By Carla Peña –
As people age, many of us eventually rely—whether temporarily or permanently—on caregivers, long-term care facilities, adult day services, home health aides, or senior-serving organizations to help with daily tasks and support overall well-being. For two spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) older adults, however, that transition can come with additional challenges. Many caregiving and senior-serving organizations are still learning how best to meet the needs of 2SLGBTQ+ older adults, including understanding their identities, histories, and experiences. The result? Too many older adults feel they must “go back into the closet” in later life to feel safe and respected.
To address this, Openhouse, a San Francisco-based nonprofit, launched Culture of Care,an educational training series designed to help caregiving organizations and their teams strengthen 2SLGBTQ+ cultural responsiveness. This program is not just timely; it’s essential.
Since 1998, Openhouse has worked to enable 2SLGBTQ+ seniors to overcome the unique challenges they face as they age by providing housing, direct services, community programs, and training to other older adult serving organizations throughout the city and beyond.
At Openhouse, we understand that many caregiving institutions were built around assumptions that clients are straight and cisgender. While staff are often well-meaning, they may not yet have had the opportunity to develop a full understanding of 2SLGBTQ+ identities, pronouns, or histories of discrimination and resilience. Without this awareness, older adults may experience missteps—from accidental misgendering to exclusion of chosen family—that can leave them feeling unseen or misunderstood.
To protect themselves, many 2SLGBTQ+ older adults hide aspects of their identity. They may avoid sharing that they have a same-sex partner, that they are transgender, or that they have children from a previous queer relationship. This self-concealment can affect relationships, decision-making, and mental well-being, and it prevents them from receiving care that truly reflects their full personhood.
Many 2SLGBTQ+ older adults also face intersecting challenges, including health disparities, social isolation, and financial insecurity. When care does not fully acknowledge their experiences, even the most thoughtful services can unintentionally fall short.
The Solution: Culture of Care
Culture of Carewas developed to help caregiving organizations provide care that is inclusive, affirming, and responsive. Its aim is not just to raise awareness but to build real skills and confidence in caring for 2SLGBTQ+ older adults.
One of the program’s strengths is that its curriculum is based on stories told by 2SLGBTQ+ older adults themselves. Participants hear firsthand accounts of identity, resilience, and lived experiences, helping staff understand how their actions and decisions impact the people they serve.
Culture of Care offers self-paced online modules that staff can complete on their own schedule, as well as live workshops. The online program is available in English, Spanish, Tagalog, and Cantonese, with captions for accessibility. Organizations can select modules that match their staff’s learning goals, rather than adopting a one-size-fits-all approach.
There are three core modules:
1. Living Histories: 2SLGBTQ+ Political Identities: Covers the history of queer activism, discrimination, and resilience, providing context for understanding older adults’ experiences.
2. Containing Multitudes: Gender-Expansive Stories: Explores a wide range of gender identities, including nonbinary, Indigenous, and fluid identities.
3. Adapting to Evolve: Offers practical guidance on day-to-day caregiving, helping staff respond to the needs of 2SLGBTQ+ older adults with dignity and respect.
Why Culture of Care Matters Now
The number of 2SLGBTQ+ older adults is increasing, and more people are living openly into later life. This shift makes culturally responsive care more important than ever.
While visible gestures like hanging a rainbow flag are important, inclusion is more than that. Culture of Care encourages organizations to implement lasting changes in policy, procedures, and staff practice to ensure care is genuinely inclusive.
Many 2SLGBTQ+ older adults have experienced stigma or discrimination in healthcare and social services. Culture of Care helps build trust by teaching staff how to provide affirming, respectful, and person-centered care—for all people in their care.
Older adults who feel safe, seen, and respected are more likely to engage with services, share health concerns, and maintain social and emotional well-being. Good care is about more than meeting basic needs; it’s about honoring identity, choice, and dignity.
What Culture of Care Looks Like in Practice
• Name and Pronoun Respect: Consistently asking, recording, and honoring chosen names and pronouns.
• Inclusive Documentation and Policies: Forms and procedures that recognize same-sex partners, chosen family, nonbinary identities, and privacy.
• Relational Inclusion:
Understanding that support networks may include chosen family, former partners, or community members.
• Adaptive Care:Recognizing how prior experiences, health histories, and social isolation may affect care needs.
In short, Culture of Care helps organizations bridge the “identity gap” and provide care that respects every older adult fully. Even the most well-intentioned organizations can fall short without structured support. Culture of Care offers a practical, evidence-informed pathway to better serve 2SLGBTQ+ older adults ensuring that care is safe, affirming, and always about the person in front of them and all that they bring.
The dignity, safety, and humanity of 2SLGBTQ+ older adults depend on it. Learn more at https://www.openhousesf.org/care
Carla Peña is a queer, non-binary facilitator and trainer, who currently leads the Strategic Partnerships and Education Department at Openhouse. With over a decade in community education and a deep commitment to equity and social justice, they bring a heart for advocacy and inclusion to all they do. The proud child of an immigrant Cuban father and a Nuyorican mother, they believe everyone has the birthright to thrive.
Aging in Community
Published on October 23, 2025
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