Physicians: Don’t Ignore Sexuality in Your Dying Patients

By Pebble Kranz, MD

I have a long history of being interested in conversations that others avoid. In medical school, I felt that we didn’t talk enough about death, so I organized a lecture series on end-of-life care for my fellow students. Now, as a sexual medicine specialist, I have other conversations from which many medical providers shy away. So, buckle up! Here’s a topic that rarely emerges in medical care: sexuality at the end of life.

A key question in palliative care is: How do you want to live the life you have left? Where does the wide range of human pleasures fit in? In her book The Pleasure Zone, sex therapist Stella Resnick describes eight kinds of pleasure:

  • pain relief
  • play, humor, movement, and sound
  • mental
  • emotional
  • sensual
  • spiritual
  • primal (just being)
  • sexual

At the end of life, both medically and culturally, we pay attention to many of these pleasures. But sexuality often is ignored.

Sexuality — which can be defined as the experience of oneself as a sexual being — may include how sex is experienced in relationships or with oneself, sexual orientation, body image, gender expression and identity, as well as sexual satisfaction and pleasure. People may have different priorities at different times regarding their sexuality; but sexuality is a key aspect of feeling fully alive and human across the lifespan. At the end of life, sexuality, sexual expression, and physical connection may play even more important roles than previously.

“I just want to be able to have sex with my husband again.”

Z was a 75-year-old woman who came to me for help with vaginal stenosis. Her cancer treatments were not going well. I asked her one of my typical questions: “What does sex mean to you?”

Sexual pleasure was “glue” — a critical way for her to connect with her sense of self and with her husband, a man of few words. She described transcendent experiences with partnered sex during her life. Finally, she explained, she was saddened by the idea of not experiencing that again before she died.

As medical providers, we don’t all need to be sex experts, but our patients should be able to have open and shame-free conversations with us about these issues at all stages of life. Up to 86% of palliative care patients want the chance to discuss their sexual concerns with a skilled clinician, and many consider this issue important to their psychological well-being. And yet, 91% reported that sexuality had not been addressed in their care.

In a Canadian study of 10 palliative care patients (and their partners), all but one felt that their medical providers should initiate conversations about sexuality and the effect of illness on sexual experience. They felt that this communication should be an integral component of care. The one person who disagreed said it was appropriate for clinicians to ask patients whether they wanted to talk about sexuality.

Complete Article HERE!

How Hospices Can Improve Health Equity for Rural-Based LGBTQ+ Seniors

By Holly Vossel

Aging LGBTQ+ populations have few options for quality end-of-life care – particularly those in rural areas – and hospices are ramping up efforts to reach them.

Access to hospice can be challenging for many seniors in remote or rural regions. Terminally ill seniors in these locales often experience higher levels of loneliness and isolation at the end-of-life due to a lack of nearby hospices or support from family caregivers.

This isolation can be compounded for LGBTQ+ seniors with terminal and serious illnesses, according to Dr. Jennifer Ritzau, vice president of medical staff services at HopeHealth, a Rhode Island-based hospice, palliative and home care provider. She also serves as medical director of palliative care at the nonprofit organization.

“I think one of the things that feels like the tip of the iceberg for my team is loneliness and hopelessness,” Ritzau told Hospice News during the Palliative Care Executive Webinar Series. “I think increasingly in our world, sadly, many rural people are alone. I think especially LGBTQ+ elders end up alone. There are lots of places where we see that words and actions fail in being loving and supportive in that part of their life.”

LGBTQ+ communities have historically faced discrimination across the care continuum, leading to fear and mistrust that complicate their ability to access hospice and palliative care professionals, Ritzau indicated. These issues can be even more challenging for LGBTQ+ seniors than other social determinants of health such as socio-economic status, she said.

“There are resources for some other [social determinants], but when someone really has nobody that is a harder one to solve sometimes. You and your team can’t be there for them 24/7,” Ritzau said. “It is really hard [for clinicians] to walk out of that house, close the door and know that nobody’s coming back until you do later.”

The dangers of isolation

Roughly 3 million LGBTQ+ adults live in rural areas across the United States, representing nearly 20% of the nation’s overall population of this community, according to a study from the Movement Advancement Project.

Though more hospices are trying to improve access to end-of-life care among underserved communities, more work is needed to ensure LGBTQ+ seniors have quality experiences, according to Dr. Michael Barnett, hospice and palliative physician at Four Seasons. The North Carolina-based organization provides adult and pediatric hospice and palliative care across three counties in western regions of the state.

Hospices stand to improve upon their recognition and understanding of what the LGBTQ+ rural community looks like and what challenges they often have as they age, Barnett indicated.

In addition to having smaller social circles of family and friend caretakers, LGBTQ+ individuals in rural areas can also have fewer hospice providers available in their geographic regions, he said. These isolation issues are layered by the practical challenges of rural living that can create barriers to end-of-life care such as spotty internet and phone connectivity, Barnett stated.

“As seriously ill LGBTQ+ adults get sicker, they’re increasingly isolated from an outside world that gets much smaller as they’re able to do less,” Barnett told Hospice News. “And that’s even harder for rural areas where patients can sometimes have little to no cellphone coverage or internet access. They’re disconnected socially, physically and distanced from medical support structures.”

As seriously ill LGBTQ+ adults get sicker, they’re increasingly isolated from an outside world that gets much smaller as they’re able to do less. And that’s even harder for rural areas where patients can sometimes have little to no cellphone coverage or internet access. They’re disconnected socially, physically and distanced from medical support structures.
– Dr. Michael Barnett, hospice and palliative physician, Four Seasons

Though telehealth can be a window into the worlds of rural-based hospice patients, it can also represent a barrier for LGBTQ+ individuals who may lack connectivity, as well as the trust to confide in health professionals, Barnett added.

“We’ve come to rely on technology for support, but that’s a real issue for LGBTQ+ seniors who are already experiencing technical challenges, let alone trust factors and isolation,” he said. “It’s looking at the real issues of this broader community in a whole different context.”

Gender-affirming hospice care hard to find

Not only are hospices in rural regions often stretched thin in terms of available clinical resources, they can also face regulatory challenges around providing gender-affirming training for staff. Evolving state laws represent a key challenge in striving toward more gender-affirming hospice care.

Some states have recently passed legislation banning the delivery of gender-affirming care including Idaho, Indiana, Mississippi and Tennessee, among others

About 574 bills have been introduced thus far in 2023 across 49 states nationwide that include legislation related to transgender rights, according to the Trans Legislation Tracker. Around 83 of these laws have passed, 366 are actively in consideration and 125 were blocked, the data showed.

Many of the states with some form of these laws in place have large rural regions with several pockets of seniors, including LGBTQ+ communities that may be less than well-known among providers due to fear of discrimination, according to Barnett.

“It’s still fairly common to hear hospices say, ‘I don’t really have many gay or transgender patients in my community,’” Barnett said. “The truth is, you do, and many of these aging LGBTQ+ adults have never had affirming health care providers. They come from generations where gay activity was criminal or treated as a pathologic mental illness. So to suddenly expect them to be open and create that safe space of respect, quality and a good death is a big challenge, especially in rural regions where they’ve often been mistreated by bias in their own communities.”

Despite regulations within their geographic service regions, hospices must recognize the importance of ensuring that staff at all levels are trained and educated in gender-affirming care, along with the leading reasons behind disparities among LGBTQ+ communities, according to Kimberly Acquaviva, social worker and professor at the University of Virginia’s School of Nursing.

Having interdisciplinary teams that are trained in gender-affirming health care delivery practices is a crucial part of breaking down barriers among underserved LGBTQ+ seniors, Acquaviva said. This type of training is a large responsibility for leaders to instill in their code of ethics and training policies to avoid discriminatory practices, she stated.

“They absolutely have to bring attention to human rights violations,” Acquaviva said during a recent American Academy of Hospice and Palliative Medicine webinar. “Nurses have a right to speak out. Social workers also have an obligation to engage in advocacy [and] should engage in political and social action that seeks to ensure all people have equal access to resources, services and opportunities they require to meet their basic human needs. Chaplains [and] spiritual care professionals are accountable to the public faith community, employers and professionals [and] must promote justice in relationship with others in their institutions and in society.”

How to improve

Hospices seeking to address this issue need to provide employee training that has “hard empathy pieces” woven throughout, according to Barnett.

Important training elements include teaching staff about the intersectionality of community structures and social determinants that add to layers of stress, discrimination and health inequities around sexuality, gender and class, he said. This allows staff to see how these factors “stack on top of one another” in the dying process for LGBTQ+ seniors, Barnett stated.

Hospices can also instill clear nondiscrimination policies and ensure staff understand how these apply to their roles, he said. Having a staff that includes representatives of the LGBTQ+ community can also improve reach among this group through trust building and understanding, Barnett stated.

“It’s about being thoughtful of how we train on these practical and discriminatory issues. It’s also being thoughtful about hiring LGBTQ+ staff,” Barnett told Hospice News. “Seeing someone in their care team that represent themselves in some way allows them to have the language and comfort level. These things will go a long way in responding and speaking to the suffering at the end of life.”

Hospices that invest in gender-affirming care delivery improvement stand to gain in terms of improved quality, reach and utilization of their services among LGBTQ+ seniors, according to Ben Marcantonio, COO and interim CEO for the National Hospice and Palliative Care Organization (NHPCO).

Focusing on these and other underserved populations can be part of how hospices shape their strategic growth plans, Marcantio said. Hospices that actively focus on quality measures aimed at reducing health inequities have demonstrated improved outcomes among these communities, he indicated.

“The key areas of focus right now in progressing those measures towards improved goals of serving underserved communities that hospices are doing is reflected in both their strategic plan and direction, the implementation and the execution of those,” Marcantio told Hospice News. “That’s where a lot of this work gets done where there’s evidence that organizations are committed to and carrying out those should be noted. It’s having measurable outcomes demonstrating that there is an increased impact in the community in the percentage of, for example, Latino, African American or LGBTQ+ community members now being served in relation to their presence in the population of that given region or or community.”

Complete Article HERE!

A Compassionate Journey

— Advocates for Inclusive End-of-Life Options

Compassion & Choices

By Jen Peeples

The journey towards the end of life is an inevitable part of our human experience. However, the circumstances surrounding this transition can be far from equal, particularly for marginalized communities. We had the opportunity to meet with Meagan Williams, a member of the Communications Team for many national campaigns, including in Minnesota. She connected us to the exploration of tireless efforts of organizations like Compassion & Choices, that are dedicated to advocating for expanded end-of-life options through education, outreach, and legislative change.

Williams expressed that their work serves as a beacon of hope for those directly affected by inequities from the system, while also striving to grant patients who request medical in aid death a greater autonomy and respect during their final moments.

Compassion & Choices is a prominent advocate in this space. They are relentlessly working to shed light on disparities in end-of-life care. Understanding that the path towards a compassionate and inclusive approach to end-of-life decisions begins with education and awareness. Through their outreach efforts, they aim to empower individuals and communities-especially those from marginalized backgrounds, by providing information and resources needed to make informed choices. We had the opportunity to sit-down with 4 amazing advocates of Compassion & Care. Their work is an expression of their passion. One to be known today and remembered tomorrow:

Osha Towers (they/them), a key figure in the LGBTQ+ Leadership Council, shared firsthand the shortcomings in LGBTQ+ end-of-life care during the trying times of the COVID-19 pandemic in 2020. Towers emphasized that there is deep discrimination that often arises from a profound lack of understanding and empathy– leading to distressing challenges such as misgendering, legal vulnerabilities, and the denial of chosen families.

When asked the purpose of their passion in this field, they shared, “I lost many loved ones throughout my community. Working within Black and brown LGBTQ+ healthcare– Yet advocacy work within end-of-life care specifically rose for me within the LGBTQ+ community when my coworker lost their long-time partner. Although this was someone, they had spent years caring for, their partner’s family did not honor their relationship or the queer life this person lived. So, they swooped in, took over, booted any level of queer community from the process, and buried them outside of reflecting on their whole identity.”

The fire behind the Council’s mission centers on priorities like inclusion by meeting the unique needs of LGBTQ+ individuals while driving institutional change. By engaging with diverse LGBTQ+ groups across the nation, Towers has developed a shared understanding of the importance of medical aid in dying, shaped by the community’s collective losses during the AIDS epidemic.

Now, the medical in aid dying has not always been accepted or approved by certain communities. However, a different intention and meaning was brought the platform by Dr. Joanne Roberts, a terminally ill physician, also initially held reservations about medical aid in dying laws. However, her personal journey and convictions have led her to recognize that such legislation can provide relief and rested assurance to suffering patients.

Dr. Roberts has a compelling mission to humanize this issue through the power of storytelling, emphasizing that death transcends political divides and dispels concerns about the misuse of aid-in-dying by citing data from states with extensive experience in its implementation. To hesitant lawmakers, Dr. Roberts gently reminds them that this is an individual choice, and no clinician should feel compelled to participate if it violates their moral principles.

Along with Dr. Roberts fight to appeal to legislation, Dr. Rebecca Thoman oversees legislative advocacy for Compassion & Choices in Minnesota and has been tirelessly working to advance the proposed End-of-Life Options Act. Though it faced setbacks in 2022, Dr. Thoman remains hopeful that it could see action in 2024.

Recognizing the importance of countering misinformation and creating a sense of urgency around the topic of death through peer testimonies, Dr. Thoman faithfully educates and leads other physicians on the infrequent use and strict oversight of aid-in-dying. This is all while respecting individual doctors’ moral right to opt out. Dr. Thoman understands that for lawmakers, bridging the gap between hypothetical concerns, the realities of clinical practice, and personal stories are keys to garnering their unrelentless support. If the legislation passes, Dr. Thoman believes it will bring solace through expanded end-of-life options for countless diverse individuals.

While also on the legislature end, we have attorney Phil Duran. Duran is known for his advocacy in LGBTQ+ rights in the approaches of medical aid in dying work with a unique perspective. He understands that arranging the plans one’s medical aid in death can offer a sense of peace; a sentiment shared by same-sex couples who were once denied the right to marry.

Through his work with Rainbow Health, Duran is actively expanding culturally competent care access for LGBTQ+ and aging communities through provider education and patient empowerment. He acknowledges that privilege often plays a role in determining the level of agency one has in making end-of-life decisions. Duran believes that by countering religious opposition and amplifying diverse stories, we can broaden the movement for compassionate end-of-life options.

While each advocate featured in this article brings their own expertise and experiences to the table, there are common threads that unite them in their pursuit of a more compassionate and equitable approach to end-of-life choices. Education, empowerment, and equity are at the heart of their endeavors. Despite their diverse backgrounds, they all share a profound understanding of the value of having options and autonomy when it comes to one’s own passing. Through their steadfast commitment to amplifying diverse voices and stories, driving policy changes, and expanding societal mindsets – these advocates serve as inspiring examples of the passion that fuels a movement toward greater compassion and care at life’s transitioning end.

Complete Article HERE!

How to know when you’re ready to date again after the death of a partner

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  • If you’re mourning the recent death of a spouse, the idea of dating again may seem impossible.
  • But moving forward is an important part of grieving, and dating doesn’t mean you’ve forgotten your late spouse, experts say.
  • Crying a lot and wanting to share stories of your spouse are signs you’re ready to date again.

When Mr. Big died in the first episode of “Sex and the City” spinoff “And Just Like That…” Carrie Bradshaw was unsure she’d ever date again.

But as her newly single era unfolds, Carrie finds herself dating, kissing, and sleeping with a string of eligible bachelors who are in their fifties. Throughout it all, Carrie is shown mourning Mr. Big, crying over a photograph of him, making the painful decision to sell the apartment they shared, and wearing Big’s suit jackets as part of her outfits.

Carrie first feels overwhelmed while mourning Big, but as time passes, she regains sight of the life she has ahead of her.

When someone transitions from feelings of intense pain to smaller moments of grief that are mixed in with new experiences, it suggests they’re healing from their loss, Marilyn A. Mendoza, a psychologist who specializes in bereavement wrote for Psychology Today.

“If and when you decide to start dating again, you need to understand that it is possible to be happy in a new relationship even though you are still having thoughts and feelings for your deceased spouse,” Mendoza wrote.

There’s no right or wrong time to start dating again after the death of a spouse, since everyone mourns such a massive loss on their own time, Mendoza said. But there are milestones you can look out for that signal you’re ready for a new romance.

“Try to find meaning in your life and [think about] how you can continue to find meaning while carrying on their legacy here,” Jonathan Singer, a grief specialist at Texas Tech University, told Insider.

You’ve cried a lot or spent days in bed

In order to mourn a life-changing loss like the death of a spouse, you have to allow yourself to feel emotions like sadness, despair, anger, and hopelessness, licensed social worker and therapist Shahem McLaurin previously told Insider.

It can feel overwhelming or impossible to recover in the moment, but crying your eyes out or spending a full day in bed enveloped in sadness are common ways to move through intense grief, even if it feels like the last thing you want to do in the moment. In fact, Sarah Chaves, who lost her father in 2007, wrote that screaming out her intense emotional pain helped her move forward.

As time passes, those feelings should be less acute, allowing you to enjoy parts of life outside of your marriage. But if they don’t dissipate within a year’s time, it could mean you have prolonged grief disorder and should speak with a mental health professional.

“You’ve got to go through rage, but don’t get stuck in it,” Edith Eger, a therapist and Holocaust survivor, previously told Insider.

You want to share stories about your spouse

If you’re dating after the death of your spouse, you’re bound to have sweet or silly memories pop into your head from time to time.

If you get the urge to share one of those stories out loud with a friend or even a date, you should, as it’s an empowering way to dually honor their memory and your strength, Megan Devine, a psychotherapist and grief advocate, previously told Insider.

You still feel grief, but it comes in waves

According to Eger, prioritizing your needs is another sign you’re mourning in a healthy way that’s conducive to dating.

Part of that is realizing you deserve to feel love and support from a romantic partner again, if that’s something you desire. And that desire doesn’t detract from the love you had, and still have, for your late spouse.

When you live by that idea, allowing yourself to have new experiences without your spouse, the grief will no longer feel all-consuming, according to Jacobsen.

Complete Article HERE!

‘A delicious distraction’

— The truth about sex and dating after your partner dies

Nicky says Andy was the ‘John to her Yoko’

By

‘On our first date he told me the songs he wanted played at his funeral – I just didn’t know that I’d be playing them as soon as I did,’ says Nicky Wake.

The 51-year-old met her late husband, Andy, online in 2002, before their ‘fabulous first date together’ at a bar in Manchester.

Soon, wedding bells chimed, and the pair welcomed their ‘beautiful baby boy’ Finn, now 15, in 2007.

Speaking to Metro.co.uk, Nicky says: ‘Andy was the John to my Yoko. We were just destined to be together, and he got me like no one else did.

‘He was the introvert to my extrovert, we complimented each other beautifully.’

Tragically, in July 2017, when Nicky was 49, and Finn was barely 10-years-old, she began what she describes as her ‘widow journey’.

Nicky and Andy in April 2017, four months before Andy suffered his heart attack
Nicky and Andy in April 2017, four months before Andy suffered his heart attack

Andy suffered a heart attack, leaving Nicky with no option but to perform CPR for 40 minutes while she waited for the paramedics. Andy survived but suffered a catastrophic brain injury.

‘My late husband, my soulmate…ended up in a care home being looked after 24/7 with little or no quality of life,’ Nicky says.

‘So I spent a few years in what they call “anticipatory grief,”‘ says Nicky, who discusses this in more detail in this week’s Mentally Yours podcast episode.

‘His doctors told me there wasn’t going to be a happy ending, that I just needed to try and navigate a way forward. Eventually we lost him to Covid in 2020.’

Three months prior to Andy’s heart attack, in April 2017, the married couple had had a poignant conversation.

‘He said “if anything ever happens to me you have to promise me that you will move forward”, and I said “absolutely, the same applies to you”,’ Nicky says.

Nicky and Andy in Australia
Nicky and Andy making memories on holiday in Australia

So, twelve months after Andy passed away, Nicky ventured back into the world of dating.

‘I knew at 49 that I was too young to sit in black and wait at home and mourn the loss of my husband,’ says Nicky.

‘And he would have wanted me to find a way forward, I know he would.’

Nicky downloaded Tinder, Hinge and Bumble, saying she ‘knew that it worked, it certainly worked for me last time’.

Online dating…it’s full of dick pics and being ghosted

‘But oh my goodness online dating has moved on so much in 20 years,’ she says. ‘It’s full of dick pics and being ghosted, none of that happened back then.’

Nicky’s says her first date after Andy died, ‘wasn’t the best first date’.

She says: ‘I felt nervous, totally terrified at the prospect. If you’ve slept with the same person for 20 years, you’re so incredibly comfortable, and Andy was my soulmate.

‘If he wasn’t dead already, I could have bloody killed him for making me part of this dating world that I never wanted to be back in.’

The facts: experimenting sexually after being widowed

Three in five people said they are more experimental in the bedroom since the death of their partner.

Over half of widows and widowers have found a new kink or fetish.

About 52% either have, or have considered experimenting with a gender different to their deceased spouse.

Of those surveyed 57% said they have a higher sex drive than before
About 53% said they are more open to exploring sexual relationships with younger partners.

More than half say they are more open to exploring sexual relationships with older partners.

Over two-thirds (67%) are now more confident in the bedroom and 56% said they enjoy sex more now than before their partner died.

About 48% of widows and widowers have more sex now than with their late partners.

Nicky also says she experienced ‘widow’s fire’ – an uncontrollable and all-consuming desire for sex following bereavement, which is regularly talked about in widow Facebook groups and forums.

Nicky says: ‘Widow’s fire is a very real thing. I met someone that scratched an itch and that’s sometimes what you need.

‘That first time you kiss somebody is weird. If you’ve only kissed the same person for 20 years then that’s a real thing, but you ache for physical comfort.

‘If you’re used to sharing a bed with someone for 20 years and that person is gone, it’s a physical pain almost.

‘I had a fling with someone who was entirely inappropriate in terms of a long term relationship.

‘He was a delicious distraction from the pain and grief that I was feeling, and will always feel probably.

‘But did it have any future? No, absolutely not. Was I going to take him as my plus one to various things? No. But he was a lot of fun.’

After suffering from online dating burnout, Nicky had ‘a lightbulb moment’ at a Widowed and Young charity get together. She decided to set up a dating app exclusively for those who have lost partners, called Chapter 2.

Those joining the app have to prove they have lost a partner by providing a death certificate, or a link to a memorial page.

Nicky and Andy had a conversation about moving on if the other passed away there in Australia
Nicky and Andy had a conversation about moving on if the other passed away

Nicky explains that the app is so important, because widows and widowers are uniquely placed to understand each other.

She says: ‘It’s so hard for anyone who hasn’t lost a partner to date someone who has.

‘For example, my house is full of photographs of my husband and my heart is full of our memories and I need someone to respect that if they are going to date me,’ she adds.

Widows and widowers also understand the outside influence of loved ones, saying, ‘they wrestle with it in terms of approval by friends and family’.

She points out: ‘I was very nervous about telling my mother-in-law that I was dating again, but she was wonderfully supportive.

‘She had also been widowed many years ago and she said “you’re too young to spend the rest of your life on your own”.

My house is full of photographs of my husband and my heart is full of memories – my date needs to respect that

In a new study by Chapter 2, which surveyed 500 widows, about 58% of widowers begin feeling sexual urges within six months of their partner’s death.

However, when it comes to actually having sexual relations with someone new again, the average widow waits one year, three months and two weeks to lose their ‘widow virginity’.

Those aged between 18 to 30 wait the shortest time – an average of nine months, two weeks and four days.

Nicky and Andy have a 15-year-old son together
Nicky and Andy have a 15-year-old son together

For now, Nicky is still on the dating scene.

She adds: ‘I am always a glass of rioja full kind of girl. I’ve tried to get positivity out of tragedy.

‘I often say if I can help some people find some joy that helps me make sense of my loss.

‘It’s not the big things that you miss. It’s the little things. It’s having someone to come back home to. To talk about your day with. Dating is hard work.

The facts: Orgasms and masturbation in widowhood

One in five widows and widowers said that they have more frequent orgasms with their new partner(s), and another one in five (19%) said they have better orgasms.

Regarding self-pleasure, 30% of widows and widowers said they began masturbating more than before their partner died.

Almost half (47%) said they bought their first-ever sex toy for masturbation, and 41% began watching porn for the first time during masturbation.

‘But I’m ever the optimist and think that hopefully, if I kiss enough frogs, I will find my prince.’

Nicky is soon to be launching a sister-app to Chapter 2 in June 2023 called WidowsFire. The app is ‘all about the physical’, for those seeking a fun and flirty place to explore natural urges.

Nicky sat on a bench dedicated to her late husband Andy
Nicky has a bench dedicated to her late husband Andy

Nicky explains that people think the sex lives of widows ‘must be really depressing’ but actually says that non-widows, whom she and her widowed friends refer to as ‘muggles’, aren’t ‘blessed with the same magical powers that we are’.

She says: ‘You think that widows spend their lives crying into their gin, but actually widows know to live for the moment.

‘They’ve seen someone they love die in front of them. If that doesn’t give you a wake up call to live in the moment and breathe every second of every day and love your life, then what will?’

Complete Article HERE!

How Gender-Affirming Care Bans Could Impact Hospice Access, Utilization

By Holly Vossel

Hospice providers are growing increasingly concerned about how state laws related to transgender rights may impede access to their services among LGBTQ+ communities.

A rash of states have recently passed legislation to ban the delivery of gender-affirming health care, including Idaho, Indiana, Mississippi and Tennessee, among others.

What’s happening in these states has caused mounting concern around access to quality hospice care for LGBTQ+ individuals, according to Kimberly Acquaviva, social worker and professor at the University of Virginia’s School of Nursing.

“It’s not difficult to imagine that transgender individuals living in those states may be hesitant to seek hospice care,” told Hospice News in an email. “If they receive hospice services in an inpatient facility like a hospice house, will they be addressed by their name and supported in their efforts to dress and groom themselves in a manner that affirms their gender 100% of the time? I’m not confident the answer to either question would be ‘yes.’”

Currently, 19 states in the United States have enacted bans or restrictions on the delivery of transgender health care, according to a recent report from The British Medical Journal (BMJ). Out of these states, 10 have already enacted such laws. Other states have similar laws that will take effect beginning July 1, in October or in January 2024, the BMJ report indicated.

Approximately 560 bills have been introduced thus far in 2023 across 49 states nationwide that include legislation related to transgender rights, according to the most recent data from the Trans Legislation Tracker. Around 83 of these laws have passed, 364 are actively in consideration and 113 were blocked, the data showed.

This compared to 26 bills out of 174 pieces of proposed legislation that passed the prior year, or roughly 15% of those proposed in 2022, the Trans Legislation Tracker reflected.

The volume of legislation that has been mulled or passed limiting transgender rights has been “disheartening” and makes it difficult for hospice providers to improve access and address quality, according to Dr. Noelle Marie Javier, internist at Mount Sinai Health System.

“There are roughly 29 states that do not have anti-discrimination protections in place for the LGBTQIA+ community,” Javier said during a recent American Academy of Hospice and Palliative Medicine webinar. “This number has grown tremendously and exponentially. At the end of the day, the LGBTQIA+ community simply wants to be accepted, supported, respected and treated humanely across the board. We are still dealing with the very same issues that our predecessors have long fought.”

The risks for transgender individuals in violation of current state laws has created health care access barriers for many in the LGBTQ+ community, according to Acquaviva.

“Hospice and palliative care professionals have an obligation to ensure transgender individuals have access to care and are treated with dignity and respect,” Acquaviva said. “If laws at the state level impede access and care delivery that aligns with those obligations, hospice and palliative care professionals need to speak up, speak out, and advocate for changes to the laws.”

Complete Article HERE!

‘I thought sex would be like medicine if I got my hands on it’

— Meet the widows (and widowers) craving human touch

After the death of a partner, widows and widowers often face judgment when they’re ready to have sex again. Widow’s Fire, a new online community, is trying to help.

By Christine Sismondo

When Lori* started dating less than a year after her husband suddenly died, she knew some people would judge her.

And they did.

She recalled the reactions: “Whoa, why isn’t she grieving longer? Did she even really love her husband?”

Lori didn’t allow the judgment to faze her. She filled out an online dating profile and started meeting men.

“I needed to be distracted,” she said. “I dated different guys, but I didn’t get serious about anyone and I wasn’t intimate with them. It was just really nice to have some touch, like holding hands — even having someone show me attention. I missed that.”

Julia*, the founder and host of Widow’s Fire, an online community for people who have lost their life partners, said that many of her members make similar comments about their motivation for joining the site for “heartbroken but hopeful” widows and widowers.

“A new member wrote me just this morning and said, ‘I miss the closeness of another body, not necessarily the sex act itself,’” said Julia.

She noted, though, that there are also plenty of Widow’s Fire members who joined the community because they simply miss sex.

Five years ago, when she was 31, Julia’s husband died. That’s when she first heard the term “widow’s fire,” which is defined by the community as “a burning desire for sex following bereavement of a spouse or partner.”

“When friends and family asked how I was doing, I would say ‘I’m OK’ or ‘I’m struggling,’ but what I was actually thinking most of the time was, ‘I miss sex,’ ‘I wish I could have sex’ or ‘When will someone ever touch me again?’” said Julia. “It was all-consuming. I thought sex would be like medicine if I could get my hands on it.”

Julia said there was a decent level of support for her as a grieving widow and a parent of a newborn, but there was a dearth of resources when it came to bereavement sex.

And, like Lori, she felt she was being judged for wanting it.

“I had someone say to me, ‘Don’t you want to wait a couple of years?’” she said. “And I thought, ‘How lovely for you to be able to sit there and say that to me and then go on with their day.’”

"The experience of grief is highly individual," said Dionne Gesink, a professor at U of T. For some people, bereavement has no effect on their sex drive; for others, it can decrease it. For others still, it will increase it, sometimes dramatically.
Dionne Gesink, a professor with the Dalla Lana School of Public Health at the University of Toronto, said the experience of grief is highly individual. For some people, bereavement has no effect on their sex drive; for others, it can decrease it. For others still, it will increase it, sometimes dramatically.

“Partly that’s because, with sex, you get an increased sense of power and control,” said Gesink, who also researches sexual health. “It’s a way to get back into your body and to get access to great hormones like endorphins, dopamine and oxytocin, which make you feel better, block pain, decrease stress and improve your mood.”

And, Gesink added, human connection can help you feel less disconnected, a common problem for people grieving a loss.

“Loneliness is kryptonite for the widowed in general because, not unlike teenagers and retirees, we need meaning and purpose to move forward,” said Andrew*, a 42-year-old father and widower in Toronto who joined the Widow’s Fire community two years ago.

He added, however, that his interactions with others he has met on social media and through Widow’s Fire have led him to believe that sex alone doesn’t bring most people much long-term relief.

“I find value in my faith and my child along with our family and friends,” he said.

That tracks with Gesink’s research on sexual health. Touch is essential for human existence, which is part of the reason the loss of an intimate partner can be so devastating. Sex can alleviate some of the suffering but, when it comes to healing, it can only get you so far.

That doesn’t mean that sex can’t play a role, of course. Some people have a harder time than others being alone, so everyone’s journey will be different. Gesink said it’s important that friends and family stay “flexible” in their thinking about moving on after bereavement.

“Anyone going through that kind of grief should just try to be kind to themselves and to give themselves permission to explore different ways of connecting to others,” said Gesink.

“You shouldn’t have to carry guilt around for that.”

*Last name withheld.

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