In the U.S., sexual and gender minority (SGM) older adults are disproportionately at risk for Alzheimer’s disease and related dementias (AD/ADRD), and more likely to rely on nursing homes and assisted-living residences than their cisgender, heterosexual peers. But when it comes to adopting SGM-explicit policies and training the long-term services and support (LTSS) staff in culturally sensitive care of SGM clients, the U.S. care system has a number of flaws.

While some states mandate SGM-specific training for LTSS staff, others do not. There is also a lack of research on what policies exist to train LTSS staff in those states where cultural care training is not mandated. Even in states that mandate training, there is currently no scalable, sustainable, evidence-based training program to educate workers in the culturally responsive care of older SGM adults.

A $2.5 million-plus National Institutes of Health (NIH) grant will allow researchers at the University of Minnesota (U of M) School of Public Health (SPH) to address these policy gaps and help improve the care of SGM with AD/ADRD in LTSS facilities. SPH Professor Simon Rosser and Associate Professor Tetyana Shippee are co-principal investigators on this collaboration.

​​“There is a growing population of sexual and gender minority older adults in care facilities, and a critical need to make sure they are receiving the culturally sensitive care they need and deserve,” said Rosser. “The existence of proactive SGM policies, and availability and quality of trainings for staff in long-term care settings, has a profound impact on the quality of life for sexual and gender minority adults who are in their care.”

SPH researchers will conduct a mixed methods and comparative effectiveness study with three specific aims:

• Aim 1: A comprehensive analysis of more than 700 nursing homes and assisted-living facilities in Minnesota to assess how many currently have explicit SGM-affirmative policies in place, including in their human resources, marketing, training and governance divisions, as well as anti-discrimination policies guiding culturally responsive care.
• Aim 2: Incorporating the findings of Aim 1, the researchers will recommend steps to make the current training program — an in-person curriculum used in 12 states called Training to Serve — scalable by developing and piloting an asynchronous, online version of the training curriculum.
• Aim 3: The researchers will assess the effects of the in-person training versus an online curriculum. At the individual level, researchers will assess management and staff knowledge, attitude, and skills providing care to SGM clients. At the agency level, researchers will evaluate changes in SGM-explicit policy, practices, and environmental conditions that provide SGM with AD/ADRD with culturally responsive care.

“The study will involve the first evidence-based training for the care of SGM older adults with AD/ADRD, and the first randomized control study on this subject,” said Shippee. “This is a truly collaborative project across the School of Public Health. As co-principal investigators, Simon and I will bring together our areas of expertise to assess how the care of SGM older adults can be improved.” 

Dr. Rajean Moone who leads the UMN Long-Term Care Administration for Professionals in the College of Continuing and Professional Studies is a co-investigator on the study and has a leading role in curriculum development for the project.

The researchers expect the study to be completed in 2026. Results of their findings will be shared via a variety of dissemination channels in partnership with Rainbow Health Minnesota.