Landry is an exception. Unlike most Americans, she made her end-of-life decisions years ago: no heroic measures to save her and even instructions on the bar where mourners should gather.

The health overhaul bill that narrowly passed the House on Saturday includes a provision to nudge more people to confront such choices: It would pay for end-of-life counseling for Medicare patients.

Supporters say counseling would give patients more control and free families from tortuous decisions. Critics have warned it could lead to government “death panels.” What few on either side note is that counseling could lead more people to choose less intensive care when they’re dying, and ultimately trim government-funded health bills.

Hospice care has grown from about 25,000 patients in 1982, when Congress approved coverage under Medicare, to 1.45 million people in 2008. It’s for patients who have a prognosis of no more than six months – and it ranges from in-home care to stand-alone centers to special wings in hospitals. It does nothing to artificially lengthen or shorten life, focusing mostly on a patient’s comfort.

People on Medicare account for the vast majority of U.S. deaths, and care in the last year of life accounts for roughly a quarter of Medicare’s budget. So increased use of hospice could mean sizable savings for the government, particularly if patients enter it sooner.

A 2007 study published in the journal Social Science and Medicine found that among Medicare patient deaths, those who used hospice saved taxpayers an average $2,309 over their last year. In some cases, the savings were as much as $7,000, depending on the illness and length of hospice stay.

Still, only about 39 percent of Americans who died last year were in hospice. The average patient spent a little more than two months under that care; about a third moved to hospice only in the last week of life.

“It’s significantly underutilized. People are referred very late,” said Dr. Richard Payne, a Duke University professor who heads the school’s Institute on Care at the End of Life.

“Our culture just doesn’t tolerate talking about death and dying. And the minute you even start talking about having conversations with a doctor, it’s immediately pejoratively labeled as ‘You’re trying to kill me.’”

That perception is precisely what got affixed to the counseling measure in the House bill. Even though the legislation specifies counseling wouldn’t force patients to limit efforts to keep them alive, and even with the support of the American Medical Association, AARP and others, suspicion has lingered, encouraged by conservative voices including Sarah Palin.

Dr. Jim Small, a Denver pathologist who belongs to the Christian Medical and Dental Associations, said he feared the provision would be twisted into something more intrusive if bureaucrats lay out the details.

“It’s incredible micromanagement,” Small said. “End-of-life discussions are part of normal, good patient care, but there’s no reason for it to be in the bill.”

Even when patients do opt for less invasive, potentially cheaper care, there are limitations. Predicting when someone will die is notoriously inexact. Terminal patients can live for years. So deciding on less intensive treatment isn’t always an easy choice.

“The concept of the last year of life is entirely retrospective,” said Donald Taylor, a public policy professor at Duke who was the lead author of the study looking at hospice’s cost savings. “It’s just not that clear when people are dying.”

Among those for whom death is clearly imminent, though, advocates argue hospice offers a more compassionate approach.

Dr. Joel Policzer is medical director for VITAS Innovative Hospice Care, which runs the hospice wing at Florida Medical Center where Landry spent her final days. Many of the patients have been hospitalized repeatedly, often getting arguably unnecessary tests before finally succumbing. He characterizes the American medical perspective as “Do something! Do something! Do something!”

Often, Policzer says, a dying elderly patient may have wanted less invasive care. But it doesn’t happen.

“It doesn’t happen because people are never asked. If they were, people would tell you they want to die at home in bed, surrounded by their family, their friends and their pets,” he said. “People who are dying do not need to have needles shoved in them two or three times a day. It’s not going to make a difference.”

On a recent morning, Policzer stopped to check on 76-year-old Walter Norton, who lay frail and silent in his hospice bed. He had made numerous trips to the emergency room before his family turned to hospice. He had dementia and was suffering from pneumonia and dehydration.

No one’s sure exactly what Norton would have wanted. “He wasn’t asked, ‘What do you want to have done?’” Policzer said.

Five days later, Norton was dead.

Landry, on the other hand, had thought about life’s ending years ago.

Four days before she died, her closest friend, Joe Takach, was sitting in a recliner beside her. Her head was tilted, her mouth open and her left hand lay across her waist atop a crisp white sheet.

End-stage heart disease brought hospice care to Landry’s home in July; she entered the inpatient unit in late October. Until then, she had continued her routine, going to church every week, making coffee in the morning, sitting for hours in a swivel chair watching birds and squirrels from her bedroom window. She’d make four-course dinners and sometimes stay up talking with Takach until 2 a.m.

Landry had moved in with Takach after Hurricane Wilma destroyed her home four years ago; the 49-year-old retired police dispatcher said it was like having a grandmother again.

He called her the Energizer Bunny. She called herself a tough New Englander.

“You OK?” Takach asked her in one of their final meetings. “I’m OK,” she said in a soft, garbled voice, her eyes opened just a slit.

“You don’t have any pain?” he asked. “No,” she said.

Had Landry not made her wishes known, she likely would have been subjected to CT scans, blood tests, IVs and a feeding tube.

“She would not want that,” Takach said. “She would say, ‘Enough!’”

Through its Administration on Aging, HHS will award a single resource grant in the amount of $250,000 annually, depending on the availability of funds.  According to HHS, the center will provide resources to LGBT organizations, as well assisting mainstream aging services providers in developing cultural competence in serving LGBT elders. 
 
“Despite the many advances our community has seen, LGBT elders face significant discrimination from senior care providers, including in places where we are most vulnerable, such as assisted living facilities and end-of-life care,” said Human Rights Campaign President Joe Solmonese.  “As more and more openly LGBT people reach their later years, it is incredibly important to ensure that we are treated with dignity, respect and fairness.  We applaud HHS for taking this important step on behalf of older LGBT Americans.”
 
HRC and Services and Advocacy for GLBT Elders (SAGE) host a collaborative forum on LGBT aging issues, available at www.hrc.org/issues/aging/.  As part of the New Beginning Initiative, coordinated by the National Gay and Lesbian Task Force, SAGE has advocated for policy changes that would benefit LGBT elders.  Earlier this month, the Administration on Aging issued the first-ever grant focused on LGBT aging to the Los Angeles LGBT Community Service Center.  

“SAGE, the entire LGBT aging field, and  all those who work with and care for LGBT older adults, are thrilled by this announcement,” Michael Adams, executive director of SAGE, said in a statement. “For too long, programs that serve LGBT older people have been ignored and shut out from most public funding, and there has been no federal funding to help mainstream aging services become educated about and sensitive to the unique needs of  LGBT older adults. This resource center is a truly historic recognition of the needs of LGBT older adults across the country  and will make a huge difference in the lives of so many seniors.”

The lawsuit was filed Tuesday in U.S. District Court for the Eastern District of Arkansas by Lambda Legal on behalf of 75–year–old Rev. Dr. Robert Franke, a retired university provost and Unitarian-Universalist minister, and his daughter, Sara Franke Bowling. 

Lambda said that Franke, who relocated to Little Rock to be closer to his daughter, moved in to Fox Ridge of North Little Rock, an assisted living facility, after fulfilling all of its residency requirements — including submission of medical evaluation forms from a local physician.  

The next day, however, after realizing Dr. Franke is HIV-positive, Fox Ridge officials abruptly ejected Franke from the facility, according to the lawsuit.

A Fox Ridge staffer allegedly told Bowling her father’s personal belongings could remain, but that the “body” had to be out by the end of the day. 

“I was stunned that my dad was thrown out of his new home,” said Bowling in a statement. 

“The people at Fox Ridge were supposed to make sure that he was comfortable and cared for, and instead they shunned and rejected him, making him feel like a complete outcast.”

Dr. Franke requires no special medical attention beyond daily medication and regular check–ups with a physician, and Fox Ridge is licensed by the state to provide Dr. Franke with the kind of care he and his daughter were seeking for him, Lambda said. 

“Federal and state laws exist to protect people from just this sort of unjust treatment,” said Scott Schoettes, HIV Project staff attorney for Lambda Legal.

“Unfortunately, this is something we are seeing far too frequently, all across the country. Those tasked with caring for our elderly loved ones need to know that it is illegal to discriminate against someone with HIV based on outdated and misguided beliefs about its transmission.”

Franke and Bowling are seeking damages under the Fair Housing Act, the Arkansas Civil Rights Act and the Arkansas Fair Housing Act, as well as an injunction, under those laws and the Americans with Disabilities Act, preventing Fox Ridge from continuing to engage in this kind of conduct.

“This is about doing the right thing,” said Franke.  “I want to make sure it doesn’t happen to anyone else — because no one should ever be made to feel the way I did.”

It’s a subject so taboo that the cabinet minister responsible for seniors and representatives of the gay and lesbian communities couldn’t find a seniors residence willing to host a news conference.

It was eventually held in a community center on the fringes of Montreal’s gay village.

Still, Minister Marguerite Blais says it’s more about ignorance than malice.

“We would have found a residence eventually,” she said. “I don’t want to accuse anyone of anything. I just want to show how important it is to educate people on this issue.”

Laurent McCutcheon of the gay helpline Gai Ecoute says homosexuality isn’t discussed in most institutions that serve the elderly, leading many Quebec seniors to hide their sexual orientation.

As they age and lose their autonomy, gay, lesbian or transgendered seniors face stigma, loneliness, social isolation, rejection and in extreme cases, harassment from the very institutions they depend on to meet their needs.

The new initiatives funded by the government are meant to highlight the isolation many of them feel.

“We know there are gays and lesbians in these institutions who, sadly, spent their lives in the closet and will stay there until the end,” McCutcheon said.

“We’ll try to do as much as we can for them but also lay the groundwork for the generations coming up.”

In some ways, it’s become the final frontier of gay and lesbian rights.

“We’ll be the first generation to reach to our golden years after fighting for our rights,” McCutcheon said, a comment later echoed by Blais.

“Baby boomers don’t want to accept these situations after a lifetime of living openly,” she said.

Gai Ecoute will receive $400,000 over four years to produce an education campaign for people who work with the elderly that will include a website and an information kit.

The Quebec Lesbian Network will receive $120,000 over three years to broadcast a film that portrays the lives of six lesbians in their golden age.

Diane Heffernan, director of the Network, spoke about the resistance she faced when she approached old age homes about airing the film.

She says she was rejected outright by 118 of the 120 institutions she petitioned and in one home, only 25 of some 4,000 residents attended the screening.

“They were rebels,” Heffernan joked. “They’d been warned they’d be marked as lesbians if they showed up.”

Blais says her support for the projects came after statements made during Quebec-wide public consultations in 2007 on issues facing the elderly.

“There’s a long way to go in their social recognition. These two projects won’t end taboos but it’s a start…(But)I believe a human being is allowed to have dreams, a fulfilling life, right up to their last breath.”

It’s a subject so taboo that the cabinet minister responsible for seniors and representatives of the gay and lesbian communities couldn’t find a seniors residence willing to host a news conference.

It was eventually held in a community center on the fringes of Montreal’s gay village.

Still, Minister Marguerite Blais says it’s more about ignorance than malice.

“We would have found a residence eventually,” she said. “I don’t want to accuse anyone of anything. I just want to show how important it is to educate people on this issue.”

Laurent McCutcheon of the gay helpline Gai Ecoute says homosexuality isn’t discussed in most institutions that serve the elderly, leading many Quebec seniors to hide their sexual orientation.

As they age and lose their autonomy, gay, lesbian or transgendered seniors face stigma, loneliness, social isolation, rejection and in extreme cases, harassment from the very institutions they depend on to meet their needs.

The new initiatives funded by the government are meant to highlight the isolation many of them feel.

“We know there are gays and lesbians in these institutions who, sadly, spent their lives in the closet and will stay there until the end,” McCutcheon said.

“We’ll try to do as much as we can for them but also lay the groundwork for the generations coming up.”

In some ways, it’s become the final frontier of gay and lesbian rights.

“We’ll be the first generation to reach to our golden years after fighting for our rights,” McCutcheon said, a comment later echoed by Blais.

“Baby boomers don’t want to accept these situations after a lifetime of living openly,” she said.

Gai Ecoute will receive $400,000 over four years to produce an education campaign for people who work with the elderly that will include a website and an information kit.

The Quebec Lesbian Network will receive $120,000 over three years to broadcast a film that portrays the lives of six lesbians in their golden age.

Diane Heffernan, director of the Network, spoke about the resistance she faced when she approached old age homes about airing the film.

She says she was rejected outright by 118 of the 120 institutions she petitioned and in one home, only 25 of some 4,000 residents attended the screening.

“They were rebels,” Heffernan joked. “They’d been warned they’d be marked as lesbians if they showed up.”

Blais says her support for the projects came after statements made during Quebec-wide public consultations in 2007 on issues facing the elderly.

“There’s a long way to go in their social recognition. These two projects won’t end taboos but it’s a start…(But)I believe a human being is allowed to have dreams, a fulfilling life, right up to their last breath.”

The report, appearing in the WHO Bulletin, notes that not only are family doctors not recommending regular HIV tests for senior patients, there have been few studies on HIV among those over 50.

“In the last 5 years, only 13 of 30 surveys included older males and none included older females. The National Health and Nutrition Examination Survey in the United States of America does not collect data from people older than 49,” the WHO report said.

Yet information from those studies  indicate that about 11 percent of new HIV diagnoses and eight percent in Europe are in the over 50 age group.

The studies also suggest that men over 50 are less likely to engage in safe sex.

“These individuals have a shorter time from diagnosis to onset of AIDS, reflecting both age-related faster progression to AIDS and doctors’ failure to consider HIV as a diagnosis,” the WHO study conducted by Minnesota’s St. Olaf College said.

“HIV prevalence and incidence in the over-50-year-olds seem surprisingly high and the risk factors are totally unexplored. Understanding the epidemiology of HIV infection in older individuals can lead to interventions to make these years safer and more enjoyable.”

The WHO report suggests greater research into HIV among older people and the role of erectile dysfunction drugs, especially in the Third World.

“While erectile dysfunction is common and erectile dysfunction drugs are widely available in developing countries, no study has been done of their possible impact on the HIV epidemic, although their use in industrialized countries has been associated with risky safety practices,” the report said.

“We begin the New Year knowing that all LGBT people, including youth and seniors, have better protections and rights than ever before,” said Equality California Executive Director Geoff Kors. EQCA pushed for passage of all three bills.

“The new laws provide important protections for members of our community and reinforce our state’s commitment to treat all people with respect and dignity under the law, regardless of their differences.”

The Foster Youth School Safety Education Act helps protect foster youth against harassment and discrimination at school. The new law educates foster care youth and their caregivers about existing California laws that protect students against bias. It was authored by Assemblymember Julia Brownley (D) and supported by the National Association of Social Workers and the Gay-Straight Alliance Network.

The second new law will help prevent bias in senior care facilities and nursing homes. Authored by former Sen. Carole Migden (D) it requires licensed healthcare professionals who have constant interaction with seniors to participate in a training program that focuses on preventing discrimination based on sexual orientation and gender identity.

Many health professionals already receive cultural diversity training, but it does not include information and education about LGBT issues.

Basic rights, such as the choice to live in the same nursing home with a partner and the right to hospital visitation are routinely denied to same-gender couples in older age, according to a 2000 study from the Policy Institute of the National Gay and Lesbian Task Force.

The study also found that same-gender partners lack essential protections, including Medicaid benefits and access to pensions, which typically protect the homes and retirement funds of surviving spouses who are married.

The third law is the Civil Rights Act of 2008. It strengthens existing law to ensure protections based on gender, race, color, religion, ancestry, national origin, disability, medical condition, marital status and sexual orientation.

The law clarifies sections of law that prohibit discrimination in insurance and government services and activities. In addition to support from EQCA, it was endorsed by the California State Conference of the NAACP.

The new session of the Assembly sees three members of the Legislature’s LGBT Caucus heading key committees. Sen. Christine Kehoe has been appointed chair of the Senate Appropriations Committee. Sen. Mark Leno will head the Senate’s Public Safety Committee, and Assemblymember John A. Perez is chairing the Assembly Democratic Caucus.

The LGBT caucus also includes freshman Assemblymember Tom Ammiano. All four are Democrats.

The Worker, Retiree and Employer Recovery Act of 2008 – known as WRERA – contains technical corrections to the Pension Protection Act of 2006.

The Pension Protection Act, or PPA, made it possible for employers to allow any non-spouse beneficiary of an employee’s retirement plan—including an employee’s same-sex partner—to roll inherited retirement benefits directly to an individual retirement account and avoid immediate taxation.

WRERA requires that all employers provide this rollover opportunity to non-spouse beneficiaries.

“This legislation secures much-needed protection for lesbian and gay couples,” said Human Rights Campaign President Joe Solmonese.

“Our community faces unique challenges in preparing for retirement because we are denied Social Security spousal and survivor benefits. Protecting our hard-earned retirement savings is even more crucial to us, and until now, the tax code made it that much harder.”

Before 2007, partners who inherited retirement plan savings typically faced immediate taxation on inherited benefits, unlike opposite-sex spouses, who could roll savings over to an IRA with no tax penalty.

Under the PPA, which came into effect in 2007, qualifying plans could permit any non-spouse beneficiary—including a domestic partner, parent or sibling—to roll over inherited retirement benefits paid as a lump sum directly to an IRA. Qualifying plans include defined benefit plans pensions, 401K plans, employee stock ownership plans, profit-sharing plans, money purchase plans, 403B plans and governmental 457B plans.

But the provision was subsequently interpreted to be optional for employers, meaning each company had to affirmatively adopt this protection for partners under each qualifying plan.

Under the WRERA, which takes effect in January 2010, all qualifying plans that pay lump sum benefits to non-spouse beneficiaries are required to provide the rollover opportunity.

“This is progress toward eliminating the more than 1,000 inequities that our families face under federal law,” said Solmonese.

He also called on employers to make the rollover provision available as quickly as possible and not wait for the 2010 deadline. Solmonese said that LGBT workers should ensure their partners and children are designated as beneficiaries.

Land for the RainbowVision project was reclaimed this week by its lender in a foreclosure auction.

The land, at East Palm Canyon Drive and Gene Autry Trail, was mortgaged for $9.6 million. The lender, Senior Housing Partners III, took it back, successfully bidding $8 million for the 13-acre site.

RainbowVision had planned to build 184 condos, with a pool and tennis courts, and a clubhouse with spa, nightclub and cafe. It was to have been the first LGBT seniors community in Palm Springs.

RainbowVision president Joy Silver said it is possible the complex will someday be built, but not until the economy improves.

“The only thing stopping us is the economy — the fact that banks have not been in a position to make construction loans,” Silver told The Desert Sun newspaper. “We plan to move forward as soon as the economy allows.”

Dozens of people have paid deposits on the Palm Springs project. Silver said many of the prospective buyers have agreed to keep their reservations intact. Others have had their deposits returned.

The money crunch appears to only have affected RainbowVision’s Palm Springs site.

San Francisco-based RainbowVision opened its first LGBT seniors community in Santa Fe, New Mexico in 2006. It also announced plans earlier this year for other projects in San Francisco and Vancouver, Canada.

The New Mexico project is operating with 100 percent occupancy, Silver said. It features condominiums along with independent-living and assisted-living apartments.

The crisis in the mortgage market has tightened credit throughout the world. In an attempt to free up lending money in the US the Federal Reserve announced Wednesday it would slash its target interest rate to nearly zero.

The central bank also pledged to use “all available tools” to fight the current downturn. It said it was likely that rates would be kept at “exceptionally low levels” for some time to come. 

Police have not divulged how Milton Lindgren, 70, and Eric Hendricks, 73, were murdered, or how long their bodies had been inside the house. A police spokesperson would say only that the men died by “violent means.”

Officers were sent to the home after friends notified police that the men had not been seen for some time.

Investigators say they have not determined a motive for the slayings, but friends say they believe the men were killed because they were gay.

One friend, Patrick Beard, told WRTV that the men had been targeted by vandals, with their phone and cable lines cut twice in the past few months, and that homophobic graffiti was found on their front door.

“I firmly believe it was definitely a hate crime. Milt was 70 and his partner was 73 and to go into someone’s home and do something like that, it’s just too coincidental,” Beard told WRTV.

“I’m not a genius, but if someone’s being harassed like that and fagot gets stamped on their door on a piece of paper, it’s not that hard to connect the dots two months later that these two people are brutally killed in their home,” Beard said.

Police say only that they are investigating all possibilities.