Your facility is a unique environment where special requirements are needed to maintain comfort and happy, productive lifestyles.

What type of care do/can we provide to patients in facilities?

1. Visual inspection of the ear canals for ear wax/foreign objects.
2. Basic ear wax cleaning.
3. Immitance testing to test integrity of the ear drums.
4. Hearing screening at four frequencies to detect the presence of hearing loss.
5. Summary counseling to patients/family members.

Which residents/patients can receive these services?

1. Residents/patients whose families request the service.
2. Residents/patients who are referred to the Director of Nursing due to a suspected hearing loss.
3. Residents/patients who request the service themselves.

What are the recommended follow up protocols?

1. Pass all aspects of screening—no recommendation.
2. Wax impacted ear canals—removal of ear wax followed by re-screening.
3. Significantly abnormal ear drum function—ENT referral.
4. Fail hearing screening—follow-up audiologic evaluation with Dr. Goldstein’s Western Reserve Audiology, either in patient’s apartment or in the clinic area of the facility.
5. If family needs to be included in decisions regarding follow-up, they are either phoned by, or they receive a letter from, Dr. Goldstein or her staff.

How are these services handled at the facilities we serve?

1. All services in #1 above are provided at no charge, except ear wax removal. The current charge for removal is $34.00, and we are not a Medicare provider, so residents pay directly. (Our experience is that many residents prefer to wait and see their regular doctor, while some are either unable to travel or are anxious to have the wax removed, and do request this service from WRA.) If we determine that we cannot remove all of the necessary ear wax, we stop the procedure and make a medical referral to an ENT.

2. The follow-up audiologic evaluation is provided only to residents/patients who have failed the hearing screening, and who express a clear interest in looking into obtaining a hearing aid.

How well do we think we provide this care?

Dr. Goldstein personally brings experience since 1970 to the business. For the initial 15 years or so, she was a college professor and a clinic director. She was responsible for coordinating and passing peer review accreditation audits in hospitals, clinics and universities. Her standards have not altered upon her entering private practice. As the owner of her own business, she now actually has more control over quality and outcomes.

How should we structure audiologic services to your facility?

1. Services in the initial year may need to be more frequent than they will be once the facility has filled up, and new residents arrive at a slower pace.
2. Quarterly for the first year.
3. Twice a year beginning year two.

Testing everyone in a facility is not usually an effective use of our time; referral is still the best method.

Participation in a staffing of a resident whose hearing loss is one of the facility’s primary concerns with this specific resident is occasionally included.

We are available to make recommendations on how the facility can make sure its common areas are not negatively affecting persons with hearing loss, especially those who wear hearing aids.

What equipment does WRA have available to bring on site to your facility?

Portable diagnostic equipment is available which is capable of performing as many or more procedures than the older clinical non-portable equipment, and can be used in our office as well as at your facility. Current equipment includes:

• Automatic Tympanometer, Acoustic Reflex screener, and pure-tone screening audiometer—used to perform the three tests completed at hearing screenings.

• Dual channel audiometer—used to perform audiologic evaluations.

• Hearing Aid Analyzer—used to analyze hearing aid operation, and to measure the response of hearing aids directly in individuals’ ears (very helpful in confirming the correct prescription in the ears of residents who have difficulty reporting their perceived success or failure with their hearing aid).

• Evacu-Aid—used to dehumidify hearing aids and extract ear wax.

• Lap-top computer w/ printer and Hi-Pro Unit—used with residents to select programmable hearing aids.

An issue often raised is: How can successful hearing testing be accomplished without using a sound proof booth?

1. Sound proof booths are essential when testing the hearing of young children with hearing loss, completing pre-op hearing testing of persons who are being considered for otologic surgery, testing being performed for the purpose of audiologic research, and testing being performed for the purpose of monitoring hearing fluctuation during the use of ototoxic drug therapy.

2. The testing of hearing of older adults who have hearing loss, as evidenced by their inappropriate or failing communication, can be accomplished in a quiet room without a sound proof booth. The hearing loss which they have "functions" as their own personal sound proof booth. Hearing testing for the purpose of selecting and fitting hearing aids needs to be accurate, but does not need to be exact, and fitting the aids to the residents in the actual sound environment where they will be worn and used results in a better pragmatic fitting.

Summary

We have all the equipment required to provide comprehensive services, as well as the training, ability, and experience to be a vital partner in helping your facility to manage the communication needs of your residents.