustrative case that shows ways that affirmative therapy can help individuals achieve greater self-actualization. The case formulation and conclusion will highlight specific ways that therapists can convey an affirmative stance and help clients feel welcome and accepted in the therapeutic setting. Recommendations for environmental cues, intake questions, and treatment skills will be offered at the conclusion.

LGBT-specific training and EBTs are needed. Facilities need to address stigma with residents and providers.

The Department of Veterans Affairs (VA) is likely the largest provider of health care for LGBT persons in US. However, histories of homophobia, stigma, discrimination, and past military policies have all had a lasting impact on the health of LGBT veterans. Effects can be seen across healthcare needs, disparities, access, and utilization for or by LGBT veterans. A case from a VA hospice unit is used to illustrate some challenges and opportunities when providing end-of-life care for an older, lesbian veteran. This veteran had been cared for by her wife who was struggling to meet care needs at home. Over time, it became clear that the wife was emotionally and financially dependent on the veteran, and would be facing many psychosocial and financial challenges when the veteran died. However the wife was reticent to accept referrals for help or services due to past negative experiences with social service agencies related to her sexual orientation. The interdisciplinary team collaborated to care for the veteran's medical needs, and the wife's emotional and psychosocial needs, until after the veteran's death. This case highlights many of the unique needs and challenges that may arise in caring for LGBT veterans and their families at end-of-life.