Centering sexual and gender diversity within Compassionate Communities: insights from a community network of LGBTQ2S+ older adults

Abstract

Background and Rationale: The Compassionate Communities movement emphasizes the importance of illness, disability, dying, caregiving, and grief across the lifespan and highlights the communal responsibility of caring for one another. There is a need to recognize and incorporate the needs of diverse communities within this movement and research on dying, caregiving and grief. An important axis of this diversity is related to individuals’ sexual orientation and gender identity. Methods: As part of the early phases of Healthy End of Life Project Ottawa, a Compassionate Communities, community-based, participatory action research project, we held focus groups with older members of lesbian, gay, bisexual, transgender, queer, and two-spirit communities. Nine older lesbian, gay, bisexual, transgender, queer, and two-spirit people participated in the focus groups (mean age = 72 years). Data were analysed using an inductive, reflexive thematic approach. Results: Through an iterative analysis process, we identified themes related to lifecourse experiences of trauma, the need for safety within care contexts, the importance of relationships and connection, as well as participants’ ability to ask for and receive help. A core tenet of Compassionate Communities involves responding to the needs of diverse communities with respect to aging, end-of-life, and grief. Our findings emphasize the importance of incorporating the voices of diverse sexual and gender identities and promoting health equity within Compassionate Community initiatives.

Barriers to LGBTQIA-Inclusive Palliative Care

“…The lived experiences of LGBTQIA persons has historically been marked by increased adversity relative to the general population. 4,5 This is due in part to historical social stigma, lack of legal protections and medical stigma in the form of identity-pathologizing, the overall effect of which is an observed increase in mental health issues and engagement in dangerous health behaviors. 6 Each of these factors has personal, institutional and financial effects on LGBTQIA individuals, the sum of which serve as barriers to accessing appropriate palliative care.…”

“…Elderly LGBTQIA persons are more likely to live alone, be estranged from family and live in poverty, compared to their heterosexual counterparts. 11 Whether being forced to live independently early in life or having experienced job and housing discrimination, numerous historical obstacles have made establishing financial security difficult for some LGBTQIA individuals, 5 such that by the time they reach retirement age, they may not be financially equipped to handle the surmounting medical costs incurred by chronic illness.…”

Editorial: Introducing the special collection on ‘Palliative Care for LGBTQ2S+ Individuals and Families’

“….’. 4 Furthermore, they state that trauma-informed practices are not unique for LGBTQ2S+ communities but rather should be part of a larger hospice and palliative care imperative to embrace all aspects of anti-oppressive, equity-based, and trauma-informed policies and practices.…”

“….'. 4 .. to increase health and social care professionals' awareness about the specific issues and needs of LGBT+ people and their families and partners living with advanced illness', 7 while providing participants with specific strategies enabling them to recognize barriers to inclusion. They focused on helping participants gain inclusive skills appropriate for services while using a palliative approach to care.…”