Increasing LGBT Cultural Sensitivity in Aging Services: Service Providers Baseline Knowledge and Training Needs

Background and Purpose: As the U.S. population continues to age and diversify, so too does the need for community-based interventions that support an age-equitable society for all. Older lesbian, gay, bisexual, and transgender (LGBT) adults experience disparities in several social and health indicators. LGBT older adults face higher rates of social isolation, physical and mental health challenges, and lower utilization of health and social services. LGBT older adults of color face additional stigma and negative outcomes due to racial discrimination, thus contributing to further cumulative disadvantage. In health and social service settings, LGBT older adults continue to experience bias grounded in hetero- and cis-normative values and assumptions. This paper serves two aims. We first describe a nation-wide collaborative academic-community initiative to deliver and evaluate cultural sensitivity training to service providers in an effort to -improve the ability of mainstream aging services to care to lesbian, gay, bisexual and transgender (LGBT) older adults. Next, we provide a descriptive analysis of over 9,000 people who attended trainings between 2013 and 2018 in an effort to demonstrate demographic and geographic characteristics, as well as baseline knowledge of service providers attending the LGBT cultural sensitivity trainings.

Methods: This descriptive study is one of the first to examine knowledge about LGBT aging from a national convenience sample of aging service providers. A secondary analysis of program evaluation data (n = 9,454) from cultural sensitivity trainings delivered from 2013 through 2018.  Demographic and occupational characteristics are compared over time to measure the increase in racial/ethnic diversity, education level, job title. Baseline knowledge prior to receiving the training was measured through scales of six to eight questions (depending on type of training). Mean knowledge scores were standardized (converted to a percentage) in order to explore similarities and differences in knowledge among aging service providers as well as temporal and geographic trends or patterns.  

Results: Training participant demographics reflected increased diversity over the course of six years of trainings in terms of race, age, education and job title. Preliminary results indicate higher baseline knowledge scores in first three years (Median Score = 87.5% each year in 2013, 2014, 2015) the trainings were delivered, and lower scores in the next three years (Median Score = 60% each year in 2016, 2017, 2018). Geographic differences are also demonstrated with higher baseline knowledge scores in major metropolitan areas.   

Conclusions and Implications: The differences in baseline knowledge across time and geography suggest a need for targeted interventions that reflect shifting societal attitudes toward LGBT individuals in time and place. One policy implication to be considered is state-mandated training for aging service providers. Further research is necessary to better understand the efficacy and effectiveness of LGBT cultural sensitivity training in aging services.