Big Aims, a Clear Path to Reach Them

Editor’s note: The John A. Hartford Foundation, the Administration for Community Living (ACL) and The SCAN Foundation fund the Aging and Disability Business Institute, led by USAging. The mission of the Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Institute, ASA and USAging are collaborating on a series of articles and case studies in Generations Now that highlight community-based integrated care networks.

At a time when states across the country are ramping up draconian anti-LGBTQ+ legislation on a regular basis, it is reassuring to note that SAGECare, a long-running training and consultancy social enterprise at SAGE, just last year trained 50,000 staff who work with elders to be culturally competent when it comes to LGBTQ+ older adults. Since its beginning in 2017, the program has credentialed more than 900 organizations in all 50 states, the District of Columbia and Puerto Rico. SAGECare has even started talking with partners in the U.K. and Canada about LGBTQ+ cultural competency training there.

Nic Watson, SAGECare’s managing director of Social Enterprise, recently walked us through how the program works and reaffirmed why it’s so necessary. Watson’s been in the business of helping people since before he finished his MBA from the Stern School at NYU, mostly working with those experiencing homelessness to help them get on their feet and skill up. He came to SAGE in 2022.

SAGE had for years run a National Resource Center on LGBTQ+ Aging, serving people in the industry, LGBTQ+ elders looking for care and people looking for care for someone in their family. Through that work, SAGE had developed training for the long-term-care industry that ensured a community was welcoming and had the resources necessary to serve LGBTQ+ older adults. In 2017, that training component became known as SAGECare.

SAGECare partners with businesses that seek to improve their LGBTQ+ competency to improve their services and better understand their elder community. There are 11 SAGECare Certified Trainers across the country that train any business that works with older adults, from Independent living, Skilled nursing, home health organizations, and hospice to health systems and financial planners. Because, as Watson says, “If you work with older adults, you work with LGBTQ+ older adults. That’s just how statistics work.”

‘SAGECare’s goal is to get the whole eldercare industry to be inclusive of LGBTQ+ older adults.’

He also thinks the whole industry desperately needs this competency. “We know from statistics and our expertise at SAGE that LGBTQ+ people live everywhere, and everyone is aging,” said Watson. “And we want the industry to have options for people to seek out care that is affirming to themselves and that will serve them well whether they live in a rural area or in a big city.

“SAGECare’s goal is to have the whole eldercare industry be inclusive of and welcoming to LGBTQ+ older adults,” Watson added.

What’s surprising is how little pushback SAGECare receives in what seems to be an intolerant era. On occasion, an individual will express a reluctance to learning this sort of competency due to a religious or personal reason, but the bottom line, Watson stressed, is that people who work in eldercare are generally a caring and kind populace seeking to do the best job they can. And SAGECare is providing them with the competency and best practices they need to do that.

The Nuts and Bolts

The first and best way to get organizations on board happens before any training, and that is in the education and sales process, according to Watson. SAGE as an organization is very visible in the eldercare space, and nationally as an advocacy group. SAGE staff do a lot of speaking at conferences and its CEO Michael Adams (former ASA Board Chair) often writes pieces in national magazines. “People in Diversity and Equity or who are in training or HR often go looking for that kind of thing,” Watson said, “and if they’re in eldercare, they end up emailing us.”

SAGECare provides all the statistics on how many LGBTQ+ elders there are, backed up with excellent reasoning on why specialized training is necessary to welcome LGBTQ+ elders properly into the community—no matter where it might be. SAGE’s expertise is rooted in its 45-year history of serving LGBTQ+ older adults in NYC and across the country.

The training is available in multiple modalities, but the process begins by training management, which includes the C-suite and anyone who manages staff. These trainings are done in small groups and can be a 4-hour in-person training or a mix of individual study and live online meetings. Topics covered include background on the LGBTQ+ population and what people may have dealt with prior to entering long-term care, what their access to care has been, and how much has changed during their lifetime. Training is well-supplemented with first-person stories via video and narrative.

SAGECare recommends a three-year contract for training, as deep cultural change requires time and repetition, according to Watson. SAGECare offers a credential for organizations that go through the process. To receive the platinum-level credential, the organization has to make this an annual process, maintained across three years.

‘Deep cultural change requires time and repetition.’

Next, trainers work with management on the existing culture of the place, setting priorities on what needs to change (which can be policy); they come out of the training with action items. Moderated discussions are included about how the changes will be made, what roadblocks might appear and how to overcome them. Some questions to be answered are: Do our policies support being welcoming to LGBTQ+ people? Do our intake forms indicate that it’s OK to come here if you’re trans or in a same-sex relationship? Following this is a 90-minute live webinar with the same group of people.

Then it’s time for staff training, which is virtual to make it flexible and adaptable to schedules, but all staff members must prove competency via knowledge checks to pass as they progress through the training. To accommodate the changing staff needs in any business, SAGECare makes the training available as part of the organization’s onboarding process.

“Our point is it needs to be everybody because you can’t create a welcoming environment for your residents if you don’t do that for the staff at the same time. If your staff isn’t comfortable being their authentic selves at work, then they can’t, in good faith, try to project that it’s all OK,” said Watson.

SAGECare retains testimonials from management, staff and residents in communities trained by SAGECare. What follows is one of the latter: “[At this community] I was never asked how many children I have. So, I was never asked why on Earth someone like me doesn’t have children. Or why I’m not married. Every time I hear those questions, I feel sad, helpless and vulnerable … But no one (at this community) asked why. It took several months at home to realize—it must be a policy of [this community]. It required great insight and sensitivity by the people responsible for that policy. It allowed me to let down certain defenses and be cared for.”

Watson thinks his mom is a great sample customer for imagining the future of long-term care and demonstrating its need for cultural competency. She’s 79 and lives in a CCRC in Connecticut. Straight and married to his dad for the past 58 years, a tad older than a classic Boomer, she told him she was NEVER, she made very clear, going to move into a place that was not welcoming for LGBTQ+ people. They were not willing to live somewhere where ALL of their friends and family would not be explicitly welcome.

“I think as the Boomers we’re seeing now, and especially Gen Xers, are starting to think about aging, we’re not willing to consider services that aren’t welcoming to everybody, and I think that alone should be compelling. … Even those who don’t identify as being LGBTQ+ understand that being culturally competent and being an open and welcoming community is an important indication of quality and service,” said Watson.

And with such enlightenment comes progress.

Alison Biggar is ASA’s editorial director.