"Fear Runs Deep:" The Anticipated Needs of LGBT Older Adults in Long-Term Care.

OBJECTIVES: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults' anticipated needs and fears related to nursing homes and assisted living. METHODS: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. RESULTS: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. DISCUSSION: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.

Social Network and Nutritional Value of Congregate Meal Programs: Differences by Sexual Orientation.

This study explored the associations between sexual orientation and the perceived social network and nutritional value of congregate meal programs (CMPs) in Massachusetts (N = 289). Descriptives, t tests, and chi-square tests analyzed sexual orientation differences. Linear regression tested the effects of sexual orientation on the value of CMPs. Sexual minorities (SMs) were more likely to have non-kin-based social networks and reported higher levels of loneliness compared with heterosexuals. Heterosexuals, fewer of whom have non-kin-based networks, place a stronger value on access to a social network via CMPs. Nutritional value is important for people of all sexual orientations. SMs traveled seven times the distance to attend CMPs, highlighting the need for greater access to such sites. Results of this study support the specification of SMs as a population of "greatest social need" under the Older Americans Act and the expansion of services that are tailored for their social support needs.

Patient-Physician End-of-Life Discussions in the Routine Care of Medicare Beneficiaries.

OBJECTIVE: Medicare reimbursement for physicians who discussed end-of-life care and planning with a patient during an office visit was cut from the 2010 Affordable Care Act. We assessed the characteristics of patients who reported having had such discussions, and whether these discussions are associated with trust in one's physicians and with rates of family advance care planning (FACP). METHOD: The sample consisted of 5,199 Medicare beneficiaries who reported having an ongoing relationship with a primary care physician. We estimated ordinal and multinomial logistic regressions that controlled for health care utilization, current health, and recent family deaths. RESULTS: Less than 1% (n = 310) reported an end-of-life conversation with a physician during the course of routine care. However, conversations were associated with greater trust in one's physician and higher rates of completion of FACP. DISCUSSION: Findings support renewed efforts to reimburse physicians for discussing end of life with their Medicare patients.