Making Long-Term Care More Inclusive for 2SLGBTQ+ Older Adults
08/24/2026
Many of today's older 2SLGBTQ+ adults have lived through remarkable social change. An 85-year-old today was just 28 when homosexuality was decriminalized in Canada. They were 64 when same-sex marriage became legal in 2005. Legal protections for gender identity and gender expression did not arrive until 2017, when they were already well into their later years.
For many people, those milestones represent progress. But they also tell a story of decades spent navigating stigma, discrimination, and exclusion. Those experiences can shape how people feel about aging and accessing care.
“Years of evidence show that many 2SLGBTQ+ older adults have significant concerns about entering long-term care,” said Arne Stinchcombe, PhD, Investigator at Bruyère Health Research Institute, PHAC-CIHR Applied Public Health Chair, and Director of the Healthy Aging Research Program (HARP) Lab. “Some fear they may need to hide parts of their identity to feel safe. For people who have spent years fighting to live openly, the thought of "going back into the closet" can be deeply distressing.”
At the same time, many long-term care staff want to provide inclusive care but have not always had access to the training and resources they need. Previous conversations with care providers revealed that many received little or no education about 2SLGBTQ+ issues during their professional training.
Recognizing this gap, the Ontario Centers for Learning, Research and Innovation in Long-Term Care (CLRI) at Bruyère Health partnered with Rainbow Health Ontario and the HARP Lab to deliver a province-wide training program on 2SLGBTQ+ inclusive care for long-term care staff.
The program combined self-paced online learning with facilitated discussions and opportunities to hear directly from older adults with lived and living experience. Training was designed for everyone working in long-term care, not just clinical staff. Participants included people from across the home, from kitchen and support staff to recreation teams, managers, and organizational leaders.
“Across 38 participating long-term care homes in the first year of training, participants reported stronger knowledge about 2SLGBTQ+ aging, and a better understanding of the unique experiences older adults may bring with them into care settings,” said Stinchcombe. “Negative biases decreased, and staff felt more confident and better prepared to support 2SLGBTQ+ residents.”
Nearly half had worked in long-term care for more than 10 years, demonstrating that learning about inclusion is valuable at every stage of a career.
Perhaps most importantly, many participants described meaningful shifts in perspective. Some said they had never fully considered concepts such as identity erasure, the impact of historical discrimination, or the possibility that residents might feel that they need to hide who they are. Others left feeling inspired to make changes in their own workplaces, from reviewing forms and language to creating more visibly welcoming spaces.
While education alone cannot solve every challenge, it can help staff build the knowledge, confidence, and awareness needed to provide more inclusive care. It can also spark conversations and changes that make long-term care homes feel safer and more welcoming for residents of all identities.
This training builds knowledge and confidence, but the work of Ontario CLRI at Bruyère Health’s Advancing EDI in Long-Term Care Program also extends into everyday tools that LTC homes can use to put learning into practice.
“Education is a big part of what can drive culture change, but so is creating resources for homes to use in everyday situations,” said Ashley Flanagan, PhD, Senior Knowledge Broker at Ontario CLRI at Bruyère Health. The Embracing Diversity Toolkit and recently released Welcoming Trans and Gender-Diverse Older Adults to Long-Term Care give long-term care homes practical starting points.
“Inclusion is not a once-a-year initiative,” said Stinchcombe. “Inclusion happens every day, in everyday interactions. For 2SLGBTQ+ older adults, those daily efforts can make the difference between feeling unseen and feeling truly at home.”
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For more information about this training, visit Supporting 2SLGBTQ+ Inclusion in Long-Term Care Training Program, or find resources for inclusive care by Ontario CLRI and Rainbow Health Ontario.