As highlighted in the NCIOM’s Task Force on Access to Health Services for the Deaf and Hard of Hearing report, individuals who are deaf and hard of hearing often face significant barriers to receiving effective communication accommodations[1] in health care settings.1–3 Effective communication in health care settings between patients and their medical care providers is critical for a satisfactory health care experience. Complex, sensitive, and vital information is often conveyed in medical settings, and effective communication is essential to ensure that all information shared is understood clearly by all parties. But a lack of effective communication remains a significant barrier to health care for individuals with hearing loss. In addition to the already existing barriers faced by the deaf and hard of hearing in health care settings in normal times, the COVID-19 pandemic, which has disrupted all aspects of medical services, poses additional issues for this population.
Barriers to effective communication, which exist across health care settings (inpatient, outpatient, hospitals, long-term care settings, etc.), include providers and medical staff not having the requisite knowledge of what is required of them by federal law and regulations and protocols that assume a “one-size-fits-all” approach to effective communication across most situations. The cost of providing services, and staff not understanding what services may aid in effective communication or how to access those services, also pose challenges. When facing barriers to effective communication, deaf and hard of hearing individuals often experience dissatisfaction with their care, are unable to successfully navigate health care systems, and face negative health outcomes such as higher readmission rates, increased medical costs, and lower treatment adherence.4
Ironically, many of the communication challenges posed to the deaf and hard of hearing in health care settings during the COVID-19 pandemic are the result of safety precautions. To slow the spread and reduce the risk of exposure, many health care facilities have implemented mandated precautions such as the wearing of personal protective equipment including masks; visitation and capacity restrictions, which may limit or eliminate access to in-person sign language interpreters; and increased use of telemedicine, all of which create communication challenges.4
Some individuals who are deaf and hard of hearing rely on lip reading, visual cues, and residual hearing. With the proliferation and common use of face masks during the pandemic, individuals who rely on residual hearing and visual cues to understand others may not be able to do so if the person they are communicating with is wearing a mask. Since a mask covers the mouth and much of the face, it takes away the ability to observe lip movement and facial expressions. 5,6 For individuals who wear hearing aids, mask wearing also poses challenges; both masks and hearings aids are worn around the ears, and when wearing a mask, deaf and hard of hearing individuals who use hearing aids may face increased discomfort and may even lose their hearing aids.6
Restrictions on visitors in health care settings may limit access to in-person sign language interpretation for deaf and hard of hearing individuals who rely on sign language to communicate with hearing people. Even the use of video remote interpreting, in lieu of an in-person interpreter, can pose challenges when the video feed is delayed, choppy, or poorly positioned. Telemedicine visits can provide similar obstacles to clear communications as with video remote interpretation, and a significant amount of health care has moved to telehealth during the pandemic.
As our health care system continues to work to mitigate the effects and spread of COVID-19, keeping safety precautions in place, health care leaders and administrators should be aware of the unique communication challenges faced by the deaf and hard of hearing during the pandemic. Having an understanding of the barriers faced can lead to policy and system changes that not only keep everyone safe, but allow for equitable, clear, and effective communication for all patients.
[1] Communication accommodations for the Deaf and Hard of Hearing include, but are not limited to, assistive listening devices, sign language interpretation, video remote interpreting, and tactile sign language interpretation.
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