Consult local groups on hearing impairment
Most health care facilities need a more comprehensive policy on accommodating the hearing impaired, say some experts who deal with related discrimination claims.
A formal policy will help health care providers overcome some ingrained assumptions about the hearing impaired, says Jackie Roth, a consultant in New York City who works with hospitals and other companies to develop such policies. She says many people are well-intentioned when working with the hearing impaired, but they do not have the knowledge needed to communicate effectively.
"A lot of people have not known someone with a profound hearing loss, so they are just unfamiliar with what it is like to try to communicate with them," Roth says. "Many deaf people are very uncomfortable being deaf and will not ask for help when they need it. That leads to situations in which the message just does not get across."
People with hearing impairments are reluctant to ask speakers to repeat themselves, for instance. Most will ask no more than three times before giving up, says Roth, who has a hearing impairment herself. After that, they may pretend to understand or to be disinterested.
"A lot of people assume that deaf people are fabulous lip readers," she says. "Some are, but statistics show that they get only about 30% of the words spoken, and the rest comes from context. If the other person is talking about a medical condition that is completely unfamiliar to you, with many words you have never encountered, just imagine how difficult that is to lip-read."
Health care providers also can be misled by a patient or family member’s initial understanding at the start of a conversation. A deaf person may understand a simple question like, "Does this hurt?" or "How are you today?" and that leads the doctor or nurse to think effective communication is occurring. But as soon as the conversation moves to more involved matters, there may be no understanding at all.
If hospitals need another reason to enact effective procedures for dealing with the hearing impaired, revenue potential is a good one. Deaf people and their families make up a significant base of potential revenue, says Alan Rich, JD, the attorney who represented a deaf man and his wife in a discrimination suit against Mount Sinai Medical Center in New York City.
"If these patients learn that they can effectively communicate with the physician at your facility, they will come to your facility every time," he says. "They will be very loyal because they receive better care. The revenue could more than make up for the cost of an interpreter."
Providing effective communication also can help cut down on unnecessary emergency department visits, Roth says. Many deaf people seek help in the emergency room because they are unable to contact physicians for appointments, for instance. If you provide the means for them to make appropriate contact for your services, they will gladly take advantage of them, she says.
He notes that many of the strategies put in place for helping hearing impaired patients will be of benefit to hospital employees as well. There are about 23 million people in the United States with some degree of hearing loss, according to statistics from the National Institutes of Health.
"Every hospital wants to provide the best health care service to everyone who walks through the doors, and they should want to do the same for deaf people," Roth says. "The only way they can do that is to overcome the communication barrier. It’s not as difficult as a lot of people think."
Solutions often less costly than expected
Marcia Maynard, interpreter and accessibility coordinator for Southwest Washington Medical Center in Vancouver, WA, says her hospital has found that developing policies and procedures is not overly burdensome. She cautions that you should not focus exclusively on the need for sign language interpreters because that is only part of the solution.
A good accommodation program also involves educating staff and providing equipment used to communicate with the deaf, solutions that tend to be less expensive than many people think when they consider hiring a sign language interpreter. (See p. 69 for a list of auxiliary aids available at Maynard’s hospital. The list is made available to staff and patients.)
Roth, Rich, and Maynard offer this advice for improving communication with the hearing impaired and developing a facility response:
1. Remember that deaf people have different abilities and needs.
Not every deaf person is going to want a sign language interpreter, and many cannot read sign language. Likewise, many cannot read lips.
2. Try to enunciate clearly when speaking to someone with a hearing impairment.
Speaking slowly, loudly, and clearly, which is silly when trying to communicate with someone who doesn’t speak English, is the best strategy to use with the hearing impaired, who may be trying to read your lips or may be able to hear slightly, Roth says. Also, remember to face the listener and not obstruct the view of your face with a clipboard or anything else.
Heavy accents may be more difficult to understand. People who have strong accents should be especially careful to speak clearly, and it may be better to have someone else do the talking.
3. Use nonverbal cues to your advantage.
Deaf people often look for nonverbal cues when communicating, such as the other person’s facial expression, body stance, and hand gestures. Use those to your advantage if you are having difficulty communicating with a deaf person, Roth says.
Also, beware of misunderstandings caused by the way deaf people interpret nonverbal signals. A doctor may have an unpleasant look on his face because of an unrelated matter, such as a message he just received about another case, but a deaf patient straining for context cues may think it means bad news.
4. Consult local groups representing the hearing impaired.
Input from your local community is important because it may provide information about problems encountered in the past or the needs of particular ethnic groups, for instance. Enlist the aid of community groups in designing your policy, Rich says, but do not consider them your "experts" on accommodating the deaf.
"That’s like suggesting that just because you’re black, you’re an expert on how to fix the problems affecting the black community," he says.
5. Make sure your policy conforms to state and federal laws.
Remember that some state laws will be stricter than federal requirements. Some laws will require you to provide an interpreter or other accommodation within a certain amount of time.
6. Understand the different methods of accommodation and communication.
It is not necessary for most staff to learn sign language, but it is important for risk managers and clinicians at least to understand how the hearing impaired communicate. American Sign Language, for instance, is not just the alphabet signed on the hands.
In many cases, a deaf person will need only a minor form of accommodation and not a sign language interpreter. You have to ask what would help the person communicate better.
"You should explain that your goal is to communicate effectively and you want to provide whatever will help make that happen," Maynard says. "When you ask how to help, often the patient will tell you that, Yes, I speak sign language, but all I really need right now is a new battery for my hearing aid.’"
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