11 Jun ‘Inclusive’ care home design for people with hearing loss.

Hearing loss may be a ‘hidden’ disability but with an ageing population, its prevalence in care homes is growing.

It’s estimated that by 2032 almost 80% of people in residential care in England will have some form of hearing loss and an inability to hear clearly can contribute to feelings of isolation, depression and even a need for greater care.

So how can care homes respond?

Care homes are well used to meeting the needs of residents with disabilities.  Bathrooms have grab rails, doors are wheelchair accessible and understanding and awareness of dementia is commonplace.

But hearing loss, or the extent of someone’s inability to hear, can be more difficult to recognise and to manage.

The impact of hearing loss

Hearing loss can dramatically change a person’s way of life.  Someone who was previously very sociable may suddenly decline invitations to go out, especially to noisy environments like restaurants.  They may be reluctant to answer the phone and a love of the theatre or music may vanish because of their frustrations at not being able to hear.

People may come to a care setting with a recognised hearing loss but there will be some who are either not aware of, or don’t want to admit to, a hearing impairment.  Initial signs of hearing loss could be asking for things to be repeated, a reluctance to take part in general conversations or activities and their mood may be low.  And this can happen even if the person wears a hearing aid.

Hearing aids amplify all sound.  This means the sounds a person wants to hear have to compete with the surrounding background noise of others’ conversations, televisions, vacuum cleaners etc.

This assault on the senses can be overwhelming.  Residents may find the inability to identify the desired sound terribly frustrating and staff could see more challenging behaviour as a result.  Residents may withdraw to the calm of their room or remove their hearing aids altogether, leaving them at risk of isolation and depression.

And for family members with hearing loss, there could be a reluctance to engage in conversation with staff because of a difficulty hearing what’s being said.

Challenges to communication such as these can affect a home’s ability to provide truly person-centred care and staff may under-estimate a resident’s cognitive abilities because they can’t hear.

A care home’s obligations

Care homes are covered by the Equality Act 2010, legislation that combines a number of laws including the Disability Discrimination Act.  It states that everyone should be treated equally and requires service providers to “make changes, where needed, to improve services for disabled customers or potential customers.”

“Potential customers” is a key point – homes aren’t obliged just to meet the needs of their current residents but should provide an environment that is inclusive and accessible for everyone.

The Act also requires “reasonable” adjustments to be made for those with hearing loss when they are at “substantial disadvantage” compared with people who are not disabled.

In that instance, homes must “provide auxiliary aids and services” which include hearing loops.  “Reasonable” is not clearly defined and will depend on the size of the home and the relative costs involved – so what may be “reasonable” in an 80+ bed home will be different to what’s expected of a 10-bed home.

Homes planning refurbishments or owners looking to build new premises also need to be aware of revisions to British Standards that offer a code of practice for creating “inclusive” environments.

“Inclusive” vs “accessible”

The British Standards Institute BS8300 guidelines govern the design of buildings to meet the needs of disabled people.

These were revised at the beginning of 2018 to respond to changes in lifestyle and technology, with the aim of creating premises fit for the future that are inclusive and welcoming to all members of society.

The updated guidelines have two main differences – firstly, they have shifted their emphasis from offering an “accessible” environment to one that is “inclusive” meaning residents, staff and visitors with a disability should have their needs accommodated within a general space and not set apart in a separate area.  An example of this is all visitors being able to access the home through the same doorway rather than a side entrance being designated for wheelchair users.

Secondly, they contain, for the first time, detailed guidance for meeting the needs of people with hearing loss.  And throughout, the onus is on the provider, and not the individual, to make sure people can access the information or the service on offer.

For care home managers, that means making group activities inclusive, information about residents’ care plans audible and enabling people to participate in conversations.

The role of hearing loops

The use of hearing loops is detailed in the BS8300 guidelines as central to offering an inclusive environment.

Hearing loops improve communication by cutting out background noise.  Rather than making all sounds in a room louder, loops amplify the sound a person wants to hear.  They convert speech, music or the television through a specially positioned microphone into a magnetic signal.  This is transmitted by a loop aerial and is picked up by the telecoil in a wearer’s hearing aid, and converted back to speech.

The guidelines have clear examples of best practice for a range of settings.  For example, a communal room where homes might hold entertainment should have a large area loop around its perimeter plus a microphone for the activity leader.

By switching their hearing aid to the ‘T’ or telecoil position, residents with hearing loss can clearly hear the words to the songs and join in, the number called in bingo or the next movement required by the fitness instructor.

Full compliance with the guidelines would also see homes installing loops in residents’ rooms so they can watch television comfortably and at a volume that doesn’t disturb their immediate neighbours.  Sound is relayed to their hearing device via a small loop pad placed under a seat or via a cable installed around the edge of the room.

Portable loops with a built-in microphone are an option for one-to-one conversations and can be moved so staff can greet people at reception or chat to an individual while they enjoy the company of others at lunch.

Installing loops can benefit even those who don’t have or don’t want to wear hearing aids.  Portable listening devices allow residents to ‘tune in’ to the sound they want to hear through standard headphones.

The impact for CQC inspections

The ability to communicate is an essential part of care, so making sure residents can hear clearly feeds into four of the key questions asked by CQC inspectors.

Being able to hear allows people to maintain their dignity, helps to keep them safe and allows staff to provide the personalised care appropriate to that individual.

As previously mentioned, an unmanaged hearing loss can be mistaken for cognitive decline, particularly when the resulting frustrations prompt changes in behaviour, and this may lead to a well-intentioned but misguided care plan.

Training staff to use hearing loop technology also contributes to the fifth question of whether a home is well led.  Installing loops has little effect if staff don’t know they are there or how to support residents who can benefit.

The business case for loops

Although homes are not legally required to meet the BS8300 guidelines, they do represent best practice.  And they arguably represent a sound business decision for care home owners, too.

The NHS Action Plan on Hearing Loss 2015 estimates that by 2032 there will be 620,000 older people living in care homes in England alone.  Of these, almost 500,000 are expected to have a hearing loss and will need support to maximise their independence and wellbeing.

Where potential new residents are considering their options, a home that can promote its inclusivity and its provision for existing or future hearing loss could have the edge over one that does not.

It also suggests to families a commitment to dignified care – personal issues can be discussed with staff at a normal volume and communication can take place easily without the need for raised voices or repetition.

This has value for relatives and staff, as well as visiting professionals and members of the community invited to the home.  People may not always want to disclose an inability to hear, especially if it isn’t central to the conversation, and when a loop is in place – working and clearly signposted – it means they don’t have to.

Hearing loops should be considered in refurbishment plans and at the earliest stage in designing a purpose-built home, but it’s never too late to install assistive listening technology in a setting.  Advice from a specialist company is invaluable as the correct specification, maintenance programme and staff training are essential to the loops working properly and not being a well-intentioned but wholly ineffective investment.