Find ways to encourage providers to undergo training
Work with organizations that accredit health service providers to develop standards for serving LGBT elders
Help patients/ residents who are mistreated to hold facilities accountable
Advocate for better support of, and training for, long-term care ombudsmen
•• Many staff members will not make the time to participate in voluntary cultural competency training, even if they are generally supportive of the idea. In cases of hostile staff members, trainings can help them deal with their behaviors and focus instead on the value of providing high-quality care to everyone in need. •• Local groups can urge their regional AAAs, which control funding for direct service providers, to strongly recommend the training. Other potential levers include adjustments to state regulations for the training of health professionals (which may fall under a department of health, aging or commerce);197 statewide anti-discrimination laws; and the policies of regional organizations that administer the accreditation of health care providers. •• Various organizations accredit service providers who receive funds from sources such as Medicaid, Medicare or AAAs. Accreditation groups also provide best practice resources and training. Advocates can work with these groups to develop policies and standards for LGBT elder services. • The Joint Commission evaluates whether a facility is eligible for Medicare reimbursements. It is an independent nonprofit that evaluates and accredits more than 16,000 health care organizations and programs in the United States. In 2009, the Joint Commission released standards stating that patients have a right to care free of discrimination based on sexual orientation and gender identity/expression.198 • The American Medical Association has adopted 28 policies indicating the importance of culturally competent care that addresses the needs of the LGBT community.199 •• If a nursing home resident or a family member or friend thinks a facility is not providing adequate care or is jeopardizing the resident’s health and well-being, a formal complaint can be filed against the facility.200 Nursing home residents or their families who are not able to navigate the government complaint process themselves can work with the long-term care ombudsman in their state (see below).201 •• The OAA requires every state to create an ombudsman program to “investigate and resolve complaints” of individuals in long-term care facilities.” These ombudsmen also train facility staff on resident rights. Unfortunately, many ombudsman programs have limited staff resources, and most rely on volunteers.202 Advocates can lobby states to adequately fund ombudsman programs203 and educate and work with the programs on meeting LGBT elder needs. 57