A recent survey conducted by a group of both mainstream and LGBTQIA (lesbian, gay, bisexual, transgender, or questioning) aging organizations and investigating how LGBTQIA older adults fare in long-term facilities uncovered pervasive discrimination and abuse. Older adults today have lived through a historical period that distinguishes them from younger generations and this must be considered by social workers and others in the health and service professions. Older LGBTQIA persons have inevitably faced many challenges with self-esteem and overall mental health due to many factors. For lesbian and gay populations, one key factor is the history of the Diagnostic Statistical Manual used by mental health providers noting mental illness simply for being 'homosexual' until 1973. As stated by Grant, there are both definitional challenges to the categories of lesbian, gay, bisexual and transgender, and the fact that few national surveys ask about sexual orientation, much less gender identity.