by Phoebe Hershenow

Thanks to support from the Orcas Gay and Lesbian Fund (via the Orcas Island Community Foundation) and the Orcas Family Health Center, I recently attended the 2010 Gay and Lesbian Medical Association (GLMA) conference in San Diego.

Every one of us knows people who are gay or lesbian. They are our neighbors, coworkers, family members and friends, but even in the relatively open society of Orcas, there are gay and lesbian members of our community who are wary of being open about their sexual orientation. This is especially true of some of the elderly, who grew up in a much more repressive social environment.

The care of aging gay and lesbian patients was the focus of several presentations at the GLMA conference. But as it turns out (not surprisingly), gay and lesbian elders do not have dramatically different physical health care needs than other elders. For the most part, what creates special issues in gay and lesbian health care are differences in social and legal status. Two themes came up again and again: “families of choice” versus “families of origin” and health care ramifications of legal prohibitions of same-sex marriage.

When it comes right down to it, when someone needs to step up and take responsibility for care of a very sick or aging person, it’s all about family. Gay and lesbian patients often rely on support from families of choice (close friends or partners) as opposed to families of origin (siblings, parents, etc), from whom they may well be estranged. But institutions tend to resist acknowledging families of choice. This can create difficulties regarding everyday decisions about care and can contribute to the isolation of a sick or aging person. Though many hospitals and emergency services are making conscious efforts to work with families of choice, this remains a problem, not just in medicine but in business, real estate, education, and other venues as well.

The issue of “families of choice” is linked to the issue of same-sex marriage. A gay or lesbian couple (like any unmarried couple, regardless of sexual orientation) does not have the same protections that a legally married couples does, especially with regard to paying medical expenses. Rules about spending down assets that protect a legal spouse (from having to sell a home, for example) do not apply to same-sex partnerships. Many of these rules involve insurance coverage and retirement benefits, or federal programs like Social Security and Medicare. This essential inequality can easily contribute to financial difficulties and subsequently poor health.

I attended this conference as a “straight ally.” A straight ally is someone willing to stand up publicly for the basic civil rights of gay and lesbian friends, neighbors, co-workers, family members, and patients. We may feel that we are allies without having to overtly say so, but at times it may be necessary to state it, to “come out” as a straight ally and explicitly support equal treatment for all members of society.

Phoebe Hershenow is a Family Nurse Practitioner at the Orcas Family Health Center.