Four Conversations Caregivers Need to Have. Now.

April 2011

Do you know your loved one’s health care and financial wishes? Talk about it now, so you can protect those decisions.

All caregivers face the need to have difficult conversations with their loved ones about medical care, finances, and whether and how to receive care at home. As an LGBT caregiver, it’s especially important to talk about these issues. Not only should you know what your friend or loved one wants, but in many cases, you might have to take legal steps to protect his or her wishes.

Here are four conversations to have now with your friend or loved one:

Health and End-of-Life Care

Many heterosexual spouses take for granted that they will have access to each other’s hospital rooms and be in charge of each other’s medical and end-of-life decisions, should one spouse be incapacitated. Same-sex couples have no such assurance. Unless we put specific legal arrangements in place, most states give priority to heterosexual spouses and biological kin—rather than life partners and families of choice—for visitation and decision-making on health care, long-term care, and funeral plans.

Despite this, many LGBT older adults do not talk about these issues, or take steps to make the necessary legal arrangements, thinking, as many of us do, that there will be enough time later. However, if something happened to your loved one tomorrow, do you know what his or her wishes are when it comes to health care and end-of-life plans? And if so, would you have the legal authority to carry out those wishes?

Some questions to ask your loved one include:

  • Who do you want to make medical decisions for you should you become incapacitated?
  • What kind of treatment do you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious?
  • Where do you want to spend your last days?
  • What kind of funeral do you want?
  • Where do you want to be buried?
Use the answers to help your loved one put together advance directives, legal documents that explicitly describe his or her wishes for care, such as health care proxies or a living will. Read the article, Legal Documents Every LGBT Older Adult Needs for more information.


Talking about money is never easy, and deciding when to get involved in a friend or loved one’s finances can be tricky. However, your loved one still needs to pay bills, balance the checkbook, and pay taxes. If he or she is letting these tasks slide because of declining health or a cognitive impairment, it may be up to you to step in.

Some questions to ask your loved one include:

  • What are your current and future bills?
  • Do you have any bills you can’t pay?
  • Do you need help getting government or pension benefits?
  • Do you have a plan to pay for your current and future health care needs?
  • Is all of your financial information in one place?
Starting the conversation from here can help you create a plan to ensure that your loved one’s finances are in order.

LGBT older adults also have other financial matters to consider. If you or your partner have life insurance, retirement or pension plans, make sure you specify who should receive those benefits should you or your partner pass away. In addition, some state laws can shut LGBT partners out of an inheritance. Therefore it is important for you and your care recipient to have the appropriate legal documents, such as a will, in place to ensure that your loved one’s wishes regarding his or her estate are heeded. As with medical and end-of-life decisions, the sooner you have these documents in hand, the better. Review the article, Legal Documents Every LGBT Older Adult Needs for more information.

In-Home Care

Even though you’re providing care for your loved one, there are times you may need to rely on a paid caregiver. However, the thought of welcoming a stranger into your home who could be hostile to LGBT older adults, or unaware that we exist, can be unsettling.

Before bringing up the subject with your care recipient, do some research on in-home care agencies. Ask your friends, people at your local LGBT community center, or your care recipient’s caseworker for recommendations. Knowing that you’ve done this homework in advance may help ease any concerns your loved one has about a paid caregiver.

Once you have your loved one’s buy-in, you can start to interview prospective caregivers to ensure they’ll be a good match. Read the article Nine Tips on Finding LGBT-Affirming Services for more information on choosing an in-home care provider.

Moving to a Long-Term Care Facility

Most likely, your loved one will want to stay in his or her home. You may also prefer this arrangement, for the sake of both comfort and privacy. There could come a time, however, when moving to a long-term care facility is the best choice for you and the person you’re caring for.

But you and your care recipient might feel uncertain, nervous or even afraid to consider a long-term care facility, assisted living community or nursing home. Will your friend or loved one be welcome as an LGBT older adult? Will your relationship with your care recipient, and your wishes, be respected? Will you have to go back in "the closet?"

As with finding an in-home care worker, some advance research should help ease your loved one’s worries. Read Nine Tips on Finding LGBT-Affirming Services to help you find the right long-term care facility for you and your loved one.

For More Information

LGBT Caring Community Online Support Group. FCA: Family Caregiving Alliance
Find support from other caregivers online: FCA offers a place for LGBT caregivers of adults with chronic health problems to discuss the unique issues of caring for their loved ones.

LGBT Older Adults and Estate Tax and Inheritance. Movement Advancement Project and SAGE.
A policy brief summarizing the impact of current estate and inheritance laws on LGBT older adults.

LGBT Older Adults: Facing Legal Barriers to Taking Care of Loved Ones. Movement Advancement Project and SAGE.
A policy brief summarizing the impact of federal and state laws on LGBT older adults’ ability to provide care for a loved one; covers hospital visitation, end-of-life care, funerals, and medical decision-making.

35 Questions to Ask Your Aging Parents. AARP Caregiving Resource Center. While directed at people caring for parents, this series of questions provides a good starting point for many caregiving conversations.