Training That Respects Every Life Stage: Massachusetts Sets Standards for Serving LGBT Older Adults

In senior centers, visiting nurse agencies, and home care programs across Massachusetts, a quiet shift is underway. After decades of advocacy, the Commonwealth now requires that providers serving older adults complete training designed to build understanding and trust with LGBTQ+ clients. For many elders who lived through discrimination or were once forced to conceal their identities, these efforts are more than policy—they’re a long-overdue acknowledgment of their experiences and dignity.

In a field where personal care and trust are everything, getting it wrong can have profound consequences. Older LGBTQ+ adults are twice as likely to live alone and four times less likely to have children than their heterosexual peers, according to national data from SAGE, the advocacy and training organization for LGBTQ+ aging. Many still avoid health or social service programs for fear of bias or mistreatment. The state’s goal is to ensure that every interaction—from an intake call to a home visit—reflects respect, safety, and professionalism.

To that end, Massachusetts law now requires state-funded elder service providers to complete LGBTQ+ awareness and cultural competency training. The Executive Office of Elder Affairs (EOEA), working with The Fenway Institute’s LGBTQIA+ Aging Project and the Boston University Center for Aging and Disability Education Research (CADER), developed the official online course, LGBTQ+ Aging in Massachusetts. Providers may use this training or an equivalent program, but any alternative must meet strict content and delivery standards.

To provide truly competent care and meet regulatory expectations, any alternative LGBT-inclusive training used by aging service providers must satisfy a defined set of content and delivery standards. When choosing or commissioning training, agencies should ensure the following:

Required Criteria for Alternative Training

1. Provider expertise
   The training must be delivered by an organization or instructor with demonstrated expertise in social determinants of health specifically affecting LGBT older adults and caregivers.
2. Delivery format
   Training may be in-person or delivered via a web-based learning module; virtual formats are acceptable provided they offer effective interaction.
3. Duration
   The session must be at least 60 minutes in length (or equivalent, with opportunities for interaction or reflection).
4. Recency of development
   Content must have been developed or updated in 2019 or later, to reflect contemporary language, research, and best practices.

Creating a Culture of Competence and Trust

The intent, advocates say, is not to add another bureaucratic layer, but to change culture. “We want older LGBTQ+ adults to see home care workers, case managers, and program directors who understand their stories—who know what it meant to live through the closet, the AIDS crisis, or marriage equality,” said one trainer with Fenway’s LGBTQIA+ Aging Project. “This is about safety and dignity in the most personal part of someone’s life.”

For providers, compliance isn’t just about meeting a checkbox. It’s an opportunity to better serve a growing population of older adults who expect the same standard of empathy and respect afforded to any client. And for Massachusetts, it reflects a broader commitment: that aging services remain inclusive, informed, and humane—no matter who you love or how you identify.

Core Content Requirements

To be valid for this purpose, the training must cover the following topic areas:

1. LGBT terminology and definitions — clear, current understanding of sexual orientation, gender identity, and expression
2. Practical skills and strategies — how to engage respectfully and effectively with LGBT older adults, their caregivers, and collaborating professionals
3. Historical and institutional discrimination — past and ongoing cultural, legal, and institutional barriers faced by LGBT elders
4. Impact of discrimination on access & engagement — how stigma and bias affect participation in health care, social services, community life, family, and support networks
5. Transgender-specific experiences — challenges transgender older adults may face in healthcare institutions, social services, and daily encounters
6. Managing conflicts between personal beliefs and professional duty — clarifying how to separate one’s own views from ethical obligations to inclusive care
7. Best practices at the individual level — behaviors, attitudes, and protocols that foster welcoming interactions
8. Organizational best practices — policies, procedures, staff training, environment, data practices, and institutional commitment
9. Scenarios and case studies modeling both positive and problematic interactions — applying principles to real-world situations

Group Training & Use of Approved Online Modules

Providers may deliver training in group settings, using free online modules as long as the full module is shown and active discussion time is built in. An optional group training form (often on the sponsoring organization’s site) can document that the module was presented in full and supplemented with Q&A or reflection. This format is recognized and approved by AGE (the entity overseeing some training compliance) when conducted accordingly.

The challenge for many providers is selecting a training that is not generic (e.g. youth-oriented or facility/hospital-focused) but rather tailored to aging and home-based care settings and the lived needs of LGBT older adults.

Recommended Resources & Training Providers

• The Fenway Institute’s LGBTQIA+ Aging Project offers training, workshops, and technical assistance oriented to aging service networks. Fenway Health+1
• SAGE / SAGECare is a national leader in LGBTQ+ aging, offering cultural competency training, credentials, and consulting for elder-serving organizations. SAGE+2SAGE+2
• The National Resource Center on LGBTQ+ Aging (LGBTAgingCenter.org) provides a hub of resources, evidence-based models, and reference materials relevant to LGBT older adult care.

✅ Relevant State Laws & Requirements

Massachusetts General Law, Chapter 19A, Section 43 mandates that the state develop a curriculum and training program to prevent discrimination based on sexual orientation and gender identity/expression for older adults and caregivers. Providers who contract with or receive funding from the state, including Aging Services Access Points (ASAPs), must complete this training. Massachusetts Legislature

Under this same statute, new employees are required to complete the mandated training within 12 months of hire. Massachusetts Legislature

A state “memo” from the Executive Office of Elder Affairs (EOEA) describes that all providers must complete the LGBTQ-aging training (through BU/BU CADER) for record and compliance purposes. highlandvalley.org

The “Act Relative to LGBT Awareness Training for Aging Services Providers” was signed into law requiring that elder care providers receiving state funding or licensure deliver inclusive, competent care to LGBT older adults. Fenway Health+2Lgbtshc+2

📚 State Training Portals & Programs

The Massachusetts Training Portal / LGBTQIA+ Aging in Massachusetts offers an online course, group enrollment, and certification options. The Network for Professional Education+1

The Fenway Institute’s LGBTQIA+ Aging Project is a key resource in Massachusetts, offering training, technical assistance, and institutional support for culturally competent care. Fenway Health

The Massachusetts Department of Public Health / Fenway Health offers training modules on cultural competence, SOGI data collection, and care for transgender and gender diverse populations. mass.gov