What Is the Long-Term Care Equality Index? A Consumer Guide

When you are trying to tell a genuinely affirming senior community from one that just says the right things, third-party benchmarks are some of the most useful tools you have. The Long-Term Care Equality Index, usually shortened to LEI, is one of the two you will encounter most often. This guide explains what it is, what it measures, what its recognition levels mean, and how to use it as a consumer without over-relying on it.

What is the Long-Term Care Equality Index?

The Long-Term Care Equality Index is a benchmarking survey of senior and long-term care communities, measuring how well they include and protect LGBTQIA+ residents. It is run by the HRC Foundation, the educational arm of the Human Rights Campaign, and it was launched in partnership with SAGE, with the first edition appearing in 2019. If you are familiar with HRC's better-known Corporate Equality Index, the LEI applies a similar idea to the world of aging services.

The point of the LEI is to replace vague claims with a structured assessment. Communities complete a detailed survey about their policies and practices, and the results are published, which gives families an outside reference rather than only the community's own marketing.

What does the LEI measure?

The LEI scores communities against a set of foundational criteria, often summarized as four core areas:

1. Nondiscrimination and staff-training policies, including whether protections explicitly name sexual orientation and gender identity.
2. Resident services and support, meaning how inclusion shows up in day-to-day care and programming.
3. Employee benefits and practices, since how a community treats LGBTQIA+ staff tends to track how it treats residents.
4. Resident and community engagement, including outreach to and inclusion of the LGBTQIA+ community.

Because HRC updates the exact criteria and wording with each edition, it is worth reading the current LEI report for the precise standards when you are evaluating a specific community.

How many communities take part?

Participation has grown but is still selective. In the 2025 edition, 274 communities across 33 states took part, representing tens of thousands of residents and staff. Within that group, communities earned recognition at different levels based on how fully they met the criteria: a top tier of Equality Leaders, a middle tier of High Performers, and a Builder tier for those establishing their foundations. The takeaway for families is that an LEI recognition is not automatic; a community has to opt in and do the work.

What kinds of questions does the LEI ask?

While the exact survey changes edition to edition, the questions generally probe whether inclusion is written into how a community runs. Does the nondiscrimination policy explicitly name sexual orientation and gender identity, for residents, visitors and staff alike? Are there patient- or resident-rights materials that make LGBTQIA+ people visible? What training do staff receive, and how regularly? Are chosen family and partners recognized in visitation and decision-making? Are there inclusive practices around names, pronouns and room assignments? The value of the LEI is that it forces a community to answer these on the record rather than in a sales conversation, which is why a strong result carries weight.

How does the LEI compare with SAGECare?

They are complementary, and seeing both is a good sign. As our guide to SAGECare explains, that credential focuses specifically on staff training. The LEI takes a wider view of policies and practices across the whole organization. Think of SAGECare as evidence that the people are trained and the LEI as evidence that the system around them is built for inclusion. A community with a strong LEI recognition and a current SAGECare credential is demonstrating commitment on two independent fronts. Neither, though, removes the need for your own questions, covered in our tour checklist.

How should I use an LEI score as a consumer?

Use it as positive evidence, and read the absence of it carefully rather than harshly. A strong LEI recognition tells you a community volunteered for outside scrutiny and met a real standard, which is meaningful. But because participation is voluntary, plenty of genuinely good communities are simply not enrolled, especially smaller ones. So if a community you like is not in the LEI, do not treat that as a red flag; treat it as a prompt to ask for other proof, such as its written nondiscrimination policy, staff training and resident references.

Should the LEI be the only benchmark I use?

No, and the strongest approach is to triangulate. The LEI is one credible signal; SAGECare training is another; a community's own written nondiscrimination policy, its treatment of partners and chosen family, and what current residents tell you are all evidence too. Any single source can miss something, so weigh several together. A community that shows up well across independent measures is far more likely to deliver in practice than one leaning on a single badge or, worse, on marketing language alone.

This is the same principle behind the Chosen Years verification model: weigh documented evidence, from more than one source where you can, and keep it separate from any paid placement. To start comparing affirming providers by the evidence they can show, visit the directory, and see what affirming senior care means for the practices these benchmarks are trying to measure.