Supporting Hearing Loss in Care Homes – Common Difficulties

Hearing loss can leave people feeling lonely, isolated and confused. For many care home residents, this is an all too common problem. The Royal National Institute for Deaf People (RNID, 2018), the UK’s biggest hearing loss charity, predicts that around 75% of residents have some kind of hearing difficulty. This can at times go unnoticed and unsupported. Combine this with dementia, which approximately 80% of residents have, and the effects can be debilitating. Worsening cognition, communication, agitation and social withdrawal are some of the symptoms of untreated hearing loss in people with dementia. It’s easy to see how these can be misinterpreted as dementia progression, an infection or another condition.

With this in mind, it is important that residents receive effective, suitable hearing care. The most obvious treatment for hearing loss is hearing aids, but we know from previous research that uptake and long-term use is low in care homes. There are numerous reasons that residents might not wear their prescribed hearing aids. They might find them physically uncomfortable, find the sound amplification overstimulating, or not recognise or understand that they have a hearing problem. Smaller hearing devices often get lost or broken within a busy care environment, and reports of residents with more advanced dementia putting them in tissues, laundry baskets, pockets or the bin are common. Because of the difficulties with traditional hearing aids, it is important that we look towards a more individualized and dementia-friendly hearing approach within care homes.

An Individualised Approach to Hearing Loss?

When adopting a resident-centred approach to hearing loss, we acknowledge that each resident is different in their needs, abilities, preferences and personality. If a resident with dementia isn’t able to use hearing aids, alternative methods must be trialled with the support of caregivers. For example, because of their dementia, somebody might experience tactile discomfort and struggle with something in their ear. They may be better suited to using visual aids, e.g., a whiteboard for care staff to write things down. At the same time, a person with dementia may have lost their ability to read and comprehend, so written material wouldn’t be suitable to address their hearing needs. This resident may benefit from picture flashcards, lip-reading and physical gestures. Another tool that can be used to support residents’ hearing needs is a sound amplifier or assistive listening device. Larger than hearing aids so less likely to get lost, easier to manage for those with poor dexterity and less invasive as they sit outside the ear, they offer a different approach to sound amplification.

These hearing support methods, amongst others, can be utilised instead of or alongside traditional hearing aids. They can also be used all together. Utilising alternative techniques such as these offers a better opportunity that residents don’t just hear but actually understand what is being communicated to them. It’s important to work with the resident, and as their abilities and capacity can change, so should the hearing support.

Tips for Care Homes:

• Consider that hearing loss might be contributing to residents’ behavioural symptoms. Imagine that you need assistance with personal care, but you can’t hear what staff are asking of you, so you struggle to co-operate with them and are scared. You’re not even able to tell them that you can’t hear as your speech is affected by dementia. You might also struggle to make connections with other residents and join in with activities. Not being able to communicate can severely impact quality of life and mood.
• Bear in mind that it might take a little while to establish the best method of hearing care for each resident. If they have never used a hearing aid before, living with dementia might make this very difficult to adapt to. Try different methods, ask (or observe) what they prefer and can use. A transitionary period where the resident builds up time spent wearing the device may help. If possible, involve family members too.
• For residents that use hearing aids or other amplification device, keep a routine going for changing batteries every 2 weeks and cleaning the device. There are instructional videos online on how to help with this if staff or family are unsure.
• Always speak slowly and clearly to residents with hearing loss and dementia. Shouting will distort speech and make it harder for everybody involved. This might sound obvious, but ensure that you are standing face to face with the person. Using your hands to gesture and demonstrate can help.
• Provide visual prompts and aids within the home, such as whiteboards and pens, laminated flashcards, cue cards and picture cards. These can be used alongside amplification. They can also help when staff and visitors are wearing face masks, hindering their ability to lip read.
• Consider installing a loop system in communal areas. As care home lounges can be busy, this can help those who wear hearing aids because it reduces some of the background noise that comes through the hearing aid.
• Because residents often rely on staff members for their hearing needs, any training opportunities for staff would be beneficial to increase awareness of hearing loss and how to manage hearing devices.

If you have any questions or would like more information you can contact me on: Hannah.cross-3@postgrad.manchester.ac.uk