Treatment of LGBT+ people and their spouses in social care settings

Regulatory requirements

All providers of adult social care who carry out “regulated activities”, including running a care home or providing personal care, are required to register with the Care Quality Commission (CQC) and demonstrate they meet fundamental standards set out in regulations. This includes requirements to provide person-centred care and to always treat people with dignity and respect.

Guidance for providers on meeting the regulations, published by the CQC, explains that people using services “must not be discriminated against in any way and the provider must take account of protected characteristics, set out in the Equality Act 2010.” It says providers must also “have due regard to people's protected characteristics in the way in which they meet all other regulatory requirements.” This includes, for example, in relation to ensuring care reflects a person’s preferences. The guidance adds that people’s relationships with visitors, carers, friends and family should be respected.

The CQC has also published further guidance for inspectors and adult social care providers on relationships and sexuality in adult social care services (PDF).

Social care experiences of LGBT+ people

For a number of reasons, LGBT+ people may “not have the expansive family networks of support as they enter old age when compared to people who do not identify as LGBT+”. However, research suggests LGBT+ people report worse experiences of social care than people who do not identify as LGBT+.

A 2019 report on health and social care and LGBT communities (PDF), published by the Women and Equalities Committee, said:

LGBT people need to be treated equally, but not identically to, other groups. Access to the same services as others is ineffective if that service is structured for a heterosexual and cisgender default and has limited flexibility. There is not enough understanding from service-providers of the different needs that LGBT people might have.

We have found that too few health and social care providers are actively thinking about LGBT people when they plan their services and that senior leaders are not doing enough to ensure that LGBT-inclusion is hardwired into commissioning strategies…While few people set out to discriminate, training currently sends the message that sexual orientation and gender identity are not relevant to providing “person-centred care”. We have heard that for many witnesses that it is, in fact, essential.

The evidence suggested, the report said, that most social care professionals “feel under-equipped to deal with LGBT people’s needs rather than intentionally discriminating.” It added that most innovation in creating LGBT-inclusive services seems to come from individuals rather than at a strategic level.

Among other things, the report recommended that:

• Those responsible for the training of social care professionals “should treat training on LGBT needs with the same integral importance as other basic training.”
• The CQC should conduct a thematic review of social care services for LGBT people which should include examples of best practice and guidance to social care providers around how to create LGBT-inclusive services.

LGBT+ Survey and Action Plan

In July 2017, the Government Equalities Office launched a national LGBT survey in order to develop a better understanding of the lived experiences of LGBT+ people. The survey received 108,100 valid responses. Its findings included:

• 72% of respondents who had been in a care home or other form of institutional care in the preceding 12 months had been open about being LGBT+ with care staff and other residents, some, most or all the time.
• The most common reason for not being open with care staff and other residents was fear of a negative reaction (50%).
• Of those who had been open about being LGBT+, 35% said it had no effect on their care, 28% said it had a positive effect, and 23% said it had a negative effect.

Some respondents were concerned that elderly care “were heteronormative spaces where elderly LGBT people were left ‘invisible’”. Some also described staff as having poor knowledge and understanding of LGBT+ issues.

Following the survey, in July 2018 the Government published a LGBT Action Plan (PDF). Among other things, the plan said the Government would “ensure LGBT people’s needs are taken into account in health and social care regulation” and that the CQC would “continue to improve how it inspects the experience of LGBT people in adult social care.”

Skills for Care’s LGBT+ learning framework

In February 2023 Skills for Care, the workforce and development and planning body for adult social care in England, published a new LGBT+ learning framework.

It is intended for use by those in social care, including employees, employers, regulators, commissioners and policy makers, to “build their own knowledge of LGBTQ+ issues, to support colleagues’ understanding, and to create learning programmes which will allow teams to better support LGBTQ+ people in later life.”

Among other things, the framework includes a background on LGBTQ+ issues and awareness, information on providing personalised care, and “recommendations for leadership, education, and service development to continue to improve care and support in this area.”

Alongside the framework, Skills for Care published a number of supporting documents, including a review of research and evidence on LGBT+ care in later life and a list of guides and reports on LGBTQ+ ageing and care.

Further information was contained in a press release published by Skills for Care: New guidance released to support care workers in providing care to LGBTQ+ people in later life.

Pride in Care Quality Standard

The Opening Doors charity awards the Pride in Care quality standard to UK organisations assessed as providing quality care and support to LGBTQ+ people over the age of 50. The standard is attained following an accreditation process and LGBTQ+ advisors offer policy reviews, internal training and ongoing consultancy.

Further information is available on the Opening Doors website at: Pride in Care.

Further reading

• Skills for Care, LGBTQ+ learning framework, February 2023.
• Skills for Care, LGBTQ+ learning framework, Appendix 1, LGBT+ Care in Later Life: A short review of the research and evidence to improve inclusive and affirmative practice (PDF), February 2023.
• Skills for Care, LGBTQ+ learning framework, Appendix 3, List of guides and reports on LGBTQ+ ageing and care, February 2023.
• Skills for Care, New guidance released to support care workers in providing care to LGBTQ+ people in later life, February 2023.
• Laura Skeldon and Simon Jenkins, Experiences and Attitudes of the LGBTQ+ Community on Care/Nursing Homes, Journal of Homosexuality, July 2022.
• Dan Bailey and others, Equal but different! Improving care for older LGBT+ adults, Age and Ageing, June 2022.
• Age UK, Safe to be me. Meeting the needs of older lesbian, gay, bisexual and transgender people using health and social care services: a resource pack for professionals, September 2021.
• Age UK, The health and care needs of older LGBT+ people, February 2021.
• Women and Equalities Committee, Health and Social Care and LGBT Communities, 22 October 2019, HC 94 2019.
• Government Equalities Office, LGBT Action Plan (PDF), July 2018.
• Government Equalities Office, National LGBT Survey: Research report, July 2018.
• Stonewall, Unhealthy attitudes: the treatment of LGBT people within health and social care services, September 2015.
• Age UK, Lesbian, gay, bisexual and trans (LGBT+) information and advice.
• Alzheimer’s Society, Finding the right care settings as an LGBTQ+ person with dementia