Watermark, Affinity Launch Company-Wide LGBTQ Initiatives

Watermark Retirement Communities CEO David Barnes remembers the first time he recognized his company could be more inclusive for all.

About seven or eight years ago, two gay men visited Watermark’s central office in Tucson, Arizona for advice on conducting market research for building a senior housing community exclusively for lesbian, gay, bisexual, trans and queer (LGBTQ) older adults.

At one point during the visit, one of the men explained that a large number of LBGTQ people are afraid of moving into senior housing, out of a fear their sexual preference or gender status will compromise their care.


The revelation stopped Barnes in his tracks.

“I could not imagine being in my 80s, living in an environment I didn’t believe would be safe and secure,” he told Senior Housing News.

Barnes’ anecdote is not unique, and the senior living industry is nearing a reckoning where it needs to address how to accommodate the specific needs of LGBTQ seniors, as well as make them feel welcome when they first enter a community and when they transition to higher acuity levels of care. Two of the largest providers in the nation — Watermark and Affinity Living Group — are among those leading the charge.


There are nearly 3 million LGBTQ seniors in the U.S. and that population is expected to number 7 million by 2035, according to LGBTQ advocacy group Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE).

Caring for LGBTQ seniors brings unique challenges, from healthcare laws that favor biological families to a lack of resources for LGBTQ-related needs, and this is becoming more acute as that segment grows. An estimated 20% avoid medical care out of fear of discrimination, and 88% of LGBTQ seniors want long-term care facilities that address their needs in a competent and caring manner.

A top-down culture shift

Barnes’ experience laid the foundation for Watermark to make its communities more inclusive. It is working with SAGE LGBTQ advocacy group, Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) to train its staff in LGBTQ competency training in order to recognize and meet the needs of this segment of the aging population, as well as to provide a living environment free from discrimination.

Watermark is aiming for SAGE Platinum certification for its entire portfolio of 58 communities, the highest possible certification under SAGE’s SAGECare platform. SAGE has certified 388 organizations through SAGECare, totaling over 64,000 people.

To qualify for SAGE platinum certification, a minimum of 80% must be trained. Community leadership receives a four-hour intensive training and support staff an abbreviated version. To date, 45% of Watermark staff across the country has completed SAGE training.

Watermark is spending nearly $500,000 to implement all aspects of SAGE Platinum credentialing across its portfolio.

The Watermark by the Bay, an assisted living and memory care community in Emeryville, California, recently received SAGE Platinum certification. Another Watermark community, Lakeside Park in Oakland, became the first exclusively memory care community in the U.S. to attain SAGE Platinum status.

Geriatric care is a team sport.

Affinity Living Group Chief Medical Officer Dr. Kevin O’Neil

SAGE worked with senior executives at Watermark’s corporate office to certify them as trainers for the communities. These executives then travel to individual communities to certify associates, learning case studies of LGBTQ seniors and what they went through as they aged.

The training also involves learning proper terminology to communicate with LGBTQ seniors, what is offensive and where are the boundaries between regular interaction and discrimination: essentially, what is and is not the role of the caregiver at a community.

“You gain a lot of appreciation for what this [LGBTQ] community went through growing up,” Barnes said.

Watermark is also rewriting its policies, procedures and handbooks to strengthen its ability to care for LGBTQ seniors, specifically in identifying friends of gay, lesbian and transgender residents as the primary caregivers.

LGBTQ seniors are twice as likely to age alone and four times less likely to have children, according to SAGE. Most often, the role of primary caregiver falls to a friend or partner. Fifty-four percent of LGBTQ seniors receive care from their partners, and 24% receive care from a friend.

LGBTQ-friendly senior living Watermark Retirement Communities
Watermark by the Bay, a Watermark Retirement Communities community in Emeryville, California, is SAGE Platinum certified

Affinity’s initiative involves a mix of classwork and meetings among everyone involved with the care of LGBTQ seniors, including staff, family, providers, and home health and therapy services, O’Neil told SHN.

Affinity is also adding the role of medical director to its communities to help establish and monitor the systems being put in place for the program.

The staff training is essential in developing a more inclusive community. If an associate in a community is tolerant, it will hopefully change the attitudes of recalcitrant residents, O’Neil said.

“Geriatric care is a team sport,” he said. “We would be playing a more supportive role.”

Affinity’s initiative takes the extra step to educating everyone on the probability of intimacy and sexual relationships occurring among LGBTQ residents. That extends to memory care, where Affinity will assess degrees of cognitive impairment to determine if residents have the capability to make informed decisions on sexual relations.

There are no additional costs to roll out this training out, beyond the work of Affinity’s innovation and clinical teams.

“We need to be understanding of that and educate our staff on how to respond effectively,” O’Neil said.

Tracking progress

Across the country, another senior living operator is addressing the need for more inclusion in its communities. Hickory, North Carolina-based Affinity Living Group launched an initiative to educate its workforce and residents around sexuality and gender issues across its portfolio of 120 communities across the Southeast.

Affinity is not coordinating with SAGE on its initiative but Hickory, North Carolina-based Affinity is cognizant that peoples’ attitudes are gradually changing, and that LGBTQ seniors have felt ostracized in the past, Affinity Chief Medical Officer Dr. Kevin O’Neil told SHN.

“It’s about recognizing we’re all different and that Affinity is open to people from all walks of life,” he said.

Affinity will roll out the education component of its program across its portfolio in the fall, while services and training will be piloted in a handful of communities. Depending on the success of the educational component, Affinity expects the program to be scaled across the whole company within 12 to 18 months, O’Neil said.

I could not imagine being in my 80s, living in an environment I didn’t believe would be safe and secure.

Watermark Retirement Communities CEO David Barnes

The operator will measure specific benchmarks to track the progress of the initiative including patient and resident satisfaction, successful integration into a community and measuring the quality of life of LGBTQ residents.

Watermark has added a skill in its digital learning center to track the progress of associates who have completed SAGECare training. The provider is still exploring ways to track if the training takes hold across its communities, such as changes in the performance of the workforce after training has been completed, but anecdotal evidence so far has proven promising, Barnes told SHN.

Ultimately, Barnes believes this will benefit everyone involved and does not see the SAGECare certification as strictly an LGBTQ issue.

“We should have welcoming, tolerant, compassionate communities. No one should be afraid to not receive proper care,” he said.

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