[Here we would have video similar to http://www.youtube.com/watch?v=j0p74MgfV-8 pick up after the commercial and introductory page]Narration:Hospitals --- they can be a scary and confusing place for anybody. But imagine if you had to go through a scenario like this, in silence (continue with pictures, but with no sound) and with no way to communicate.
About 9% of the US population or over 21 million people have hearing problems in America. Anywhere from 2 million to as many as 8 million Americans are completely deaf As the population aged between 1971 and 1991 a 53% increase in hearing problems was seen.
About a third of hearing problems can be the result of other complex health problems.
Subsequently a significant number of deaf persons can also have complex medical issues which means that they are more likely to end up in the hospital.
Going to the hospital can be intimidating for anyone.When you are deaf or hard of hearing, or even if you CAN hear, the hospital can be a confusing place. Additionally, staff may not have the resources or understand how to care for you in the best way possible. What if you knew that because you were deaf, your chances of having something go wrong during a hospital visit was three times more likely than for the average person who can hear?
According to a Canadian study, hospital visits are significantly more dangerous for patients with hearing problems than for people without that disability.Researchers studied nearly 2,400 patient records from twenty hospitals in Quebec.
They found that preventable adverse events in hospitals occur three times more often among patients with communication problems like deafness.A preventable adverse event is defined as “an unintended injury or complication caused by the delivery of health care”
The most common adverse effects were: drug related, or caused by inappropriate treatment, treatment delay, or failure to monitor a patient’s condition. Researchers found these preventable adverse events were significantly more likely among people with communication problems like deafness. In fact, deaf patients were more likely to experience more than one preventable adverse event.
The underlying problem is the inability of deaf people to effectively communicate and be effectively communicated to by health care professionals.The conversation between the doctor and patient is the heart of medicine.
The conversation between the doctor and patient is the heart of medicine.
The ability to effectively diagnose and treat illness comes from a thorough medical history that only happens through a thorough conversation between a doctor and patient. Good patient doctor communication is fundamental to good healthcare.
However deaf people often cope with extraordinary communication problems in healthcare settings. The result is inadequate care and in some cases, inappropriate care that harms.
Oral Communication is the BIG ISSUE for most hard of hearing, late deafened, and oral deaf people, because it is a fundamental capability that pervades a person's entire life. Communications problems increase the complexity and difficulty of many areas of a person's life.As you might imagine, people with hearing loss are often left out of the process of deciding hospital policy, which means that their needs are ignored.
Hearing aid affordability is increasingly becoming a significant issue among people with hearing loss.As the cost of hearing aids skyrockets, fewer people are able to afford the aids that can help them retain personal communications.
The problem of communication is compounded by the other challenges deaf people face.Many deaf have a lower education level and difficulty with employment.This means that they havelower income to access hearing and communication devices and often can’t afford them. The average deaf person has a lower level of literacy, less health knowledge and fewer health education opportunities.
Lack of access compounds communication problems where healthcare is concerned. The deaf are at a distinct disadvantage in advocating for their own health care needs. They are among the most vulnerable in our society.
Almost 60% of hearing impaired people said that they went to the doctor more often, for assistance to problems not resolved in the last visit because they left the first visit not understanding what to do.That means higher health care costs.So the deaf face higher health costs, less access to health information and a significantly higher risk of something going wrong in the hospital, especially in an emergency.
The law says, it’s not supposed to happen!When communication with hearing challenged patients in a healthcare setting is substandard, not only is the patient’s care compromised but the hospital may be guilty of illegal activity and puts its facility at risk for costly lawsuits.
In 1990 the Americans with Disabilities Act was passed and included definitions of what constituted adequate communication between health care providers and deaf orhard of hearing patients.The Americans with Disabilities Act guarantees people with disabilities equal access to healthcare.
The law says that communication aids must be provided to give the a deaf person equal access to communication with the doctor and health care providers.The might include a sign language interpreter, note takers, written materials, assistive listening devices like pocket talkers or CART.The law says that health care must be equally accessible to all people including those who can’t hear.Accommodation is the law for hospitals!
More than a decade after it was passed, too many facilities still have not made provisions mandated by the Americans with Disabilities Act.They aren’t prepared to deal with deaf patients and don’t understand what is at stake.
Many hospitals are still uninformed about the full mandates of the law.Some health care institutions have even ignored them, assuming that deaf clients would not pursue a law suit against their non-compliance.
The cost of ignorance and neglect may be far more than the cost of assistive devices to help a deaf person communicate.The number of successful lawsuits file by deaf people against healthcare providers has gone up. Hospital administrators sometimes fail to invest in equipment to help the deaf communicate and don’t train hospital staff about how to properly operate it. That means failure to comply with the law.
The law states that the cost of the communications equipment is the responsibility of the hospital facility. The law says that providing the equipment and trained staff is part of the cost of doing business and not the responsibility of the disabled patient.
Trying to cut hospital overhead by not providing deaf patients with the equipment they need to communicate with doctors, and staff members trained to use it can also raise the cost of care for hospitals.
One study says, “Almost half of preventable adverse events were associated with some level of disability in the patient and multiple hospital admissions.”Research shows that 57% of patients who experienced a preventable adverse hospital event ended up having to stay longer.One third (35%) of patients who experienced preventable adverse events had to be re-admitted to the hospital (32%) were discharged with minimal impairment or recovery because of the event(10%) of patients experienced moderate impairment that took a year to recover from (5%), experienced permanent impairment (6%) died from the event These kinds of statistics show the risk of not providing improve patient safety by providing ways for deaf patients to communicate effectively.”communicate effectively.”The study concludes that it’s vitally important for hospital and healthcare settings to take a closer look at interpersonal dynamics between a deaf patient and hospital staff that may be responsible for problems.
[We could also have an interview with a deaf advocate talking about these things and insert it here]What do hospitals and emergency rooms need to do? Provide assistive devices Have staff trained to use themProvide a way to transfer Teletypewriters (TTY) or even Video Relay calls (VRS) to patients, pr provide pocket talkers and CART.A TTY is a special device that lets people who are deaf, hard of hearing, or speech-impaired use the telephone to communicate, by allowing them to type messages back and forth to one another instead of talking and listening. Video Relay Service (VRS) is phone service accessibility between deaf and hearing people VRS allows deaf and hard of hearing individuals to have telephone conversations with hearing people. Using a videophone with real-time video connection, an interpreter relays the conversation between the two parties. Among the communication options for deaf and hard of hearing people is a fast growing service called CART, a method of Speech–to–Text translation. The term ‘CART’ is an acronym for Communication Access Real-time Translation or Computer Aided Real–Time Captioning (both titles describe the same service).Using stenographic machines and computer software, CART providers translate the spoken word into the written word nearly as fast as people can talk, hence the “real-time” tag. Text is displayed on a laptop computer, monitor, or large screen, depending on the situation. CART results in a verbatim (word–for–word) text of all spoken content. A related service, computer–assisted note taking (CAN), produces a briefer summary that may not be as complete as a CART transcript.A CART specialist sets up a stenographic machine and a laptop computer, listens to what is said, and transcribes every word so that it can be viewed on the computer screen almost as soon as it is spoken.
[We could also have an interview with a deaf advocate talking about these things and insert it here]There are other simple, less expensive measures to ensure the safety of deaf patients.Every medical chart should have patient identification, for example, asticker that states: “Deaf” or “Hard of Hearing” and additional information like “Speech reads or Reads lips” or “Does NOT read lips,” or “Interpreter needed” (and contact information for interpreters).Hospitals need to know how to arrange Pre and Post-surgery interpreters in their areaHospitals can use a color wristband ID—similar to the Allergy ID bands that say “Deaf” or “hard of hearing.” 4. Check about possibly putting a yellow (or other color) sign on the wall behind the bed in a patient’s room that states, for example, “Patient is Deaf,” or a sign on the door to the patient’s room.5. Make sure call buttons with the hospital operator and nursing stations say that a patient is Deaf or hard of hearing. Have nursing and other staff go to the patient when the “Call nurse” button is pushed.6. Make staff members aware that surgical masks may need to be removed for a short period of time to accommodate lip reading. 7. The surgeon and anesthesiologist should not do the operation unless emergent. You need to understand the procedure clearly and sign any consents with a qualified interpreter. Make sure an interpreter or other accommodation is available before your surgery happens. 8. Be sure the Emergency Room is aware of interpreter contact information or who to contact when needed.9. When a deaf or hard of hearing person is admitted through the Emergency Room or from your doctor’s office, make sure the “floor” they go to knows about needed interpreters or assistive devices. 10. Work with their Information Technology department for innovative ideas that allow patients (Deaf or hearing!) to check themselves in, provide insurance and other necessary information, interpreter or other accommodations needed, and telephone field modifications so they can include TTY and/or video relay numbers.
In summary, the entire system needs to know what to do when a Deaf or hard of hearing person is in the hospital:Health care workers, switchboard operators, food services,transportation and others.Numerous state and federal laws have been passed which seek to minimize the effects of disability bias and give people with disabilities equal opportunities. All hospital workers need to know the legal rights of with hearing loss.
Deaf people have the right under law to be free from discrimination in employment, public accommodations, transportation, education, and communication. Hospital safety and accommodation makes for happy patients. Reputation is everything! A good one will for a hospital will only bring the health care system more business, make life easier the disadvantaged, and provide the hospital with incentives to provide excellent patient safety and quality ratings!The problem of deafness is not going away, it is increasing.
This issue is not going away! In fact the problem of treating deaf and hard of hearing patients will become more critical in the years to come.That’s because the number of adults with hearing disabilities is going up as the elderly population increases.But perhaps the most noticeable segment of the population to report symptoms of hearing loss are the so-called "baby boomers" in their 40s and 50s.In a twenty year period from 1971 to 1991, hearing problems among those between ages 45 and 64 jumped 26 percent, according to the National Health Interview Survey. In California, a research study showed the rate of hearing impairment jump 150 percent between 1965 and 1994 among those in their 50s. The trends will only continue as baby boomers age. Almost 50% of age of 89 year olds in American now have hearing problems.The deaf population is expected to grow.Former President Bill Clinton was 46 years oilwhen he entered the White House as the second youngest U.S. president in history. Five years later, he was wearing hearing aids in both ears at least occasionally, when he had to mingle in large crowds. He isn't alone in his hearing problems. Clinton’s generation, the baby boomers, are the first generation to be raised on rock-n-roll and arefacing far more hearing loss than their parents ever did.
In the past we have thought of hearing loss as a condition that typically strikes seniors, but more and more Americans are experiencing difficulties with hearing loss at an earlier age. Last year, a study in the Journal of the American Medical Association reported that nearly 15 percent of school-aged children had hearing deficits at low or high frequencies.There was also a 17 percent increase of hearing problems in the 18 to 44 age group.
That means hospitals will soon be facing a whole generation of potential patients with hearing issues. Is your hospital prepared to deal with it? Wouldn’t it be wise to be sure your facility is in compliance with the Americans With Disabilities Act now ?[This could be ended with the video we began with of the emergency room situation]
Presentation Hospitals and Hearing Loss
Hospitals and Hearing Loss The Hard of Hearing Are Still at Risk in Some Hospitals!
Hospitals: Scary and Confusing [Insert Video here]
The Growing Problem of Silence About 9% of Anywhere from 2 Americans or over to 8 million 21 million people Americans are have hearing completely deaf. problems. Between 1971 and More than 20 1991 we saw a million of those 53% increase in have hearing hearing problems problems. in the aging. Deafness or loss Almost half the of hearing is the hearing problems single most are significant. chronic disability in America.
Hearing and Health• About a third of hearing problems come from other health problems.• A significant number of deaf people have complex medical issues that contributed to their deafness.
Preventable Adverse Effects• Significantly more likely among those with communication problems like deafness• A preventable adverse event is defined as “an unintended injury or complication caused by the delivery of health care”
Common Adverse Effects• Drug related• Inappropriate treatment• Treatment delays• Failure to monitor a patient’s condition• The deaf experience more than one event
The Underlying Problem• The underlying problem is communication between deaf patients and health care professionals.
The Heart of Medicine• The conversation between the doctor and patient is the heart of medicine.
Effective Diagnosis and Treatment • A thorough medical history happens through a thorough conversation between a doctor and patient. • Good patient doctor communication is fundamental to good healthcare.
Deaf Healthcare Communication• Extraordinarily difficult for the deaf to communicate in healthcare settings• The Result: – Inadequate care – Inappropriate care – Care that harms
The BIG Issue• Oral communication for the deaf• Deaf people not included in the process• Needs are ignored
Hearing Aid Affordability• Becoming a significant issue for the deaf• Fewer can afford hearing aids• Communication difficulties result
Challenges Deaf People FaceLower Income Level Lower literacy Level
The DeafAmong the most vulnerable in our society
Almost 60 % of the. hearing impaired go to the doctor more often: • Higher health Due to unresolved costs medical problems • More healthcare A lack of • Inability to resolve understanding from health issue prior visit • More health risksNegative Outcomes for Deaf Patients
What the Law Says for Deaf PeopleThe Hospital MustProvide:• A sign language interpreter• Note takers• Written materials• Assistive living devices• Health care must be equally accessible
Persistent Hospital Problems for the DeafLack of Understanding Lack of Preparedness• Yet many doctors still don’t understand the needs of deaf patients.• Some hospitals still aren’t prepared to really level the playing field in their facilities.
The Americans with Disabilities ActHospital Staff Uninformed Too Few Provisions Made
The Cost of Ignorance and NeglectHigher Than Assistive Healthcare Lawsuits and Devices Costs Go Up
Assistive Devices Required• The cost of the communications equipment is the responsibility of the hospital.• The law says its part of the cost of doing business and not the responsibility of the disabled patient.
The High Cost of Doing Nothing • However trying to save money by not providing deaf patients with equipment to communicate and staff members trained to use it can also raise the cost of care.
Preventable Adverse Hospital Events• Half of all preventable adverse events happen to the communication challenged• 57% of those affected had to stay longer• More than a third (35%) had to be re-admitted• About a third (32%) were suffered minimal impairment• A tenth (10%) suffered moderate impairment• (5%) experienced permanent impairment• (6%) died from the adverse event• Non-communication in healthcare is risky and costly!
What Do Hospitals Need to Do?• Provide assistive devices for the deaf• Train staff to use them• Provide transfer Teletypewriters (TTY) or Video Relay calls (VRS) pocket talkers and CART
What Else Can Hospitals Do?• Use patient ID on charts• Arrange for deaf interpreters• Use wristbands, signs• Special provisions• Remove surgical masks
Deaf People Have Legal Rights!• Everyone in the hospital system needs to know when a deaf or hard of hearing person is a hospital patient• Everyone needs to be trained know what to do to avoid adverse outcome
Deaf People Have Rights in Hospitals• Hospital safety makes happy patients!• Reputation is important!• The problem of communicating with the deaf in healthcare settings is not going away!
The Baby-Boomers: A Hearing Loss Time Bomb• Former President Bill Clinton: One of many baby- boomers who face hearing problems• The numbers will increase as baby boomers age
PREPARE FOR • More Americans are THE FUTURE losing hearing at an earlier age • 15% of school age children have hearing deficits • Young adults are showing signs of hearing impairment • The trends are expected to continue as baby boomers age.