| Lack of sensitive health care/ service assessments/ forms |
| Lack of LGBT friendly/ open/ respectful health care services; need for LGBT friendly Hospice |
| Being in the closet/ inhibiting self-disclosure; invisibility to providers and others; "complexity of being out"; fear of being out/ discrimination in health care institutions |
| Taboo in dealing with sexual issues in general by health care institutions |
| Need for case managers/ family caregivers |
| Lack of advocacy, public voice |
| Lack of regulatory/ legal support and protection; lack of legal status/ rights for life partners (HCPOA, real estate, health insurance) |
| Need for education of policy makers on LGBT issues |
| Lack of spiritual/ religious support |
| Lack of access to social services provided by religious groups |
| Barriers/ biases in workplace; no diversity training |
| Lack of education and training for providers/ RSCs on LGBT issues |
| Minority CNAs may have cultural bias against LGBT people |
| Absence of LGBT Community Center |
| Lack of social opportunities, venues; limited participation in activities |
| Need for resource guide for LGBT friendly services/ providers |
| Discrimination in housing/ lack of LGBT friendly; need for new care models in long term care/ assisted living |
| No organization to represent elder LGBT people |
| Lack of knowledge among providers about gerontology in addition to about LGBT issues |
| Need for senior centers to be inclusive/ open to LGBT people |
| Lack of demographic data on elder LGBT community/ no way to reach community |
| Lack of sense of community among LGBT elders |
| Lack of knowledge about, problems assessing, and reluctance to use social services |
| Small social networks, mainly socialize in homes |
| Loneliness |
| Lack of individualization when addressing LGBT elder issues |
| No intergenerational activities |