How to Manage Communication with a Hearing Loss During Your Hospital Stay

By Janice L. Schacter

Editor: Hearing loss is tough enough when we're in our normal routine. It becomes that much tougher when we're in a new environment - like being in a hospital. Here with some tips on how to manage your hospital stay is Janice Schacter. Janice is a retired attorney whose 14-year old daughter is hard of hearing, and she is the pro-bono Chair of the Hearing Access Program.

This article originally appeared in the March 2009 NJ Department of Human Services Division of the Deaf and Hard of Hearing Monthly Communicator and is reprinted here with the author's kind permission.

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March 2009

Being a patient with a hearing loss does not have to be frightening but preparation is needed. It is important to contact the hospital as far in advance as possible to discuss and request aids or services that may be needed. Hospitals should have a designated person/office to whom such requests should be made and to whom patients can contact in the event the hospital fails to provide the requested accommodations, if those provided are not effective or if others are needed. The Center for Healthcare Access at The League for the Hard of Hearing is a resource for consumers to call with complaints if they do not receive the access that they need. The numbers are 917-305-7809 Voice or 917-305-7999 TTY.

The following are questions to ask your doctor and hospital prior to your stay:

For People Who Use Hearing Aids or Cochlear Implants:

1. Can you keep your hearing aids/cochlear implant processors on during surgery or until you fall asleep? If not, can your hearing aids/implant processors be placed in your ears/ reattached immediately after surgery or as you leave the operating room? Bring a small container labeled with your name for storing your devices during surgery to avoid losing them.

2. Will an oral interpreter (OI) be available in the operating room (OR)? Every patient with hearing loss is at a huge disadvantage in a hospital situation. The hospital experience can be stressful with so many different and strange things happening including staff wearing surgical masks and the effects of medications. The hospital can be difficult to navigate even if you function well in everyday situations. The OI is responsible for the patient's communication access. A clear view of the interpreter's face, especially mouth movements, is essential for oral and other interpreting to be effective. It is helpful if the OI can wear a clear surgical mask or have their mask down in the OR. The OI will need to manage the surgical experience if they cannot lower it when they speak. The OI can assist you to understand what is happening during surgery and at discharge.

3. Does the telephone have a visual alert, is it hearing aid compatible and/or is CapTel (captioned telephone) available? There should be a visual alert on the phone to alert you when the telephone rings. The telephone should be hearing aid or T-coil compatible but the hospital should confirm this. Find out if the hospital allows cell phones or other personal communications devices since many hospitals now allow their use. Do you need and do they offer an alternative telephone, such as a TTY, CapTel, or videophone? You may want to advise the hospital, specifically, if you do not use a TTY. (Many people think that every person with a hearing loss uses a TTY.)

4. Is a portable FM or amplifier such as a PockeTalker available? This can improve communication even if you do not have a hearing aid and may be helpful when communicating critical medical information.

5. Is your doctor aware that your otolaryngologist or audiologist should be contacted if there is any perceived change in hearing? Anesthesia can sometimes cause a decrease in hearing loss. Hospital personnel may need to compare or review your most recent hearing tests. You may want to bring a copy with you to the hospital.

For People who use Qualified Interpretation such as ASL or Oral Interpreters:

1. Will a qualified interpreter be available? You may request that the hospital arrange for qualified ASL, oral, tactile, or other interpreter services for specified time periods including but not limited to pre- and post-surgery. These blocks of time should be when doctors are expected to make their rounds or when other services are being provided. You should discuss whether and how communication with hospital personnel can be effective when interpreter services are not present. A nurse or other person, such as a companion or family member who has knowledge of sign language, is not a substitute for qualified interpreter services. They may know sign language to some degree, but may not be able to interpret expressively and receptively, not have appropriate interpreter training, and may not have knowledge of specialized medical or other vocabulary. People who "use sign language" may have only rudimentary sign language skills, or limited knowledge of the manual alphabet.

2. Is Video Remote Interpreting (VRI) available when a qualified Interpreter is not available on site? VRI services may be provided for unscheduled communication or emergency situations. Arrangements and procedures for handling VRI equipment and services should be discussed in advance. A recent case established some guidelines for hospitals to ensure effective communication when using VRI. See http://www.ada.gov/laurelco.htm. In addition, the National Association of the Deaf position paper on VRI is also insightful. See www.nad.org/2008VRIpositionstatement.

General Tips:

1. How will hospital personnel be notified about your hearing loss? All staff including nurses, doctors, anesthesiologists and recovery room staff should be aware that you have a hearing loss and how you communicate. You may have difficulty hearing when emerging from anesthesia. Hospital personnel may think you appear non-responsive or are not responding appropriately if they are not notified about your hearing loss

2. Can a sign noting your hearing loss be posted above your bed? This is especially important at night when your hearing aids or devices are removed and the night staff may be unaware of your hearing loss. Some hospitals may be reluctant to offer this without your requesting it because of patient privacy rights. The benefits outweigh the privacy issues. Healthcare providers tend to speak before checking your chart so the sign is important even if your chart is noted with your hearing loss.

3. The General symbol for people with hearing loss is:

This symbol does not communicate what you need or how you communicate. It is, unfortunately, the only universal symbol that is available. The more specific symbol for people who use sign language interpretation is:

4. Are the nurses aware that you may not be able to hear over the intercom? Can the hospital place a sticker on the intercom at the nurse's station indicating that you are hard of hearing or deaf? This will alert the staff not to use the intercom if you are unable to hear it. The staff will need to come into your room rather than speak over the intercom so the hospital may want to place you in a room near the nurses' station.

5. Did you pack a pad and pen for your hospital room? A pad and pen will allow you and the staff to write down critical information and medical terms to ensure you hear them properly.

6. Can staff wear clear surgical masks or remove them when they speak with you? Let everyone know prior to entering the operating room if you rely on lip reading and therefore need to see people's faces. Wearing clear surgical masks or removing them when they speak with you allows you to see their lips. The entire OR process should be discussed and reviewed with you prior to entering the OR including, but not limited, to the IV will cause a burning sensation or the sticky tabs will be placed on your chest to monitor your heart.

7. Are any of the medicines that will be used ototoxic and have hearing loss as a side effect? If yes, can these be avoided? This information should be provided to your doctor even if they do not anticipate that you will receive medication. The situation may change and the consequences are serious.

8. What visual alerts does the hospital offer for emergencies and to alert you someone is at the door? There are a variety of devices that can alert individuals with hearing loss to emergencies, to the phone ringing and/or to someone knocking at the door. Find out what the hospital has available and what is recommended based on your procedure.

9. Are assistive listening devices and/or captioning available for the television? A portable DVD player or laptop and DVDs are an alternative.