In Michigan, where politicians debate on several bills, including bathroom bills, LGBTQ+ rights face daily challenges. Among these battles is one being fought in living rooms and hospital beds: the right to simply die with dignity.For most queer elders who spent years of their lives hiding their authentic selves, death can be the final closet but an underground network is changing that story, a network of death doulas, operating without formal training or legal recognition, and creating the support systems that mainstream healthcare refuses to provide. Related Frank Kameny & Sylvia Rivera are heroes, but their deaths reveal a sad truth about queer elders The encrypted message was received at 3:45 a.m.: Trans fem elder. Stage 4 pancreatic. Family hostile. Needs advocate. Can you help?Maya Rodriguez, a 43-year-old transgender woman and a volunteer death doula, was already awake and on her feet. Rodriguez hardly sleeps for more than five hours a day, a dedicated individual, always ready to respond to urgent calls or messages from LGBTQ+ elders facing their final days in a healthcare system that most times denies their humanity. Never Miss a Beat Subscribe to our newsletter to stay ahead of the latest LGBTQ+ political news and insights. Subscribe to our Newsletter today We operate like a resistance movement because we have to.Pat WilliamsWithin the space of an hour, she was at the beautiful Detroit apartment, making sure her clients name and gender identity would be honored in medical records. The elder kept saying, Thank God you are here. I was scared they would not understand, she recalls. She held the elders hand when the ambulance arrived.It is work that hospice corporations rarely have time to do properly, if they are willing to do it at all. Why Queer Elders Fear Dying in ShameDeath doulas also referred to as end-of-life doulas provide non-medical assistance or support to persons and their families during their final days, offering emotional, spiritual, and practical assistance. Unlike hospice workers who focus on medical care and symptom management, doulas spend hours or days to ensure that a dying persons final chapter honors their complete life story.For queer elders, this support is crucial. Many came of age at a time when being openly queer could mean losing their jobs, families, and safety. They now encounter similar prejudices in healthcare settings. These systems assume everyone has a supportive biological family and fit heteronormative boxes. These assumptions are wrong.Rodriguez became a death doula after losing her own mentor, her mother, a transgender elder often misgendered by hospice staff despite her legal documents. As a teen, she watched someone she loved dearly be erased in her final weeks. She swore not to let that happen to others. The Number Behind the NeedMichigan mirrors a national crisis. According to the Williams Institute at UCLA School of Law, about 40% of LGBTQ+ adults who are over 50 report experiencing healthcare discrimination; for transgender elders, the rate is higher. About 15% avoid care entirely for fear of discrimination, maltreatment, or verbal harassment by health workers. Isolation worsens the problem: 39.8% of LGBTQ+ elders live alone, compared to 26.2% of heterosexual peers, leaving many without advocates.Michigan, unlike other states, does not have any dedicated LGBTQ+-affirming hospice or senior living facilities. States like California and New York have LGBTQ+-focused senior living communities like Stonewall Gardens in California and the Palms of Manasota in Florida. This gap forces LGBTQ+ elders to rely on underground networks like the queer death doulas for affirming care. In contrast, for-profit hospices nationwide prioritize shareholder returns, often minimizing expenses on training and services not incentivized, such as extended cultural competency programs.I watched 37 years of love being erased in real time. Thats why we existnot just to help people die, but to help them live fully until they dont.Maya Rodriguez Building Networks in the ShadowsIn response to these systemic failures, an informal network of queer death doulas operates largely through encrypted apps like Signal and WhatsApp, sharing client referrals and maintaining password-protected spreadsheets that rate providers on their LGBTQ+ competency.We operate like a resistance movement because we have to, says Patricia Pat Williams, 67, a retired social worker and network coordinator. She started offering end-of-life support during the height of the AIDS crisis, a time when hospitals denied dying gay men access to treatment. We learned early that we couldnt rely on institutions to treat us as equals, with dignity, so we built our own through word-of-mouth referrals and encrypted networksbecause many of us fear professional retaliation if our identities are discovered.The networks principles stand in direct opposition to for-profit healthcareno one is turned away for their inability to pay, all gender identities are honored regardless of legal paperwork, and family is defined by chosen relationships, and not blood ties. Training Through Experience and Shared WisdomMost death doulas flee expensive certification programs; instead, they learn through rigorous, in-depth practical workshops, monthly programs held in Detroit, Grand Rapids, and Lansing. Sessions cover practical skills: preventing bedsores, advocating with medical staff, and solving issues related to cultural sensitivity.Experienced death doulas mentor newcomers through their first cases. They learn everything from how to advocate with medical staff to creating a safe space for clients who have spent decades hiding their authentic selves. The network maintains detailed records of best practices, legal considerations, and cultural sensitivity protocolsall shared through secure digital channels.Formal training teaches you about the bodys processes, Rodriguez says. We teach each other how to protect dignity for people who have been told for decades they do not deserve it. Legal knowledge is critical. Michigans 2023 expansion of medical aid-in-dying laws increased patient autonomy but also opened doors to risks. Without formal medical credentials, doulas must be wary of actions that could be seen as unauthorized medical assistance. The Daily Practice of DignityA days work might mean updating a trans elders legal documents, intervening when hospital staff misgenders a patient, or helping to plan a memorial that reflects a persons true identity. Doulas also carry out body autonomy ritualswashing the dead while affirming their gender. This helps to counter funeral home erasure and advocates for clients whose families reject their chosen relationships.Rodriguez recalls accompanying a lesbian couple who had been together for 37 years to the hospital for an appointment. A particular staff member repeatedly misgendered theman experience that highlights the day-to-day discrimination many LGBTQ+ elders face daily.I watched 37 years of love being erased in real time, she says. Thats why we existnot just to help people die, but to help them live fully until they dont. From Resistance to RecognitionSome healthcare institutions are beginning to recognize the value of community-based approaches. Corktown Health in Detroit, for instance, has expressed interest in learning from grassroots models, and academic institutions, including the University of Michigan, have shown curiosity about community-led care innovations. Advocates are fighting for Medicaid reimbursement, affordable state certification pathways, and stronger legal protections for chosen family decision-making.Under Michigans law, a clients estranged family member who hasnt spoken to them in years could override the client on morphine decisions. Death doulas help clients avoid such scenarios. They legally outmaneuver hostile families while surrounding queer elders with love. Qualitative reports and community feedback suggest that queer death doula networks achieve higher patient satisfaction rates and better symptom management than traditional hospice care for LGBTQ+ patients, though formal studies and funding remain limited.While Michigans medical aid-in-dying legislation allows terminally ill patients with fewer than six months to request life-ending medication under strict safeguards, including waiting periods and mental capacity evaluation, its implementation has been uneven, with many healthcare providers refusing to participate on religious or moral grounds. These legal changes, while broadening access, mirror ongoing systemic challenges that affect marginalized communities, including queer and Black elders, who often face additional barriers in healthcare and end-of-life planning. As the network continues to grownow exceeding 80 active volunteers across Michigancritical questions about formalization and sustainability emerge. Some advocates are calling for state recognition and funding to sustain the network, while others worry that formal institutionalization might undermine its flexibility and cultural sensitivity.Were at a crossroads, says Williams. Should we work to change the system from within, or focus on building independent alternatives that truly meet our communitys needs?For Rodriguez, the path is clear. During the AIDS crisis, we buried lovers that hospitals refused to touch. Today, were committed to ensuring that LGBTQ+ elders never have to endure that kind of forgotten trauma again. This isnt just about care; its a movement for dignity and justice. As she speaks, her phone buzzes with another message. Another elder reaching out in fear, another opportunity to provide the care that mainstream medicine too often denies.Names have been changed to protect the privacy of doula network members and their clients. Many doulas fear professional retaliation if identified, hence the encrypted networks and underground operations.Some locations were altered to protect safety.Subscribe to theLGBTQ Nation newsletterand be the first to know about the latest headlines shaping LGBTQ+ communities worldwide.