Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
Long Term Services and Supports Center of Innovation, VA Providence Healthcare System, Providence, RI, USA.
J Am Med Dir Assoc. 2024 Nov;25(11):105215. doi: 10.1016/j.jamda.2024.105215. Epub 2024 Aug 14.
Most older adults with lesbian, gay, bisexual, queer, questioning, transgender, and related identities (LGBTQ+) are concerned about receiving lower-quality care and/or being mistreated in nursing homes. Older LGBTQ+ veterans may have additional reservations about care in Department of Veterans Affairs (VA) nursing homes (Community Living Centers [CLCs]) because of experience with past discriminatory military policies (eg, bans on participating in military service, Don't Ask Don't Tell). This article describes one of the first VA CLCs to participate in the Human Rights Campaign-developed Long-Term Care Equality Index (LEI).
A single-site formative evaluation was completed to support quality improvement and identify opportunities for growth using the LEI. The LEI is a facility benchmarking tool to support more inclusive environments for LGBTQ+ residents and employees. The LEI offers 4 evaluation criteria: (1) Non-Discrimination and Staff Training; (2) LGBTQ+ Resident Services and Support; (3) Employee Benefits and Policies; and (4) Resident and Community Engagement. Facilities receive ratings based on the number of requirements achieved in each category.
Older LGBTQ+ veterans, current CLC residents, interdisciplinary CLC providers and leadership, and national Geriatrics and Extended Care program managers collaborated to pilot the LEI and develop tools and materials to support other VA facilities' participation in the LEI.
Qualitative interviews with veterans and CLC residents supported inclusion of gender identity and sexual orientation in resident handbooks, discussions about person-centered care, and opportunities for additional staff training and community engagement (eg, observing Pride Month in June). Resources to support VA long-term care facilities' participation in the LEI were developed.
The LEI offers a structured approach to identifying areas for improvement in providing high-quality and equitable care in long-term care settings. Practical suggestions for CLCs and other nursing home settings considering the LEI for the first time are discussed.
大多数有女同性恋、男同性恋、双性恋、酷儿、疑问、跨性别和相关身份（LGBTQ+）的老年人担心在养老院接受低质量的护理和/或受到虐待。由于过去有歧视性军事政策的经历（例如，禁止参军、不问不说），老年 LGBTQ+退伍军人可能对退伍军人事务部（VA）养老院（社区生活中心 [CLC]）的护理有更多的保留意见。本文描述了第一个参与人权运动开发的长期护理平等指数（LEI）的 VA CLC 之一。
使用 LEI 完成了一项单一地点的形成性评估，以支持质量改进并确定增长机会。LEI 是一种设施基准工具，旨在为 LGBTQ+居民和员工提供更具包容性的环境。LEI 提供了 4 个评估标准：（1）非歧视和员工培训；（2）LGBTQ+居民服务和支持；（3）员工福利和政策；和（4）居民和社区参与。根据每个类别中实现的要求数量，设施会获得评级。
老年 LGBTQ+退伍军人、现任 CLC 居民、跨学科 CLC 提供者和领导层以及国家老年病学和扩展护理计划经理合作试点 LEI，并开发工具和材料，以支持其他 VA 设施参与 LEI。
对退伍军人和 CLC 居民的定性访谈支持在居民手册中纳入性别认同和性取向、讨论以人为本的护理以及为员工提供更多培训和社区参与的机会（例如，在 6 月观察骄傲月）。开发了支持 VA 长期护理设施参与 LEI 的资源。
LEI 为在长期护理环境中提供高质量和公平的护理提供了一种结构化的方法。讨论了首次考虑 LEI 的 CLC 和其他疗养院的实用建议。
