More than 75% of the 300,000 older adults living in UK care homes struggle to hear the world around them properly. Hearing loss is one of the most common conditions in later life, yet it remains routinely unidentified, unsupported and overlooked for care home residents. Here, Dr Hannah Cross and Dr Rebecca Millman outline the significant impact of untreated hearing loss on residents and their caregivers, present research insights into this issue, and offer policy recommendations to improve hearing care within care homes.

• Untreated hearing loss has serious consequences for care home residents, including increased social isolation, loneliness and risk of falls, poorer mental health, and worsened dementia symptoms.
• Staff lack training, resources, time and support for the provision of hearing care, even though effective hearing care has the potential to reduce overall health and social care costs, and improves outcomes for residents, their families and staff.
• Implementation of mandatory hearing care training within care homes, better integration between care homes and NHS audiology services, and improved funding to allocate time and resources to embed hearing care into routine practices is needed.

Hearing loss is highly prevalent in care home residents but is often an invisible issue. Untreated hearing loss has a huge effect on residents’ communication, independence and mental wellbeing. Despite this, hearing care is not embedded in policy frameworks, and often not part of daily care routines For policymakers and regulators, this is a critical gap in the delivery of holistic, effective, person-centred care.

The consequences of untreated hearing loss are far-reaching – increased risk of falls, social isolation, depression, anxiety, accelerated cognitive decline, and distressing behavioural symptoms like aggression and confusion. Residents with untreated hearing loss are less independent, less confident and lonelier. These outcomes reduce their quality-of-life and increase the pressure on health and social care systems. Falls alone costs the NHS around £2.3 billion annually, and dementia care costs the UK economy around £42 billion annually.

Hearing care remains fragmented, inconsistent and under-resourced in care homes. Audiology services can be inaccessible to care home residents, particularly because the majority of residents are also living with dementia.

Research insights: voices from care homes

From our research with residents, care staff, and family members, it was shown that effective hearing care can dramatically improve outcomes for residents with dementia and their caregivers. When a resident’s hearing loss is managed properly, either with hearing aids and other amplification devices, reducing sound in the care home, or using evidence-based communication strategies, this improves their quality-of-life and communication, and reduces agitation, distress and psychotropic medication use. Effective hearing care also improves relationships between residents and caregivers and boosts job satisfaction in care staff.

However, fewer than half of residents with dementia who would benefit from hearing care are receiving it. Hearing assessments are rarely conducted in care homes, while hearing aids are under-used and are often unchecked and unmaintained. Care staff feel responsible for providing hearing care, but face wide-ranging barriers. Most staff never receive training on hearing loss, and lack clear guidance for providing hearing care. The skills needed to recognise the signs of hearing loss, manage hearing aids, and support residents to communicate are varied. Care homes also face shortages in hearing-related resources. Time-pressures and complex care needs mean that caregivers have little capacity to focus on hearing needs. High staff turnover – a prominent issue within social care – contributes to patchy hearing care. Staff don’t often stay in their role long enough to understand residents’ unique communication needs.

Finally, the co-ordination between NHS audiology services and care homes is poor. Routine hearing tests, recommended every 1-2 years, are infrequent or non-existent. For residents with dementia who may not understand that they have hearing difficulties, routine testing is essential for picking this up. Home visits by audiologists are rare, despite being the only realistic option for many residents with dementia. Access to audiological services is inequitable for care home residents, even though the vast majority of residents have hearing loss.

Recommendations for change

Mandatory hearing care training should be provided for care staff; for example, through inclusion in the Care Certificate’s ‘Communication’ module. Provision of ‘appropriate’ training is a requirement under the Health and Social Care Act (2008) and assessed by the Care Quality Commission, but it is up to management to decide what qualifies as appropriate. The Department for Health and Social Care (DHSC) should introduce a clear, regulated standard of training based on best practice and evidence. Introduction of hearing care training will empower staff with the knowledge and confidence to support residents with hearing loss.

Audiology services are difficult to access for care home residents with dementia, and integration between care homes and NHS audiology services must be strengthened. Under The Care Act (2014), authorities are required to promote the wellbeing of the person receiving care by insuring integration of social and health care. Currently, residents depend on regular, dementia-appropriate, multidisciplinary care, which they do not receive for their hearing loss. NHS service delivery must improve in care homes, through adequate funding of NHS services to visit care homes on a regular basis and having a known referral network of professionals to determine care protocol.

Care homes themselves also require an increase in funding. The contextual difficulties within the UK’s social care system include predicted increases in national shortages of care home staff due to work-related stress and poor pay, which directly contribute to ineffective hearing care provision. While staff training important, this strategy alone is unhelpful in the long-term if staff do not work, and residents do not live, in an environment in which skills can be put into practice with the necessary time, resources and support.

Effective hearing care would improve the dignity, independence, safety and quality-of-life of over 300,000 UK care home residents. Being able to communicate is a human right, allowing relationships to be made and personhood to be maintained. This must be safeguarded through effective policy and practice.

Credit to additional contributors to the research: Professor Christopher Armitage at The University of Manchester, Professor Piers Dawes at Queensland University, and Professor Iracema Leroi at Trinity College Dublin. 

This research was funded by the Alzheimer’s Society and supported by the NIHR Manchester Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.