Providing Better Healthcare for Diverse LGBTQ Populations
Many statistics point to increased rates of chronic health issues affecting the lesbian, gay, bisexual, transgender and queer (LGBTQ) community. This calls for increased awareness of this community and putting policies and procedures into place to specifically assist the community and having resources available for healthcare providers.
All people have a sexual orientation as well as a gender identity.
- Heterosexual – attraction to opposite sex
- Lesbian – female attracted to female
- Gay – people attracted to others of the same sex
- Bi-Sexual – those attracted to both sexes
- Cisgender – identify as the gender at birth
- Transgender – identify as the opposite gender at birth
- Non-binary – gender identified on a spectrum
In the LGBTQ population compared to the heterosexual/cisgender population there are multiple health disparities. These include higher incidences of alcohol, drug, and tobacco use. Young gay and bisexual men experience eating disorders. Lesbian and bisexual females have increased rates of obesity. In the Transgender community the likelihood of HIV is more prevalent.
In America 70 percent of new HIV infections show up in gay and bisexual men and transgender women. Those living with HIV are more susceptible to chronic kidney disease through the prolonged use of antiretroviral treatment.
Due to higher rates of obesity, alcohol, drug, and tobacco use there is also a higher risk of diabetes and cardiovascular disease in within the LGBT community.
Social determinants according to Health People 2020 are, “Conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
On per capita basis, LGBTQ people are more likely to be targets of hate crimes than any other group in America. In 2015 46 percent of transgender Americans reported verbal harassment, 9 percent reported being physically attacked in the past year.
LGBTQ people experience discrimination in employment, housing, and public accommodations, including healthcare. One in four LGBTQ Americans reported experiencing discrimination in 2016.
- 69 percent of those who reported discrimination said it affected their psychological well-being, and 44 percent said it affected their physical well-being
- 57 percent said it negatively affected their neighborhood and community environment
Many older LGBTQ Americans came of age under conditions of intense homophobia. Homosexuality was criminalized in all 50 states until 1962 and categorized as a mental illness until 1973. Homosexuality was considered a legitimate rationale for being fired, denied employment, housing and child custody. Non-disclosure is sometimes thought of as a survival strategy. Some continue to fear discrimination in health care and senior living settings
Compared to heterosexual and cisgender peers, LGBTQ older adults are:
- More likely to be single and/or live alone
- Less likely to have children, grandchildren
- More likely to be estranged from family
LGBTQ older adults are also more likely to report physical disability and have higher rates of mental distress.
All of this proves there are unique challenges, especially in access to LGBTQ aware and affirming services. Limited provider education on LGBTQ health, negative provider attitudes or lack of sensitivity, barriers to access including insurance coverage and lack of nondiscrimination policies along with the anticipation by the patient of social stigma in general are all factors.
The first step you may want to take in your own setting is garnering education on the subject from the CMS Medicare Learning Network. You can create a free account and go through “Catching Everyone in America’s Safety Net: Collecting Data on Sexual Orientation (SO) and Gender Identity (GI) in Health Care Settings”. This even includes CEUs and CMEs. There is additional education on the National LGBT Health Education Center.
It is recommended you explicitly include sexual orientation and gender identity in your non-discrimination policy and prominently display it.
- Collect Sexual Orientation Gender Identity (SOGI) data in patient questionnaires
- Normalize questions by saying this is something I ask all of my patients
- Use welcoming open language
- Mirror terminology used by your patients (i.e. pronouns)
It is important to be aware and educated on the needs specific to your LGBTQ patients so you are able to provide the best possible care for the CMS priority population.
- “Advocating for yourself and others: Health and aging services”
- “The graying of AIDS: Stories of an aging epidemic”
- CDC, HIV Surveillance Report, 2010-2016
- Swanepoel, Atta, D’Agati, et al., Kidney Int 2018
- 2014 FBI data, New York Times, June 16, 2016
- US Transgender Survey 2015.
- Rosenkrantz, Black, Abreu, et al., Stigma and Health, 2017