What Are the Different Types of Hearing Loss? Find Out!

For the audiologist: Easing Hearing Aid Return Pain

It's never a pleasant scenario. The customer is completely unsatisfied with his hearing aid and you have agreed to give him a credit. That's gotta hurt. Here, from the Hearing Journal, is an article that could help ease your pain.

The link between hearing loss and dementia

Hearing health care is one of the most neglected areas of treatment. There are no pills for hearing loss, the doctor can't write a script. And 15 minutes in a doctor's office, which is what most of us usually get, is not enough to determine whether a person has hearing loss bad enough to require treatment.

Most doctors evaluate hearing by simply asking the patient "how's your hearing?" Many people, particularly men, are dishonest about this because they don't want to be saddled with hearing devices. As a result, they often go undiagnosed until they really can't hear.

So you can imagine the poor folks who may have hearing loss, but who also might be suffering the first signs of dementia. There is, unquestionably, a link between hearing loss and dementia. It's one of those chicken and egg situations. A person who might have dementia might be mistaken for someone who is hard of hearing. Or a person experiencing the first signs of dementia might become more isolated because of hearing loss.

Audiologists can play an important role in detecting early onset dementia or Alzheimer's Disease because they spend more time with patients and they should start adding cognitive testing to their stable of routine tests on their elderly patients, according to Marilyn Reed, an audiologist at Baycrest in Toronto.

Her team was surprised last summer when a psychology student came to Baycrest, a facility for elderly patients, to do cognitive testing on patients. She found that the majority of patients had some degree of cognitive problems.

“We didn’t know that such a huge percentage of our patients had cognitive impairment,” she says. “We didn’t know because most of them behave normally. Since mild cognitive impairment affects memory but doesn’t necessarily affect their behavior, you wouldn’t notice it during the time you spend with them in a clinic for one appointment.”

The 2011 World Dementia Report stated that the world is facing a "global epidemic" of Alzheimer's Disease, with more than 60% of cases going undetected and undiagnosed by health practitioners.
It is evident, therefore, that health care professionals need to do more cognitive testing on elderly patients.

Mild cognitive impairment often goes undetected for months, sometimes years. Audiologists begin to notice it when patients start repeatedly complaining that their hearing aids aren’t working.

“They’re getting frustrated, upset; they’re not wearing their hearing aids. They’re forgetting to change the battery or forgetting to clean them. It’s then we realize they are having difficulty with cognitive impairment.”

But there is good news on the horizon.

The Baycrest Audiology team was awarded a clinical research grant at the fall meeting of the Canadian Academy of Audiology to assess the cognitive status of their patient s and determine a) if this corresponds to the audiologists’ impression and b) if it influences management protocols. A research assistant will use cognitive tests such as the Montreal Cognitive Assessment (MoCA) to assess the cognitive status of audiology patients. The team will report back to the CAA meeting in St. John’s, Newfoundland with the results.

Failure at the Primary Level

Missing the warning signs of early cognition problems come at a price to our society.

 

• The 85 plus population is the fastest growing segment of the Canadian population.

• The prevalence of Alzheimer’s and other forms of dementia increases with age. Its rate doubles every five years.
• ·It is a serious public health concern, as the 7^th leading cause of death in Canada with no prevention or cure.
• It costs the Canadian economy $2 billion a year in health care costs.

Patients and their families also suffer.

• The association between age-related hearing loss and social isolation is commonly accepted and profoundly important.
• Direct causal and neurobiological pathways link loneliness with psychological pathology.
• The more social stimulation and communication opportunities a person with Alzheimer’s Disease has, the more likely surviving brain cells are to restore connections.

Detecting cognitive problems in the early stages isn’t easy.

“The big problem is that people generally in health care find it difficult to tell the difference between cognitive impairment and severe hearing loss because they present themselves similarly. People give inappropriate responses or don’t respond much at all. It may be hearing; it may be cognition.  How do you know?”

 

 

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.

 

 

 

ODSP: Two quote policy unfair to patients, audiologists

The Ontario government says it has a clear policy on how it will pay for hearing aids for people on disability. Too bad the bureaucrats aren’t listening.

According to the Ministry of Community and Social Services, there is no new policy requiring individuals on the Ontario Disability Support Program (ODSP) to get two quotes for everything from hearing devices to batteries. Yet audiologists are being told by their clients with disabilities that they must get at least a second opinion, in writing and at their own expense, before they can obtain hearing services and devices.

This is hard on people who are physically and mentally challenged who have trouble sitting through hearing evaluations, which require a great deal of concentration. Many people with autism don’t like being touched. Other persons with disabilities have difficulty with health professionals working around their faces so they take some comfort in using familiar health care providers.

Petawawa resident Donald Cole is one of those people. A mentally-challenged man in his 60s, Donald gets agitated around new people. So it is no wonder that Donald became distraught when he was told he might have to give up his audiologist, a woman who has treated him for more than 13 years.

That’s because his caseworker wants a second opinion and if the quote is lower, Donald has been told, he will have to change audiologists.

As a result of this directive, which shocked Donald and his caregiver, Ellen McMillan, the pair must make a round trip of more than 80 kilometres to Pembroke at their own expense to have a second hearing evaluation performed. Donald has to do the same thing to get his corrective lenses and the batteries for his hearing aids.

To Donald, this makes no sense.

“I feel like I’m doing duplication,” he says. “I find it’s too hard on my nerves.”

According to those working in hearing health care, the unofficial two quote policy is costing unnecessary time and money to be spent by both patients and their health care providers. The average hearing evaluation takes between 60 and 90 minutes and audiologists are unclear whether they will be paid for their time. Some rural patients have to be transported long distances, often to other communities, and try to work around the policy by sharing their quotes. As one provider put it, they have no intention of using the services of the second audiologist.

The implications of the unofficial two-quote policy go much farther than getting the best bang for the public buck.

Fitting hearing aids, pocket talkers and other devices is a specialized field which requires years of training and an understanding of physiology and cognition. Choosing appropriate hearing solutions for seniors and the disabled is not as simple as choosing a piece of hardware.

Audiologists from across Ontario are complaining to their association that caseworkers, who are not regulated health professionals, are making medical decisions on behalf of patients. They are playing fast and loose with privacy information and sharing quotes. They are also violating the rights of patients who are guaranteed, under the Canada Health Act, the ability to choose their health care providers.

According to Rex Banks, Director of Hearing Healthcare at The Canadian Hearing Society: “ there has been quite a bit of confusion regarding the two quote process and our clients have been the ones caught in the middle. The Canada Health Act guarantees the right to choose one’s healthcare provider along with recognizing individual needs and preferences. I am hopeful that ODSP will find an equitable way of addressing costs related to hearing healthcare without compromising the rights of those involved.”

In the meantime, in the words of Mary Cook, the executive director of the Ontario Speech Language Pathologists and Audiologists Association (OSLA), “the whole thing is a mess”.

More than 60 audiologists in Ontario have signed a petition urging the government to put an end to the practice. Members of OSLA want the Ontario government to work with audiologists to establish a fee schedule, an idea that the government is now considering. But by the time that happens, it may be too late for Donald Cole and other people with disabilities who are caught in the system right now.