Lee Rood

lrood@dmreg.com

Copyright Des Moines Register and Tribune Co.

Whether working as a drag queen or a government employee, LeQuan Edwards always managed to find a bathroom to use.

So that rolling debate over public restrooms and transgender people?

“That’s the dumbest thing,” Edwards chafes. “It’s so ridiculous. C’mon folks, let’s find another story.”

Edwards, 52, is transgender. From where she’s been sitting these past few months — a hospital bed in Des Moines — her struggle to be treated like anyone else has never been so great.

Her current problem is a national one and arguably more critical than the one a Florida congressman recently dubbed The Great Bathroom Debate.

VIDEO: Catch up on the issues being debated

Iowa’s Civil Rights Act expressly prohibits discrimination based on gender identity. Still, Edwards’ caregivers have been unable to find a place for her to live.

Brian Carter, a retired United Methodist pastor and a longtime friend of Edwards and her family, contacted the Reader’s Watchdog about her dilemma:

Last August, Edwards had a stroke. She went to a rehabilitation facility in Clarinda, Iowa, and arrived at Mercy Medical Center in Des Moines in March with bad wounds on her legs.

She was scheduled to be discharged Tuesday. But a hospital social worker said hospital staff checked with roughly 90 nursing homes and rehab facilities and none — except one that was 2 1/2 hours away in Muscatine — would take her.

Edwards’ legs are wrapped in compresses. She has very limited use of her right arm and needs help getting to a bathroom. She also struggles with mental health issues, including bipolar and post-traumatic stress disorders.

But those conditions aren’t all that unusual in the general population.

Carter said a hospital social worker told him Monday one of the reasons they can’t find a nursing or rehabilitation facility near Des Moines is that Edwards is transgender. He said the social worker told him that facilities are accepting new residents say men don’t want to room with a person who is biologically male but identifies as a woman. Neither do their female residents.

And Medicaid, Edwards’ health care provider, won’t pay for private rooms, except on a temporary basis.

A national problem

If this seems like an isolated incident, here’s something to chew on: Edwards’ plight is a growing one. The transgender population in the United States is growing substantially right along with the baby boomer population.

While estimates vary widely as to how many Americans are transgender, people 65 or older in the U.S. will reach 19 percent of the population by 2030.

“The problem is huge,” said Donna Red Wing, executive director of One Iowa, the statewide advocacy group for gay, lesbian, bisexual and transgender people. “I can’t tell you how many people get turned away. And in the state of Iowa, you can’t discriminate against transgender people like this.”

Red Wing said transgender people face similar issues with where to sleep or go to the bathroom while held in jails and lock-ups.

But the problem takes on a different tenor when people are at their most vulnerable.

“Imagine you’re in your mid-70s, you’re really sick and you’re transgender,” she said. “You don’t have a lot of power.”

Since One Iowa receives frequent calls from people seeking long-term care for elderly or disabled transgender people, the organization hoped to put together a resource guide.

Last year, an intern attempted to survey 50 Iowa nursing homes and rehabilitation centers to determine whether they accepted transgender residents or if they would be willing to provide training so staff could learn how to be more welcoming to transgender residents.

“The reception was very chilly,” Red Wing said. “Of the 50, only three responded.”

One Iowa provides what’s called “Safe Zone” training with nursing homes and rehab centers, covering what Red Wing called “LGBT 101.” Whatever each of our personal biases may be, she said, gender identity is protected under the Iowa Civil Rights Act.

“If someone’s identity is female, you have to treat them as a female because that’s what they are,” Red Wing said. “It’s the law that people are to be treated with dignity and respect, and it’s the right thing to do.”

Nursing homes and rehabilitation facilities that accept Medicaid patients are prohibited from discriminating against residents based on gender identity, according to Amy Lorentzen McCoy, a spokeswoman for the Iowa Department of Human Services.

Facilities are supposed to factor in available resources, training and staff when deciding which residents they will accept. But Medicaid recipients can't always be served in their home communities, McCoy said.

“Their personal care needs may require training or resources that aren’t immediately available in a nursing facility in their community that accepts Medicaid reimbursement,” she said.

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Her darkest days

Edwards can trace the feeling of her identity being different than her biological sex — what’s called gender dysphoria — to age 4 or 5.

Growing up in Des Moines, she says, she felt like a loner most of the time. But she felt most accepted when she began performing as a 17-year-old drag queen under the stage name Brandi Vegas in Des Moines and other bars around the Midwest.

Edwards earned a college degree, worked in Omaha for eight years in the state revenue department, got in some trouble and even fathered a daughter.

In her mid-30s, she returned to Des Moines and the north-side neighborhood in which she grew up.

Her mother, Bobbi Edwards, worked at the Y-Not Grill on Sixth Avenue, a place once frequented by ex-cons, prostitutes and the after-bar crowd. The two tried to reach out to the neighborhood's needy.

“If you were hungry, we would feed you,” Edwards said.

Four years ago, however, Edwards’ identity struggle became acute.

“I came to the realization that I either had to change my sex or end my life,” she said.

She had already undergone hormone therapy before suffering the stroke and was saving what money she could to have sex reassignment surgery.

Edwards, who had previously lived in apartments, was living with her dog in her car at the time. As bad as that was, she said, it doesn’t compare to how she feels now.

“I haven’t really asked for anything in this life. This is the first time,” she said. “But I am being treated like a leper. No one deserves to be treated like this.”

At risk as they age

A disproportionate percentage of transgender people attempt suicide at some point in their lives, Red Wing said.

According to the American Psychological Association, elderly transgender people are also more vulnerable and at risk for institutional neglect and mistreatment. Among the reasons: discrimination due to age, sexual orientation or gender identity.

Generational differences and lack of legal protection may cause them to be guarded about their gender identity. They also are more likely to live alone and to be single.

Carter, the pastor, was hoping a Norwalk home open to transgender residents would take Edwards this week. But she was ultimately rejected because it was unable to serve her mental illness issues, he said.

Edwards cries and gets upset easily these days, in part because she is so worried about being moved so far from her mother.

She hoped Medicaid would help her find an efficiency apartment where she could live alone, near her mother, cook for herself and perhaps get another dog. Iowa’s newly privatized managed care system is supposed to have more flexibility in providing that kind of care, but it has to be cost-effective. Edwards' provider is United HealthCare.

Doctors: 24-hour care needed

Bobbi Edwards said doctors have advised against her daughter living on her own.

“They said they’ve taken her as far as they can, and that they don’t believe she’s going to get better than she is,” she said

Bobbi Edwards says she, too, has a litany of physical issues — including epilepsy, congestive heart failure and two kinds of arthritis. But Medicaid has managed to provide her the care she needs at home.

“I got all these things wrong with me, and I still get to live on my own and go to the senior citizens center, do a little shopping. I’ve got two pets,” Bobbi Edwards said.

Frank Kiener, social work manager for Mercy Care Coordination, said LeQuan Edwards is the only openly transgender patient he is aware of needing long-term care.

Most facilities asked about the availability of long-term care for Medicaid patients reject them simply because the reimbursement rate is too low. Some facilities decline patients with serious mental health issues if they are behavior-related or require certain medications, Kiener said.

Some of the facilities that Mercy contacted about Edwards said they believed she "needs to be in a private room for the comfort of all involved," Kiener said.

Edwards' doctors and physical therapists say she has so many care issues that a 24-hour facility would best meet her needs.

In the meantime, Edwards' daily nursing care and meals alone can cost more than $1,000 a day, not all of which is reimbursed by Medicaid, Kiener said.

As of Wednesday, Edwards had not decided whether to try to temporarily live with a brother in a one-bedroom home or move to Muscatine for the long haul.

Living with family is still her choice, but it's not one her physicians recommend.

I will update Edwards' case after she decides what she will do.

Lee Rood's Reader's Watchdog column helps Iowans get answers and accountability from public officials, the justice system, businesses and nonprofits. Contact her atlrood@dmreg.com, 515-284-8549 on Twitter @l,eerood or at Facebook.com/readerswatchdog.