LEI Commitment to Caring Pledge

LEI Commitment to Caring Pledge

I, in an executive role, pledge to take action and commit my organization to caring for LGBTQ+ older adults by creating an inclusive, welcoming and culturally competent and responsive environment, free from discrimination. With this pledge, our organization is committing to completing the LEI 2023 Survey and taking intentional steps toward adopting policies and practices that foster, cultivate and preserve a culture of diversity, inclusion, fairness and equality for all of our residents and staff, including those who identify as LGBTQ+.
Note: The LEI 2023 Survey opens late-August through November 2022.
Organization Information

Please tell us a little bit about your organization.
Individual Community/Facility Name*
What Type of Organization are you signing the Commitment to Caring Pledge for?*

An Individual Senior Housing Community/Facility (i.e. skilled nursing, assisted living, independent living, memory care, free-standing hospice community, continuing care retirement communities, affordable senior housing, active-adult communities)A Senior Living & Care Corporation (i.e. a parent organization that owns or operates multiple individual residential long-term care communities/facilities)Other
Number of senior housing properties
Thank you for your interest in the Long-Term Care Equality Index. The LEI is designed for senior housing communities. Non-housing providers and home & community-based service providers are not eligible. If you are a senior housing provider, please select the corresponding answer.

If you would like to join our email list to stay informed about the LEI, sign up here.
Name of Parent Company
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip CodeCountry
Website*
Type of Community/Services provided (please check all that apply)*

Continuing Care Retirement Community/Life PlanIndependent LivingAssisted LivingSkilled NursingMemory CareHospice (stand-alone facility based)Affordable Senior HousingOther
Contact Information

Please tell us a little bit about yourself. Please note that the Commitment to Caring Pledge should be signed by an executive from the organization.
Your First Name*
Your Last Name*
Your Title:*
Your Work Email:*
Additional Contact

First NameLast Name
Contact's Title
Contact's Email
example@example.com
How did you hear about the LEI? (Check all that apply)

LinkedInMcKnightsLeadingAgeFrom a colleagueAt a conferenceOnline searchNews articleOther
Signature
* Please check this box to acknowledge the commitment and then sign in the box below.*

By submitting this form, I, an executive at my organization, am signing the Long-Term Care Equality Index's Commitment to Caring Pledge on behalf of my organization and will begin the process of adopting policies and practices that foster, cultivate and preserve a culture of diversity, inclusion, fairness and equality for all of our residents and staff, including those who identify as LGBTQ. As the first step in this process, I pledge that our organization will complete the Long-Term Care Equality Index’s online self-assessment within three months of my signature.
Signature

Clear
Should be Empty:

LEI Commitment to Caring Pledge

Note: The LEI 2023 Survey opens late-August through November 2022.

Organization Information

Contact Information

Signature