#169 Say What? Tips for Accommodating Patients Who Are Deaf or Hard of Hearing

You likely have Patients who are deaf or hard of hearing in your practice. Mis-understanding  recommended dental care can lead to poor outcomes. The Divas discuss patient’s rights, the dentist’s obligations, and effective communicate skills.  The podcast will address hearing issues that can develop for dental team members exposed to noises in the dental office.

Resources:

• Univ. of Washington Disabilities, Opportunities, Internetworking, and Technology - How Are the Terms Deaf, Deafened, Hard of Hearing and Hearing Impaired Typically Used? https://bit.ly/3Wcdb2O 
• Univ. of Washington School of Dentistry - Oral Health Fact Sheet for Dental Professionals - Children with Hearing-Impairment https://bit.ly/3LrEZv8 
• Univ. of Washington School of Dentistry - Oral Health Fact Sheet for Dental Professionals - Ad with Hearing-Impairment https://bit.ly/3xYxWHr
• MI Dental Association - Hearing-Impaired Patients:  Your Legal Obligations  https://bit.ly/3xS0B0R  
• American Dental Association:  Serving the Hearing-Impaired https://bit.ly/3LvlnGG 

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_00 0:05

Welcome.

SPEAKER_01 0:05

I'm Leslie Cannum. I'm Mary Gavoni.

SPEAKER_02 0:09

I'm Linda Harvey. I'm Olivia Wann. And together we are the Compliance Divas.

SPEAKER_00 0:23

Hello and welcome to the Compliance Divas podcast. My name is Leslie Canum, and I'm the moderator of this podcast today. And this podcast focuses on our death or hearing impaired population of patients. At the Compliance Divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. If you'll subscribe to the Compliance Divas podcast for your favorite podcast channel or on our website, thecompliancedivas.com, you'll never miss an episode. I also want to remind our listeners that if you have questions, please submit them to support at thecompliancedivas.com. So according to the National Council on Aging, hearing loss affects about 60.7 million Americans aged 12 and older. Hearing loss is on the rise in the United States and is expected to almost double by the year 2060. Only one in six Americans with hearing loss wears hearing aids. And there are a variety of reasons for this. Cost may be a factor, or they may be embarrassed or stigmatized by wearing a hearing aid. And in many cases, people are simply in denial because they don't perceive how bad their hearing is. Deaf or hard of hearing patients may have difficulty in understanding treatment plans, financial arrangements, post-operative instructions, or directions from medication prescribed. Misinterpretation of treatment recommendations or other important instructions could harm the patient and lead to poor outcomes for dental care. So by increasing our awareness and attention to patients' special needs, the dental team can take steps to ensure effective patient communication occurs with both deaf and hard-of-hearing patients. Mary, will you explain what the terms deaf, deafened, hard of hearing, hearing impaired, how they're typically used?

SPEAKER_01 2:29

Absolutely, Leslie. And I will say that in preparing for this podcast, this was a learning experience for me because I have always perceived that using the term hearing impaired was the politically correct way to describe someone, but now I'm learning that it may not necessarily be. So there is confusion over the terms hearing impaired, hard of hearing, deaf, and deaf end, both in definite definition and appropriateness of use. So the term hearing impaired is usually associated or used to describe people with any degree of hearing loss from mild to profound, including those who are deaf and those who are hard of hearing. Many individuals who are deaf or hard of hearing prefer the terms deaf or hard of hearing because they consider them to be more positive rather than hearing impaired, which implies a deficit or something that's wrong with that person or they're not whole. I have a husband who is in absolute denial about his hearing loss. And so I can understand where some people would feel that way. The term deaf refers to hearing loss so severe that there's very little or no functional hearing. Hard of hearing refers to hearing loss where there may be enough residual hearing that an auditory device, such as a hearing aid or an FM amplification system, provides adequate assistance to process speech. The term deafen refers to a person who becomes deaf as an adult and therefore faces different challenges than those of someone who was deaf at birth or became deaf as a child, because they learn from a very young age to accommodate or to adapt. Where if you suddenly the same thing with someone who is not sighted, if they are blind, that they, if that's the way they've been from birth, they learn to rely on other senses in order to um do their activities of daily living. Deaf, deafened, and hard of hearing individuals may choose to use hearing aids, cochlear implants, and other assistive listening devices to boost their available hearing. Or they may read lips, use sign language, sign language interpreters, and or captioning. And so captioning on their computer, on their television, on their telephone, if they have a landline phone. People who are deaf or hard of hearing may have speech that is sometimes difficult to understand due to the inability to hear their own voice. So if you talk to someone who is deaf, you know that they have almost sort of a characteristic type of speech where you don't see a lot of intonation because they can't hear it.

SPEAKER_00 5:38

Mary, that's a great explanation of those various different terms. And patients will likely provide their preference of how they would like us to address their particular impairment. Olivia, would you kindly give us information about whether a dentist would be required to accommodate deaf or hardy of hearing patients? Many times I think they feel that they don't have the skills or the tools, they don't sign, they they don't have feel confident in providing information to patients. But tell us whether they should be looking at ways to boost that ability to communicate with their patients. So are they required to see patients who have these disabilities?

SPEAKER_02 6:24

And that's a good place to start, Leslie, is to understand the fact that you know, federal law, the Americans with Disability Act of 1990, was intended to eliminate discrimination against persons with disabilities. We often think of it as a rule that applies more to the employment setting. You know, if you have 15 or more employees, then this federal rule applies. But we have to remember that it also applies to the aspect of public accommodation, such as a dental office. And then we also weave in section 1557 of the Affordable Care Act of 2010, which prohibits discrimination on the basis of a disability in certain health programs that receive federal funding. So when we look at our dental offices, the point is that we cannot discriminate or deny services to a patient simply because they are disabled as it is relates to their hearing. And so we look at, you know, how can we make that treatment uh possible? Now, granted, if the dentist is not accepting new patients at all, then the dentist could decline a new patient who has deafness because they're not taking new patients. But Leslie, I haven't found that to be the case. Most uh dental practices are taking new patients. So then we look at, you know, what could we incorporate as an auxiliary aid or a service for an individual with hearing or speech impairments to better communicate with them. And it's not just limited to providing an interpreter, there could be some other means or device that could help us communicate. I was thinking maybe even like an iPad or you know, writing it down and passing it back and forth to make sure there's an understanding. But we would never just rely on a family member that comes up with language barriers, you know, where somebody's child's coming in to interpret, and that's not safe, it's not conveying the message accurately. So if you know, if there is a complex visit, it might require the services of an a professional interpreter. And keep in mind, Leslie, if this is required, then the dental office would absorb that cost. And so they cannot discriminate, they would accommodate that patient and make sure that it results in a safe visit. And the only way they could be discharged from having to provide those added services for a deaf patient is if the dentist could prove that it would be an undue burden to have to provide those services. So when you cross-reference, you know, what does that mean to be an undue burden or an undue hardship? That would be that the you know, the dental office would have a significant difficulty in paying for that expense. So would you be able to prove that? Because that would be a case-by-case determination. So, you know, if you've got a million-dollar practice and you can't pay for an interpreter, that probably would not go over well with the gov the government. Now, I can say this when I'm in the courtroom and observing other people's cases. I have seen where the court provides the services of an interpreter. So, with our private practices, same issue comes up that making sure that we are providing the services because we have to comply with the law, and it's our legal obligation not to discriminate against the patient that is hard of hearing. So I hope that's helpful, Leslie.

SPEAKER_00 10:40

It certainly is, Olivia. And I just want to add to our listeners that according to the law, it exceeding the cost of the fee that you would charge with the interpreter service if you were to use a service, does not qualify you for the undue burden. You still have to pay for that, even though you're not going to be making a profit on that patient. So it's important to keep in mind that we need to go, as you said, a case-by-case basis. And it would be pretty hard for dental practice to prove that undue burden when the costs of interpreters and other means of communication are fairly widely available, and you can Google even HIPAA-compliant medical type of interpreters. I'd love that you mentioned that a child or maybe someone that's then well informed about medical care could be the interpreter for the parent or the person who is hearing impaired. Well, I'd like to just tap on the door of a thing that you may not notice in your dental practices. Patients will sometimes nod their head, yes, yes, yes, I understand, when they don't really understand because they're embarrassed to ask you to repeat what you said. So let's try to screen our patients too and make sure that they understand what we're saying. And we may even recognize signs of hearing impaired or deaf patients. Well, a deaf patient obviously would forewarn the dental practice ahead of their appointment or at their time of visit that they are deaf. But sometimes people who are hard of hearing or hearing impaired don't want to share that information again for whatever reason, stigmatized or embarrassed. So they may speak more loudly than others. They don't hear well on the telephone, they don't respond when addressed, and they may wear hearing aids but still not hear well. They may fail to hear someone who's speaking from behind them, and they may claim that people used to speak more clearly and state that they can't hear because people mumble. Family members may state that the patient doesn't heal hear well, and the patient may frequently say what, or state that they didn't understand you. So it's crucial when we're providing instruction to our patient, home care or prescription or anything surrounding their health, it's crucial that we improve our communication, learn to recognize and screen where when your message might not be flying or landing on the right spot. And so here's some steps that you can use to help can improve communication. You can repeat information, you can slow down and speak more clearly, you can avoid speaking from across the room, and then use layman terms, not jargon, not dental jargon when we're talking to our patient. And remove your mask when you speak to your patient. You can also ask the patient to repeat back to you what you said or what they think you said, and be sure that you speak loud enough, but don't shout. Just instead project your voice. A quiet environment is best. Background noise makes it hard, much harder to hear. And make sure you have your patient's attention before speaking. Standing in front of the person you're speaking to and making sure they can see you. And make sure that you smile or have a gesture or go over to them, touch them on the shoulder before starting to speak. And as Olivia mentioned, using a notepad or electronic device to write instructions or information can certainly help. So, with that, what I'd like to do is give a little shout-out from our diva, Linda Harvey, who could not be with us today. She wanted to make sure that everyone was aware of some of the great resources. We'll put them in our show notes, but the University of Washington School of Dentistry has a fact sheet for dental professionals on accommodating hard-of-hearing adults or deaf adults and the same hard-of-hearing or deaf children. And we highly encourage you to take a look at that fact sheet and familiarize yourself with some of the ways that you can better communicate with patients. We also have a podcast, number 168, on the Affordable Care Act, that does describe discrimination, non-discrimination, and we include a little bit about hearing impairment. And then Olivia and I had our favorite podcast that we did together, the podcast number 75, on service dogs in the dental setting. I would like to also call on our divas to tell us a little bit about the things that you have experienced in a dental office that can be pretty loud and might cause hearing loss for us, the dental professional. So, Mary, can you give us some idea?

SPEAKER_01 15:40

Absolutely. So we focused so far on how do we accommodate patients. And before I move to how do we protect ourselves, I just have a question, and Olivia, maybe you can weigh in on this one. Would it be appropriate on a registration form or on a health history to ask a question about whether or not a person is hard of hearing or needs any assistive devices? So making sure that we shared with them or made the statement that in order for us to communicate more effectively with you, would that be appropriate?

SPEAKER_02 16:22

Mary, I think it's it's very appropriate because it's assessing their medical condition. And so if they're hard of hearing or or deaf, that's something within the parameters of medical information that we can gather. And if it's not on the medical history, perhaps there's a section for other. So if the clinical worker notices something out of the ordinary, they can ask questions.

SPEAKER_01 16:49

Right. And the reason I asked that question, it just seems to me like it might alleviate some of the sensitivity of the patient having to say, Oh, I need you to repeat that, or we can find that out up front and then follow the great tips that Leslie talked about about facing the patient and projecting your voice better and those kinds of things that I think might be great. But let's shift now to how do we protect ourselves? Because we work in kind of a noisy environment. We've got in the treatment rooms, we've got handpieces, high-speed handpieces, we've got ultrasonic and sonic scalars that we're working with all the time. And it's interesting, I've seen a number of dentists that I used to work for that over their career working in dentistry, they had very profound hearing loss in the ear that was closest to where they used their handpiece all day long. So those are issues in the treatment room. And then we look at our labs and our sterilization areas. In the sterilization room, we've got our ultrasonic unit for cleaning instruments that's working at a pretty high decibel level, and equipment in the lab, whether it is a handpiece or a vacuum to help control the dust, model trimmers, lots of different kinds of equipment. And what we will do in a future podcast is actually focus exactly on the dental team and what does OSHA say about whether or not you should wear some hearing protection, whether you're working with certain devices at certain decibel levels.

SPEAKER_00 18:36

Mary, thank you very much for that. And I just want to add to the noise in a dental office. If you've ever been the one that has to go in to do maintenance in the compressor room or the mechanical room, you know, that's always very loud. And so you're not in there for hours and hours on end, but it is something that we notice in a dental practice that increases the volume. It's important to confirm that the patient understands you. And improving communication with patients can improve dental outcomes. Dental professionals can eliminate gaps in understanding by simply learning to, first of all, recognize the signs of a hearing-impaired patient, and then taking steps to improve communication with the various different items that we or things that you can do that we mentioned. And with that, we bring a close to this podcast and remind you, remind our listeners that you can apply you can subscribe to our podcast on your favorite podcast channel or at thecompliancedevas.com. Send your questions to support at the compliancedevas.com. And the resources that we mentioned today will be available in the show notes. While you're in the show notes, if you wouldn't mind giving us a review, we'd certainly appreciate it. And with that, thank you very much for listening today.