Research and experience have shown that a patient’s access to visitors is a crucial part of the healing process. Yet LGBTQ+ people have been denied the same access to their loved ones as other patients and visitors. To help remedy this discriminatory practice, President Obama issued a memorandum in April 2010 ordering the Department of Health and Human Services to guarantee the visitation rights of LGBTQ+ people, inspired by the tragic experience of Janice Langbehn, Lisa Pond and their children, who were kept apart by discriminatory hospital officials as Lisa lay dying.
When inpatient healthcare organizations explicitly guarantee equal visitation to LGBTQ+ patients, they offer vital assurance to patients and clear guidance to employees.
In 2011, in response to the President’s memorandum, the Centers for Medicare and Medicaid Services (CMS) revised their CMS Conditions of Participation to require covered facilities to “not restrict, limit or deny visitation privileges” based on sexual orientation or gender identity. The Joint Commission simultaneously aligned its visitation standards (see RI.01.01.01 EP 2 Note) with the CMS requirements. Revisiting Your Hospital’s Visitation Policy, a joint publication from HRC and the American Health Lawyers Association, details the CMS’ and The Joint Commission’s requirements and provides a wealth of other background information, as does The Joint Commission LGBT Field Guide. In addition, some state laws guarantee equal LGBTQ+ visitation.
CMS explicitly requires that hospitals must adopt written policies and procedures concerning patients’ visitation rights, including any clinically reasonable and necessary restrictions or limitations on visitation. Additionally, hospitals must provide notice to patients or support persons of their visitation rights, including the right to receive visitors designated by the patient. Hospitals may not deny visitation privileges based on race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.
The Joint Commission also requires hospitals to have written policies that address procedures regarding visitation rights, aligned with the same CMS standards of allowing the presence of a support individual of the patient’s choice, and prohibiting discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression.
To receive credit in the HEI, a facility must:
Upload a copy of the facility's equal visitation policy.
More information:
Many facilities go above and beyond explicitly noting that patients may designate the visitor(s) of their choice and prohibiting discrimination in visitation based on sexual orientation or gender identity. To further alleviate worries held by LGBTQ+ patients and families, hospitals often make an explicit reference to equal visitation for same-sex couples and same-sex parents. In addition, it is a best practice for facilities to include an explicitly LGBTQ+ inclusive definition of “family,” or link to or make direct reference to such a definition in the visitation policy.
Approaches to offering this critical guarantee include:
See templates that include sample language for each of these approaches.
Examples:
AtlantiCare Regional Medical Center (Atlantic City, NJ)
This equal visitation policy clearly indicates that patients have the right to designate a visitor of their choosing, along with alleviating LGBTQ+ specific worries by including “same-sex partner” in the list of those who might visit, and finally through a non-discrimination statement that includes both “sexual orientation” and “gender identity.”
It is the policy of AtlantiCare Regional Medical Center (ARMC) to promote patient and family-centered care while providing a therapeutic environment for patients and a safe environment for patients, family, visitors, and staff.
ARMC will provide notice to patients or their Support Persons (where appropriate) of their visitation rights, including the right to receive, subject to the patient’s consent, visitors designated by the patient, including but not limited to a spouse, civil union partner, domestic partner (including a same sex partner), another family member, or a friend. The notice must also advise of the patient’s right to withdraw or deny consent at any time either orally or in writing. The provision of notice will be documented in the medical record.
ARMC will not restrict, limit, or deny visitation privileges based on race, skin color, age, national origin, ancestry, nationality, religion, sex, gender identity or expression, sexual orientation, or disability. All visitors enjoy full and equal visitation privileges consistent with patient privileges and the limitations set forth in this policy.
Thomas Jefferson University Hospital (Philadelphia, PA)
This is shorter equal visitation policy that clearly indicates that patients have the right to designate a visitor of their choosing, along with alleviating LGBTQ+ specific worries by specifically including “same-sex partner” in the list of those who might visit, and finally through a non-discrimination statement that includes both “sexual orientation” and “gender identity.”
In support of each patient’s rights, the hospital allows patients to receive visitors that the patient designates including, but not limited to, a spouse, domestic partner (including a same sex domestic partner), family members, or a friend, for emotional support during the course of his/her stay. Patients are able to withdraw or deny such consent at any time. TJUH prohibits discrimination against visitors based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression. Visitors designated by the patient (or support person, where appropriate) do not have to be legally related to the patient and shall enjoy visitation privileges that are no more restrictive than those that immediate family members would enjoy.
Children’s Mercy Kansas City (Kansas City, MO)
This equal visitation policy specifically addresses the worries LGBTQ+ families have when visiting their children. By including a broad definition of “family,” this policy welcomes LGBTQ+ families in addition to other diverse families.
Purpose: To define the expectations for persons visiting hospitalized patients, recognizing our commitment to non-discrimination and providing access without regard to race, color, sex, national origin, disability, age, religion, marital status, citizenship, gender identity, gender expression, sexual orientation, and/or other legally protected classification at all Children’s Mercy inpatient locations.
Specific Considerations:
To receive credit in the HEI, a facility must:
Provide at least two examples – typically one is a website example and the other will be a document like a brochure. It could also be a poster or photo of sign/poster in waiting area. If the policy is included in the Patient Bill of Rights, the same example(s) from PND question may be used.
More information:
Communicating your equal visitation policy to patients is just as, if not more important than having the policy itself in place. Adding your equal visitation policy to your facility website, patient bill of rights poster or brochure alleviates the added anxiety LGBTQ+ people face when visiting their loved ones.
The HEI requires survey participants to document not only that they have equal visitation policies, but also that they make these policies readily accessible to patients in at least two of the following ways:
Examples:
Posted on facility website:
In materials given to patients at admitting/registration:
In materials available for take-away in patient waiting areas:
Posted in patient waiting area(s):
To receive credit in the HEI, a facility must:
Upload at least one example of how the policy is communicated to staff. This example must be an internal example, not a public document. It cannot be the same as the example of how the policy is communicated to patients.
More information:
The HEI requires facilities to share their LGBTQ+ inclusive Visitation Non-Discrimination Policy with its employees in at least one of the following ways:
Examples:
Posted on facility intranet site:
Posted in employee work area(s):
In materials routinely given to employees at orientation:
Reviewed in in-person employee training:
Reviewed in online employee training:
The HEI requires inpatient healthcare organizations to implement and document a visitation policy that explicitly guarantees equal visitation to LGBTQ+ patients and their visitors. The following are three different approaches that a healthcare facility can take to ensuring equal visitation.
Within Policy Statement
Patients may receive visits from visitors of their choice. Patients also have the right to withdraw or deny consent to visitation at any time. Patients who lack capacity may receive visits from family, friends and other individuals, consistent with the non-discrimination provisions of this paragraph.
Healthcare organizations can ensure equal treatment of LGBTQ+ patients and their families by adopting an explicitly inclusive definition of “family.” The following definition of “family,” which is being used by healthcare organizations nationwide, incorporates expert advice from hospital administrators, legal counsel, and health professionals:
This definition of "family" establishes a usefully broad concept of family. The specific enumeration of family members provides guidance to staff and prevents biased interpretations of “family.” It should also be noted that the term “domestic partners” in this definition encompasses not only domestic partnerships but also all legally recognized same-sex relationships, including civil unions and reciprocal beneficiary arrangements.
The definition of “family” focuses on a functional definition of parenthood, established by an individual’s role as caretaker of a minor child. This is designed to ensure visitor access for the individuals most responsible for the care of a minor patient, even if this caretaker relationship lacks formal recognition under state law.
This definition of “family” informs hospital personnel about the unique nature of parenthood in the visitation context. While the definition requires that caretaker individuals be granted visitation for minor patients, this caretaker status does not necessarily confer the rights that accompany legal parental status. For instance, applicable state law may dictate that only a biological or custodial parent may determine the course of medical care for a minor child.
As stated in the patient rights and responsibilities, hospitalized patients have the right to:
Visitors may include, but are not limited to, spouses, domestic partners, both different-sex and same-sex significant others, both different-sex and same-sex parents, other family members, friends, and persons from a patient’s community.
A designated family/support person may be present to support the patient during their hospital stay. A support person may include but not be limited to a spouse, adult child, parent, close relative, friend, domestic partner, and both different and same sex significant others. A support person is welcome to stay at any time depending on patient’s need for medical care/treatments, rest, privacy, safety and patient preference.
This definition may include a person (s) not legally related to the patient. This person(s) is often referred to as a surrogate decision maker or health care proxy if authorized to make healthcare decisions for the patient should he or she lose decision making capacity. More specifically, family means any person(s) who plays a significant role in an individual’s life. This may include a person (s) not legally related to the individual. Members of “family” includes spouses, domestic partners, and both different sex and same sex significant others. “Family” includes a minor patient’s parents, regardless of the gender of either parent. Solely for the purposes of visitation policy, the concept of parenthood is to be liberally constructed without limitation as encompassing legal parents, foster parents, same sex parent, step parent, those serving in loco parentis and other persons operating in caretaker roles. ed to make healthcare decisions for the patient should he or she lose decision making capacity.