Better Access to Hospitals for the Deaf, Hard of Hearing and the Deaf-Blind

Better Access to Hospitals for people who are Deaf, Hard of Hearing and Deaf-Blind: Pittsburgh takes initiative in improving the services for the disabled communities Wednesday, April 29 2009 Richard Meritzer/ ADA Coordinator Department of City Planning, City of Pittsburgh Ying Lee/ Intern Fall 2008 Master of Product Development, Carnegie Mellon University Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

The mission of the City of Pittsburgh-Allegheny County Task Force on Disabilities is to advise the Mayor and County Executive on City and County policies that will benefit persons with disabilities. This City/County Task Force is concerned with the issues of independent living for all persons with disabilities. The purpose of the Task Force is to integrate individuals into community activities and employment of their choosing, with the goal of eventually eliminating the need for such a Task Force. The Task Force will also advise the Mayor and County Executive on state and federal issues that impact upon the dignity of the lives of people with disabilities. Executive Committee Other Members Paul O’Hanlon, Chairperson Aurelia Carter Milton Henderson Katherine D. Seelman , Ph.D., Co-Chair Linda Dickerson Richard McGann John Tague, Treasurer Janet Evans Jeff Parker James “Chris” Noschese, Sarah Goldstein Executive Board Member At-Large Liz Healy Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Mayor Ravenstahl is creating a Pittsburgh with a vibrant economy and 21st century job growth. He is: • implementing his public safety action plan • working to attract and retain residents and businesses • serving as one of the key creators of the recently announced Pittsburgh Promise, an innovative student scholarship program Mayor Luke Ravenstahl Mayor Ravenstahl reinstituted the ADA Coordinator position in September 2008 after a previous administration had eliminated it during budget cuts. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Department of City Planning City of Pittsburgh The Department of City Planning sets the framework for the City’s development through policy and development review by the Planning Commission and through administration of the zoning ordinance. The department pursues community development by facilitating community planning processes, supporting community-based and technical assistance organizations and programs, and administrating the Community Development Block Grant (CDBG) funds. Noor Ismail, AICP Director Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Special Thanks to Leslie Cooke, intern summer 2007 Michelle Corkum, intern summer 2008 Kim Mathos, Ph.D Teresa Nellans James Chris Noschese Susan Schaeffer, Ph.D Katherine D. Seelman , Ph.D Tanya Ulrich Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

“...Imagine being taken all over the hospital and having things done to you and you have no idea why — because you can’t hear anything. You are reading notes here and there from different people that say: scheduled; rescheduled; you can’t eat; you have to; sorry; don’t know; will see; I’ll ask; try to find out; wait. ...I was never able to talk to my wife again. She died the following day.” --Clyde, Letters to the Editor, Jan 30 2009 A Sad Story from Ohio.com Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Americans with Disabilities Act III-4.3200 Effective communication. In order to provide equal access, a public accommodation is required to make available appropriate auxiliary aids and services where necessary to ensure effective communication. The type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the length and complexity of the communication involved. ADA Title III Technical Assistance Manual Covering Public Accommodations and Commercial Facilities Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Project Time Line January and February 2007 – Issue brought to the City of Pittsburgh / Allegheny County Task Force on Disabilities by residents. June and July 2007 – Problem identified and confirmed through survey community of members by intern. August of 2007 – Intern finished the Preliminary Report. The hospitals received copies of her report. June and July 2008 – follow-up meetings were held with the hospitals to discuss the report and provide technical assistance. September through November 2008 – resurveyed people who are Deaf, Deaf-blind and Hard of Hearing to evaluate what, if anything, had changed. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Preliminary Report Issue CPAC Task Force Meeting January 2007 The issue of accommodations in hospitals for patients who are deaf and hard of hearing was first broached to the City of Pittsburgh / Allegheny County Task Force on Disabilities. A 10-week research consisted of questionnaires for hospitals and consumers was then initiated by the Department. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Preliminary Report Survey Methodology The intern sent out questionnaires to the hospitals in the area asking them to evaluate elements of accessibility with 13 questions. Another survey was sent out to members of the community asking about there hospital visits. The survey had 20 questions and was designed with input from people who are Deaf and Hard of Hearing. The results of these two groups of questionnaires were compared and reported on. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Preliminary Report Findings Many consumers suggested staff should be more knowledgeable about: - Deaf culture - American Sign Language - assistive listening devices - other assistive devices for better communication with people who are hard of hearing, deaf or deaf-blind. Example of inadequate communication with hospital personnel: “They write to me- too many words, too little, hard to understand. Had them call my therapist-she explained why I needed and interpreter and TTY.” Approximately 30% of the consumers reported: “…no effort was made from the medical personnel in contacting an interpreter to come to the location.” Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

For the rest of this presentation we will be discussing two hospital systems which operate almost all the hospitals in City of Pittsburgh/ Allegheny County. Hospital System A is a leading American healthcare provider and institution for medical research. Systemwide, It is a $7 billion non-profit organization that has 48,000 employees, 20 hospitals, 400 outpatient sites and doctors’ offices, a 1.2-million-member health insurance division, as well as commercial and international ventures. It consistently ranks in U.S. News & World Report’s “Honor Roll” of the approximately 15 best hospitals in America. On that annual list, it has appeared eight consecutive times from 1999 through 2007. As of 2007, it ranks 13th among the best hospitals by U.S. News & World Report. (From Wikipedia) Hospital System B is comprised of some of the oldest and best-known names in health care in western Pennsylvania. From their inception, the system’s hospitals have been in the vanguard of patient care, medical research and health sciences education. It is comprised of two tertiary and four community hospitals, offering a comprehensive range of medical and surgical services, the hospitals serve Pittsburgh and the surrounding five-state area, house nearly 2,000 beds and employ more than 13,000 people. Together, its hospitals admit nearly 79,000 patients, log over 200,000 emergency visits and deliver more than 4,000 newborns each year. Combined, the hospitals are among the leaders in percentages of total surgeries, cardiac surgeries, neurosurgeries and cardiac catheterization procedures performed throughout the region. (Hospital System Web Site) Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Hospital System A has a director of their Disabilities Resource Center who acted as a single point of contact and coordinated their response. Hospital System B had various hospital and departmental representatives working with us. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Meetings with Hospitals Hospital System A The deaf and hard of hearing consumers suggested: • clearer signage throughout the hospital systems (consumers who are deaf and hard of hearing) • training for staff on the locations of accommodation equipment Hospital A agreed to: • implement strobe alarms and door knockers; • adapt ADA picture books http://www.abledata.com/product_images/images/92A0276.jpg http://www.drillspot.com/pimages/11/1163_300.jpg Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Meetings with Hospitals Hospital System B The consumers reported: • Patients waited hours for interpreters. Hospital B agreed to: • obtain American’s With Disabilities Act (ADA) picture books • educate staff on accommodations for hard of hearing and deaf patients. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Methods Online Survey via Survey Monkey Respondents : 22 consumers 19 were deaf 3 were hard of hearing 7 family members or friend 5 were hearing 2 were deaf 12 hospitals Participants recruited via: The City of Pittsburgh/ Allegheny County Task Force on Disabilities ADA Coordinator’s e-mail list, Center For Hearing And Deaf Services, School For The Deaf, local universities and others Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Feedback on general visits How was your most current visit? communication accommodation treatment very poor poor neutral good very good in general 0 2 4 6 8 10 Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Feedback on assistive devices Most consumers did not request for accommodating devices or the devices were not applicable to their situations. One deaf consumer suggested that the hospital acquire flashing alarm clock for deaf patients. “When the nurse wake me up, I got scared. I would like to have a flasher before the nurse wake me up. A lot of deaf people (do), too.” http://uk.gizmodo.com/loud%20alarm%20clock.jpg Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

“Recently during son’s Emergency Hospital visit and stay, nurses did not feel the need to call an interpreter and flat out refused telling me and my wife that they would tell us and we could tell our son what they said. Very ignorant!” image source: http://www.mmc.org/images/mmc_services/deaf.jpg Reassessment Feedback on interpreters Many consumers requested a certified visiting interpreter but not every request was served. Of the 6 family/friends capable of communicating in ASL, 5 of them were often compelled to be the “family interpreter.” Department of City Planning, City of Pittsburgh Fall 2008 Presentation designed by Ying Lee. All rights reserved.

Reassessment Feedback on interpreters Decreased services received might have resulted from: • Small subject pool • Increasing use of assistive devices Preliminary Report 2007 Current Survey Result Service received without request 29% 7.7% Service received with request 60% 30% Request declined --- 23.1% Not applicable/ Didn’t think --- 30.8% about requesting one Department of City Planning, City of Pittsburgh Fall 2008 Presentation designed by Ying Lee. All rights reserved.

Reassessment Feedback from Hospital System A Most accommodations are provided upon request, including, TTY/TDD, hearing-aid compatible amplified phones, captioned televisions, and videos However, video phones and video relay services are still not provided. http://www.prattville.com/Sites/Prattville/Images/Main/t2_img_relay.jpg Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Feedback from Hospital System A Hospital System A is still investigating if the strobe frequency would inter- fere with other equipment, therefore • strobe door knockers ordered, not installed • strobe fire alarms are installed in hallways, not in individual rooms http://www.abledata.com/product_images/images/92A0276.jpg http://www.drillspot.com/pimages/11/1163_300.jpg Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Improvement since 2008 “Some improvement. I see the problem as staff turnover in the hospitals. When new staff is hired they are not informed of the law for providing interpreters when requested by my parents/ siblings.” (hearing family member) Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Suggestions from consumers “WORKSHOPS, INSERVICE training, Sensitivity training for the office managers- most of the office manager are responsible to cover for the interpreting fees due to their responsibilities with billing and requesting for any kind of services, etc. and also doctors and nurses- to learn how to accommodate and work with the deaf patients. “ American Sign Language (ALS) is different from English. The syntax is different and some words are different as well. And some English words don’t exist in American Sign Language. It is like comparing French and Spanish. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Recommendations • Hospitals have what the consumers need, yet these services are not always effectively provided. • Often an effective distribution channel is missing • When designing, distributing and preparing reports on surveys, always include consumers who are deaf, deaf-blind and hard of hearing and their respective organizations in the early and at all stages to avoid revisions, incorrect identification, and omission of different methods of communication and equipment accommodations. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Other recommendations Communication cards The Behavioral Health Task Force for Persons who are Deaf, Deaf-blind and Hard of Hearing in Pittsburgh is developing a communications card that people can carry and show. It will specify the consumer’s preferred method of communication. We support this card as a way to aid in treatment and communication and recommend it be used nationally. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Reassessment Changes for future surveys Apply different surveying methods Written English is not effective with consumers who are deaf or deaf-blind who only communicate in ASL. Explore different channels of engaging consumers If available, future online survey should incorporate ASL video clips or other forms of ASL communication tools. Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

The Compliance Manual This Compliance Manual provides information on standardizing procedures for admitting patients who are deaf, hard of hearing and deaf- blind. It is our hope that this Compliance Manual will become a standard for hospitals to use across the nation as a way of providing equal care to people who are deaf, deaf-blind and hard of hearing. The Compliance Manual will be available upon request. Please send your request to: Department of City Planning Attn: Richard Meritzer, ADA Coordinator 200 Ross Street – 4th Floor Pittsburgh, PA 15219 Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

President Obama’s Agenda on disabilities “... end discrimination and promote equal opportunity by restoring the Americans with Disabilities Act, increasing funding for enforcement, supporting the Genetic Information Nondiscrimination Act, ensuring affordable, accessible health care for all and improving mental health care.” --The Agenda. Disabilities http://www.whitehouse.gov/agenda/disabilities/ Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

Better Access to Hospitals for the Deaf, Hard of Hearing and the Deaf-Blind

by Ying Lee on Sep 03, 2009

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