Making Strides in LGBT Patient-Centered Care

By Kait Scalisi, MPH

A new report from the Human Rights Campaign (HRC) highlights the huge strides healthcare facilities have made in LGBT patient-centered care while also showing the need for more inclusive policies and practices and increased staff training. The report, called the Healthcare Equality Index (HEI), rates facilities on how they treat LGBT individuals, commends hospitals that show commitment to LGBT patient-centered care, and provide resources and information to facilities looking to become more equitable and inclusive. In their words:

[…] the HEI offers healthcare facilities unique and powerful resources for providing a long overlooked group of patients the care that everyone deserves — while also complying with new regulatory requirements and gaining access to high-quality staff training.

The ratings are based on four core criteria. These include:

A patient non-discrimination policy that includes sexual orientation and gender identity and is communicated in at least two accessible ways.
Visitation policies that are equal for LGBT patients and visitor snad are communicated in at least two accessible ways.
An employment non-discrimination policy that follows the guidelines for patients.
Training in LGBT patient-centered care.

“Accessible” forms of communication include being posted on the facility’s website, in materials given to the patient at registration or other times, posted in the waiting room or in materials located there.

This year, there were 31 other questions that participating facilities answered. These “additional best practices” further gauged facilities’ engagement and interest in recommendations for optimal care. Questions were asked about facilities’ current and planned non-clinical plans in these areas.

2014 was the largest HEI ever, including data from over 1,500 healthcare facilities. Of these, about one-third (500) actively participated by responding to the HRC’s request for information and answering questions in the aforementioned 35 areas. This number is nearly double the response received in 2013, showing a huge growth in facilities’ commitment to meeting the unique needs of LGBT individuals. Information from the remaining 1,000 facilities was gotten either through researching hospital policy or reviewing results from the 2012 and 2013 HEI.

Unsurprisingly, actively participating facilities were more likely to meet each of the core criteria, with 84% meeting all of them and earning the status of “2014 leader in LGBT healthcare equality.” All but two states, Idaho and North Dakota, had at least one “equality leader.” Additionally, 10,000 hospital and clinic staff received training in at least one aspect of LGBT health. Alongside the official news that the federal government will recognize same-sex marriage in seven new states, this data shows that the US is becoming increasingly inclusive of and, hopefully, compassionate towards LGBT individuals.

Among the hospitals that did not respond, 86% had an equal visitation policy. This likely is due to the fact that such policies are now required by Medicare/Medicaid; therefore, not having such a policy violates federal standards. More facilities included only sexual orientation in their non-discrimination policy than both that and gender-identity. This fact encapsulates the increased acceptance of same-sex partnerships as well as the work that still needs to be done to include trans* individuals. Generally speaking, the HEI provides a fairly accurate snapshot of national attitudes towards these groups. In recent years, there have been huge improvements in inclusion of LGB individuals and now the focus is rightfully shifting towards trans* people who remain more marginalized. Though these statistics are no ideal, they show drastic improvement from even two years ago and give hope that in another two years, the majority of healthcare facilities in the US will fully comply with all best practices for LGBT patient-centered care.

The results from facilities’ responses to “additional best practices” they currently or plan to enforce most clearly reflect this. Specifically, substantial improvements were noted in the following areas:

Providing transgender-focused training to employees
Recording domestic partnerships
Providing training to remind employees that LGBT-status is confidential
Providing healthcare benefits to same-sex partners of employees
Having at least one health insurance plan covering medically necessary services to transgender employees

The HEI also profiles several leaders who represent the very best of LGBT patient-centered care. Lastly, they provide four recommendations for hospitals who did not achieve Leader status this year. These recommendations include updating non-discrimination and visitation policies to cover both sexual orientation and gender identity and communicate these inclusive policies on the facility’s website alongside Patient Bill of Rights, visiting hours, and on the career page.

This report tells us both that huge strides are being made within healthcare and that there is still more work to be done. The nearly two-fold increase in the number of hospitals who willingly participated, the large number of staff who received training, and the hundreds of facilities designated as leaders offer an inspiring look at the future of LGBT patient-care.