It's not only long-term care. Some hospitals won't provide GF meals unless someone has a diagnosis of celiac. I have celiac, but no formal diagnosis because the GI 14 years ago thought because I wasn't anemic that I had diverticulosis (still none), so only GF for a week and one biopsy sample of my small intestine (the celiac was new, triggered by H1N1, so minimal GI damage). I have the HLA DQ8 0302 haplotype, but that just means that I am at risk for it; the genetic test doesn't confirm celiac because ~30-40% of people have HLA DQ2 or DQ8. There is no way that I'm making myself sick for weeks just to confirm something that I have. I have celiac listed on my medical charts, but some doctors won't accept that without endoscopy and bloodwork. It is easier convincing them now that I have collagenous colitis (8 years). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10039793/#:~:text=Background,based%20cohort%20studies%20are%20rare.