A Report on The Impact of Hearing Loss on Older Adults in North Carolina Study Commission on Aging February 4, 2010 The Division of Services for the Deaf and the Hard of Hearing Jan Withers, Director
Overview • Report on S.L. 2008-181, Section 12—Studies Act of 2008 • In March 2008, the Division approached the Study Commission with an intent to attempt to address issues within the growing older adult hearing loss populations • Hearing loss is the least understood disability because of its “hidden” nature • Unaddressed hearing loss: enormous adverse economic and public health ramifications
Overview • Study methodology: a compilation of efforts from three different sources: – Division staff research – Random survey of Nursing Homes and Skilled Care Facilities’ Directors—543 mailed, 254 returned at 46.7% – Study Group formed consisting of members from varied professional fields—audiologists, hearing instrument specialists, aging, legal, and consumer grassroots groups • Divided into four groups to study the four areas specified by the General Assembly
Overview • Skilled Care Facility Directors’ Survey Results: – 56% rated themselves less than knowledgeable of hearing loss and the overall impact on older adults – 72% stated no hearing loss professionals visit facilities – 68% were not aware of hearing aid purchase assistance programs – 63% do not provide hearing loss assessments as part of the intake process – 54% consider the facility to be fully accessible for ALL persons with hearing loss – Special notes: Directors requested 1) more information; 2) hearing aid purchase assistance from Medicare and Medicaid for residents
Findings of the Study • Demographics • Tangible Impact and Costs – Severe Adverse Economic Ramifications • Intangible Impact and Costs – General Health and Well-Being • Physical, Social, Medical, Mental effects
Demographics--2008 2008 NC Population age 18 and over 216,494 75 and up (42.64%) 507,724 174,867 (27.68%) 65-74 631,744 (11.61%) 681,568 18-64 5,870,528 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 7,000,000 Total Population Total Population with Hearing Loss Hearing Loss % is derived fromthe 2008 Series 10 report data fromwww.cdc.gov/nchs/nhis.htm P opulation data from http://www.osbm .state.nc.us/dem og/countytotals_agegroup_2008.html
Demographics--2029 2029 NC Population age 18 and over 428,867 (46.84%) 75 and up 915,599 (30.22%) 386,371 65-74 1,278,527 (11.80%) 892,906 18-64 7,567,000 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 7,000,000 8,000,000 Total Population Total Population with Hearing Loss Hearing Loss % is derived fromthe average of Series 10 reports from2004 to 2008 fromwww.cdc.gov/nchs/nhis.htm P opulation data from http://www.osbm .state.nc.us/dem og/countytotals_agegroup_2029.html
Demographics • Population totals do not reflect the facts that: – Because NC is a retirement haven, the state has a higher percentage of older adult residents with hearing loss than surrounding regional states – Involvement by adult children, family or care givers when misunderstandings occur due to communication issues experienced by older adults only broaden the impact spectrum – End Result: significantly more people are impacted by hearing loss either directly or indirectly • NC ranks highest in hearing loss population of regional states— GA, TN, SC, VA
Tangible Costs of Hearing Loss • Economic Ramifications – 95% of the hearing loss population can benefit with use of hearing aids – However, only 23% reportedly use hearing aids – High COST of hearing aids is the most frequently stated reason for not seeking hearing aid treatment – Average retail hearing aid costs range from $1400 to $5000 per hearing aid – Consumer Reports cites average mark-up pricing at 117% above wholesale costs; found ranges from 25% to 300% mark-up
Tangible Costs of Hearing Loss • No mandated insurance coverage from private or public sources for adult hearing aids; decreasing number of non-profit and civic groups able to help due to diminishing membership and the economy • Persons with untreated hearing loss are shown to have approximately $13,000 less income per year than those using hearing aids • Lost incomes mean lost tax revenues for state • An estimated lost income of $3.2 billion for NC citizens equates to lost annual tax revenue of $477.4 million
Intangible Costs of Hearing Loss • Impact on Health and Well-Being – In 1999, a study by the National Council on Aging debunked the myth that hearing loss in older adults was a harmless condition – Hearing health care providers have projected hearing loss to be a public health problem due to increase in population – The Centers for Disease Control noted a correlation between the quality of hearing health and the quality of overall health. The greater the hearing loss, the greater the chance that the individual would report poor health. • 28.9% of those deaf or who have a lot of trouble hearing report only fair or poor health as opposed to excellent or good health while only 10.5% of those with good hearing report fair or poor health.
Intangible Costs of Hearing Loss • Strong association of hearing loss with the following: depression, anxiety, impaired memory, paranoia, reduced coping skills, reduced ability to learning new tasks • The inability to effectively participate in communication leads to greater isolation and withdrawal and leads to lower sensory input • Hearing loss is the 3rd most chronic, but treatable condition among older adults following arthritis and hypertension
Intangible Costs of Hearing Loss • Lack of Knowledge by General Populace • Confused on how to address hearing loss and possess unrealistic expectations of results of treatment • Unaware of resources and how to access to them • Hearing loss is becoming a health care issue because it is erroneously assumed that many professionals, including medical, have the necessary expertise to address hearing loss issues • Only 12.9% of primary care physicians perform some form of hearing screening
Intangible Costs of Hearing Loss • Ear, Nose and Throat physicians, Audiologists, Hearing Instrument Specialists are available to help with varied needs of people with hearing loss • These professionals often do not address the full spectrum of needs such as coping skills, grief counseling, effective use of assistive technology. • A comprehensive approach to treatment is critical to ensuring successful use of hearing aids and other devices
Significant Conclusions to Study • Hearing loss is widespread among older adult and, left unaddressed, could have profound and devastating impact on their health and functioning • Hearing loss is highly varied, complex and very little understood, even among professionals • Effective communication is the key to an individual’s ability to develop and maintain healthy social connections and to independently access and use the services and resources in their own communities
Recommendations • In order to address these issues and to enable older adults with hearing loss to achieve effective communication, three recommendations are presented:
Recommendation One • Establish a task force to assess the feasibility of developing and implementing a formal system that optimizes consumer capacity to fully evaluate quality of hearing aid services prior to and during the process of purchasing hearing aids – Consumer protection tool to prevent costly errors – Enhance awareness and empower consumers, especially older adults, in making informed decisions – reassure customer of professional integrity at all times – Involve professionals from every aspect of the hearing health care industry in developing solutions
Recommendation Two • Enact legislation that would require all hearing aid dispensers provide a minimum of a 30-day trial period with money back guarantee and instruction on the function of the telecoil and its use – Also a consumer protection issue; two-part recommendation – Part A: Eliminate costly misunderstandings and clarify for the older adult any and all fees associated in the process, with or without a purchase – Delineate for the consumer responsibilities of both parties including any financial responsibilities
Part B: Provide better use of telephone by removing the electromagnetic interference between the hearing aid and telephone --Allow a Hard of Hearing and sometimes Deaf consumer to receive needed amplification and easier access to sounds from electronic audio equipment including radios, public address systems and assistive listening devices --Most consumers are unaware of this beneficial device and do not inquire about it; likewise, many dispensers do not inform customers the device exists
Recommendation Three • The General Assembly should consider legislation requiring hearing aid health insurance coverage for all ages from any private agency providing health insurance and doing business in North Carolina and from any public agency providing medical insurance coverage assistance. – Hearing aids are expensive and improvements in technology cause costs to rise rapidly – Costs is a primary reason for non-treatment – Currently, health benefits plans rarely include coverage for hearing aids; totally out-of-pocket expense
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