News & Updates | June 20, 2025 | Labhrás Quigley
Note: If you’d like support with some of the terms or acronyms used in this article, please see the section titled “Establishing Shared Language” at the end of the post.
What does it mean to die with dignity when the systems around you were never designed to see you? For 2SLGBTQIA+ older adults, the end of life can be a return to silence or an opportunity for transformation.
Canada’s long-term care system was not designed to meet the needs of 2SLGBTQIA+ older adults. Long-term care, hospice, and palliative spaces often operate with assumptions around family, identity, and culture that don’t reflect the lived realities of Queer and Trans people. Consequently, many are forced to suppress parts of themselves, returning to the closet after decades of hard-won self-expression to stay safe. For some, this results in a final chapter of life shaped more by fear than by dignity.
At Dignity Seniors Society, I lead the Inclusive Long-Term Care Project, a multi-year effort to identify affirming, culturally responsive care homes across British Columbia. We’re building relationships with all five regional health authorities, as well as the First Nations Health Authority and Provincial Health Services Authority, to map and expand access to safe, inclusive care environments for 2SLGBTQIA+ older adults.
The stakes are high, leading to isolation, delayed care, and profound indignity. Without affirming care, many Queer and Trans older adults delay accessing services altogether. They remain at home long after it’s safe to do so, or cycle in and out of emergency care. Others feel pressured to hide their identities to protect themselves, reversing decades of healing and community-building. Our project aims to change that narrative by embedding dignity and inclusion into the heart of long-term care.
One of the people who deeply shaped my path into this work was an 80-something gay man, a Holocaust survivor facing a terminal leukemia diagnosis and pursuing MAID.
Fiercely independent and deeply private, he had lived alone in Vancouver since losing his partner of 50+ years during the pandemic. But as his health declined, so did his options. He feared that entering long-term care would force him to once again hide who he was, a burden he had carried through much of his life. Instead, he chose to remain at home, even as his care needs outpaced what independent living could provide. He was hospitalized every few weeks.
After it became known to some of his home care workers that he was gay, their behavior changed. They became colder, less attentive. He felt it immediately, and so did I. Supporting him through his Medical Assistance in Dying (MAID) process was an act of deep presence, love, and advocacy. It was also a window into the failures of a system still learning how to hold Queer lives with the dignity and care they deserve at the end. MAID remains a deeply personal and complex decision, especially for 2SLGBTQIA+ people navigating systemic discrimination in care settings.
His journey left a lasting impression on me. It reminded me that even in progressive cities like Vancouver, many older adults still carry the weight of state-sanctioned discrimination. The fear and trauma of earlier decades live on, shaping how people approach aging, illness, and death.
The HIV cohort in Canada is aging. In British Columbia, the median age of people on HIV treatment was 55 as of 2022. For many, this is a testament to progress. But it also brings new challenges in addition to pervasive stigma:
2SLGBTQIA+ people aging with HIV often face triple stigma: for their diagnosis, for their sexual or gender identity, and for their age. Stigma refers to the social disapproval or discrimination individuals experience based on characteristics perceived as different or outside the norm, and it can significantly impact one’s ability or willingness to seek care. It is important to distinguish between sex, gender, and whom someone loves: sex refers to biological attributes, gender is a social and cultural construct that includes diverse identities and expressions, and love or attraction reflects deep relational connections, not simply sexuality or sexual behaviour.
These layered burdens can lead to social isolation, reluctance to access care, and inadequate support in long-term or palliative settings. These challenges are further compounded by intersecting factors such as race, Indigeneity, class, and disability, underscoring the need for care that is both inclusive and intersectional.
Like those aging with HIV, Trans elders also face unique barriers at the end of life. Many encounter medical providers unfamiliar with gender-affirming care or who make assumptions about their bodies, identities, or histories. Legal name and document mismatches can complicate everything from medication administration to funeral planning. In dementia care, gender identity and expression may be forgotten or dismissed by staff.
These experiences compound a lifetime of discrimination. Trans people are at higher risk of poverty, violence, and social exclusion. When they reach the end of life, too often the system fails to meet them with dignity.
One such case I came across involved a Trans senior who was initially placed in a faith-based long-term care unit. After six months, they were forcibly transferred following an internal campaign by other residents. Their story underscores the deep vulnerability of Trans older adults in systems that prioritize the first available bed over the first appropriate one.
Their experience highlights the urgent need for identity-affirming care environments in long-term care. Despite these challenges, resilience and innovation are emerging from within Queer and Trans communities themselves.
Across Canada, Queer and Trans communities are working to change these realities and build systems of care rooted in dignity, choice, and belonging. Toronto’s Rekai Centres are leaders in inclusive elder care, offering dedicated wings and programs for 2SLGBTQIA+ residents. Nationally, organizations like Egale advocate for 2SLGBTQIA+ rights across the lifespan; CATIE provides information on sexual health, HIV, and hepatitis C; and Realize focuses on the intersection of aging, disability, and HIV. Beyond clinical settings, grassroots efforts are creating spaces of connection and care: from peer support groups and friendly visitor programs to community-led hospices and deathcare initiatives. These efforts ensure that Queer and Trans older adults can age and die with the same dignity and agency they have long fought for.
As a death worker and peer support volunteer, I’ve seen how much care happens in the in-between spaces; in living rooms, kitchens, waiting rooms, and over the phone. The work of accompaniment is often invisible, but it matters deeply. It reminds us that every person deserves to be met not only with competence but with love.
To support this vision, we need comprehensive education initiatives that train healthcare providers in 2SLGBTQIA+ affirming care, robust advocacy efforts to push for inclusive policies within long-term care systems, and dedicated investment in community-led organizations that provide crucial support services to 2SLGBTQIA+ older adults. This includes training on gender-affirming care, advocacy for non-discrimination protections, and investment in programs that foster peer support, connection, and belonging.
Pride is not just about how we live, it’s about how we are held in death. Let us build a world where Queer and Trans people are celebrated, not erased, in their final days. Pride means showing up. Let’s ensure no one faces the end of life alone.
Recognizing these gaps led me to found The ABE Project (A Beautiful Ending), a nonprofit initiative dedicated to reimagining deathcare through an equity-based lens. It offers education, community programming, and resources focused on death, dying, and bereavement particularly for marginalized communities.
ABE Care is its affiliated social enterprise, offering a virtual clinic in B.C that connects individuals with end-of-life practitioners including death doulas, spiritual companions, and grief counselors. Together, these related initiatives aim to build a more just and compassionate approach to endings and transitions.
This vision aligns with the growing call for community-based, culturally grounded responses to the failures of mainstream systems. To realize this vision, we must urgently prioritize inclusive care, ensuring that 2SLGBTQIA+ older adults can age with dignity and receive the support they deserve.
“A Beautiful Ending is not a fixed destination, but a consciously tended crossing. A place where love, truth, and grief meet, where the sacredness of life is honoured in death, and where no one walks to the threshold alone.”
Labhrás Quigley (he/him) is an end-of-life consultant and community organizer working to improve care pathways for underrepresented communities. With a background in the tech sector and a deep commitment to death literacy, he leads The ABE Project, a non-profit advancing inclusive, compassionate approaches to aging, dying, and bereavement.
The acronym 2SLGBTQIA+ stands for Two-Spirit, Lesbian, Gay, Bisexual, Trans, Queer and/or Questioning, Intersex, Asexual, and additional identities not explicitly listed. This term is used to respectfully reflect the diversity of sexual orientations, gender identities, and expressions within our communities. While various versions of this acronym exist across organizations and communities, for consistency, this article will use the 2SLGBTQIA+ form, acknowledging the validity of all expressions of identity.
The ‘2S‘ at the front of the acronym honours the sacred and distinct identity of Two-Spirit people within many Indigenous cultures. Its placement reflects a recognition of sovereignty and a commitment to decolonizing language. The plus sign (+) acknowledges the ever-evolving nature of identity and includes individuals whose experiences may fall outside traditional categories.
In this article, the terms Queer and Trans are intentionally capitalized to honour identity, increase visibility, and reflect community empowerment.
This blog post was originally published on March 17, 2022 Editor’s note: This weekend, we honour and remember Audrey Parker…
October 31, 2025
This blog post was originally published on October 21, 2022 Dr. Jyothi Jayaraman is a palliative care provider in Vancouver,…
October 10, 2025
Every year on September 5, people around the world come together to mark the International Day of Charity.
September 5, 2025
Empower. Inform. Protect your rights.
