Caregiving for LGBTQIA+ Older Adults: Religious Exemptions and Cultural Discord in Long-Term Care.

Religious and moral exemptions have burgeoned since the U.S. Supreme Court affirmed marriage equality in 2015. These laws allow individuals to refuse services based on religious or moral beliefs. LGBTQIA+ advocates have raised concerns regarding exemptions to deny care to LGBTQIA+ individuals with heightened health needs. Research suggests that LGBTQIA+ individuals have higher anticipated needs for nursing home care; however, a gap in empirical research exists on how nursing home staff understand religious exemptions in the context of their caregiving. This study, thus, employs a qualitative case approach to examine this question: How do nursing home staff make sense of staff refusal to provide care to LGBTQIA+ residents because of religious or moral beliefs? Data includes semi-structured interviews of nursing home staff (n = 90) and was analyzed with thematic analysis. While dominant narratives present religious exemptions as a conflict between religious liberty and equality, staff employed a variety of cultural frames to reconcile cultural discord and achieve social coherence about whether to accommodate a colleague who refused care to an LGBTQIA+ resident. Cultural frames included individual rights, individual religious belief, fairness, job obligations, resident safety and comfort, and legal compliance.