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8 FEBRUARY 10.2007 • Q-NOTES
HEALTH
Providing hospice care to
LGBT elders
Aging LGBT boomers face challenges
their straight counterparts don't
by Kimberly D. Acquaviva
In the coming years, hospice and palliative
care programs in urban, suburban and rural
areas alike will increasingly be called upon to
provide quality, compassionate care to LGBT
elders. An estimated 10 million to 15 million
LGBT adults currently live in the United
States; according to the 2000 U.S Census, 97
percent of counties have at least one elder in a
same-gender partnership. Hospice and pallia
tive care professionals need to understand
how the experiences of LGBT elders near the
end of life may differ from those of other older
adults.
Some LGBT elders die without ever calling
hospice because they fear being rejected or dis
respected by hospice staff. Since hospice servic
es are predominantly provided in the home and
include the family as the unit of care, hospice
may be the most intimidating type of care for
LGBT elders who are not My open about their
sexual orientation or gender identity.
Hospice and palliative care programs that
wish to communicate their acceptance of the
LGBT community can do so by playing a visi
ble role in the community — for example, by
staffing a booth at the gay pride festival in
their region or placing an advertisement in a
local gay newspaper. Programs also can sup
port the community by nurturing a welcom
ing work environment for LGBT staff and pro
viding healthcare benefits to both married
and unmarried partners.
For many LGBT elders and their families,
the admissions pro'cess for hospice and pallia
tive care has the potential either to provide
welcome and comfort or to leave them feeling
alienated and disconnected. A seemingly
innocuous question — ’’Are you married, sin
gle, widowed or divorced?” — may present a
dilemma to LGBT older adults: Should they
come out to hospice and palliative care profes
sionals? Fearing discrimination, many of these
elders have become accustomed to hiding who
they are — and whom they love — from
healthcare providers.
Removing the barriers
, This barrier to care is relatively simple to
remove. Many programs have changed the
question about marital status on intake forms
to include “partnered” as one of the choices,
making the question more inclusive both of
individuals in same-gender relationships and
of those in mixed-gender unmarried relation
ships. Once the hospice and palliative care
staff know about a patient’s same-gender
partnership, everyone on the team must strive
to honor that relationship: Same-gender part
ners deserve the same support that any other
Some LGBT elders die without ever call
ing hospice because they fear being
rejected or disrespected by hospice
staff.
spouse would receive from the hospice team.
In addition, hospice and palliative care
professionals should recognize that typical
LGBT patients and famihes do not exist. Not
all LGBT elders have a partner — some are
single, some are widowed, some are divorced
and some are separated from a same-gender
partner. LGBT elders may have been married
to a person of the other gender, and in some
cases, they may still be married to a person of
the other gender.
Furthermore, some LGBT older adults have
children — either through birth or adoption
— and some have grandchildren. Some LGBT
elders are extremely close to both their family
of choice and their family of origin, whereas
others may not have had contact with their
family of origin for decades. Transgender
patients may be male or female and may or
may not disclose their status as transgender
during the'hospice admissions process.
As with the admission of non-LGBT
patients to hospice or palliative care, staff must
see next page >
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