Building an LGBTQ+ Inclusive PACE Program: Key Learnings on How the Program of All-Inclusive Care for the Elderly (PACE) Model Addresses the Needs of LGBTQ+ Older Adults

Michael Adams
Ryn Skultety
August 2023


Lessons for developing LGBTQ+ inclusive Program of All-Inclusive Care (PACE) programs for older adults.


Stemming in part from experiencing discrimination throughout their lives, LGBTQ+ older adults have disproportionate health needs as they age. Yet many are not able to rely on typical age-related formal or informal caregiving supports. Nursing homes often lack cultural competency and there are concerns about mistreatment of LGBTQ+ older adults in these settings. A promising approach to serve nursing-home eligible LGBTQ+ older adults is the Program of All-Inclusive Care (PACE), which provides interdisciplinary, comprehensive care to people who are also eligible for Medicare and Medicaid and who wish to age in their homes. This report details lessons from SAGE, a national nonprofit dedicated to advocating for older LGBTQ+ adults, for adapting a LGBTQ+ inclusive PACE model.


Based on interviews with stakeholders from a recent project exploration for developing a LGBTQ+ oriented PACE Center, the report outlines four challenges and suggestions for ensuring LGBTQ+ inclusivity in PACE, including: (1) ensuring financial viability; (2) exploring possible structures of partnerships and collaborative relationships; (3) building trust and mutual respect in collaborations; and  (4) building PACE expansion through utilization and sexual orientation and gender identity (SOGI) data.


Existing PACE programs and programs that serve LGBTQ+ older adults can use this brief to consider approaches to developing LGBTQ+ inclusive PACE programs. A notable challenge at the program and policy levels is the lack of SOGI data among PACE participants, which is not gathered by Medicare and Medicaid, and in regions where it may not be safe to reveal SOGI data.

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