California Supreme Court Upholds LGBTQ+ Protections for Elders in Long-Term Care

In a landmark decision, the California Supreme Court has affirmed the constitutionality of a law designed to protect LGBTQ+ elders in long-term care facilities. The ruling, issued in November 2025, upholds a provision of the LGBT Long-Term Care Facility Residents’ Bill of Rights that prohibits staff from willfully and repeatedly failing to use a resident’s preferred name or pronouns after being clearly informed of them, when such conduct is based on the resident’s sexual orientation, gender identity, gender expression, or HIV status .

The law was enacted in 2017 in response to documented discrimination and mistreatment of LGBTQ+ seniors in nursing homes and other long-term care settings, where residents are particularly vulnerable and often lack alternative support networks . Advocates have long argued that misgendering and deadnaming can have serious psychological and emotional consequences for transgender and nonbinary elders, exacerbating feelings of isolation and contributing to poor health outcomes .

The legal challenge was brought by Taking Offense, an association opposed to laws requiring recognition of transgender identities. The group filed a petition for a writ of mandate in Sacramento County Superior Court, arguing that the pronouns provision violated the First Amendment by compelling speech. The trial court denied the petition, finding the law to be a permissible, narrowly tailored regulation serving a significant state interest in preventing discrimination. The California Court of Appeal, Third Appellate District, reversed this decision in part, holding that the provision was a content-based restriction on speech that failed strict scrutiny and was therefore facially unconstitutional .

The California Supreme Court reviewed the case and ultimately reversed the Court of Appeal’s judgment. The Court held that the pronouns provision regulates discriminatory conduct that only incidentally affects speech, and is not subject to First Amendment scrutiny as an abridgment of free speech. Even if intermediate scrutiny applied, the Court found that the provision would satisfy that standard, given the state’s compelling interest in protecting vulnerable LGBTQ+ elders from discrimination and mistreatment .

The decision has been widely celebrated by LGBTQ+ advocacy organizations. “This ruling is a victory for dignity, respect, and equality for all elders, especially those who have faced a lifetime of discrimination,” said a spokesperson for the ACLU of Southern California . The law is seen as a critical step in ensuring that LGBTQ+ seniors can age with dignity and receive the care they need without fear of harassment or mistreatment.

California’s commitment to LGBTQ+ rights extends beyond long-term care. The state continues to support access to gender-affirming medical care for both adults and young people, and has taken steps to protect families and providers from prosecution by other states . The Supreme Court’s decision reinforces California’s role as a leader in LGBTQ+ rights and sets an important precedent for other states considering similar protections.