“LGBT older adults are disproportionately affected by physical and mental health issues and are more likely to live alone than their heterosexual counterparts,” says journalist AJ Trager in a new article for PrideSource. Despite this, a recent study by Eastern Michigan University professor Dr. Beverly Mihalko found that most long term care facilities lack proper inclusion policies and practices for their LGBT residents.

As Trager and Mihalko point out, LGBT seniors grew up in a very different era. Most were raised at a time when it was acceptable to openly harass LGBT people. Some can even remember when they risked institutionalization for expressing their love.

Things have changed greatly since then. Homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders in 1972, and just last year the United States legalized gay marriage nationally. However, many LGBT seniors still report feeling “rejected” by their long term care facilities, and some have even gone back into the closet.

“There is a general lack of inquiry on sexual orientation and gender identity, and staff awareness training which perpetuates the invisibility of LGBT older adults in long-term care,” said Dr. Mihalko.

According to Mihalko, the solution is cultural competency and awareness training for all levels of long term care facility employees, including health professionals. From her study, Mihalko found that most long term care facilities don’t actively discriminate against or want LGBT seniors to feel excluded. They’re simply not aware of the specific struggles their LGBT residents face.