Providers strive to improve their understanding of and access to LGBTQ + communities, historically a group underserved by hospices. Staff training, marketing and outreach focused on the unique needs and challenges of LGBTQ + patients will play an important role in reaching more of this population.
Issues of equity, inclusion and diversity have plagued the country’s health system, with hospices among providers working to reach underserved communities. Available research indicates that the LGBTQ + population is one of the groups that under-utilize palliative care.
Many members of the LGBTQ + community access hospice and palliative care too late or avoid them altogether. Some predict that they will face discrimination from providers, according to Annie Acs, senior director of health policy and innovation at the National Hospice and Palliative Care Organization (NHPCO), which also serves as a liaison between the staff and the NHPCO Diversity Advisory Council. Hospices should work to improve their understanding of LGBTQ + patients, Acs told Hospice News.
“LGBTQ + people come from all communities, races and backgrounds, and they frequently suffer from almost all socio-economic health harms at higher rates than heterosexual and cis people. It is important that healthcare providers are properly trained to address LGBTQ + health disparities, ”said Acs.
A 2018 AARP study found that 60% of the LGBTQ + community is concerned about the lack of sensitivity to their needs among healthcare providers.
LGBT seniors 65 and over made up 7% of the US population in 2019, according to a report from UCLA Williams Institute Law School. The number of people identifying as lesbian, gay, bisexual or transgender (LGBT) has exceeded 4.5% of the overall population in nearly 20 states and the District of Columbia, according to the report. Among these regions, 35% or less of LGBT adults are raising children, according to NHPCO estimates.
Many LGBTQ + patients lack family support or other home caregivers, according to Tim Johnston, national projects director for Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE).
“LGBT people are less likely to be part of multigenerational care networks and are more likely to be cared for by family members of their choice, who are often the same age. This makes it difficult to seek informal care, ”Johnston told Hospice News. “This means LGBT people need to make sure they have made advanced planning decisions that ensure the right people will be able to help them as they approach the end of their lives. “
Hospice and palliative care providers should educate staff on cultural competency, diversity, equity and inclusion, including the needs of the LGBTQ + community, according to Johnston. Deepening clinician understanding and awareness is an important first step in ensuring staff know key terminology, family dynamics, and the LGBTQ + experience.
An important consideration is that palliative care providers must recognize that “family” is defined by the patient. The patient may view some people as a family who are not related by genetics or marriage. This is essential when it comes to establishing guidelines for inpatient visits, advance care planning and goals of care for LGBTQ + patients, according to Altonia Garrett, vice president of public affairs and partnerships. at Capital Caring Health, based in Virginia, and Executive Director of the Center. for equity, inclusion and diversity.
“Some considerations often have nothing to do with actual medical care, but rather respect for the individual,” Garrett said. “An example that comes to mind concerns the management of transgender patients and the use of pronouns. This is so important as patients at the end of their life, and even when they are no longer able to speak for themselves. ”
Hospice organizations can start with an internal review and update of their organizational policies to demonstrate a more inclusive and welcoming organizational culture for LGBTQ + team members.
An important first step can be to use non-sexist language in an organization’s literature and job postings, and to show diversity in pictures or photos. This creates a more welcoming environment for patients and staff, according to Acs.
Adopting more inclusive language in marketing materials and community engagement will be vital in building lasting relationships and partnerships. Building relationships with local LGBTQ + services, nonprofits, or community centers can help hospices improve their understanding of barriers preventing access to care.
“Marketing is a key step, and it should be your last task on the path to becoming more inclusive,” Acs told Hospice News. “This is because you only want to start marketing to the LGBT community after you have completed the training and other best practices to make sure LGBT people will be safe and supported to access your services.”