You know how sometimes you’re asked to speak on a subject with which you have years of experience? Then during your research you discover a wormhole that’s so much deeper and more concerning that you had previously thought when you agreed to take on this engagement? I do.
My experience with LGBTQ healthcare has included meeting geriatric people upon admission who brought their “best friend” with them, and that friend wanted access to all medical information. My experience has been the 85-year-old widower with three daughters, who confessed that he always thought he should’ve been born a girl and entered the healthcare system wearing nail polish. My experience has been a female patient who came for outpatient therapy and specifically wore a skirt throughout, and finally confessed to being born a male and afraid of being judged and rejected for not conforming.
During my very long tenure in healthcare, beginning in the 1970s, I have encountered many adult and geriatric patients who did not conform to what we considered sexual norms. Early on, these geriatric patients were almost exclusively closeted and would have their “sister” or “brother” as their POA. As the decades progressed, we began to see more openness about sexuality and gender identity. But here we are, more than 40 years later, and the discrimination and difficulties among those who identify differently persist. So many of our LGBTQ elderly face stigma, discrimination, violence, rejection by their families and the community, substandard care, and outright denial of care. The old idea that “you’re either born one way or the other” no longer holds up. Studies show that 1/100 children are born with an XX or XY anomaly. These anomalies may not show up until the patient needs healthcare.
This year, the Department of Health and Human Services finalized the ruling that healthcare providers can refuse treatment based on their religious beliefs. This is in the name of “religious liberty.” That exemption can pertain to life-or-death issues, mental health care, pharmacological care, or anything that may conflict with the viewpoint of the provider. There are currently six states that are legally allowed to withhold healthcare based on the provider’s religious belief. You read that right. In 2019, there are Americans who are not getting the healthcare they need because their providers are legally allowed to reject them. This could even extend to HIV treatment and Naloxone use. This could even extend to denial of services on the basis of race.
The geriatric LGBTQ community also faces higher illness rates as they age because of chronic conditions, earlier onset of disabilities, HIV/AIDS, mental illness, substance abuse, and sexual and physical violence. They are more susceptible to faster and more severe decline because of their reluctance to seek healthcare. Studies indicate that 56% of LGB people and 70% of transgender and gender-nonconforming report discrimination by healthcare providers, including refusal of care, harsh language and physical roughness.
What can we do?
- Assure the resident that our care will not be different because of their sexual identity.
- Assure the resident that their privacy will be protected.
- Assure the resident that their physical well-being will be protected.
- Ask ALL residents upon admission how they want to be addressed and who can have access to their information.
- Show respect by being relaxed and courteous.
- Use the name/pronoun they prefer.
- Offer private rooms if necessary.
- Ensure that all staff get LGBTQ competency education.
In the 21st century, there should no longer be a question about who deserves healthcare. We got into our professions to help people. Discrimination on the basis of gender, gender identity, race, height, age, weight or any other random determinant has no place in our lives or in our country.
Jean Wendland Porter, PT, CCI, is the regional director of therapy operations at Diversified Health Partners in Ohio.