Friday, June 14, 2013

One Of My Worries As I Get Older…

…Is elder care. How will I be treated in a nursing home or in a senior living center? They is a number of studies about gays and lesbians but there are very few on trans-people*.

We have different needs then senior gays and lesbians, will we still need our hormones and if so at what dosage? Our biology might not match our identity. Some of us might be hair challenged, will we still have access to our wigs? These are just some of the questions that still have to be answered.

There is an article in GeriPal (A Geriatric and Palliative Care Blog) by Robert Killeen MD about this,
Hospice and the Transgendered

Hospice is beset by many societal obstacles in its care of the transgendered patient.  I saw a most recent example of this in our local community hospice.  An elderly female (MTF) transgendered patient had developed metastatic cancer.  Chemotherapy had failed and had left her profoundly weak and infirmed.  Estranged from her family, she had only a few friends to rely on but then only intermittently so.  Hospice admitted her to their IPU and, with supportive care, her overall status did improve.  However, now she was in a dilemma.  She was well enough to leave the unit but not well enough to go home.  Too poor to afford a single room, the patient was unable to be placed.  Chronic care facilities viewed her as if she were both male AND female.  This prohibited her placement with a roommate.  As she was physically female she wished to have a female roommate; the facilities saw her as originally 'male' and either could not or would not comply.  In the end, she remained at the hospice center for the remainder of her life.  While the hospice provided her with exemplary care, the obstacle of society's views on gender prevented her from ever leaving the unit.
When the Connecticut Transadvoacy Coalition (CTAC), the Commission on Human Rights and Opportunities (CHRO), Gay and Lesbian Advocates and Defenders (GLAD) and the Connecticut Women Education and Legal Fund (CWEALF) held a workshop in 2011 on the new gender inclusive anti-discrimination law one of the questions that was asked was from a lawyer at a hospital. His questions were “how do we place a trans-patient?” and “what happens if we put a trans-woman in the women’s ward and someone complains?” The CHRO and GLAD lawyers responded that you place the trans-patient in the ward of their gender identity and for the second question they asked a question to the hospital doctor, what would you do if there was a patient that complained about a Muslim in the room? The hospital lawyer replied that they would remove the patient who complained and the CHRO lawyer responded that person who complained about a trans-patient should also be moved and not to isolate a trans-patient in their own room.

Dr. Robert Killeen goes on to say…
The transgendered population confronts a myriad of difficulties which hospice must also address.  Socially, transgendered folk, gentle folk, find themselves relegated to a near-netherworld existence.  Forced to society's fringes they feel isolated, even abandoned, by family and friends.  They may find their friendships restricted to a "gay-friendly" environment or to other 'T-girls'. … In an era when patients can be nudists, "fuzzies", or carry tattoos of violent causes (eg. Nazis), why must the transgendered have fear of disfavor from a medical staff corrupted by society?  Their only supposed crime is gender.
In a national survey of trans-people it was reported that 20% of trans-people surveyed we denied treatment in a doctor’s office or a hospital and 25% reported that they were harassed in a doctor’s office or hospital. What is even worse is that the report found that 28% postponed medical care due to discrimination. I was one of those who postponed treatment because of a fear of being discriminated against.

In Dr. Robert Killeen blog he said…
The transgendered population is often helpless to find support for their health care.  Transgendered people are a 'minority of minorities', "society's most vulnerable population" as per the Reverend Stan Sloan of Chicago House, creator of the TransLife Center.
Many of us say that they are not activists or that they don’t want to be an advocate. But we all must be pro-active when it comes to our own health-care.

*In a report titled “The Aging and Health Report Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults” they say it is a LGBT survey but in reality it is only a LGB survey. Their report mainly talks about Lesbian, Gays and Bisexuals and of the more than 2500 participants only 174 were trans.

What we need is our own study of elder care for trans-people.

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