LGBTQI+ People Are Working, Healing, and Caring in a Country Without Guaranteed Paid Leave

Everyone deserves the time they need to heal or care for those they love when they need them most. For LGBTQI+ people, the pervasive impacts of discrimination—in health care, at work, and even from family—can make that time both uniquely essential and more costly to access. New survey findings from the Center for American Progress’ 2024 LGBTQI+ Community Survey highlight how LGBTQI+ people are especially likely to be pulled away from work for health or care needs, including for chosen family, despite being less likely to work in ways that provide paid leave.

LGBTQI+ people are more likely than non-LGBTQI+ people to take time off work for health or caregiving needs

Many LGBTQI+ workers need time off from work for their own health. In the past year, 29 percent of LGBTQI+ adults took time off from work to “recover from or treat [their] own serious illness, injury, surgery, or health issue.” By comparison, only 18 percent of non-LGBTQI+ adults took time off for serious health reasons during that same period. Similarly, a larger proportion of LGBTQI+ adults (38 percent) than non-LGBTQI+ adults (29 percent) took time off to attend routine or nonemergency health appointments. These differences may reflect broader disparities in health between LGBTQI+ and non-LGBTQI+ people, including as result of discrimination and barriers to accessing supportive health care.

Across a variety of relationships, LGBTQI+ adults are also more likely than non-LGBTQI+ adults to take time off from work to care for friends and family. In the past year, 1 in 7 LGBTQI+ adults (14 percent) took time off from work to care for a child or spouse with serious health issue, compared with 9 percent of non-LGBTQI+ adults. Moreover, LGBTQI+ adults were 50 percent more likely than non-LGBTQI+ adults to report having taken time off in the past year to care for an elderly parent. Other gaps were even more pronounced: LGBTQI+ adults are nearly four times as likely as non-LGBTQI+ adults to report having taking time off in the past year to care for either an extended family member or a friend or neighbor in response to a serious health need.

LGBTQI+ people rely on—and are relied on by—chosen family for care

Many LBGTQI+ people look to “chosen family” for care: loved ones they consider family but to whom they may not have a legal or biological relationship. Often, LGBTQI+ people call on chosen family, such as an unmarried partner or a close friend, due to strained relationships with their families of origin as a result of discrimination or stigma.

The 2024 survey results confirm the continued importance of chosen family to LGBTQI+ Americans. Collectively, these results very closely parallel the responses to the same question in CAP’s 2022 LGBTQI+ survey, suggesting enduring trends. Half of LGBTQI+ adults report that they have called on chosen family for support in response to a health-related need. In comparison, a still notable third of non-LGBTQI+ adults have relied on chosen family in the same circumstances. Similarly, 57 percent of LGBTQI+ adults have been called on by chosen family for support, along with 44 percent of non-LGBTQI+ adults.

LGBTQI+ people also anticipate continuing to count on chosen family in the future. The survey asked, “If you had to take time off work for health-related reasons, who are you most likely to rely on for caretaking support?” Among LGBTQI+ respondents, 42 percent indicated they would be most likely to rely on either “[c]lose friends who are like family to me (sometimes called ‘chosen’ family members)” or a “[s]pouse or partner, to whom I am not legally married or legally registered.” By comparison, just 20 percent of non-LGBTQI+ respondents said they would rely on close friends or an unmarried partner for care.

Conversely, LGBTQI+ adults are much less likely to expect to call on a legal spouse or registered domestic partner for care: only about a quarter (27 percent) of LGBTQI+ adults named those relationships, compared with about half (47 percent) of non-LGBTQI adults. Interestingly, LGBTQI+ and non-LGBTQI+ people indicated that they would rely on “[f]amily members, to whom I am biologically or legally related (i.e., parents, siblings, etc.)” at essentially identical rates: 38 percent versus 37 percent.

LGBTQI+ people are more likely to work in ways that make them less likely to have access to paid leave

The 2024 survey confirms that LGBTQI+ people continue to be more likely to work in jobs that are unlikely to provide paid leave, continuing the dynamics seen in the 2022 CAP LGBTQI+ survey. Discrimination, notably, constrains LGBTQI+ workers’ choices: 40 percent of LGBTQI+ adults—including 63 percent of transgender adults—have made decisions about where to work to avoid discrimination. Moreover, 1 in 6 LGBTQI+ adults were fired or not hired in the past year because of their LGBTQI+ status; and among LGBTQI+ people of color, nearly 1 in 4 report having been fired or not hired due to discrimination.

LGBTQI+ people, especially transgender people, are more likely to be employed part time than non-LGBTQI+ people. Part-time workers are dramatically less likely than full-time workers to have access to either paid sick time or longer-term paid leave. Similarly, LGBTQI+ people, especially transgender individuals and LGBTQI+ people of color, are disproportionately likely to work in food service or retail. Most workers in these industries have no access to short-term disability or paid family leave; almost half of leisure and hospitality workers (46 percent) and a third (31 percent) of retail workers do not have even a single paid sick day.

States are increasingly guaranteeing workers paid leave from work in ways that include LGBTQI+ people

The United States does not guarantee any paid leave at the national level, leaving too many workers—including especially high numbers of LGBTQI+ workers—without the protections they need. In an effort to respond to this critical gap, states are stepping up, with particular benefits for LGBTQI+ people.

Eighteen states and the District of Columbia, along with a number of municipalities, have passed laws giving workers the right to earn and use paid sick time. Because LGBTQI+ people are especially likely to work in ways that otherwise do not provide paid leave guarantees, LGBTQI+ workers are particularly likely to gain new paid leave rights through these laws. For example, these laws typically cover employers in all industries and regardless of employer size, ensuring access for LGBTQI+ workers in industries such as retail and food service as well as those covering part-time workers. Most paid sick time laws also specifically allow paid sick time to be used to care for chosen family.

Thirteen states and the District of Columbia have passed paid family and medical leave laws, which cover lost income for extended absences due to serious health and family needs. These laws generally broadly cover employees in their state and allow workers to keep their benefits as they move from job to job, supporting those who lose a job or must change jobs due to discrimination. All state paid family and medical leave laws provide equal bonding leave benefits to all parents—regardless of gender and including foster and adoptive parents. LGBTQ+ people are more likely to foster or adopt than non-LGBTQ+ people, making this inclusion particularly important for equity. About half of state paid family and medical leave laws explicitly cover caring for chosen family, while nearly all cover caring for extended family members or domestic partners.

Conclusion

Each day, LGBTQI+ people balance caring for themselves and their families with the need to earn a living. But the lack of guaranteed paid leave, especially in the face of persistent workplace and health discrimination, make this balancing act that much harder. LGBTQI+ workers—and all workers—deserve the paid leave they need to heal, to care, and to thrive.

The author would like to thank Caleb Smith and Haley Norris for their contributions to this column.