Hearing aids and extra care housing; what we can do to make things better

There are over 12 milion people with hearing loss in the UK and most people with acquired hearing loss are older adults (40% of over-50s have hearing loss, rising to 71% of people over 70). A significant number of people who live in Extra Care Housing will therefore have a hearing loss. Some of them have hearing aids. Some (most) will struggle with their hearing aids from time to time (or even every day). What does that mean for staff training? What do your staff need to know?

I’m writing this in an attempt to straddle two worlds. Before I retired in 2010 I worked for Hanover Housing for fifteen years. I was very involved with their Extra Care programme from its inception in the mid-nineties and then ended up as Director of Retirement Housing. I wore hearing aids, but I coped fine (with some lip reading). However, since 2010 my hearing has deteriorated significantly. I’m now severely/profoundly deaf and have a cochlear implant. I’ve learnt things about hearing loss I didn’t have a clue about when I was working. How I wish I knew, back then, what I know now. This, then, is an attempt to write from the future (the hearing loss future that affects so many people) for you, the service providers of today.

Let’s start with the basics. I’m assuming your staff (I’m using the term to include all the people working at your Extra Care Housing schemes, whoever their actual employer) have had some basic deaf awareness training? It needn’t be expensive to provide, just someone explaining how best to communicate with someone with hearing loss. A few examples:

• Look at us when you are talking to us. If we don’t immediately understand you, try rephrasing rather than repeating; it might help us make sense of it. 
• Don’t, whatever you do, shout. It won’t help (the problem is nearly always clarity not volume) and it feels just as aggressive to someone on the receiving end as shouting would in any other situation. 
• If you are talking to someone with hearing loss on the telephone remember that they might struggle to hear. It might not be about the volume control!
• Don’t laugh when we get something wrong. Sometimes our hearing mistakes are really funny, but often it feels like you are laughing at us, not with us. 

Your staff probably know all this so let’s move onto hearing aids. Do your staff know what they do? No, really? So many people don’t understand that a hearing aid isn’t like a pair of glasses; they don’t restore hearing to what it was like before. All they do is amplify the sounds you CAN still hear. So if someone is profoundly deaf for high pitched sounds (as I was, before my cochlear implant) those sounds are GONE to a hearing aid. And what that means is that speech becomes incomprehensible without lip reading. We don’t hear in the way hearing people do, we decipher. We hear bits, lip read other bits and guess the rest.

Another thing about hearing aids is that people who have never had to wear them don’t realise how annoying they can be, and how hard to get used to. I know how exasperating it is when someone who is clearly having problems won’t have their hearing tested or has hearing aids but won’t wear them. It’s the “they’re in my bedside cabinet” syndrome.  There have been times when I’ve wanted to chuck mine in my bedside cabinet too; it’s a common feeling. Your staff need to try to remember that hearing aids aren’t a magic fix. Encourage people to wear them, or to have their hearing tested, but if they won’t just keep trying to communicate. Or maybe, if they have a hearing aid already, it’s “no use” because something has gone wrong with it?

Ha – now we’re getting to the nub of it. Are your staff trained in the routine everyday operation and maintenance of hearing aids? Not the things you need to see an audiologist for (more of that in a minute) just the everyday faffing about that an audiologist teaches us in a couple of minutes but which is hard if your fingers aren’t as nimble as they were or you get confused easily. For example:

• Do your staff know how hearing aids turn on and off, how to check if the battery is flat and how to change the battery? 
• Do they know how to check if the tube is blocked and how to unblock it if it is? Or how to check if the hearing aid has somehow been put on the wrong setting (for example, on the loop setting when that’s not wanted)? 
• Do they know what a loop setting IS? Or when you use it? 

ALL staff in Extra Care Housing establishments should know these things. At the very minimum, there should be one staff member who has this knowledge on duty at all times. It’s easy, easy stuff, and it makes a massive difference. 

Sometimes, though, bigger stuff goes wrong. The hearing aid isn’t working, your staff know it is switched on, on the right setting, the tube isn’t blocked and there is a new battery in there, but it still won’t work. The person needs to visit audiology.  So who takes them there? I ask this question because, a few years ago when my mother-in-law was in a care home, we had big problems with how the staff related to her hearing aids. 

My husband ran a training session for the carers, covering the sorts of issues mentioned in the last paragraph, but it didn’t seem to make much difference. Equally infuriating was when the home would ring us up and say she needed to be taken to audiology. Of course, we were very happy to do everything we could for her, but it was a four or five hour round trip from our house to where she lived (midway between us and her other son) plus another hour’s round trip to audiology and back. What if we’d not been retired? What if the person doesn’t have any children to help out in this way? The point is, Extra Care facilities need to have arrangements in place to make sure that residents can see an audiologist promptly when they need to (arrangements that don’t rely on asking a family member). What’s the arrangement in YOUR establishment?

I’m going to round this up with a few thoughts on attitude. A few weeks ago a friend told me that she had recently tried to speak to the manager at her father’s care home about the fact that the care staff weren’t doing the sort of things I’ve talked about here. “Hearing aids!” the manager said “they are the bane of my life.” A young carer at my mother-in-law’s home shuddered theatrically when I tried to explain to her why mum’s hearing aid was whistling (it wasn’t fitting snugly in her ear – do all your staff know how to gently correct that?). “Oh how I HATE that whistling”, she said, “it goes right through me”.  Ask yourself whether staff would have felt able to say similar things about another disability. “People with colostomy bags! They are the bane of my life”.  “How I HATE it when people walk so slowly with their frames when I want to get past.” It wouldn’t happen, would it? They wouldn’t say it. Are YOUR staff as sympathetic towards people with hearing loss as you want them to be?

If this article has given you food for thought and you want to look for resources to help you review your staff training programme the best place to start is with Action on Hearing Loss (formerly the RNID) and your local audiology department. Both will have literature available and should be able to point you to appropriate local resources and trainers.

One invaluable publication is a new guide from AoHL - Supporting older people with hearing loss in care settings – a guide for managers and staff. It covers just about everything I have written on here, plus a lot more besides. Here’s a link (opens new window).

You might be lucky and find that Action on Hearing Loss (AoHL) have a Hear to Help scheme operating near you. Hear to Help volunteers offer hearing aid support, sometimes at drop in centres and sometimes via home visits.  Find out here (opens new window). However, be aware that this isn’t a substitute for your staff knowing how to do the things I’ve described above. The volunteers provide a hugely valuable resource, but they are not at your Extra Care Housing scheme every day.

"Extra Care facilities need to have arrangements in place to make sure that residents can see an audiologist promptly when they need to"

This is the first of a selection of guest blogs that Vera has kindly agreed to write for the Housing LIN.