My name is Ellen Mitchell, MA, RN, CCM. I am a straight, cisgender female whose pronouns are she/her. I have over 30 years’ experience in nursing, with more than 25 of those spent in Case Management, in a variety of positions from staff to leadership.
There are many obstacles that the LGBTQ+ community face in our current healthcare system. In 2021, the National Institute of Health (NIH) stated, “Many populations in America, whether defined by race, ethnicity, immigrant status, disability, sex, gender, or geography, experience higher rates of certain diseases and more deaths and suffering from them compared with the general population. While the diversity of the American population is one of the nation’s greatest
assets, one of its greatest challenges is reducing the profound disparity in health status of its racial and ethnic minority, rural, low-income, and other underserved populations.” (NIH, 2021)
LGBTQ+ individuals encompass all races and ethnicities, religions, and social classes. Sexual orientation and gender identity questions are not asked on most national or state surveys, making it difficult to estimate the number of LGBTQ+ individuals and their health needs.
The Healthy People initiative of the US Department of Health and Human Services provides science-based objectives every 10 years, with the goal of improving the health of all Americans. Per Healthy People 2020, LGBTQ+ individuals face health disparities linked to discrimination and denial of their civil and human rights. Discrimination against LGBTQ+ persons has been associated with behavioral health disorders, including substance use disorders. Experiences of violence and victimization are frequent for LGBTQ+ individuals and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the physical health, the mental health and personal safety of these individuals. (HP 2020)
Based on this data, Healthy People 2020 identified LGBTQ+ persons as a U.S. national health priority (U.S. Department of Health and Human Services [HHS]), with the Institute of Medicine concluding that insufficient information exists on the health of LGBTQ+ people. (Emlet, 2016) Lesbian, gay, bisexual, and transgender people experience many specific health-related challenges and disparities. Healthy People 2030 focuses on collecting data on LGBTQ+ health issues and improving the health of LGBTQ+ adolescents in particular. Collecting population-level data is key to meeting the needs of LGBTQ+ people.
When I was in post-master’s grad work, I had a professor who always asked “so what” when presented with data. Now I pose the question to all of us… SO WHAT?
It is important that we as case managers understand the clients with whom we work. It is on us to learn, to understand the background of our clients, and we can do that by learning how history impacts healthcare.
Our consumers and clients need to understand that case managers work with them to make sure they receive the medical and, behavioral health care, and other community services they need. In other words, case management provides all the necessary resources - with the right care, at the right time, with the right provider, in the right care setting, and at the right cost.
Marginalization also has health impacts. It leads to a paucity of resources available to a population. When resources are few, poorer health outcomes are to be expected. This finding is supported in 2017 research by Fredriksen-Goldsen, et al. This is not new information as much has been written in both academic and popular sources on the impact of social determinants of health on population health, in access to care, and the availability of resources to promote and maintain health.
So how can case managers be allied in health care to patients who are part of the LGBTQ+ community? I believe it is a necessary challenge to look inside and acknowledge one’s own biases. More importantly, once acknowledged, don’t allow them to impact the care provided. Seek more learning on the topic, it goes a long way! Lifelong learning is key to successful case management practice. Through our dedication to lifelong learning, we need to recognize the issues, and in doing so, better facilitate the care of our clients and truly be an advocate. The resources are there, we just need to reach out to find them.
Remember! Client-centered care is intrinsic to the role of the case manager. Culturally competent care includes applying our knowledge of social, cultural and other factors that ultimately help us to work with our clients to achieve positive outcomes and promote a good client experience.
Emlet, C.A. 2016. Social, Economic, and Health Disparities Among LGBT Older Adults. Generations, 40,2. 16-22
Fredriksen-Goldsen KI, Kim HJ, Bryan AE, Shiu C, Emlet CA. The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults. Gerontologist. 2017 Feb;57(suppl 1):S72-S83. doi: 10.1093/geront/gnw170. PMID: 28087797; PMCID: PMC5241752.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241752/#:~:text=Marginali….
Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-…- and-transgender-health
Healthy People, 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/…