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People identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) comprise a significant portion of the population across all age groups. Persons who identify as sexual minorities and gender nonconforming persons not only account for a considerable percentage of the overall population, but this part of the population continues to grow. The baby boomer cohort of people (persons born between 1946 and 1964) is the largest cohort of people in the United States and has many persons identifying as sexual minorities or gender nonconforming. Baby boomers are reaching retirement age and beyond making planning for the end of life essential to sustain a high-level quality of life.

LGBTQ persons have historically faced stigma from society, family, organizations and institutions making them less likely to seek help from professional or official sources. LGBTQ persons may also have fewer resources to cope with the challenges that come with aging due to this stigma and marginalization. Making matters worse, older LGBTQ persons have generally experienced poorer health care outcomes than their heterosexual counterparts.

One area that is often neglected as we age is planning for end of life. This area of health care is especially important for LGBTQ people to address since many jurisdictions have no legislated or statutory protections for sexual minorities or gender nonconforming persons. Existing laws may transfer decision-making power to a biological relative instead of a partner the person has spent their life with. Many biological families have ostracized or isolated LGBTQ family members, making this especially frustrating. Planning for the end of life is one strategy for LGBTQ persons to improve their overall quality of life as they age.

There are many reasons people put off planning for the end of life. One reason is our reluctance to discuss death due to the emotional toll it takes thinking about a loved one’s demise. Cultural and family prohibitions may also present barriers to planning for the “end.” Stigma and marginalization are another reason LGBTQ people are reluctant to access resources such as health care professionals.

Although we plan for weddings, considerably less time is spent planning for the end of life. The need to have a conversation with a loved one before a health care crisis arises can ease the additional burden of making important medical decisions in times of crisis under extreme pressure. Talking to key family members regarding issues such as your wishes for life-sustaining treatment or who you would like to act as your proxy if you are unable to make decisions are much easier when they occur before a health care crisis rears its ugly head.

Several options should be discussed with family members. A Medical Power of Attorney (MPOA) is a person chosen to represent the wishes of the aging person if they are unable to make decisions such as they were delirious, in a coma, under anesthesia, etc. A living will is a set of written instructions to communicate treatment recommendations in predetermined scenarios. For example, a living will could stipulate that no cardiovascular pulmonary resuscitation (CPR) be performed for chronic progressive conditions. Once the conversation among family members has occurred, it is important to follow through and have the appropriate documents drafted, signed and filed. The National Hospice and Palliative Care Organization (NHPCO) can provide additional information on end of life planning (www.NHPCO.org).

Another organization, SAGE, focuses on issue in aging specific to the LGBT community (www.sageusa.org). SAGE is the oldest and largest organization in the U.S. whose goal is to improve the quality of life of older LGBT persons. SAGE seeks to further a greater understanding of aging and to promote positive images of LGBT persons later in life.

Although planning for the end of life is important for all people it is especially important for LGBTQ people. A thoughtful conversation with loved ones before a health care crisis that results in a proactive plan may improve the quality of life as one ages.

Reitz is an associate professor at Illinois State University Mennonite College of Nursing and a registered nurse at OSF HealthCare St. Joseph Medical Center. She is a member of Prairie Pride Coalition, Inc., whose mission is to build a more welcoming, inclusive community for LGBTQI+ people.

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