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The Impact of Certified Nurse Assistant
Training on Health Disparities in
LGBTQ+ Older Adults in Long Term
Care Settings
PRESENTED BY: BAILIE FLEMING
FACULTY SPONSOR: DR. NATALIE DICK

Introduction

1) My
grandmas
2) SRU

Health Disparities & Older Adults
• US population aged 65 or older projected to
reach 23.5% by 2060 (Office of Disease
Prevention and Health Promotion, 2020)
• Journal of General Internal Medicine (2019)
found out one out of five older adults
experiences ageism in health care settings and
those who frequently experience it have a higher
risk of developing a new disability or worsening
existing ones. (Hoyt, 2019)





Protection:
Affordable Care Act
OBRA 1987
Ombudsman

Health Disparities &
LGBT+ Older Adults
• About 2.7 million U.S. adults 50 and older identify as
LGBT, including 1.1 million age 65 and older. Those
numbers are expected to nearly double by 2060
(American Heart Association, 2018)
• LGBT older adults report worse psychological health
and greater substance use, such as heavy alcohol
consumption and cigarette smoking, compared to their
non-LGBT peers. (National LGBT Health Education
Center, 2019)

During 4 years of education,
the average medical student
spends about 5 hours
learning about LGBT health
issues, the majority of which
is focused on HIV/AIDS
(Winter, 2012, p. 15) out of
35,040 hours

.00014269

InspirationMaslow's
Hiearchy of
Needs

LGBTQ+ Older Adults
in Long-Term Care
• Nearly nine in 10 respondents said that they
thought long-term care staff would discriminate
against someone who came out in a facility.
(Redman, 2011)
• To avoid discrimination, many—34% of
LGBTQ older people and 54% of transgender and
gender nonconforming older people—fear having to
re-closet themselves when seeking elder
housing. (SAGE, 2021, p. 7)

SelfActualization

Esteem

Love/ Sense of
Belonging

Safety

Physiological

Research
Lets Investigate
CNAs and Their
Training....

How does the
Training impact
Health Disparities
on LGBTQ+
Patients?

Certified Nursing Assistants - The
Keystone of Long - Term Care Quality
Skilled
Nursing
Facilities

Continuing
Hospitals/
Care
Surgical
Centers
Retirement
Communities
/ Assisted
Living

35%

16%

Home Health Individual /
Agencies
Family
Services

Just Under 7% 5%

1.5%
(Booher, 2020)

Certified Nursing Assistant Training
Impact on LTC Facilities/States
Total Initial
Training

Better outcomes
Greater than 75
with residents
hours

75 hours

2004
State- 49
NH-16,125
State- 26 (53.1)
NH-8,300 (51.5)

2010
State- 51
NH-15,508

NHs in states requiring
clinical training hours
above federal
State- 31 (60.7)
minimums had
NH- 9,426 (58.6)
significantly lower odds
of adverse outcomes
State- 20 (39.3)

State- 23 (46.9)
NH- 7,825 (48.5) NH-6,664 (41.4)

NH=Nursing Home

(Trinkoff et al., 2020)

National Nurse Aide Assessment
Program - (NNAAP)
• Exam - written / oral and
demonstration of skills
• Multiple choice Questions
• Continuing Education
Requirements
• Renewal

1-Activites of Daily Living
(ADLs)
2-Basic Nursing Skills
3-Restorative Skills
4-Psychosocial Care Skills
5- Role of the Nurse Aide
(National Council of State Boards of Nursing, Inc [NCSBN], 2021)

NNAAP
"The nurse aide
SHOULD
understand that a
back massage:"
"Once a client has been
pronounced dead, the
responsibility of the nurse
aide is to:"

"What SHOULD the
nurse aide do when a
client with Alzheimer's
disease seems depressed
and quiet:"

State-By-State Certified Nursing
Assistant- LBTQ+ Training
How are Certified
Nursing Assistants
prepared for
LGBTQ+ patients?

Results on Requirements of
Training/CE- LGBTQ+
Washington DCo "Have completed two (2) hours of
continuing education in cultural
competency or specialized clinical
training on clients who identify as
lesbian, gay, bisexual, transgender or
queer, and any additional Board
mandated topics."
(District of Columbia Register, 2019, p. 4)

States mainly went
through the standard
exam proctored by
Pearson Vue (NNAAP)

Nurses Aide/Certified Nursing Assistant
Training - Programs

(Community College of Beaver County)

Number of
Programs
Looked At

25

Number of
Exam Questions
Looked At

51

Pennsylvania programCommunity College of Beaver County
• MSHT 101 Nurse Aide
• Course Ration of credit- Laboratory
Hours







Alabama programJefferson State Community College
Communication
Infection Control
Caring for the Dying Resident
Long-Term Care Facility
More
(CNAs Classes Bessemer, AL)

Gap Analysis – What's Missing?

Cultural Competency
within the States for LGBTQ+
Patients

Health Outcomes and Quality of Life
Structure

Process

Outcome

• Regulations
• Interpretive
• Consumer- Driven
• How can these practices be measured?
• What are the lifestyle choices in youth and
middle ages?

(Chies, 2022)

Impact- Caregiver to Patient
Certified Nursing
Health Outcomes/Quality of Life
Assistant's Responsibility for LGBTQ+ Patients
Customer-Service Care -

Feeling comfortable within the
healthcare system to ask for help

Education -

Knowing that the caregiver is there to
help for whatever the needs are

Future Research
ResearchAdds to the body of knowledge- CNAs inclusive approaches to the LGBTQ+
community
1). LGBTQ+ are underrepresented
Challenges1). Fear of results getting out and used against participants (different types of
Bias/Discrimination)
2). Sensitive topic = not enough participation
3). COVID-19 restrictions (if applicable)

Works Cited
American Heart Association (2018, June 26). Aging LGBT seniors a 'major public health issue.' Retrieved April
4, 2021 from https://www.heart.org/en/news/2018/07/13/aging-lgbt-seniors-a-major-public-health-issue
Booher, B. (2020, June 17). Hospital CNAs Jobs Vs Long-Term Care CNAs Jobs. Nursa. https://nursa.com/hospital-cna-jobsvs-long-term-care-cnajobs/#:~:text=CNAs%20spend%20over%202%20hours%20per%20day%20of,activities%20and%20perform%20other%
20clinical%20tasks%20as%20required.%E2%80%8B
Chies, S. (2022). Pratt's Long-Term Care: Managing Across the Continuum. Jones & Bartlett Learning.

CNAs Classes Bessemer, AL. Retrieved March 30, 2021 from https://cnaclassesnearyou.com/alabama/cna-classes-bessemeral/

District of Columbia. (2019, August 23). Chapter 96, CERTIFIED NURSING ASSITANTS. Retrieved March
30, 2021, from https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/CNA%20Chapter%209
6_0.pdf

Works Cited (Continued)

Hoyt, J. (2019, February 27). How Ageism in Health Care
is Affecting Society. SeniorLiving.org. https://www.seniorliving.org/health/ageism/#:~:text=Ageism%20innate%20to%20old
er%20adults.%20Even%20older%20adults,not%20usually%20seek%20medical%20attention%2C%20get%20less%20care.
MultiSkilled Health Technician. Retrieved March 30, 2021 from https://ccbc.edu/programs/multiskilled-health-technician
National Council of State Boards of Nursing, Inc. (2021). NNAAP
Exam. Retrieved March 30, 2021 from https://home.pearsonvue.com/getattachment/0c87d616-1cc4-4c3a-ade34aaab227e9c3/NNAAP%20Nurse%20Aide%20Practice%20Written%20Exam%20Packet-069912.aspx
National LGBT Health Education Center. (2019). Promoting the Behavioral Health of LGBT Older Adults. Retrieved April 1,
2021 from https://www.lgbtqiahealtheducation.org/wp-content/uploads/2019/07/TFIE-34_LGBT-Older-AdultsBrief_final_web.pdf

Works Cited (Continued)
Office of Disease Prevention and Health Promotion. (2020, October 08). Older Adults. Retrieved March
30, 2021, from https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults
Redman, D. (2011, June). LGBT Long-Term Care Issues. National
Resource Center on LGBT Aging. https://www.lgbtagingcenter.org/resources/resource.cfm?r=64
Sageusa. (2021, March). Disrupting Disparities: Solutions for LGBTQ New Yorkers Age 50+.
Sageusa.org. https://www.sageusa.org/wp-content/uploads/2021/01/disrupting-disparities-lgbtq-new-yorkers.pdf
Trinkoff et al. "CNA Training Requirements and Resident Care Outcomes in Nursing Homes." The
Gerontologist, vol. 57, no. 3, June 2020, pp. 501-508. Oxford Academic, https://doi.org/10.1093/geront/gnw0494
Winter, C. (2012, August). Health Equity Series: Responding to
LGBT Health Disparities. Missouri Foundation for Health. https://mffh.org/wpcontent/uploads/2016/04/LGBTHealthEquityReport.pdf