Brilliant Disguise - Bruce, HB2 and LGBT Elders

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I recently attended a program sponsored by the Western Carolina Chapter of the Alzheimer's Association entitled Conversations about LGBT Older Adults, Families, and Equality, Health, and Community Services.

Needless to say this program took on added significance against the backdrop.

So imagine, it's tough enough being LGBTQ (the Q is for questioning I Iearned) but now imagine being an LGBT elder. See we tend to freeze certain segments of the population at a point in time. Just because they grow older didn't mean they grew straight! No, now we have older people with all of the travails of growing old layered with being out of the mainstream.

  • 3 million people in the U.S. 55 and older identify as LGBT.
  • 50% of single LGBT older people believe they will have to work well beyond retirement age compared to 27% of non-LGBT people.
  • 40% of LGBT elders say their support networks have become smaller over time, as compared to 27% of non-LGBT people.
  • 1 in 3 LGBT elders live alone compared to 27% of non-LGBT people.
  • 25% of transgender older adults reports discrimination when seeking housing.
  • 40% of LGBT older people age 60-75 say their healthcare providers don't know their sexual orientations.

So let's take that last point - healthcare. There are already access issues to care. What can we do to create inclusive healthcare environments for LGBT people? According to the National LGBT Health Education Center, there are ten things in fact we can do.


  • The board and senior management are actively engaged.

  • Policies reflect the needs of LGBT people.

  • Outreach and engagement efforts include LGBT people in your community.

  • All staff receive training on culturally-affirming care for LGBT people.

  • Processes and forms reflect the diversity of LGBT people and their relationships.

  • Data is collected on the sexual orientation and gender identity of patients.

  • All patients receive routine sexual health histories.

  • Clinical care and services incorporate LGBT health care needs.

  • The physical environment welcomes and includes LGBT people.

  • LGBT staff are recruited and retained.
  • Coming Out to Your Provider

    The National LGBT Health Education Center also publishes a pamphlet on coming out to your provider. There are particular health risks associated with this population - higher smoking rates, increased risk of suicide, increased risk of sexually transmitted diseases. When you come out, a provider can truly tailor a person-centered approach to care and refer you to the right specialists like behavioral health providers.

    But not every provider may be equal in their acceptance.

    The Other Side of the Coin

    In November of 2014, LGBT HealthLink, Missouri's PROMO, and lawyer Corey Prachniak released the first ever LGBT Healthcare Bill of Rights (HBOR). The bill, in both long form and wallet sized versions, outlines the protections and rights LGBT people have in healthcare today.

    The Gay and Lesbian Medical Association publishes a directory of health professionals advancing LGBT equality. Start there to find a provider.

    The Human Rights Campaign Healthcare Equality Index showcases providers who meet their Core Four.


    Patient Non-Discrimination

    a. Patient non-discrimination policy (or patients' bill of rights) includes the term "sexual orientation" and the term "gender identity"

    b. LGBT-inclusive patient non-discrimination policy is communicated to patients in at least two documented ways AND is communicated to staff

    Equal Visitation

    a. Visitation policy explicitly grants equal visitation to LGBT patients and their visitors

    b. Equal visitation policy is communicated to patients in at least two documented ways AND is communicated to staff

    Employment Non-Discrimination

    a. Employment non-discrimination policy (or equal employment opportunity policy) includes the term "sexual orientation" and the term "gender identity"

    b. Employment non-discrimination policy is communicated to the public in at least one documented way

    Training in LGBT Patient-Centered Care

    a. Staff receive training in LGBT patient-centered care (HRC offers free, expert online training to staff at all levels)

    b. All staff involved in patient care services must be informed of the free LGBT training opportunities available through the HEI

    I was not surprised at all that one of our local health systems was identified as a leader in LGBT rights. As a patient of the organization, a family caregiver to a mom who receives care there, and as a consultant who has worked for them, the culture permeates person-centered. See there are a lot of providers talking the talk of person-centered health care experience and few walking it.

    Educate yourself on who advocates in your court. And beware of those who have in Bruce's words "A Brilliant Disguise."

    So tell me who I see
    When I look in your eyes
    Is that you baby
    Or just a brilliant disguise