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Hearing loss requires more than just devices: time to act on an important report

Introduction by Croakey: Disability rights advocates this week expressed shock and concern (see tweets at the bottom of the post) that Auslan interpreters were missing from COVID-19 update briefings from the new New South Wales Premier Dominic Perrottet.

The Australian Lawyers for Human Rights (ALHR) expressed significant concern, saying  “press conferences regarding COVID-19 are a fundamental source of information to the public to know the latest in an ever-shifting environment”.

“Failure to provide this information in an accessible manner, in real-time, violates the human rights of people with disability and places them at great risk,” it said, adding that it had written to the Premier stating its concerns.

On a more hopeful note for people living with hearing loss, a final report has been handed over to the Federal Government on a long-awaited review into the Hearing Services Program, making important and welcome recommendations.

The Federal Government now needs to act with urgency, to provide better and more equitable hearing healthcare in Australia, writes Dr Jessica Vitkovic, Acting CEO of Soundfair and a leading audiology researcher, in the post below.


Jessica Vitkovic writes:

Famously, there are two certainties in life – death and taxes – but with Australia’s ageing population, for one-in-four of us, soon hearing loss will also be a certainty.

Therefore, given it shapes the provision hearing healthcare in Australia, we should all pay attention to the Review of the Hearing Services Program (HSP), and to the final report handed down recently by its Independent Expert Panel.

Established in its current form in 1997, the Program has historically focused on the provision of hearing aids and devices.

But, while many Australians benefit significantly from the HSP and hearing device technology, our community tells us that, even at its best, this mode of hearing healthcare does not fully meet their needs.

As one member said:

“Nobody talked talk to me about safety. Nobody talked to me about the difficulties I’d experience in noisy environments. Nobody talked to me about how to strategise before socialising. Nobody told me about the awkwardness of having to say ‘Pardon, I’m sorry, could you repeat that?’ over and over and over.

Nobody talked to me about the social isolation that may present itself after hearing loss. I wasn’t given any guidance in terms of how to navigate my new normal and I wasn’t given any strategies as to how to overcome community challenges.” – Maxine.

It is clear from the research that hearing healthcare is device-centred and paternalistic.

The funding model also incentivises providers to focus their business models on high volumes of device fittings rather than the time it takes to support clients in the effective use of the device or other services including communication education or counselling, limiting the provision of high-quality services and meaningful outcomes.

Put simply, currently, the Australian Government and taxpayers are not getting optimal return on their investment.

Personal and economic costs

Enter the HSP Review. As the Review recognises, hearing loss is an immensely personal experience that can have a significant impact on relationships, career, friendships and social connection.

It is, above all, a communication barrier. Thus, hearing loss is also in and of itself a social determinant of health – influencing health outcomes in ways subtle and pervasive, by reducing employment opportunities, creating barriers to accessing care or by encouraging social withdrawal.

There is also evidence of a link between hearing loss and an increased risk of dementia.

However, the costs of hearing loss are more than personal and are borne by all of us.

The Hearing Care Industry Association, with assistance from Deloitte Access Economics, estimated that the financial costs of hearing loss in the 2019-20 financial year in Australia were in the region of $20 billion, consisting of:

  • health system costs of approximately $1 billion
  • productivity losses of $16.2 billion
  • informal care costs of $174.7 million
  • deadweight losses of taxation payments and administration of $1.9 billion
  • other financial costs of $683.4m.

What should change?

What, then, does the Review say should change about the provision of hearing healthcare under the HSP?

Firstly, the Review highlights that the program has been in operation for 20 years with no clearly set, measurable objectives. Importantly, the Review suggests that the Program’s objectives are that eligible people with hearing loss:

  1. have equitable access to prescribed services which comprise hearing assessment and hearing rehabilitation, hearing aid devices and other support
  2. are able to exercise informed choice and have control about how to live with hearing loss
  3. are able to exercise informed choice and have control on the selection of their service provider; and have clear and independent processes for resolving any complaints.

The devil is in the detail of if, and how, this will be implemented, but it is heartening that the Review explicitly recognises that hearing aids and devices are only one treatment modality of many for hearing loss and calls for rehabilitation services to be integrated into hearing healthcare provision. Interestingly, the Draft report recommended that rehabilitation services be independent of device fittings, but the recommendation for independence has not been included in the final report.

Guided by co-design principles, with lived experience embedded in the development of service provision, Soundfair’s position is that social and emotional supports are just as important as physical interventions for hearing healthcare: people are more than just ears and hearing loss requires more than just devices.

Also welcome is the Review’s recommendation to significantly extend HSP eligibility criteria.

In 2018–19, the National Aboriginal and Torres Strait Islander Health Survey reported on data from a voluntary hearing test, which indicated more than 43 per cent of Aboriginal and Torres Strait Islander people aged seven years and over had a hearing loss in at least one ear at the time of interview.

The Review panel is to be applauded for the recommendation that the HSP be expanded to include all people who identify as Aboriginal and/or Torres Strait Islander, regardless of other eligibility criteria.

Equally, the recommendation to extend eligibility to all holders of the Low Income Health Care Card has the potential to transform the lives of many, including those locked out of employment by their experience of untreated hearing loss.

What needs to happen?

Just as good communication is a shared responsibility, transforming the provision of hearing healthcare to ensure it is fit for purpose, evidence-based and is person-centred, rather than device-centric, will take action from across the spectrum: government, industry, clinicians and consumer groups.

Soundfair is working for a world that is fair – fulfilling, accessible, inclusive, respectful – for people living with hearing conditions. A fair world encompasses not only the provision of Auslan interpreters, universal captioning, equitable access to hearing healthcare, but much, much more.

Overall, the Review is a welcomed, considered and nuanced response to meeting the needs of people with hearing loss. However, and as the authors themselves note, it is only the latest in a long series of comprehensive reviews and reports on hearing healthcare provision in Australia.

With the Roadmap for Hearing Health, released in 2019, the Federal Government made a comprehensive commitment to improve the lives of the millions of Australians affected by hearing loss.

The Roadmap outlines a timeframe for implementation of seven years, but we can’t afford to wait. The time to implement the Review’s recommendations both to the letter and in its spirit of good service provision is upon us.


On #Auslan via Twitter

 


Earlier this year Croakey covered the launch of Soundfair’s HearMe Project’s report. You can read our story here:

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