Hospices are likely to come into regular contact with patients, carers and family members who are deaf or have hearing loss. Data shows that one in three adults in the UK are deaf, have hearing loss or tinnitus; and 80% of people over the age of 70 will have hearing loss [1].
Despite this, healthcare staff do not routinely receive teaching on the needs of deaf people. This can mean that deaf people's needs are not being fully met within healthcare contexts. The team at Royal Trinity Hospice recognised that this can have a significant impact within palliative care settings.
Cases from Royal Trinity's inpatient unit and community teams showed that staff felt underconfident supporting the communication needs of deaf patients. This included both diagnosed and undiagnosed hearing loss. It was clear that the inpatient environment needed adaptations to ensure it could be fully accessed by deaf people.
The hospice brought together a multi-disciplinary group from medical, community engagement and communications teams to tackle this issue.
Outcomes
The team took a range of actions to ensure deaf people had equitable access to all hospice services.
One of the team members is deaf and developed a series of education sessions on 'deaf insight' - understanding the cultural and communication needs of deaf people.
These sessions are run regularly and all staff from across the hospice are invited, including clinical and non-clinical staff. The sessions are well attended and receive positive feedback.
Attendees report having improved awareness and confidence after the sessions. More staff are now routinely asking patients and those around them about their communication needs, so that all necessary support can be put in place as early as possible.
Clinical staff received further specialist training on a variety of areas based on clinical need and feedback. Topics include:
understanding models of disability
hearing aid first aid
the needs of deaf people at the end of life.
The hospice already had a system for staff to access interpreters remotely at any time (this includes British Sign Language interpreters). However the team identified that interpreters were not necessarily being utilised when appropriate.
On the inpatient unit, the team set up dedicated devices for remote interpreting, which were put in accessible places. They were regularly discussed amongst the inpatient team so that everyone knew where they were and how to use them.
In the community team, staff were supported to access remote interpreting at any time on their devices.
As a result of these measures, the uptake of interpreters increased and clinical staff reported having greater confidence during consultations with interpreters.
Hearing devices
The team recognised that patients who are less mobile can struggle to get to audiology or Ear, Nose and Throat (ENT) appointments. This can lead to challenges with hearing devices:
Patients with known hearing loss are less able to get problems with their current hearing devices resolved.
Those with a new hearing loss can't be fitted with their first devices.
The hospice invested in simple 'hearing aid first aid' equipment so that staff can make simple fixes to hearing aids as needed. The team also purchased a personal amplification device which can be loaned out to patients. This is used regularly with good effect.
Ear wax removal
The team also invested in equipment to help remove ear wax more easily. Training helped staff become more confident as using this and similar equipment they already had.
This simple procedure often vastly improves a patient’s hearing or their ability to use their own hearing device, which in turn enables them to engage in conversations with clinicians, friends and family.
The team understand the importance of connecting with local deaf groups to help ensure the hospice is making the right adjustments for deaf people. Building long-term relationships will also help improve ongoing access to Royal Trinity Hospice’s services for all.
They delivered advance care planning with a local deaf health organisation and are continuing to develop connections with other organisations.
The hospice recognised that this need affects staff and volunteers too. In training sessions, staff are made aware how they can get further information within the organisation. Individual support is offered to staff as appropriate and managers have received training about reasonable adjustments for deaf and disabled staff.
Future development
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Royal Trinity plans to continue this work by:
strengthening links with local community groups and hearing from deaf service users to shape the project
continuing to invest in equipment to further improve access to the hospice environment, such as live captioning
sharing knowledge to help other hospices and palliative care services make their services more accessible to deaf people.
