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Hearing and understanding are ultimate challenges in everyday life, often made more difficult by the medical and physical challenges of aging. Paraphrasing Bette Davis: "Getting old isn't for wimps." As a result, it is important for audiologists to listen to patients' communication needs while guiding them to upgrade their hearing aids or to consider cochlear implants.
That said, it is important to remember that caring for older hearing-impaired patients isn't for wimps either. As people age, they often progress to more controlled living styles, such as assisted care and long-term care, and it is vital that the caregivers in these facilities receive proper education on their patients' hearing needs. By helping caregivers understand hearing technology and devices, audiologists not only can ensure optimum care for their patients but also strengthen relationships with local care facilities.
In 2008, I produced a DVD1 intended to be an ongoing educational tool to help new and experienced hearing aid users and their families understand hearing aids and how to care for them. However, the DVD also turned out to be a wonderful marketing tool because it is just as useful for training caregivers at the care centers I assist. Because these centers often experience high staff turnover, the DVD offers me a chance to maintain regular contact with their directors of nursing (DONs) to remind them to rerun the DVD for ongoing training. The education helps new staff members, but many DONs have told me they and their older staff members also learn something new about hearing, hearing aids or cochlear implant devices each time they watch it.
Communicate Early and Clearly
It is important for caregivers, such as nurses, administrators and social workers, to understand the audiologist's role in a patient's ongoing hearing and communication needs. When a hearing assessment is ordered, enhance your clinical description of the severity of the hearing loss and speech discrimination with dialogue about what the hearing loss means in terms of daily communication needs, especially if the patient does not have any amplification available. Perhaps they never did anything about hearing, they are still wearing the hearing aid they got 20 years ago or the hearing aid was a neighbor's and the family gave it to them when the neighbor passed on.
In the progress notes, write down what the daily caregivers need to do to communicate with the person. For example, write that Mr. XYZ has a moderate-to-severe-to-profound loss with fair speech discrimination; consequently, the caregiver should get his attention prior to speaking, talk within arm's distance for optimal speech understanding, get verbal acknowledgement that Mr. XYZ understands by having him repeat back, and evaluate if he answers appropriately. Also include that caregivers will have to keep in mind and consider visual aspects and where they should stand for Mr. XYZ to see their faces for communication. Always use the person's name according to the facility's policy, whether the formal Mr./Mrs./Ms. designation or, if permission is granted, the patient's first name. Some facilities use first names exclusively, but each has its own policies as to how residents are addressed.
Cochlear Implants
People are living longer, and many are still active into their 90s and beyond. Consequently, many clients are opting for cochlear implants (CI). Several of my clients have taken that step; they typically are overwhelmed when they begin hearing like they did 20 or 30 years ago and are able to reconnect with family without writing notes, straining to speech read or using other augmentative means of communication.
Many of the early CI patients of the 1980s and early 1990s are now finding themselves in assistive living or long-term care situations. As a result, many caregivers are dealing with their first CIs, and we can help them understand how they work.
One of the most important things to understand is that each patient's needs may be different. The caregiver should determine how to effectively communicate, taking into consideration whether the cochlear device is monaural or binaural; if the implant is monaural, whether the patient wears a hearing aid in the other ear; whether the patient has any visual needs; and whether the patient utilizes speech reading, writing notes or signing.
Assistive Technology
Deaf patients may use American Sign Language (ASL) or other forms of sign language to communicate. If a caregiver doesn't understand sign language and/or the deaf person's speech/voice patterns, the audiologist can introduce augmentative communication devices and community resources to help the caregiver gain insight into how to communicate with patients and more effectively treat their health and medical issues.
Other assistive listening devices, such as an FM and/or Bluetooth® link, may offer great help in improving communication and quality of life for the hearing impaired. Educate patients and caregivers about available technology and services, such as captioning for TV as well as for DVDs or VHS tapes that the patients may watch. Even though people hear the terminology and think they understand it, they often do not know that captioning is available on their TVs! And more and more TVs are set for captioning at entertainment establishments, exercise centers and restaurants.
For patients in independent living situations, devices like special doorbells, amplified phones, signalers, alerts, alarms, and timers may enhance both independence and safety. Sometimes patients don't voice their needs for such devices, but if you hand them a catalog periodically, such as when they come in for their annual check-ups, they begin to realize they are not alone and there are clever inventions to help them. Caregivers can likewise benefit.
Mark Hearing Aids
If a hearing aid is delivered to a client who is a resident in a care facility, it will help everyone-you, the patient and the caregivers-if the aids are marked red for right and blue for left or some type of marking that identifies right and left hearing aids. For many custom devices, manufacturers automatically use red for right and blue for left and will often put the last name or initials of the resident on the shell.
However, the audiologist often needs to mark behind-the-ear hearing aids in the office. Some manufacturers provide a red template to make this task easier, but when that is not an option, use red hypoallergenic acrylic to paint a red stripe or dot onto the shell of the right hearing aid. Then, when a caregiver's call comes into the office saying that so-and-so's hearing aids just don't seem to fit, you can save yourself a trip to the facility by calmly asking, "Is the red one in the right ear?"
Engraving the resident's name onto hearing devices is another great service for the caretakers, since it will enable them to get the hearing aids back to the right resident in case they were taken out and left somewhere or if a roving resident picked up the devices and wandered off with them (stranger tales have been told to this audiologist). Permanent markers don't work well on hearing aids, because they tend to be not so permanent. Engraving provides permanent identification and you can delineate "right" or "left" by rubbing a red or blue crayon to "pop" up the person's name on the case. Cover the colorized engraving with clear hypoallergenic acrylic to keep the color there longer.
Prepare Patients
Audiologists can play a big role in improving the patient-caregiver relationship by educating and preparing patients. When dealing with first-time amplification users or patients who are getting new hearing aids, strongly encourage them to talk aloud for 20 to 30 minutes, saying or singing old songs, poems, nursery rhymes, or quotations. This will help them hear their own voice again and thus discern consonants they may not have heard in some time. Then, when caregivers, family and other visitors try to communicate, patients will have a better chance to discern those sounds and be less likely to continue playing "fill in the blanks." When necessary, recommend that patients work with a speech/language clinician for ongoing aural rehabilitation therapy work.
Encourage residents to fill out a personal items list and keep it in a standard place, such as a wallet, along with their insurance card. The list should include information on healthcare and medical needs such as medications, contacts/eyeglasses, hearing aids, and dentures/dental bridges. The Vial of Life program, which promotes placing all the above information into a large prescription bottle and then placing the bottle on or into a refrigerator door so emergency personnel can easily find it, is strongly encouraged.
You can provide patients with other tricks and tools as well. For example, an anchoring device, such as the otoclip, can be attached to a custom aid with an anchoring eyehook that the manufacturer can embed into the faceplate. I often sew my clients' aids directly onto the eyehook. With various behind-the-ear devices, the otoclip is looped onto the hearing aid or onto the upper area where the traditional earhook is or would be. Offer it in the patient's favorite color and explain that it is like the librarian-style eyeglass cord that prevents losing or misplacing eyeglasses.
If a patient needs help removing a hearing aid, both the patient and the caregiver will benefit from a hearing aid with a removal handle or removal string. This device lowers the chances of the caregiver accidentally scratching the client, thus reducing the risk of infection, especially for diabetic residents.
Offer Specific Education
Along with an introductory guide to help caregivers understand hearing aids, you may want to put together a personalized daily guide for a specific resident's hearing aid. Include a check list of what to do when the hearing aid is not working, how to put the battery in properly, cleaning and care of the hearing aid, and how to put the aid in. Pictorial guides are especially helpful.
Be very wary that caregivers may begin to think they understand all hearing aids because they understand so-and-so's hearing aid. Without consistent communication and education from the referring audiologist, it can be easy for caregivers to assume all hearing aids work the same way. However, the diversity of available hearing aid styles combined with optional features and customized fittings makes it absolutely necessary for the audiologist to be consulted for every patient with hearing loss or hearing devices. For the sake of their ongoing hearing and communication needs, you need to be the expert and the advocate for your patients in care facilities.
References
1. Hobson, S. (2008). Caregiver Communication: Hearing Aids & Cochlear Implants, QNA Productions.
Sandra Hobson, AuD, owns and operates a private audiology practice in Des Moines, IA. Contact her via the practice Web site, www.hobsonhearing.com. Dr. Hobson's DVD, "Caregiver Communication: Hearing Aids & Cochlear Implants," is available through Harris Communications, www.harriscomm.com.
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