Aging comes with hearing loss for millions. And untreated hearing loss corresponds with higher risk of dementia. Moreover, healthy aging is possible with better brain functioning through good communication health. Therefore, Hearing Partnership highlighted the importance of hearing health care to the Governor's Council to Address Aging. We gave public comments on June 21, 2017. Finally, we submitted our written testimony on July 19, 2017. See our testimony below:
To the Governor's Council to Address Aging:
This submission provides written record of comments I gave in-person on June 21, 2017 at the Gloucester community listening session of the Governor’s Council to Address Aging in Massachusetts. My name is David Bergeron. I am the owner of Beauport Hearing Care, a full service hearing instrument practice in Magnolia, Massachusetts. Thank you for coming to Gloucester.
I wish to shine a bright spotlight on the importance of hearing health care. Healthy aging and good hearing health are linked. But hearing health care is deeply misunderstood. People think it's all about hearing aids, and it's not.
Protect Good Hearing
First we must recognize how important our hearing is and most especially how important it is to protect it before we acquire hearing loss. Most hearing loss is preventable. The best way to treat hearing loss is by preventing it. We need to pay a lot more attention to hearing conservation and how to protect our hearing from harmful loud noises. And then we need to treat hearing loss when it occurs.
Real treatment of hearing loss is aural rehabilitation. The fitting of hearing aids is often an important component to aural rehabilitation. But hearing aids alone are not the whole treatment program.
The human hearing system involves the sensation of sound in the ear and cochlea. But then the signal travels up the brain stem for processing in the brain to understand what is heard. Untreated hearing loss can have neurological effects to the auditory centers of the brain. Auditory deprivation causes those parts of the brain dedicated to auditory processing to go to sleep. Moreover, hearing aids do not restore natural sound. So a brain that begins receiving amplified auditory signals in frequencies that have not been heard for a long time may not know how to interpret the new signals. Things sound different. New hearing aids can be very overwhelming without proper professional guidance on how to adopt their proper use. Some people adopt hearing aids easily and others need a lot more help. It is essential for the public to understand this.
People that get new hearing aids sometimes believe their hearing aids do not work. Family members may complain that a lot of money was spent on hearing aids, and the user still cannot hear. But hearing aids do work! In many cases people new to hearing amplification need auditory training. The brain needs help and time for the patient to experience the full benefit of their new hearing instruments. Hearing aids may be correctly programmed and appropriately fitted to someone with hearing loss, but the patient may still say, “I can hear what you are saying, but I can’t understand.” The hearing professional offers games and exercises to help wake up brain auditory processing. But it takes time, and people need to understand that treating hearing loss is a process. It is not just a matter of getting hearing aids.
Better Hearing Must Be a Community Effort
Hearing is a social experience all about communication. No one hears by themselves. Hearing happens when we are communicating. Therefore the treatment of hearing loss must incorporate an understanding of the social dimensions of how we hear and communicate. Sometimes people with hearing loss need help and cooperation from family members and co-workers in order to gain the full benefit of hearing aid amplification. Communities need to talk about how everyone can help one another mitigate and prevent hearing loss. We need to have a lot of conversations about hearing loss. Get our communities educated and motivated to take action and take care of our hearing.
Recommendations - Call to Action
I offer two specific suggestions to the Council:
- Health insurance should provide coverage for aural rehabilitation and hearing instruments. Mass Medicaid is a good template for covering 'hearing aids' but health insurance should also reimburse hearing instrument specialists and audiologists for providing aural rehabilitation counseling and auditory training.
- Case managers, outreach workers, everyone working in a ‘community health worker’ (CHW) role should be trained to conduct hearing screening, provide general education on hearing health care, and provide clients with navigation support so people screened with hearing loss actually reach the hearing care clinic. CHWs can help people better understand the process and especially what to expect from their providers. These CHW services should be reimbursed by Medicaid and all health insurance. CHW navigation support and follow-up is critical to ensure that patients continue to receive aural rehabilitation after they have been fitted with hearing aids. Without this follow-up care, many hearing aid users give up in frustration and stop using their hearing aids. They never know why they did not succeed.
I submit that there is already ample scientific evidence on record to justify health insurance coverage of hearing health care as a cost savings strategy. Moreover, health insurance should cover real hearing health care. That means compensating all licensed hearing care providers for aural rehabilitation and hearing aids, and reimbursing CHW services that ensure patients access the hearing health care services they need to succeed in their treatment.
Better Hearing Health Care Must Grow from the Bottom Up
There is a lot of talk in Washington DC about how to improve access to hearing health care. Academics and special interest representatives that never see patients are not going to figure out how to fix hearing health care. Hearing loss is a community challenge. Therefore, people must address it right here in our communities. We need discussion groups. In addition, agencies that work with seniors must gather professionals, volunteers, and clients to talk with one another about how to improve hearing health. Our communities must get educated and motivated to support real community solutions to socially address hearing loss and hearing conservation. We must understand that hearing is a social experience and effectively treating hearing loss must involve cooperation of the whole community.
Shine the spotlight on hearing loss and hearing health care! Require health insurance to cover real hearing health care, including high quality hearing aids and aural rehabilitation. Train CHWs to help people cross the bridge successfully to the hearing care clinic. Finally, health insurance must reimburse CHW services related to hearing health care.
Thank you for the opportunity to comment.