Long-Term Care Expectations and Plans of Transgender and Nonbinary Older Adults

Problem: Transgender and nonbinary (TNB) older adults endure discrimination from medical providers and expect it in institutional long-term care. Gender identity-based discrimination is connected to negative health outcomes and reluctance to access needed care. Objective: The aim of this study is to explore how gender identity affects TNB older adults' fears, hopes, and plans for use of institutional long-term care. Method: Co-investigators conducted semi-structured interviews with 24 TNB older adults in Minnesota, collaboratively analyzed the results using reflexive thematic analysis, and member-checked emergent themes. Findings: Oppression is central to participants' consideration of future long-term care. They fear mistreatment and loss of authentic gender expression and recognition in long-term care facilities. Fears of oppression factor into consideration of suicide and physical transition, although some participants hope societal shifts will lead to unbiased long-term care. Conclusion: Creation of anti-oppressive institutional and community-based long-term care options is critical to effectively serve TNB people as they age into dependence.