Advocating for the elderly hard-of-hearing population: the deaf people we ignore.

Case Study M is a 77-year-old woman who has been on hemodialysis for 10 years. In addition to her kidney failure, her other health problems include seizures (which are common in end-stage renal failure), arthritis, and strokes. She is widowed and has three grown children, the eldest of whom is accompanying her to the doctor's office. The social worker is asking M questions to determine her ability to manage the change from hemodialysis performed at the dialysis center to peritoneal dialysis performed at home. Communication between the social worker and the patient is not going well because the patient is hard of hearing. The daughter explains that her mother has two hearing aids but does not wear them because they hurt her ears. The social worker repeatedly directs her questions to the daughter, leaving the mother sitting and wondering what is being said about her condition. What is wrong with this picture? Social workers are trained to be sensitive to people's needs, especially people with disabilities or physical challenges. However, because hearing impairment is an invisible disability, social workers may be at a loss when trying to communicate with hearing-impaired people. Framework for Understanding Hearing Impairment Someone who has never had a hearing loss does not realize that hearing aids do not correct hearing the way that glasses improve vision to 20/20 (Thomsett & Nickerson, 1993). The sounds that are amplified by the hearing aid may be fuzzy, unclear, and confusing. Also, background sounds may be amplified, and the sounds jumble what the hearing aid user is trying to hear. Sometimes background noise may be amplified to the point of excruciating loudness. Having that experience once or twice may be enough to persuade the hearing-impaired person to do without the hearing aid altogether. The newer aids do a better job of discriminating sound from background noise but cost approximately $5,000 each. What happens at this point? The hearing aid goes into a drawer, and the family members fuss, "Why don't you wear your hearing aid? You spent $800 on it," and they become impatient. If the person does continue to try to wear the hearing aid, the family members seem to think that the hearing aid gives the wearer perfect hearing. More frustration ensues because the wearer does not understand what is being discussed, and the conversation has to be repeated several times. Repetition results in more impatience on the part of family members. The wearer may nod and act as if he or she understands what is being said, because it is easier than having to ask to have the conversation repeated continually. Communication suffers, and relationships suffer. Information breakdowns occur. People speak in front of the hard-of-hearing person as if he or she was not there. In the case study with M, the social worker did not even look at M, instead asking M's daughter what the problem was. This left the daughter feeling outraged. She later reported to the social worker, You are not even trying to communicate with my mother. You are acting as if I am her interpreter. She can understand you if you look at her and speak slowly and clearly. My mother does not know sign language. You just need to put a little more effort into communicating with her. Imagine how you would feel if you and your spouse went to the doctor to consult about a major surgery you were scheduled for and the doctor directed the conversation only to your spouse as if you were not intelligent enough to know what was being discussed. Imagine your rage and frustration. Combs (1992) described the experience of going to the doctor with an adult caregiver: When the doctor addresses the caregiver instead of the patient, the patient begins to feel as if he or she were "a pet at a veterinarian" (p. 98). Practice Interventions for Improving Communication One of the basic principles of social work is empowerment with dignity. …