Training the Long-Term Services and Supports Dementia Care Workforce in Provision of Care to Sexual and Gender Minority Residents

Abstract In the US, sexual and gender minority (SGM) older adults are disproportionately at risk for Alzheimer’s disease and related dementias (AD/ADRD) and more likely to rely on long-term services and supports (LTSS) than their cisgender, heterosexual peers. Without training in culturally responsive care of the LTSS workforce, SGM residents are vulnerable to receiving inappropriate and/or inferior care contributing to poorer quality of life and health outcomes. To address this, some states have recently mandated training of the LTSS workforce in the culturally responsive care of SGM older adults. There are two major barriers to this approach being successful. First, we lack research on LTSS policies governing SGM with AD/ADRD care (in states where cultural care training is not mandated), which would inform whether such state legislation is needed. Second, there are no scalable, sustainable, evidence-based training programs to train the LTSS workforce in SGM with AD/ADRD culturally responsive care. This application is focused on the Training to Serve curriculum, which has trained over 12,000 LTSS workers in 12 states. This acceptable, feasible, and promising curriculum employs a multilevel approach to train management and frontline LTSS staff in culturally responsive care to SGM with AD/ADRD. But it has not been rigorously evaluated and relies solely on in person instruction. This mixed methods and comparative effectiveness study has three specific aims. In Aim 1, we will conduct a comprehensive policy analysis of 362 nursing homes and 362 assisted living facilities in Minnesota to assess the number and proportion of agencies that have explicit SGM affirmative policies in human resources, marketing, training, governance; anti-discrimination policies guiding culturally responsive care, and resident sexual orientation and gender identity (SOGI) data collection. These findings will inform Aim 2 curriculum. In Aim 2, to make Training to Serve more scalable nationally and with high fidelity, we will design and develop an asynchronous online version and pilot it with 30 LTSS management and 30 staff. In Aim 3, to assess the effects of training, we will conduct a 3-arm, management/staff stratified, group randomized, controlled trial of the in- person training versus an online curriculum versus a waitlist control group (in 62 LTSS agencies, with 310 management and 450 staff per arm). At the individual level, we will assess management and staff knowledge, attitudes, and skills providing care to SGM clients. At the agency level, at six months follow-up, we predict agencies who receive training will have more SGM explicit policies, more SGM welcoming environments, SOGI data collection at intake, and staff with significantly greater knowledge, comfort, and skills in providing SGM with AD/ADRD culturally responsive care.