Table 2.

Summary of Results for Long-Term Services and Supports (LTSS) Provider Perspectives on Lesbian, Gay, Bisexual and Transgender (LGBT) Issues in Long-Term Care

Authors	Main findings with themes
Ahrendt et al. (2017)	Attitudes toward LGBT older adults: •Researchers used vignettes in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. •No difference by vignette type was observed in the full sample. •Significant differences were found between facility types. Approval ratings for same-sex relations were significantly associated with the facility where participants were employed. •Male–female vignette was significantly more accepted at Facility 1 (religiously affiliated facility; p = .01). •The male–male vignette was less accepted at Facility 1.
Bell et al. (2010)	Lack of knowledge and training on LGBT health issues: • Nursing home social service directors with < 3 years of experience, college degrees, and those who graduated after the year 2000 were more likely to have received training in homophobia. •Only 24% of participants had received at least an hour of cultural competence training on homophobia. •Nursing home staff were not prepared to provide competent and quality care to LGBT residents.
Dickey (2012)	Attitudes toward LGBT older adults: •Certified nursing assistants reported low levels of homophobia. •77% of those acquainted with LGBT people in their personal lives had significantly lower levels of homophobia.
Donaldson and Vacha-Haase (2016)	Lack of knowledge and training on LGBT health issues: •LTSS staff need training on providing culturally competent care to LGBT residents. •Some participants felt LGBT sensitive care meant treating LGBT residents differently. Others felt it meant treating them the same as heterosexual/cisgender residents (41%). •Participants believed sexual orientation and/or gender identity disclosure could potentially risk confidentiality of residents. •Some participants reported regularly using non-heteronormative language in their practice. •There was considerable variability across facilities related to LGBT inclusive policies (including intake forms, consideration of sexual orientation for room placement, etc.). •Participants identified additional training might increase awareness and comfort in providing culturally sensitive care to LGBT residents and other stigmatized groups. However, some stated they did not want additional training.
Fairchild et al. (1996)	Lack of knowledge and training on LGBT health issues: •Social workers in LTSS facilities reported sexuality is not frequently addressed in LTSS. •Homosexuality remains invisible and less accepted by staff. •LGBT older adults appear to be at an increased risk for sexual inhibition.Attitudes toward LGBT older adults: • Social workers working in LTSS reported their coworkers would have negative attitudes about LGBT residents. •They use negatives adjectives to describe how they felt their colleagues would react to LGBT residents
Hinrichs and Vacha-Haase (2010)	Lack of knowledge and training on LGBT health issues: •Prior LGBT education influenced participant attitudes toward same-sex relations among residents.Attitudes toward LGBT older adults: •Participants responded to one of three vignettes in which LTSS staff observed sexual contact between two residents (male/female, male/male, or female/female). •LTSS staff rated same-sex pairings more negatively than heterosexual ones. •Male–male relations were viewed more negatively than male–female and female–female relations.
Smith et al. (2018)	Lack of knowledge and training on LGBT health issues: •Approximately 39% of mental health providers in LTSS settings had not cared for an LGBT resident in the past year and 62% of them reported the services provided were focused on LGBT issues. •Most participants felt knowledge of LGBT issues was relevant to their clinical role. •90% of participants were eager to learn about LGBT health but expressed lack of awareness of evidence-based practices for LGBT care in LTSS. •Approximately one-fifth of participants reported 0 hr of formal coursework or continuing education in LGBT issues. Large percentage of missing values for prior education on LGBT issues (59%–62%) makes it difficult to ascertain accuracy of data. •Identified barriers to providing care for this population included: (i) lack of training on LGBT issues (85%), (ii) residents’ unwilling to identify as LGBT (94%), and (iii) their own personal comfort (21%).