I’ll be honest with you from the outset. I’m writing this one personally.
As a gay man, I’ve spent most of my adult life navigating spaces that weren’t quite designed for me. Healthcare settings. Workplaces. Family gatherings where I learned to read the room before deciding how much of myself to bring into it.
Most of the time, I managed. I built a life, a community, and eventually a practice that centres the values I hold most deeply – dignity, honesty and the right to be seen for who you truly are.
But here’s what I’ve come to understand through my work as an End-of-Life Doula: dying strips away our ability to manage. And for LGBTI+ people, that loss of control can carry a particular kind of fear.
The closet doesn’t stay in the past
Many older LGBTI+ Australians lived through decades of criminalisation, pathologisation, and institutional rejection. Homosexuality was only fully decriminalised across Australia in 1997. Same-sex marriage became legal less than ten years ago. These aren’t ancient history – they’re lived experience for people who are now entering aged care and facing terminal illness.
Recent Australian research confirms what many in our community already know. Many older LGBTI+ people feel forced back into the closet to stay safe in aged care, while also wanting to be seen and accepted for who they are. That tension – between survival and authenticity – is something no one should have to carry at the end of their life.
Research reveals that LGBTI+ Australians’ concerns about aged care include fear of discrimination and stigma, loneliness and abandonment, loss of social networks, and a specific fear of discrimination from religiously run organisations.
This isn’t just a fringe concern. It’s a systemic one.
Chosen family and legal complexity
For many LGBTI+ people, family is not the family we were born into. It’s the people we found, built and chose. It’s the friends who showed up during the AIDS crisis when biological families didn’t. Partners of decades who were never formally recognised, and communities that became our anchors.
At end of life, this matters enormously – and the law hasn’t always caught up.
Australian research on LGBTI+ experiences of palliative care highlights estrangement from biological families as a key source of tension, including situations where patients are not out to their family, or where biological family members are not supportive of the patient’s partner or gender identity. When a person is dying and can no longer speak for themselves, these dynamics can become deeply painful – and in some cases, dangerous.
For LGBTI+ individuals, having legal documents like a power of attorney in place is a top priority. Non-registered surviving partners can be denied family leave and bereavement benefits, automatic inheritance of jointly owned property, and may lose the right to determine funeral arrangements.
Marriage equality helped. But it didn’t solve everything, and not everyone is married.
Fear of discrimination in care settings
Australian research has found that LGBTI+ people face barriers to health care access due to discrimination, inappropriate care and a lack of knowledge among both healthcare workers and consumers about legal rights at the end of life.
Some people hide photographs of their partners before a home care worker arrives. Some stop mentioning their relationships altogether. Some, like the 84-year-old woman in a 2019 SBS report, are told outright by management that they are not allowed to talk about their sexuality in a care facility.
This is happening in Australia. Now.
The Private Lives 3 survey found that only 57.5% of LGBTI+ people accessing mainstream medical clinics felt their sexual orientation was very or extremely respected, and only 33.6% felt their gender identity was very or extremely respected.
These numbers are not good enough – and they’re even more confronting when the setting is palliative care, where a person is at their most vulnerable.
What LGBTI+ people actually want
The research is clear that LGBTI+ people aren’t asking for special treatment. Participants in recent research want inclusive, respectful care that affirms their identity – not separate or special treatment that keeps them apart from others.
They want to be called by their name and their pronouns. They want their partner recognised as their partner. They want to die without having to perform a version of themselves that was left behind long ago.
That is not a big ask.
They want to die without having to perform a version of themselves that was left behind long ago. That is not a big ask.
Where End-of-Life Doulas come in
An End-of-Life Doula doesn’t arrive with assumptions. We arrive with questions, and we listen.
For LGBTI+ clients, that can mean sitting with someone and asking who their real family is – not their legal next of kin, but the people who matter. It can mean helping them document their wishes clearly so that their chosen family can be present and recognised. It can mean navigating advance care planning with an awareness of the specific legal protections LGBTI+ people need to put in place.
It also means being a consistent, non-judgemental presence in a system that has not always been either of those things.
I know this work matters because I’ve seen what it looks like when it’s absent. And I know it matters personally, because I understand – in my body, not just my training – what it costs to hide who you are in a room full of strangers.
No one should have to do that while they’re dying.
A note on planning ahead
If you are LGBTI+ and thinking about your future care, some steps worth considering now:
• Complete an Advance Care Directive that clearly names your values, wishes, and who should be involved in decisions
• Appoint a person you trust as your enduring guardian and enduring power of attorney. Note: this does not have to be a biological family member
• Have an honest conversation with your GP or care provider about your identity and your needs
• Look for care providers with the Rainbow Tick accreditation or demonstrated LGBTI+ inclusion
And if you want support from someone who gets it – I’m here.
To find out more about End-of-Life Doula support for LGBTI+ individuals and families, visit yourpathguide.com.au or book a free call.
About the Author
Shannon Beresford is the Director of Your Path Guide Pty Ltd, an Adelaide-based End-of-Life Doula practice dedicated to helping people live and die with comfort, meaning and connection. The practice works alongside individuals and families to honour each person’s story and choices at one of life’s most significant transitions.
As Chair of HELD Australia Ltd, the national peak body for holistic end-of-life and death-care practitioners, Shannon advocates for stronger recognition of the End-of-Life Doula role across Australia’s health and aged care systems. He also holds a Certificate IV in End-of-Life Doula Services, the only nationally accredited qualification in this field, and volunteers with the Central Adelaide Palliative Care Service (CAPCS), providing practical and emotional support to individuals and families in their final weeks of life.
References
• Cartwright, C., Hughes, M., & Lienert, T. (2012). End-of-life care for gay, lesbian, bisexual and transgender people. Culture, Health & Sexuality, 14(5), 537-548. https://doi.org/10.1080/13691058.2012.673639
• McMullen-Roach, S. et al. (2025). The perspectives and experiences of older LGBTI+ adults about long-term care: A qualitative systematic review and meta-synthesis. The Gerontologist. https://doi.org/10.1093/geront/gnaf048
• Roberts, M. et al. (2022). LGBTQ community members’ perspectives on palliative care in NSW, Australia. Health & Social Care in the Community, 30(5). https://doi.org/10.1111/hsc.14024
• Waling, A. et al. (2019). Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia. Health & Social Care in the Community, 27(5), 1251-1259.
• Hill, A. et al. (2021). Private Lives 3: The health and wellbeing of LGBTIQ+ people in Australia. Australian Research Centre in Sex, Health and Society, La Trobe University.
• Duncan, E. & Aboud, P. (2019). Elderly LGBTQI+ aged care residents say they’re being forced back into the closet. SBS The Feed.
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