Long-Term Care Preferences and Sexual Orientation–A Systematic Review and Meta-Analysis

  • Elżbieta Buczak-Stec
    Address correspondence to Elżbieta Buczak-Stec, PhD, University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Martinistr 52, 20246 Hamburg, Germany.
    University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
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  • Hans-Helmut König
    University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
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  • Lukas Feddern
    University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
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  • André Hajek
    University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
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Published:December 28, 2022DOI:



      The number of sexual and gender minority older adults who require long-term care is steadily increasing. The purpose of this systematic review and meta-analysis was to synthesize the evidence related to preference for long-term care with regard to sexual orientation and gender identity.


      Systematic review and meta-analysis.

      Setting and Participants

      We searched PubMed/MEDLINE, Ovid/PsycINFO, and Web of Science from inception to July 2020 (updated in July 2021). Search terms embraced 3 themes (1) sexual and gender minorities, (2) long-term care, and (3) preferences. Quantitative studies of the adult population were included.


      Screening, data extraction, and quality assessment followed the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The proportions were pooled using meta-analysis and random effects models.


      A total of 17 articles were included out of 5944 studies of potential relevance. The perception of nursing homes (NHs) that emerges from these studies is predominantly negative for heterosexuals and lesbian, gay, bisexual and trans (LGBT) individuals (n = 11). Across 6 studies (10 outcomes), the pooled estimate for the proportion of individuals with a preference to move into a NH was 10.6% [95% confidence interval (CI) 7.88%‒13.22%, I2 =  97.4%]; 13.7% (95% CI 8.6%‒18.7%) for LGBT individuals and 7.3% (95% CI 3.14%‒11.50%) for heterosexuals. LGBT-friendly NHs were preferred by between 55% and 98% of LGBT respondents. Informal care provided by partner or family was one of the preferred options (n = 6). It was preferred by 33% to 70% of various groups of LGBT respondents.

      Conclusions and Implications

      The preference to move into a NH is relatively low among both heterosexuals and sexual and gender minority adults. Findings showed negligible differences in preferences to move into a NH between heterosexuals and sexual and gender minorities. LGBT-friendly long-term care facilities where every member feels welcomed and not discriminated against seem to be one of the favorable long-term care choices among LGBT individuals. This knowledge is important to inform nursing services and policy makers about the preferred long-term care options. Providing LGBT-friendly facilities is usually less expensive than providing care in newly created LGBT-only facilities.


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