Guidelines for Medical Services to Deaf and HOH Adults

4.1 Hearing loss can complicate the communication process, making it necessary to allow additional time for assessment and treatment, including the verification of comprehension.

4.2 Systematically checking comprehension by questioning the patient is important with all patients, but more so with Deaf/Hard of Hearing patients due to the higher risk of poor comprehension.

4.3 Incorporate visual aids into the discussion. Use of visual aids is more important with people who are more visually oriented or have less experience with health care system.

4.4 Make communication accommodations as appropriate to the patients' needs.

4.5 Patient communication needs should be clarified when an appointment is setup so any necessary preparations can be made in advance.

4.6 Family members should not be used to provide communication access.

4.7 Patients may not be aware of their hearing loss. Therefore, medical professionals should know the signs and symptoms of hearing loss and take the initiative to assess the patient's hearing.

4.8 Medication side effects that impact hearing (ototoxic) will be especially significant to HOH patients and should be carefully considered with the patient before prescribing such medications.

4.9 In assessing the patient, note the following:

- The patient's self-identification;

- The medical description of the patient's condition;

- The preferred method for getting information to the patient;

- The preferred method for getting information from the patient.

5. Interpreting Guidelines

5.1 Modify billing procedures, including the creation of an interpreting CPT code, to allow billing of a third party for interpreters' services.

5.2 Patients have a choice of using a professional interpreter or an alternative, including a friend or family member or technology. Providers should advise the patient if they believe the patient's choice as not in the patient's best interest. Patients will not be required to use services against their wishes.

5.3 Patients should sign a release whenever they surrender a right to communication assistance or services.

5.4 Communication services are not only for the patient. Providers may also require interpreting or other assistive services and should negotiate the best solution with the patient, where possible. In some cases a provider may elect to obtain interpreting services apart from the patient's need.

6. Facility Guidelines

6.1 Hospitals and especially Emergency Rooms need to have interpreting services available on short notice.

6.2 Hospitals need to provide more extensive accommodations for full communication than would be necessary in an outpatient office. Some examples of accommodations should be:

* The ability to interact with the nursing station from the hospital room,

* Closed caption TV,

* Clear labeling of needs on the chart and other places to ensure continuity of care as a result of staff changes, etc.

6.3 Information on communication rights and responsibilities should be posted prominently for both staff and consumers.

6.4 Standardized notation should be used to identify Deaf/Hard of Hearing patients on charts and in conspicuous areas around the patient, with the patient's permission.

6.5 Larger facilities, especially with an ongoing census of Deaf/HOH patients, should have an office for Deaf/Hard of Hearing services.

6.6 Settings with exceptional communication needs may include hospice and mental health facilities. Special skills may be needed from an interpreter or additional or more stringent guidelines for staff and providers regarding the unique features of these settings. (For example, the recommendation to avoid use of a family member as an interpreter is especially important in a mental health setting where the family member could also become the subject of treatment.)

6.7 Facilitating communication and reducing isolation is especially important in programs where communication is part of the milieu, such as mental health and hospice.

6.8 Special interpreting skills may be necessary in specialized settings. Facilities should ensure that interpreters have the skills required for their setting and type of service.

6.9 When a Managed Care Organization reaches a certain size or if the population it serves carries a certain percent of Deaf/HOH persons, they should develop and implement a plan to meet the communication, education and access needs of these patients. System wide interpreting services could be deployed for in-office appointments, in-servicing staff across their provider network. They would have TTY's available that would be placed in provider offices, etc. Rather than burdening the patient or doctor, it would become a responsibility of the MCO or provider network.

7. Miscellaneous

7.1 Support research into the use of alternative technology for communication, such as voice recognition, Video Remote Interpreting, and Remote CART.

7.2 A system needs to be created, perhaps through State Licensing Boards, through which information on rights and obligations related to Deaf/Hard of Hearing, ADA, and related communication issues can be disseminated to providers.

7.3 Affirmative Action should address opportunities for Deaf/Hard of Hearing.

7.4 Hearing aides are essential to the quality of life and quality of health for hard of hearing people of all ages. HCFA should undertake to determine the feasibility of covering the services of audiologists and hearing devices under Medicare and Medicaid.

7.5 HCFA should explore the impact of designating Deafness/HOH as a complicating condition and allowing additional compensation when additional time is required to provide services.