California Supreme Court Upholds LGBTQ+ Protections in Nursing Homes — What Operators Need to Know

San Francisco, CA — The California Supreme Court has unanimously upheld a state law that bars discrimination against LGBTQ+ residents in long-term care settings, rejecting a First Amendment challenge that sought to overturn key protections for transgender and queer elders.

In a decision issued Nov. 6, the court affirmed the constitutionality of Senate Bill 219, the 2017 “LGBT Seniors Bill of Rights” signed by then-Gov. Jerry Brown. The ruling, in Taking Offense v. State of California (No. S277019), reverses a 2021 appellate decision that had struck down portions of the law, including its ban on willful and repeated misgendering.

Justice Carol A. Corrigan wrote for the court that the statute regulates professional conduct in a workplace setting, rather than suppressing personal viewpoints. “The law regulates conduct in a professional setting, not the content of speech,” she wrote, likening the pronoun requirement to longstanding rules that prohibit verbal abuse in health care.

SB 219 requires licensed nursing homes and assisted living communities to treat residents consistent with their gender identity, use residents’ correct names and pronouns, and honor visitation and decision-making rights for same-sex partners. It also prohibits harassment based on sexual orientation or gender identity.

How the challenge unfolded

The case began in 2019, when the conservative group Taking Offense sued the state, arguing the law’s “pronoun provision” compelled speech and violated workers’ free speech rights. A Sacramento County judge initially upheld the law, but the Third District Court of Appeal later sided with the challengers, creating uncertainty for operators and advocates. The state appealed, and the high court heard arguments in 2023 before issuing this week’s ruling.

Attorney General Rob Bonta, whose office defended SB 219, called the decision “a resounding affirmation of dignity and respect” for LGBTQ+ Californians in long-term care. Advocates said the ruling restores clarity after years of mixed signals from the courts and ensures residents will not be misgendered or denied access to their partners.

Opponents criticized the outcome. Jonathan York, an attorney for Taking Offense, said the decision would force some workers to violate their conscience, calling it “a dangerous precedent for free speech in everyday jobs.”

What facilities should expect

The ruling extends across California’s thousands of licensed long-term care facilities, from skilled nursing to residential care communities. Providers are expected to ensure policies, staff training and documentation practices align with SB 219. State regulators can cite, fine or take licensing actions for violations, and complaints can be investigated through existing inspection processes.

Industry sources say many operators had paused or scaled back training after the 2021 appellate ruling. The Supreme Court’s decision removes that ambiguity and is likely to accelerate refresher trainings, updates to employee handbooks, and the integration of inclusive communication standards into daily workflows.

Sector leaders note the practical impact goes beyond compliance. LGBTQ+ older adults experience higher rates of isolation and report elevated risks of abuse, according to multiple surveys. Advocates argue consistent, respectful communication can improve trust, reduce complaints, and support better outcomes for residents and staff alike.

Broader context and next steps

The decision places California firmly at the forefront of LGBTQ+ protections in elder care at a time when debates over gender identity and speech are intensifying nationwide. While federal nursing home rules emphasize resident dignity and freedom from abuse, explicit LGBTQ+ protections vary by state. Observers say California’s approach could influence policy in other jurisdictions and encourage national chains to adopt uniform standards.

The court’s opinion centers on the narrow question of professional conduct in a regulated health care environment. Legal scholars note that focus may limit broader free speech implications while giving regulators in long-term care clear authority to address harassment and discrimination.

For residents and families, the ruling underscores that chosen names, pronouns and partner rights must be respected in California facilities. For operators, it marks the end of a prolonged legal limbo and the start of renewed implementation. State agencies are expected to issue guidance to facilities in the coming weeks. Petitions for rehearing are possible, but the ruling takes immediate effect unless further action is granted.