Strategies for Delivering LGBT-Inclusive Care

By Jennifer Comerford, MJ, OTR/L, CHC, HEM; and Cynthia Wallace, CPHRM

Discrimination against individuals who identify as lesbian, gay, bisexual, or transgender (LGBT) has been common in many contexts, including healthcare. Consider the following de-identified events reported to the ECRI Institute PSO, a federally certified patient safety organization (PSO), from January 2013 through mid-2015:

• Physicians made inappropriate comments about an openly gay patient who was intubated.
• A physician abruptly departed from a gay patient’s room after being told about the patient’s positive HIV status.
• Staff refused to modify a transgender patient’s documentation from male to female.

These reports give some indication of discrimination against LGBT individuals. Furthermore, even well-intentioned providers may be genuinely confused about how to ensure that LGBT patients are welcome, understood, and given appropriate access to care.

With the 2015 Supreme Court ruling that same-sex couples have a constitutional right to marry, the antidiscrimination provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA), and the increase in media attention to transgender topics, it is clear that the U.S. is undergoing a sea change regarding legal rights for and social recognition of LGBT individuals.

This awareness is accompanied by a growing acknowledgment that LGBT individuals are at risk for health disparities and being underserved by healthcare providers, even in the absence of intentional discrimination. For example, LGBT individuals are 2.5 times as likely to have a mental health disorder as heterosexual men and women, and transgender individuals are at increased risk of suicide (Daniel & Butkus, 2015). Of course, discrimination by providers refusing to deliver medical care to LGBT individuals compounds the problem.

Beyond an ethical imperative to provide safe and respectful care to all patients, providers and organizations face a variety of risks—including legal action, loss of federal funding, adverse media attention, citations for failing to adhere to Medicare Conditions of Participation, and accrediting standard violations—for failure to deliver adequate care to LGBT patients. Fortunately, there are a number of steps that providers in ambulatory care and acute care organizations can take to ensure appropriate treatment for all, regardless of sexual orientation or identity.