Navigating Religious Refusal to Nursing Home Care for LGBTQ+ Residents: Comparisons Between Floor Staff and Managers.

This study examines how nursing home floor staff and managers differ in their meaning-making processes when colleagues invoke religious exemptions—exceptions to nondiscrimination laws based on individual religious or moral beliefs—to refuse care to LGBTQ+ residents. Using the conceptual framework of social coherence, which involves reflective reasoning to reconcile conflicts between religious liberty and LGBTQ+ rights, the study analyzed 80 in-depth interviews from two Michigan nursing homes. Both staff levels invoked fairness and resident safety and comfort to navigate these conflicts, but floor staff additionally referenced job obligations and personal religious beliefs, while managers primarily relied on laws and policies to guide their responses. The findings highlight nuanced differences in perspectives between caregiving and managerial roles and suggest potential strategies for dialogue and policy enforcement to ensure equitable care for LGBTQ+ older adults in nursing homes.