Phil Harper, Senior Lecturer in Health and Social Care at Birmingham Newman University, explores the urgent need for inclusive, affirming dementia care for LGBTQ+ people—where identity is respected, not erased.
What keeps me awake at night is heartbreakingly simple: the quiet, persistent fear that LGBTQ+ people—especially those living with dementia—are still being asked to hide who they are in care settings. After a lifetime of fighting to live authentically, too many older LGBTQ+ individuals feel forced back into the closet when they enter care. It’s not always overt discrimination. Often, it’s the microaggressions, the assumptions, the absence of affirming language or inclusive routines that chip away at identity. And that’s what lingers in my thoughts long after the day ends.
We know from research and lived experience that care staff are overwhelmingly well-meaning. But good intentions aren’t enough. There’s a worrying lack of knowledge about the specific needs of LGBTQ+ people—especially those who are trans or gender non-conforming. In today’s political climate, where trans rights are increasingly politicised and misunderstood, the absence of clear, affirming guidance is not just a gap—it’s a risk. Many existing resources fail to reflect the realities of trans lives, and some even reinforce outdated or harmful narratives.
One of the most damaging assumptions is that being LGBTQ+ is only about sexuality, or that it’s something people “forget” with dementia. But being LGBTQ+ is about culture, community, history, and identity. Dementia may affect memory and cognition, but it doesn’t erase who someone is. In fact, emerging research shows that trans individuals with dementia often retain their authentic gender identity—even without affirming medical treatment. Confusion may arise, as it does for cisgender individuals, but that doesn’t mean identity disappears. Care must be built around the person, not the diagnosis.
When LGBTQ+ residents feel they must hide their identity, the emotional toll is immense. Minority stress—the cumulative impact of repeated discrimination—can resurface, especially when someone feels they must “come out” again and again. The result is a loss of self, of connection, of joy. People lose not just who they are, but who they love, what they’ve fought for, and the spark that keeps them going.
So what needs to change? First, leadership must step up. Inclusion can’t be a tick-box exercise—it needs to be embedded in policy, training, and everyday practice. Staff need support in the small things that make a big difference: using correct pronouns, recognising microaggressions, and creating spaces where everyone feels safe and seen. Without clear guidance from the top, these efforts won’t be sustained.
I’ve seen glimpses of what affirming care can look like. Homes hosting Pride events, inclusive celebrations, and even drag performances—yes, I’ve performed at a few myself! These moments spark conversation, raise awareness, and bring joy. They show residents and staff alike that inclusion isn’t just policy—it’s culture.
But we can’t ignore the wider landscape. The UK is slipping down LGBTQ+ equality rankings in Europe, largely due to the treatment of trans individuals. Culture wars and polarised politics are creeping into care, with real-world consequences—from court rulings that restrict basic rights, to fear-driven narratives that undermine inclusion. Trans rights and women’s rights are not in conflict—they’re intertwined. But fear is a powerful tool, and it’s being used to divide.
Institutional routines can unintentionally marginalise LGBTQ+ residents. Are our activities, language, and assumptions built around heterosexual, cisgender norms? If so, who are we excluding? One immediate change I’d make is better data collection. We need reliable figures on LGBTQ+ individuals in health and social care to drive policy and practice. Visibility matters.
Despite the challenges, I remain hopeful. The people working in social care give me that hope. Their compassion, commitment, and willingness to learn are powerful forces for change. Seeing groups like The Outstanding Society at Pride, and the public’s response to inclusive care, reminds me that progress is possible. The future of care can be brighter—and yes, a little gayer.
Because ultimately, inclusion isn’t just about policy. It’s about people. And when we centre identity, dignity, and joy, we create care that truly cares. That’s what keeps me awake at night—and what keeps me fighting during the day.
