with hearing loss. This report addresses the needs of these Seniors. - - PDF document

The Vermont Deaf,Hard of Hearing and DeafBlind Advisory Council

Programs and Organizational Supports for Seniors

Introduction

It is estimated that well over 10% of Americans (38 million) experience some degree of hearing loss. (Better Hearing Institute, ​www.betterhearing.o​rg) ​ In our State, including all age groups that represents over 70,000 Vermonters. One in six Vermonters (104,000) are 65 and older. (2010 Census) As people age, many experience diminishing hearing. The incidence of hearing loss in this age group climbs to 33%. (​www.healthyhearing.co​m) In other words more than 34,000 Vermont Seniors struggle

with hearing loss. This report addresses the needs of these Seniors. Elsewhere is a report about services and programs for Adults who are Deaf, Hard of Hearing or

• DeafBlind. It is important to recognize that Seniors access those programs as well but in

the interest of reducing redundancy, the focus of this report is on programs and services that are exclusive to Seniors.

Demographics

So, who are we talking about? The large majority of people with hearing loss (94.6%) are hard of hearing. They rely on their residual hearing, lipreading and technology (like hearing aids) to communicate in English. The culturally Deaf community comprises 1.4%

• f all those with hearing loss. They communicate in American Sign Language. Another

3.8% are late deafened which means that they became deaf after acquiring speech and English language skills. Some do learn Sign Language later in life, but most do not. The elderly especially do not tend to learn sign language. 94.8% = 66,360 Hard of Hearing Vermonters* 3.8% = 2,660 Late Deafened Vermonters 1.4% = 980 Deaf Vermonters It is important to bear in mind that hearing loss does not only affect the person with the

• loss. Far more Vermonters are impacted when you factor in : family members, friends,

neighbors, employers and colleagues. *These percentages are from an article by Dr. Terry Portis, former Executive Director of SHHH.

Hearing Loss as a Health Issue

Hearing loss may have a profound adverse effect on health and quality of life. Unfortunately its adverse impact on the individual and his or her family is often misunderstood or greatly underestimated. The person with the loss simply does not hear what s/he does not hear and does not fully understand what s/he is missing and

• ften they struggle and suffer for years before seeking help and treatment. Typically

friends or family members detect the diminished hearing first. 2

Untreated hearing loss has a very real detrimental impact on daily functioning and quality of life in the following ways:

• Depression - Relationship Problems
• Tension and Anxiety - Misunderstandings
• Frustration - Isolation
• Loss of Confidence - Fatigue
• Embarrassment
• Withdrawal from Friends, Family and Social Activities

Diagnosis and Intervention

Hearing loss is an “invisible” condition especially to caregivers who are not trained to recognize the symptoms. The person who is experiencing hearing loss needs to be appropriately assessed and diagnosed. There is an added risk for Seniors to be misdiagnosed. Increasing confusion and social withdrawal caused by hearing loss can be mistakenly attributed to dementia leading to erroneous, ineffective and even harmful treatment approaches. Especially in the older population, the symptoms of hearing loss is often attributed to diminished cognitive functioning which leads to misdiagnosis and inappropriate treatment. In addition when the individual and caring family members are told that “nothing can be done” in regards to “curing” hearing loss, they can mistakenly think it means that other interventions such as communication strategies, amplification, assistive technologies and counseling will not improve quality of life. In fact amplification along with effective aural rehabilitation, counseling and peer support can significantly improve communication, social integration and overall quality of life and health.

Problems/Needs/Gaps:

Poor recognition of the signs and symptoms of hearing loss by state agencies and health care professionals. (home care providers, nurses and other medical staff, day treatment centers, nursing home facilities staff.) Lack of aural rehabilitation services Lack of ​holistic​ hearing health support by audiologists and hearing aid dispensers 3

Recommendations:

Design and implement training for staff to assist them in recognizing the signs of hearing loss. Establish a protocol to refer to appropriate resources for hearing assessment. ​Barriers to Treatment and Services

• 1. At this time Medicare and most other insurers do not cover hearing aids. The

high price of hearing aids makes purchasing them beyond the financial resources

• f many. Although stigma is often cited as the reason many do not want to wear

hearing aids, in fact price remains a prohibitive and primary barrier to purchasing hearing aids.

• 2. Seniors lack access to comprehensive and effective aural rehabilitation services.

Even if they get hearing aids, they and their families do not receive information about adaptive communication strategies, audio assistive technology (such as captioned phones, captioning for television, flashing doorbells, FM Loops, pocket talkers) or instruction on how to utilize them.

• 3. Seniors are too often not given information on alternate funding sources for

hearing aids or resources like the Equipment Distribution Program (EDP).

• 4. Seniors with hearing loss are put at risk when they are not told by their

audiologists, hearing aid dispensers or their staff about emergency alerting devices such as flashing smoke alarms and strobe carbon monoxide detectors for their homes.

• 5. Staff is largely unaware that effective communication modes are substantially

different whether staff is working with someone who is:

• hard of hearing
• Deaf (ASL)
• late deafened or
• DeafBlind.

If they were trained and knowledgeable, staff would be in a good position to help 4

the Senior explore what communication strategies and technological assists would work well for them.

• 6. Organizations are not always aware of these different modes of communication

when providing services and training staff.

• 7. Staff is not always aware of when it is appropriate to obtain Interpreter or CART

services, who to contact to arrange for them and how to pay for them.

• 8. It is difficult to find counseling with a therapist knowledgeable in psychological

impact of hearing loss for a hard of hearing or late deafened person.

• 9. It is difficult to find a therapist who is knowledgeable in Deaf culture and fluent in

ASL or skilled at using an interpreter for counseling sessions.

Recommendations:

Design and implement a training package for all staff that work with Seniors:

• to recognize indications of possible hearing loss
• know how to adapt communication strategies to fit the individual’s communication

method and access needs and have basic adaptive equipment on hand (cc on TV, amplified phone, pockettalker.)

• know how to initiate a referral for appropriate assessment, diagnosis and

treatment

• have awareness of environmental acoustic and visual barriers at the site and ways
• f mitigating them.

Need to Strengthen Identification and Outreach to:

Those living at home. AAA VNA VCIL Nursing Homes Rehabilitation Centers 5

Adult Day Service Facilities Hospitals

Organizations and Services currently available DAIL ​The Department for Disabilities, Aging and Independent Living (DAIL) oversees

the adult service system and the implementation of the Older Americans Act for all

• Vermonters. DAIL works in partnership with:
• The Area Agencies on Aging
• Home Health Organizations
• Adult Day Programs
• Nursing Homes, Enhanced Residential Care Homes and Assisted Living Options
• Designated Agencies
• The Vermont Center for Independent Living

Services available through DAIL and its partner organizations include:

• Employment Supports
• Residential Supports
• Nutritional Supports
• The Assistive Technology Program
• The Dementia Respite Program
• The Elder Care Clinicians Program
• The Adult with Disabilities Resource Connection (ADR)
• Adult Protective Services
• The Public Guardianship Program
• Referral and Advocacy

VABVI - Vermont Association of the Blind

The Vermont Association for the Blind and Visually Impaired serves Vermonters of all ages who have vision loss. It also serves those who have a combined vision and hearing loss to accomodate for the “vision-side” of Deafblindness. Vermonters over the age of 55 who have a visual impairment can receive services at no charge to help learn adaptive skills and learn about adaptive aids such as magnifiers, signature guides and liquid level 6

indicators, that allow individuals with vision loss to remain in their home and as independant as possible. The cost for direct service is covered through the Chapter 2 Funds (also known as the “Older Blind Grant”) which is provided through State and Federal Matching Funds. For some who do not have the resources to buy adaptive aids, some equipment can be obtained through this grant and connections to local resources.

AARP - VT Hearing Loss Association of America (HLAA)

Hearing Loss Association of America is the nation’s leading organization representing people with hearing loss. They provide information, education, support and advocacy for people who are hard of hearing or late deafened and their families to learn how to adjust to living with hearing loss.

EDP Program - Equipment Distribution Program Office of Professional Regulations OPR

Their mission is to protect the public from incompetent or unethical practitioners in 46 professions including Audiologists and Hearing Aid Dispensers. There is a process for filing a complaint. Recommendation: ​Each time a consumer is given a hearing evaluation and/or purchasing a hearing aid they are given a brochure explaining their rights along with contact information for OPR with guidance on how to file a complaint.

Summary:

With the closing of the Center for the Deaf and Hard of Hearing, it became clear that services and supports for individuals who are Deaf, Hard of Hearing or DeafBlind and their families are being delivered through several entities across state government. Employment supports and supports for Vermont seniors are delivered through Vocational Rehabilitation and the Department of Disabilities, Aging and Independent

• Living. Early screening, detection and intervention happens through the Vermont EHDI

Program (Early Hearing Detection and Intervention program) located in the Vermont Department of Health. Early intervention services are offered through the Child Development Division of the Department for Children and Families and school age services are offered in local schools under the oversight of the Agency of Education. 7

It is critical that services be directed by entities with the appropriate level of expertise and equally critical that they be woven together into a cohesive system of care. In order to provide oversight, guidance and development. The state of Vermont is one of only a few who does not have a designated Department or Coordinator of Deaf, Hard of Hearing and DeafBlind Services. This has been problematic and has led to gaps and inaccessibility in services. Hearing Loss affects a significant percentage of people in Vermont. This is especially true for Vermonters who are Seniors. It is well established that untreated hearing loss adversely affects health in a variety of ways. Appropriate and effective treatment options are too often not available to those who need them. We recommend exploring and developing a comprehensive way to ensure effective communication and full access to services for all Deaf, Hard of Hearing and DeafBlind

• Vermonters. We suggest that the protocols for referrals need to be clearly defined for

consumers and staff alike. Finally, we recommend that a key person be identified to take a leadership role of ensuring that these protocols and processes run smoothly and the quality of staff training is reviewed and maintained for the benefit of these Vermonters with hearing loss. Respectfully submitted, Deb Charlea Baker, Chair Monica Hutt Spenser Weppler AJ VanTassel Dan Norris, VABVI 8