Ontario Disabilities Act: It's so last century

At the end of this month, employers with more than 20 workers will be required to train their staff to better serve Ontarians with disabilities. These businesses will also be required to provide better services for them.
 

The Ontario government has provided a helpful document for businesses, which can be found by following this link.

I decided to check it out to see what's in it for people with hearing loss.

Let's just say, I was not impressed. The suggestions are so last century.

Here, verbatim, are the suggestions....

People who have hearing loss

People who have hearing loss may be Deaf, oral deaf, deafened or hard of hearing. These are terms used to describe
different levels of hearing and/or the way a person’s hearing was diminished or lost.

Tips:

• Attract the customer’s attention before speaking. Try a gentle touch on the shoulder or wave
  of your hand.
• Make sure you are in a well-lit area where your customer can see your face and read your lips.
• If your customer uses a hearing aid, reduce background noise or move to a quieter area.
• If necessary, ask if another method of communicating would be easier (for example, using a pen and paper).

Oh, come on.
First of all, you can't assume someone who has hearing loss is going to come up to a bank teller or a triage nurse or a kiosk and volunteer the information that they are hard of hearing or wearing hearing aids. While people with hearing loss are becoming more vocal, thanks to the efforts of support organizations like the Canadian Hard of Hearing Association (CHHA), a lot of people are embarrassed because they can't hear, or they don't want to draw attention to themselves.
So having a person waving in their faces or taking them to what amounts to a "special room" isn't going to cut it.
It is true that, by reducing noise, a person with hearing aids will be able to hear someone. But the world simply doesn't work that way. Shutting down the Muzak isn't going to help. It will just leave you with grumpy employees.
Besides, in many work places or service areas, there are fans for air circulation. There are also a lot of people talking. Waving in a person's face or offering them a pen and paper (reminding me of a Dickens' novel) is just going to make a person with hearing loss mad.
Installing assistive devices will go a long way toward helping businesses better serve their customers with hearing loss. Hearing loops are inexpensive and can cut through the background noises that irritate people with hearing loss, and yet, they are only being used in churches and a few banks right now. Why is that?
A wheelchair ramp, larger spaces in restaurants, all of these things are now being demanded by people with disabilities. Why are people with hearing loss being forced to suffer in silence?
Because nobody is telling people with hearing loss that there are tools to help them, tools they should be demanding.
The government would do well to encourage businesses, hospitals and other institutions, as well as transportation services, to install hearing loops. At the same time, hearing professionals have a job to do in educating consumers with hearing loss about the kinds of tools that are available to help them hear better.
I heard of one situation this week of a man who was excited to learn that he could have a loop installed in his home so he could finally hear his television. Unfortunately, when he contacted his audiologist, he was told he'd bought a hearing aid without a T-Coil, the little device that, when turned on, will allow a person to hear with the benefit of a looping system.
He was never told when he bought the expensive hearing aids that, in effect, the audiologist had cut him off from an opportunity to hear better.
The man was in tears.
Frankly, I was appalled when I heard this story especially because the man said he would have bought a T-Coil equipped aid if he knew it existed.
It's important to start a real conversation on hearing loss. For five decades, Europeans have been able to take cabs, ride subways and go to museums because the governments had the forethought to encourage the use of hearing loops.
Unfortunately, they've never caught on in Canada or the United States.
Only in recent times have hearing advocates begun to demand help for the more than one in seven people with hearing loss.
We need to find ways to bring Canadians with hearing loss into the conversation.
Don't hand them a pen and paper, as the government document suggests.
It's just insulting.

A short demonstration in a library....

Hearing Loops: What consumers and professionals need to know

Hearing loops have been in use for more than five decades in Europe and are widely used in museums, transportation systems, even stadiums. Yet, North Americans have been reluctant to embrace this simple, cost-effective technology which provides an invisible, direct, wireless connection between hearing aids or cochlear devices and listening environments.

Recently, the Canadian Hard of Hearing Association began a discussion about how to promote looping technology to better serve the more than 3.1 million Canadians who suffer from hearing loss.

There’s just one problem: many consumers and installers complain that hearing professionals don’t activate their telecoils or T-coils, or even bother to tell their customers that the looping technology exists and is available for churches, businesses or public institutions.

“Unprogrammed T-coils virtually nullify usage - unless one wants to use a receiver and headphones which is nothing more than a "un-T-coil / loop" mentality,” says Bill Droogendyk, a loop installer and owner of Better Hearing Solutions. He reports a general lack of interest and awareness about the benefits to looping among hearing health care providers.

We talked to Juliette Sterkens (AuD), an award-winning American advocate for hearing loops, about what hearing health professionals can do to promote the use of hearing loops, and about the challenges ahead.

 

Rose Simpson: Looping has been used extensively throughout Europe for decades, yet it has failed to catch on in North America. Why are professionals reluctant to embrace this as a tool for their patients?

Juliette Sterkens: What is needed is education of the audiologists and hearing healthcare providers. They put too much faith in the hearing aids and CIs, or too much faith in upgrading to more technologically “advanced” hearing aids.  But even the best of hearing aids cannot give a person with hearing loss normal hearing nor can hearing aids restore the users’ auditory processing issues (just like new running shoes don’t make you a marathon runner). Plus hearing aids cannot overcome poor acoustics, distance and background noise that occurs from all around. Yes, new directional microphones can make a difference if the noise is less than six feet away, if the noise is behind the person and if the person’s auditory processing issues are not too involved.  

(Background: In our case, in the United States at least, in the past, few hearing aids had the built in T-coil, unlike the European hearing aid users whose government (national health service) issued hearing aids that had built in T-coils. The focus (for years) has been on small (and hearing aids were made small by removing… you guessed it… the telecoil). Today, the availability of t-coils is on the rise because more hearing aid users are going to the BTE models and it is estimated that over 70% of the devices now have the telecoil built in or in a remote control or streamer.)

RS: What is being done to create greater awareness among the professional population about the advantages of turning on the T-coil?

This education is happening through articles in professional magazines, webinars,  letters on professional list serves and presentations at professional conferences – you can imagine that this was  s-l-o-w going when  only a few people like Dave Myers (from www.hearingloop.org) and I traveled the country to do this. The good news is looping is picking up speed thanks to hundreds of active Hearing Loss Association of America (HLAA) members, who, having experienced loops at the last several HLAA annual conventions, are actively working to loop their communities.  

The reason hearing professionals are “in the dark” as you have indicated is because some may not keep up with the professional journals where there has been a lot published on looping in the last several years.  Some professionals  don’t attend professional meetings and  rely on the manufacturers for their continuing education or CEUs. And the hearing aid manufacturers don’t educate the AuDs and Hearing Health Care Providers (HHPs) about the telecoils – they’d rather talk about what is new, sexy such as Bluetooth, wireless microphones, streamers and Made for iPhone technology – so the professionals are not educated about the telecoil, how to program the telecoils and how to teach clients how to benefit from telecoils.

 

An example: Recently I heard of a professional who discouraged a minister of installing a loop claiming that loops don’t equally serve those not equipped with hearing devices and that FM systems are the preferred technology. This person is misinformed: Hearing loops can serve 100 percent of people, by direct connection to the telecoils in hearing aids and cochlear implants as well as through loop receivers and head sets, if need be. Plus, experienced users, as shown in a recent study (2) prefer loops 9 to 1 over FM or Infrared technology.

 

RS: Where does the patient fit in?

 

JS: Audiologists don’t educate clients on the benefits of telecoils, they do not tell them about their right to reasonable access under the ADA, they do not teach them to use assistive technology nor do they demonstrate the telecoil in the office (See 1,2)   Not even the most hard of hearing clients are taught – a disgrace in my opinion. When clients don’t know any better they don’t speak up – they stop attending and unfortunately few join HLAA or other support groups where they could learn from experienced peers. They also report reduced satisfaction with their hearing devices, which is not in the hearing industry’s best interest (see 3 and 4). 

 

RS: What do you think is needed in the future to encourage the public to embrace the T-coil?

 

JS: What is needed is:

 

·        Consumer education via – associations, articles in AARP, senior magazines, newspapers etc. Some of this is happening.  When newspapers pick up stories about loops; we have seen loops appear.

·        Parents of children with hearing aids and CIs need educating.(See 5)  

·        Audio visual engineers need educating and training on how to install hearing loops (as loops can be difficult to install and most engineers face somewhat of a learning curve) and they need to be educated why users prefer loops over FM or infrared technology as shown in a recent study published in the Hearing Review (See 2)

·        Ministers, theater operators, senior centre operators and business owners need to be educated about this technology and how it will greatly improve accessibility and may actually increase business (See 6).

·        Building/construction companies and architects need to be brought up to speed, on how to specify loops including with each building design.

RS: What role does the hearing aid industry need to play?

JS: The hearing aid industry is not really fully supporting this movement. In fact, they recently announced that they are going to work to bring about a new digital wireless standard for hearing aids. That is nice but sounds somewhat disingenuous (what have they done to help with large area assistive listening technology in the past?) and the question is whether this will really happen very soon. Some experts predict it will take 5-10 years (see 7), some even suggest it may never happen. When the hearing industry makes such an announcement, they essentially discourage audiologists or consumers to bring about looping in their communities. After all, if a new wireless standard will happen “soon” – why would anyone bother with the hard wire installation of loops?

I say install loops now  to help today’s hearing device users , and when a new wireless standard does happen, be it 5, 7 or 10 years from now (imagine how long it will take for all current hearing aids to be replaced with instruments that offer this new wireless “chip”)  we will work just as hard  for places that have a loop installed to add a small wireless transmitter for the “new” hearing aids to work side-by-side with the loops for as long as people have telecoils:  make sense?  And if the new wireless standard does not happen – then we haven’t lost valuable time.  Just like my husband says: “I was promised a jetpack in the 1960’s and I still don’t have one.” What if this new digital wireless hearing device standard is all pie-in-the-sky for hearing aid users?

 RS: Do you have any advice for professionals who want to advocate on behalf of the use of hearing loops?

 

I recommend  that AuDs/HHPs start by educating themselves by reading some of the practical articles which  can be found on line (see 8, 9 and 10) and:

 

·        Install a hearing loop in their waiting and/or treatment rooms

·        Demonstrate the loop to each and every client as well as their significant others

·        Offer  clients materials to bring the technology to the attention of their churches (that is where loops can quickly gain momentum) (See http://www.loopwisconsin.com/PDFFiles/Card3.pdf and http://www.hearingloop.org/00TechWorship.pdf)

·        Donate funds towards loops or encourage their clients to make a difference

·        Educate their community on the benefits of loop  technology by public speaking and holding special “Hearing Loop Community Events” (See 11)

·        Reach out to AV engineers, refer them to articles in the professional audio magazines on looping and encourage them to attend training in the IEC Hearing Loop Standard (See 12 )

·        Invite speakers to their professional conferences to present on hearing loop technology

Yes this will take time – but most worthwhile things take time and are rarely easy. But to hear someone say they could hear every word at a wedding, a meeting or a play – makes this work very worthwhile.

(Dr. Juliëtte Sterkens recently retired from her private practice in Oshkosh, WI and travels to educate consumers and hearing care professionals as the HLAA National Hearing Loop Advocate thanks to a grant from the Carol and David Myers Family Foundation. She is the creator of www.loopwisconsin.com. Her efforts have led to well over 400 hearing loops in Wisconsin and many more beyond. She can be reached via jsterkens@hearingloss.org )

References:               

1.      http://www.hearingresearch.org/ross/hearing_aid_use/hearing_aid_services_and_satisfaction_the_consumer_viewpoint.php    

2.      http://www.hearingreview.com/2014/09/consumer-perceptions-impact-inductively-looped-venues-utility-hearing-devices/

3.      http://bhscouncil.org/pdfs/M8_Hearing_aid_satisfisfaction_2010.pdf

4.      https://www.phonakpro.com/content/dam/phonak/b2b/FM_eLibrary/Increasing_hearing_aid_adoption_through_multiple_environmental_listening_utility.pdf

5.      http://www.listeningandspokenlanguage.org/HearingLoops/

6.      http://www.marriotttheatre.com/listening-device  

7.      http://hearinghealthmatters.org/hearingnewswatch/2014/hearing-industry-seeks-new-wireless-standard-hearing-aids-t-coil-advocates-say-fast/

8.      A “How to Guide” for Practitioners at www.loopwisconsin.com/PDFFiles/ADA-invigoratepracticeLR.pdf  and “Telecoil Essentials” at www.loopwisconsin.com/PDFFiles/ADA-getinloopJS.pdf

9.      “Roadmap to a Looped Community” article (with permission from American Academy of Audiology): www.loopwisconsin.com/PDFFiles/SterkensATMayJun.pdf  

10.   “Hearing Loops: The WOW Factor—Hearing Beyond 8 Feet”, an AudiologyOnline webinar at: www.audiologyonline.com/audiology-ceus/course/hearing-loops-wow-factor-beyond-24045

11.    Tools and useful resources created by Academy of Audiology and Hearing Loss Association of America Get in the Loop Joint Task Force at: www.audiology.org/publications-resources/consumer-information/get-hearing-loop and http://www.hearingloss.org/content/get-hearing-loop

http://www.hearingloop.org/SoundCommunicationsArticle_2010.pdf

Residential school kids became deaf after experiment

Some residential school children in Kenora, Ont., suffered hearing loss or were rendered deaf after undergoing experimental ear-infection treatments from the school nurse, documents show.
According to a government report from Indian and Northern Health Services, students at Cecilia Jeffrey were subjected to ear treatments in 1953-54 because of “conspicuous evidence of ear trouble” at the school, such as “the offensive odour of children’s breath, discharging ears, lack of sustained attention and poor enunciation when speaking.”
Out of all the students treated, 80 were found to have hearing loss caused by wax build-up around the ear drums and 40 students were found to have active ear infections.

Source: Kingston-Whig Standard

Motorcycles How loud is too loud?

Police are cracking down on motorcycle noise in Windsor, Ont.
Deputy Chief Jerome Brannigan said officers are on the lookout for altered mufflers that generate excessive or unusual noise.
He said police have laid charges and ticketed 50 people since officers began the crackdown earlier this year. They have experienced a conviction rate of 50 per cent.
Brannigan said the issue isn't unique to the Windsor region.

"It's a country-wide issue, actually it's a North American issue," he said. "I've read all kinds of information in the United States where communities are experiencing very similar, troubling issues with noise."

Patrol officers are still on the lookout for offending bikers. Brannigan said 250 officers took specialized training to make the crackdown effective.
"We went through the definition of what a straight pipe is and what a gutted muffler is and what a Hollywood muffler is," Brannigan said. "We also gave examples and suggestions on how to articulate unnecessary or unusual noise."
Windsor Coun. Jo-Anne Gignac said loud bikes affect the quality of life in Windsor and that council has received numerous complaints about the noise, particularly at night.
In June 2010, Edmonton passed Canada’s first excessive motorcycle noise bylaw. It focused on engines louder than 92 decibels while idling and 96 decibels while the engine was revving. Police in Edmonton used decibel meters but found they lost cases because of compromising factors such as background noise.
The fine for noise violations under the Highway Traffic Act is $110.
Source: cbc.ca



 

Image courtesy of [Bernie Condon] / FreeDigitalPhotos.net

ODSP and hearing aids: Ministry responds

In yesterday's blog post, I presented complaints about the Ontario Disability Support Program's two quote policy, which both audiologists and some patients are calling unfair. Here is what the Ministry of Community and Social Services had to say:

Q: The Minister indicated in a letter to OSLA that there is no two quote policy unless the original cost is deemed unreasonable. Yet audiologists and patients I've interviewed say it does. In one case, a disabled man in Petawawa is being forced to travel return 100 k at his own expense to get a second quote. He is very agitated about having to lose his audiologist of 13 years.

A: For clarity, the Minister indicated in this letter that there was no change in the policy. The policy has always provided caseworkers with the authority to request a second quote, where it was considered necessary.

Clients may not be required to obtain two quotes in every circumstance, for example, where;

- Emergency and weekend repairs are needed (also exempt from prior authorization requirement)

- limited number of vendors in a geographical area

- using another vendor would void the warranty on a device

- repair costs are reasonable and or minor in nature

- addressing the specialized accommodation needs of a client (eg. client requiring the services of an audiologist with sign language expertise)

- device is a high technology mobility device as Shoppers Home Care is the vendor for Centralized Equipment Pool (CEP) mobility devices

* (list is not exhaustive)

The ministry has been in contact with the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA). The intent of the discussion was to reach an understanding of the issue from both sides and come away with a mutual appreciation of the challenges each party faces with respect to this matter. The ministry also provided further information to the OSLA that offered additional insight into the measures being taken to improve customer service for ODSP clients while continuing to be accountable to the taxpayers of Ontario. The discussion was positive and ended with an agreement that the ministry will work collaboratively with the OSLA.

Q: What is considered an unreasonable cost? Are there guidelines that audiologists/clinics can follow to ensure they operate within the guidelines?

A: At this time, there are no fee guidelines set out in the ODSP policy, however, options are currently being explored by the ministry to address both service and costs associated with the delivery of the Hearing Aid policy to ODSP clients.

Q: What is the appeal process? One caregiver was told by her MPP that "the rules are the rules".

ODSP clients have the right to request an internal review of any decision that affects their eligibility for or the amount of income support that they receive. This includes whether they are granted or denied a hearing aid benefit. Once an internal review decision has been rendered, clients who disagree with the result may appeal to the Social Benefits Tribunal.

Q: What is the Ministry's position on the fact that disabled Ontarians are refused the right to choose their caregivers, that privacy laws are being breached and caseworkers are choosing health providers for patients?

A: Clients may obtain quotes from any vendor, including their preferred vendors. While there is an importance placed on ensuring value for money, cost is not the only consideration when a quote is approved. In order to make sure that we are meeting ODSP clients’ needs while still being accountable to taxpayers, Caseworkers will review both quotes based on a number of factors, including the client's circumstances and individual needs. If the client needs a better model, this may be approved over a lower priced/inferior hearing device. In some cases, it may be necessary to follow up with vendors for an explanation of the quote.

To ensure fairness and protect the privacy of individuals in the 2 quote process, each quote should be provided independently. Caseworkers have been directed that the 1st quote should not be shared with the 2nd vendor. Further, Caseworkers have been advised that they must not forward a quote that includes a client's health information which was provided to a health professional as this violates the Personal Health Information Privacy and Access Act (PHIPA).

Q: How does the ODSP compensate audiology clinics for spending time in performing their own test and the HAE for the purpose of providing a quote? Does the ODSP reimburse the first clinic if their quote is not successful or let them know why they have not been selected?

Local ODSP offices may pay the costs if a fee is charged to obtain a second quote for hearing or mobility devices or for a test/assessment related to obtaining a second quote.

Under ODSP, the Hearing Aid benefit will cover:

· the portion of the cost for a hearing aid/appliance not covered by ADP

· the cost of the dispensing fee when it is not covered by ADP, based on the dispensing fee rate approved and listed by ADP

· the cost of a hearing test if the person does not have access to an appropriately qualified physician(hearing tests are covered by OHIP when performed or supervised by appropriately qualified physicians or administered by qualified persons they employ, including audiologists)

· the cost of the hearing aid evaluation (or re-evaluation if one is necessary) is not covered by OHIP and can be covered by ODSP if it is not covered under another resource (a hearing aid evaluation is necessary to determine the most suitable hearing aid where a hearing aid or hearing appliance is recommended)

Only the selected vendor is contacted. Audiology clinics should contact their local ODSP office to discuss reimbursement.

How does the ODSP evaluate the quote if an audiologist quotes for more expensive hearing devices if they determine that is what is needed to meet the patient's needs? I'm thinking pocket talkers or FMs or digital versus analog? Isn't this comparing apples and oranges?

There are a range of hearing devices and the decision regarding the appropriate make and model of hearing device for the client must be left up to the ADP registered authorizer, as they have the required expertise to make such a determination.

While there is an importance placed on ensuring value for money, cost is not the only consideration when a quote is approved. In order to make sure that we are meeting ODSP clients’ needs while still being accountable to taxpayers, ODSP caseworkers will review both quotes based on a number of factors, including the client's circumstances and individual needs.

If the client needs a better model, this may be approved over a lower priced/inferior hearing device.Each situation is reviewed on its own merits and in some cases, it may be necessary to follow up with vendors for an explanation of the quote.

Q: Also, do you know how many clients the CSS serves in terms of hearing loss patients who need rehabilitation services and devices?

In fiscal year 2011-12, there were about 8,000 ODSP cases in receipt of the hearing aids/batteries. It’s important to note that our database cannot separate the number individuals in receipt of hearing aids devices, or individuals who have received funding for repairs or replacement batteries. The number above is a combined total of the number of individuals who have received funding for hearing aids devices, repairs or replacement batteries.