a VA Boston Healthcare System , Boston , MA.
b Harvard Medical School, Department of Psychiatry , Cambridge , MA.
Clin Gerontol. 2019 Mar-Apr;42(2):204-211. doi: 10.1080/07317115.2018.1504848. Epub 2018 Aug 1.
The Department of Veterans Affairs (VA) is likely the largest provider of health care for LGBT persons in US. However, histories of homophobia, stigma, discrimination, and past military policies have all had a lasting impact on the health of LGBT veterans. Effects can be seen across healthcare needs, disparities, access, and utilization for or by LGBT veterans. A case from a VA hospice unit is used to illustrate some challenges and opportunities when providing end-of-life care for an older, lesbian veteran. This veteran had been cared for by her wife who was struggling to meet care needs at home. Over time, it became clear that the wife was emotionally and financially dependent on the veteran, and would be facing many psychosocial and financial challenges when the veteran died. However the wife was reticent to accept referrals for help or services due to past negative experiences with social service agencies related to her sexual orientation. The interdisciplinary team collaborated to care for the veteran's medical needs, and the wife's emotional and psychosocial needs, until after the veteran's death. This case highlights many of the unique needs and challenges that may arise in caring for LGBT veterans and their families at end-of-life.
美国退伍军人事务部（VA）可能是 LGBT 人群的最大医疗保健提供者。然而，同性恋恐惧症、污名化、歧视以及过去的军事政策都对 LGBT 退伍军人的健康产生了持久的影响。这些影响可以在 LGBT 退伍军人的医疗保健需求、差异、获取和利用方面看到。本文从退伍军人事务部的临终关怀病房选取了一个案例，说明了在为年长的女同性恋退伍军人提供临终关怀时所面临的一些挑战和机遇。这位退伍军人由她的妻子照顾，后者在家中努力满足她的护理需求。随着时间的推移，很明显，妻子在情感和经济上都依赖这位退伍军人，而当这位退伍军人去世后，她将面临许多心理社会和经济方面的挑战。然而，妻子由于过去与她的性取向有关的社会服务机构的负面经历而不愿接受帮助或服务的转介。多学科团队合作，满足退伍军人的医疗需求以及妻子的情感和心理社会需求，直到退伍军人去世。这个案例突出了在临终关怀时照顾 LGBT 退伍军人及其家属可能出现的许多独特需求和挑战。
