This article originally appeared on Aged Care Today Winter 2024 (stock photo only)

Discrimination drives many LGBTIQ+ people to avoid disclosing their diverse bodies, sexual orientations or genders in healthcare, which has a direct impact on their end-of-life planning. 

Fears of homophobia, transphobia and elder abuse can be highly distressing and re-traumatising to older people who have faced these challenges in the past. 

As such, there is an urgent need for the aged care and primary care sectors to address the unique challenges faced by LGBTIQ+ people when accessing palliative care services. 

Inclusive palliative care for older LGBTIQ+ people is a crucial yet under-researched area, with many in the palliative care sector lacking awareness about it. 

With only 12 per cent of LGBTIQ+ people having an advance care directive, the need for the aged care services industry to address these unique challenges is all the more significant. 

Unfortunately, many people in our community are uninformed about the need for a power of attorney or advance care plan, they often haven’t designated decision-makers or outlined their preferences legally, resulting in a lack of legal support when decisions need to be made on their behalf. 

This is especially important for LGBTIQ+ people, who may not have clear next-ofkin pathways, making the appointment of a legal guardian vital. 

Healthcare providers can play an important role in encouraging their LGBTIQ+ patients to consider their options for documentation to ensure their wishes are known and upheld toward the end of their lives. 

Additionally, we need to note that many LGBTIQ+ people lack contact with their families of origin or don’t have children, relying instead on families of choice for support. Unfortunately, these chosen families aren’t always welcomed by care providers, who often lack understanding of their histories of abuse or marginalisation. 

Recently, Dr Fiona Ann Papps, in collaboration with Jason Petrides (an Australian College of Applied Psychology honours student) and LGBTIQ+ Health Australia (LHA), conducted a study to better understand the needs and experiences of gender and sexuality diverse people in accessing palliative care services. 

In addition to the lack of recognition of relationships and acknowledgement of chosen families within palliative care services, the study highlighted the hesitation that many LGBTIQ+ people have in seeking care at palliative care services run by religious institutions. 

Historical persecution of people on the basis of their diverse sexuality or gender identity by many religious bodies and individuals generates considerable fear and reluctance to engage, unless services can make it very clear that they are accepting and welcoming.

These circumstances highlight the many challenges faced by LGBTIQ+ people which are often overlooked or understated. However, all these barriers can be overcome to ensure inclusive palliative care for LGBTIQ+ people. 

Further education within the healthcare sector would improve awareness of issues unique to LGBTIQ+ patients. 

Encouragement of LGBTIQ+ people by healthcare providers to discuss their preferred decision makers and establish an advance care directive will also likely have a ripple effect throughout LGBTIQ+ communities, leading to better preparation for end-of-life scenarios. 

LHA has recently launched a fourmodule eLearning program, accessible at no cost to those in palliative care or interested in the field. 

This was developed by LGBTIQ+ health experts drawing from the recent LHA study and using realistic case study examples. 

These learning opportunities are centred on providing safe, inclusive palliative care that respects and supports LGBTIQ+ people, ensuring they can access care free from discrimination. 

Acknowledging the specific needs of LGBTIQ+ people is essential. It’s not enough to treat them like everyone else, as their experiences and challenges are unique and require tailored approaches. 

By ensuring healthcare providers undergo comprehensive training and education, they can gain the understanding of the complexities faced by older LGBTIQ+ people and equip themselves with the skills necessary to create safer environments. 

Ultimately, this not only fosters inclusivity, but also sends a powerful message to the community: It’s okay to be open about your identity and needs, and you deserve to receive knowledgeable and culturally responsive care and support. 

Dr Ruth McNair

General Practitioner and Honorary Associate Professor at the University of Melbourne palliative_care