Staff Training Key to Improving Hospice Quality Among LGBTQ+ Patients

Hospice staff training models with culturally appropriate LGBTQ+ components are key to improving quality outcomes among an increasingly diverse base of underserved seniors.

Ongoing staff education and communication skill building are two significant pieces of bridging gaps of hospice care among LGBTQ+ seniors, according to Jerry Farmer, vice president of diversity, equity and inclusion at AccentCare.

“As LGBTQ+ patients come on hospice care, many may worry about whether they will experience open, safe and affirming communication with providers, or face awkward or discriminatory interactions,” Farmer told Hospice News in an email. “By educating and equipping our teams with the necessary and correct knowledge for care, we create an atmosphere where patients feel safe, supported, valued and free from discrimination and bias.”


Growing demand among LGBTQ+ seniors

The LGBTQ+ community has faced several barriers to equitable and quality health care delivery, including challenges such as discrimination, mistreatment and even neglect and abuse in some cases. As they reach the end of their life these issues compound and carry negative impacts.

Case in point, a 2018 AARP study found that 60% of the LGBTQ+ community is concerned about a lack of sensitivity to their needs among health care providers.

Greater strides are being made toward more inclusive and gender-affirming health care delivery, according to Zachary Fried, licensed clinical social worker and training supervisor for Optum at Home, a subsidiary of UnitedHealth Group (NYSE: UNH). But a growing need exists for hospices to ensure that staff are prepared to engage with a wider base of LGBTQ+ patients with varying gender identities and sexual orientations, Fried said.


Educating staff on the diversity among LGBTQ+ populations and their unique needs is an important part of building trust and improving quality among this historically underserved group, Fried stated.

“Inclusive education takes an intersectional perspective, meaning we think about various identities that patients have and how they intersect to create unique lived experiences,” Fried told Hospice News. “It’s also important that we push for diversity among service providers. Training that creates comfortable spaces for providers to learn about types of biases and how these may impact patient care are also imperative and [we] should normalize this, while providing techniques to work past them. Creating comfortable spaces for employees to be themselves can trickle down into patient care.”

Demographics have been driving demand for improved care and greater staff training measures. An estimated 7% of nearly 12,150 adults 50 and older in the United States identified as lesbian, gay or bisexual in a recent nationwide survey from the Pew Research Center.

Additionally, 0.3% of the individuals surveyed were transgender men or women, or were nonbinary. However, nearly half (44%) of American adults indicated that they knew a transgender person and 20% knew someone who is nonbinary. The survey did not specify the percentage of those identifying as gender neutral or were androgynous.

Similar to national trends, this aging population has been swelling. Roughly 1.5 million LGBTQ+ seniors made up 4.1% of the overall population in the United States in 2010, according to a report from SAGE. This demographic is projected to double by 2030, reaching 3 million, SAGE reported.

Staff training keys

Understanding the evolving trends among this growing population is key to their future end-of-life outlook as well as hospices’ bottom lines, according to Fried. Training programs for both administrative and interdisciplinary staff should include a variety of topics that help with both assessing and addressing the unique needs among terminally ill LGBTQ+ patients, he said.

“It is important to create a comfortable space for patients to express who they are, feel seen and obtain appropriate medical care,” Fried told Hospice News. “We want to avoid making assumptions about peoples’ gender pronouns, as this risks perpetuating an invisibility among patients with various sexual orientations and gender identities.”

In terms of unmet needs, LGBTQ+ patients often face increased risks of anxiety, depression and isolation and lack caregiver support. It can be challenging to navigate pain and symptom management among LGBTQ+ patients if staff are not adequately trained on ways to foster trust through effective communication, awareness and empathy, Fried indicated.

Pouring greater resources into training from subject matter experts and LGBTQ+ advocacy and education organizations can be worth the return on investment in quality outcomes, according to Fried.

“Having training on different topics is key to being more inclusive,” Fried said. “Even from a business perspective there’s a financial advantage to having well-trained staff, because you’re able to effectively engage with patients regardless of their race, gender, sexual orientation or any other identity. It increases the quality of care you’re providing because you’re developing a trusting relationship with patients.”

A significant component to consider in hospice education models is having ongoing cultural competency training to understand the importance of appropriate language utilization, according to Farmer. Staff must be aware and comfortable using the preferred pronouns of a patient, for example, he stated. Scenario-based interactions can help staff improve both empathy and comprehension when communicating with patients, Farmer explained.

Other keys include establishing and evaluating organizational policies around discriminatory practices, having diverse hiring practices, developing partnerships with LGBTQ+ community groups and ensuring all outreach and educational materials are inclusive, Farmer added.

“By having an inclusive and non-discriminatory environment, we can provide a welcoming and safe environment where patients feel respected and valued,” Farmer said. ”It’s also important that the interdisciplinary staff is culturally aware and sensitive in delivering care. By being knowledgeable and culturally aware of all walks of life, we are working to turn around the mistrust into being a trusted source and partner of services for the LGBTQ+ community.”

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