Accommodate people with hearing loss in the hospital

Hospital care for people with hearing loss can be ineffective when people cannot communicate.  Most hard-of-hearing people do not know sign language because they lost hearing later in life and remain in the oral culture.    Without effective communication, quality of care is impaired and patient compliance is often reduced. The patient’s bed needs to have proper signage and chart records to alert staff of special communication needs.

Ironically, many hard-of-hearing people don’t call themselves “deaf” and sometimes are in denial.  However, they may have high-frequency hearing loss that means they cannot understand many consonants and confuse words. Lip-reading involves guesswork since many consonants look the same.  Unfortunately patients often bluff and pretend they understand. Shouting usually does more harm than good because it can distort sounds or causes discomfort.  Shouting can sometimes violate HIPAA regulations for privacy.

Very few hospital staff understand the value of assistive listening devices for this population.  Examples include the small radios called FM systems and other technologies. They often provide enough of a signal-to-noise (SNR) improvement to overcome the lack of sensory acuity. Better SNR will reduce the cognitive load and allow more comprehension of instructions.  Real-time captioning can serve as an “interpreter” for people who don’t know sign language, as well as providing a transcript.  Laptops can often access internet-based captioning resource via WiFi if qualified local captioners are not available.

Many hard-of-hearing patients have never heard of assistive technology, so it is up to the care provider to explain it and encourage its use.   This is not an extra burden, but a way to provide better care.  It is also compatible with the requirements of the U.S. Americans of Disabilities Act to provide equal communication access.

If patients wear hearing aids or cochlear implants, the aids are often removed in the hospital.   They need to be given to the patient before communication, using good hygiene practice.

I write this as a person with hearing loss who has had problems at several hospitals in several states.  Although I have a PhD in electrical engineering, I have to admit that it takes much more than technology to improve communications.  Caregivers need to recognize effective communication as essential to quality outcomes.  They need to be courteous to the hard of hearing patients.  All staff needs to have knowledge on how to accommodate people with hearing loss.  All staff needs to know the quality impacts of effective communications.  Administration needs to enforce compliance as part of their efforts to produce quality care outcomes.  The extra minute to provide the effective communication in a courteous manner can have great benefit in patient understanding and compliance.

Margaret Mortz is a former engineering professor, hearing loss advocate, and owner of

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