< Return to Insights

Health Equity in Aging for Transgender People

Health Equity in Aging for Transgender People

Contributed by Ames Simmons, Policy Director, Equality North Carolina.

The population of the United States is rapidly aging, at the same time as more people understand themselves to be transgender or non-binary (“TNB”). Are our health care and long-term care systems prepared to welcome and provide person-centered care to TNB people as we age?

Research has shown that older transgender people have higher rates of depression, stress, disability, and poor health, and fear of accessing services was a significant mediator across physical as well as mental health outcomes. TNB people ourselves have real concerns about what may happen to us as we age. Twenty-nine percent of transgender North Carolina survey respondents reported having at least one negative experience when accessing health care, and almost as many reported not seeking health care due to fear of mistreatment.

TNB people may fear discrimination or even violence in long-term care, especially if they are experiencing cognitive decline. Advance directives, such as a health care power of attorney, have not traditionally included legal language that would ensure that TNB people continue to receive hormone replacement therapy after they experience cognitive decline. There is also a health equity need for legal practitioners to draft language that will ensure that TNB people continue to be addressed using our affirmed name and pronouns if we lose capacity.

Additionally, a real need for TNB people to have tools to make decisions about where we want to age. Seeking to fill that gap, the Human Rights Campaign Foundation and SAGE have created the Long-Term Care Equality Index (“LEI”). The LEI is a nationwide survey of residential long-term care facilities informed by experts in long-term care, aging, and the LGBTQ community. The LEI seeks to gather information about a facility’s foundational practices, resident and community engagement, employee policies, and resident services and support. For TNB people, an important component of the LEI examines gender-affirming resident services and support, such as policies related to room assignment, terms of address, non-gendered activities, and access to clothing, hair, and grooming products and affirming medical and behavioral health care. Facilities can now sign a Commitment to Caring Pledge and complete a self-assessment.

With the addition of increased evidence, creative legal planning, and tools to assess the extent of affirming policies in long-term care, TNB people will be closer to resting confident that we will be able to access the health care we need as we age and our identities will be accepted and affirmed.


Ames Simmons is a queer trans man serving as Equality NC’s Policy Director. He provides vision and strategic direction for Equality NC’s policy and advocacy agenda with the North Carolina General Assembly and the state’s executive branch and administrative agencies. He also works with local governments and federal policymakers to achieve Equality NC’s mission of health, equity and safety for all LGBTQ North Carolinians. His work is rooted in community-based efforts prioritizing anti-violence, anti-oppression and transgender justice. Ames is the author of an article in the summer issue of the North Carolina Medical Journal, and was a recent guest presenter on Friday Facts.