The next generation of aging care must be built on trust

As the U.S. population ages, the long-term care sector faces an urgent need to adapt its support structures to better serve LGBTQ+ older adults who often lack traditional family networks. Many of these individuals rely on "chosen family" and partners rather than children, yet they frequently harbor deep-seated mistrust of healthcare systems due to historical discrimination. Addressing these disparities through person-centered care and robust advance planning is essential for ensuring dignity and autonomy within the senior living industry.

Laura Piwinski, head of strategy at CareScout, emphasizes that the current long-term care system often reflects a narrow view of caregiving that does not account for the lived experiences of LGBTQ+ seniors. Having come of age in an era where living openly carried significant personal and professional risks, many LGBTQ+ older adults are more likely to live alone and less likely to have children compared to their peers. Consequently, these individuals often rely on close friends and chosen family—relationships that were not broadly recognized by legal or medical institutions until relatively recently, such as the nationwide legalization of same-sex marriage in 2015.

Research indicates that a well-founded hesitation toward healthcare systems exists among LGBTQ+ adults, who may avoid seeking medical care out of fear of bias or exclusion. In senior living environments, many worry that their identities, relationships, and preferences will not be respected, leading some to hide their true selves or delay essential conversations about aging and care. This lack of trust can result in critical challenges during vulnerable moments, such as recovering from illness or managing cognitive decline, where the absence of a recognized support system can compromise a resident's dignity and safety.

To bridge this gap, the senior care industry must move beyond viewing long-term care planning as a purely financial decision and instead frame it as a means of protecting autonomy. Effective planning allows LGBTQ+ individuals to document their preferences, identify trusted decision-makers, and ensure that chosen family members are legally and operationally recognized in care decisions. Piwinski argues that as America’s aging population becomes more diverse, providers must adapt by building trust-based, person-centered systems that recognize the individual behind the care need, ensuring that visibility and authenticity remain intact throughout the aging process.