LGBTQ Aging Welcoming Assessment - Rainbow Health

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LGBTQ Aging Welcoming Assessment

The following questionnaire was developed using signals of a welcoming provider identified by LGBTQ elders in the 2022 LGBTQ Aging Needs Assessment.

Provider Information

Submitter Name(Required)

First Last

Preferred Method of Contact

Submitter Email Address(Required)

Email Address Confirm Email Address

Submitter Phone(Required)

Provider Name(Required)

Name

Please provide the name of your business/agency/practice.

Welcome Assessment

Please answer the following questions to the best of your ability. Not all questions may apply exactly to your setting.

1. Does your organization hire openly LGBTQ staff, utilize openly LGBTQ volunteers, and/or ensure openly LGBTQ representation on boards and/or advisory councils?

Yes

No

Don't Know

2. Does your organization have general signage that includes images of same-sex couples, transgender/non-binary indiviuals, or other visual representations of LGBTQ people?

Yes

No

Don't Know

3. Do your organization’s literature and website explicitly state you serve LGBTQ older adults and/or caregivers?

Yes

No

Don't Know

4. Does your organization post a rainbow flag (or similar LGBTQ-related symbol) on your website, brochure, and/or location(s)?

Yes

No

Don't Know

5. Does your organization openly identify as “welcoming” to LGBTQ older adults and/or caregivers?

Yes

No

Don't Know

6. Has your organization received LGBTQ aging sensitivity training recently?

Yes

No

Don't Know

7. Do your organization’s intake forms include diverse options for gender, gender identity, sexual orientation, relationships, and pronouns?

Yes

No

Don't Know

8. Does your organization’s forms, marketing materials, and assessment questions regarding family include options such as chosen family or other diverse family definitions?

Yes

No

Don't Know

9. Does your organization market specifically to LGBTQ older adults and/or caregivers?

Yes

No

Don't Know

10. Does your organization participate and/or celebrate LGBTQ Pride (typically in June), LGBTQ History Month (October), or similar LGBTQ-focused events?

Yes

No

Don't Know

Phone

This field is for validation purposes and should be left unchanged.

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