A practical guide to communicating with residents with deafness: people with deafness can do anything those with hearing can--except hear.

The greatest barrier for any person with deafness is the inability to communicate in a deep and meaningful manner with hearing individuals. Without appropriate accommodations, those with deafness are often inadvertently excluded from virtually all communication. This can affect a deaf person's social, educational, and emotional environments. For these reasons, establishing meaningful communication is crucial for a deaf individual who resides in a long-term care facility. To achieve this, it is important that nursing home administrators, nurses, and other care providers have a basic understanding of the cultural and linguistic protocols with which a resident with deafness is likely familiar.

The deaf president of Gallaudet University in Washington, D.C., once said, "Deaf people can do anything hearing people can--except hear." Often the terms "deaf," "hard of hearing," or "hearing impaired" imply some form of defectiveness or disability, something that must be remedied, and/or intellectual abilities that are subpar. Such descriptors are not only misleading but are erroneous. A person with deafness in a long-term care facility is much more like the hearing population than he/she is unlike them. The deaf person can be an active, functioning member of society, can have a caring family (as well as the usual "horns and halos"), and can laugh and cry for the same reasons hearing people do.

Important Considerations

Understanding that the real barrier is communication and linguistic in nature, how might a nursing home professional establish and maintain communication with an individual with deafness? Before getting into specific recommendations, the following statements are worth acknowledging:

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Individuals with deafness communicate differently, depending on the age at which they became deaf, the type of deafness, language skills, speech and lip-reading abilities, intelligence level, personality type, and educational background.

Individuals with deafness have diverse degrees of hearing loss. Some might be able to hear certain sounds (whistles, sirens, loud shouts, etc.), while others might not. The ability to hear certain sounds does not necessarily ensure a resident's ability to decipher speech.

Some individuals with deafness will strongly identify, both culturally and linguistically, with the deaf community. American Sign Language will be the "language of choice," and social involvement will center on deaf-related activities. Individuals with deafness from an oral/aural background may depend on speech and lip-reading skills and may choose to be involved primarily with people who can hear.

The mere presence of a hearing aid or cochlear implant does not guarantee that the person actually understands the spoken word, especially in stressful situations or noisy environments. Although some people with deafness are able to benefit from a hearing aid or cochlear implant, many hearing aids simply serve to amplify sounds and do not make speech any more intelligible.

The nursing home professional's attempt to communicate with a patient with deafness via speech may be frustrating, if not impossible, for both parties, since the deaf person's speech may sound unintelligible to someone who is unfamiliar with it. Although most people with deafness have perfectly normal organs of speech, their lack of hearing makes them unable to monitor the way their voices sound.

Recommendations

Some suggestions for integrating residents with deafness into the community include:

Get the attention of the resident with deafness. Gently tap him/her on the shoulder or arm, knock on a hard surface near the person, or flick the overhead lights. You might loudly call out his/her name in a respectful manner.

Make sure the resident with deafness understands the discussion topic. The deaf individual must be able to pick up key words if he/she is to have a grasp of the issues. This can be accomplished through writing, gesturing, and/or pantomiming key words.

Face the resident with deafness while speaking. Even if the deaf individual depends on using sign language for communication, he/she possibly will be able to lip-read some key words that are spoken. Certainly, he/she will be able to discern meaningful facial expressions.

Remember that most individuals with deafness are poor lip-readers, even though some might have the innate ability to read lips to some degree. Only a small percentage of spoken words are discernible on the lips for even the expert lip-reader.

Speak slowly and clearly, but avoid exaggerated pronunciation of words. Exaggerating the enunciation of words is often more confusing than helpful. Overexaggerating, overemphasizing, and yelling distort one's lip movements and make lip-reading difficult. When addressing the person with deafness, speak in a normal manner, as you would with hearing individuals.

Maintain eye contact. The person with deafness is primarily a visual learner and communicator. Therefore, maintaining eye contact conveys a feeling of direct communication.

Do not place anything in your mouth when speaking. Mustaches that hide the lips, or having a pencil or piece of paper in the mouth while conversing, can make it very difficult for a person with deafness to understand what is being said.

Avoid standing in front of a light source while speaking. Any type of bright light that causes glare and shadows can make it almost impossible for a resident with deafness relying on visual cues to understand what is being said.

Become knowledgeable of support services that are provided in your area for individuals with deafness. In larger communities, there is often a community-based center for the deaf, a local interpreter agency, and/or a deaf club.

If an interpreter is present when you are responding to a resident with deafness, do not address the interpreter. Rather, speak directly to the deaf person. The only role of the interpreter is to serve as a conduit of communication, not as an advocate or proxy.

Do not assume that the resident with deafness understands the message just because he/she nods in acknowledgment or agreement. Quite often, feigned understanding is all that is occurring. (Hearing individuals are guilty of using this same face-saving technique.)

Remember that the resident with deafness does not have the luxury of "over-hearing" complete comments. Comments or discussions that may be deemed as idle or unimportant have the potential, if "heard" out of context, to severely affect the deaf individual's overall understanding of the topic being discussed.

Acknowledge that for many people with deafness, English is a second language, if not a foreign one, and their first language is American Sign Language. For this reason, the deaf resident might have a difficult time interacting with written English. In fact, the average reading level of those who have deafness is between third and fourth grades. This reflects a linguistic deficit caused by not being able to hear spoken English, and in no way should be construed to be an indication of the deaf person's intelligence.

Enroll in community- or university-based courses in American Sign Language. As with anyone who is in the language minority, being able to converse in one's first language is extremely important to establishing meaningful communication.

Remember that the resident with deafness is, more than likely, primarily a visual learner. The more information that is relayed through this channel, the better communication will be.

Meaningful communication can be established between the nursing home professional and the resident with deafness. The nursing home professional can also gain a basic understanding of the different, yet very similar, cultural ties (language, customs, traditions, and identity) that act as a unifying bond for the deaf community. Acknowledging the profound truism that "deaf people can do anything hearing people can--except hear" has the potential to unify long-term care professionals and the deaf community for enhanced quality of long-term care.

Resources

Alexander Graham Bell Association for the Deaf and Hard of Hearing 

3417 Volta PI., NW

Washington, DC 20007

Voice: [phone]

TTY: [phone]

www.agbell.org

National Association of the Deaf 

814 Thayer Ave.

Silver Spring, MD 20910-4500

Voice: [phone]

TTY: [phone]

[e-mail]

www.nad.org

National Center on Deafness

18111 Nordhoff St.

Northridge, CA 91330-8267

Voice/TTY: [phone]

http://ncod.csun.edu

BY J. FREEMAN KING, EDD 

J. Freeman King, EdD, is Director of Deaf Education at Utah State University, Logan, Utah. For further information, phone [phone]. To send your comments to the author and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].