RESUMEN
Older sexual and gender minority adults living in rural areas of the U.S. face challenges in accessing welcoming and inclusive formal health, mental health, social, and long-term care services. The intersection of the local rural sociocultural context with lesbian, gay, bisexual, and transgender (LGBT+) identities and aging presents both challenges and opportunities for improving formal services for LGBT+ older adults. Little is known about how the rural south central Appalachian context intersects with the identities of LGBT+ older adults with regard to accessing formal services. This paper presents the results of a qualitative study examining experiences, concerns, and recommendations regarding formal services among 11 LGBT+ older adults residing in rural south central Appalachia. Several of the participants described experiencing discrimination and/or marginalization while accessing formal services. A number of participants were fearful about the lack of LGBT+-inclusive services and expressed that they would consider leaving the area if their own or their partner's health declined or if they or their partner required long-term care services, particularly residential care. Many participants expressed the need for local provider education and training about the needs of LGBT+ older adults. Implications for practice, policy, and research are discussed in this paper.