Author ORCID Identifier

Andrew.Alberth

Date of Award

8-31-2026

Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Gerontology

First Advisor

Edward Alan Miller

Second Advisor

Jaqueline Contrera Avila

Third Advisor

Whitney L. Mills

Abstract

Long-term care (LTC) settings – including nursing homes (NHs) and assisted living facilities (ALFs) – provide necessary care for individuals with extreme health and functioning limitations. Sexual and gender minority (LGBT) older adults report challenges receiving effective, person-centered care LTC. Some LGBT older adults may hide their sexual orientation and gender identity when entering LTC settings or delay seeking needed LTC fearing discrimination from staff and other residents. Furthermore, staff in LTC settings indicate little awareness of LGBT-residents and possess inadequate LGBT-cultural competency necessary for providing person-centered care. Therefore, LGBT-residents LTC experiences remain underexplored in the broader research. Adopting LGBT-affirming policies and practices may improve LTC for LGBT-residents, but limited data and research explore the resources important for adopting LGBT-affirming policies and practices, the effects of these policies in LTC settings, and whether staffing instability moderates these effects. This dissertation draws on Resource Dependency Theory, the Health Equity Promotion Model, and the Four Pillars of Health Equity Framework, in addition to prior research on LGBT-affirming policies and practices in corporate and hospital settings and culture change in LTC settings to inform a conceptual framework. A quantitative study tests the conceptual framework using data from NHs in Minnesota, and a qualitative study explores how LTC staff view LGBT-residents’ LTC experiences and strategies to improve their LTC experiences. The quantitative component revealed that LGBT-affirming policy and practice adoption aligned with lower occupancy rates, chain-affiliation, and being located in politically unified areas. The qualitative component revealed LTC staff’s views of LGBT-residents’ experiences. Furthermore, LTC staff recommendations expanded upon prior recommendations to endorse LGBT-sensitivity training programs for LTC residents and promote specific strategies that aligned with the Pillars of Health Equity Framework. The findings from both components contribute to a revised conceptual model, with implications for future research, policy, and practice.

Comments

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