Joint Standing Committee on the National
Disability Insurance Scheme (NDIS) – Inquiry into the provision of hearing services under the NDIS
Submission by
William Demant Holding A/S
Subsidiary companies in Australia
Page 1
Contents
Executive Summary _________________________________________________________________ 3
Contact Details ___________________________________________________________________ 4
Summary Recommendations _________________________________________________________ 5
Recommendation 1: Criteria ________________________________________________________ 5
Recommendation 2: Alignment ______________________________________________________ 5
Recommendation 3: Knowledge and Resourcing ________________________________________ 6
William Demant Holding _____________________________________________________________ 7
Current Scope of WDH Engagement in the NDIS Program ___________________________________ 9
Criteria __________________________________________________________________________ 10
Issues where hearing loss is the only significant disability _________________________________ 10
Recommendation 1: ______________________________________________________________ 10
Alignment _______________________________________________________________________ 11
Issues __________________________________________________________________________ 11
Recommendation 2: ______________________________________________________________ 11
Knowledge and Resourcing __________________________________________________________ 12
Issues __________________________________________________________________________ 12
Recommendation 3: ______________________________________________________________ 13
The adequacy of funding for hearing services under the NDIS _______________________________ 14
Issues __________________________________________________________________________ 14
The accessibility of hearing services, including in rural and remote areas ______________________ 14
Issues __________________________________________________________________________ 14
REFERENCES _____________________________________________________________________ 15
Appendix 1: Hearing Healthcare Workforce _____________________________________________ 16
Audiologists _____________________________________________________________________ 16
Audiometrists ___________________________________________________________________ 16
Breadth of Clinical Services provided _________________________________________________ 17
Workforce Shortages ______________________________________________________________ 18
Appendix 2: Australia’s Hearing Health _________________________________________________ 19
Economic Impact _________________________________________________________________ 19
Hearing Care is Healthcare _________________________________________________________ 19
Years before taking action __________________________________________________________ 20
Typical patient journey ____________________________________________________________ 21
Page 2| William Demant Holding – Submission to the Parliamentary Inquiry into provision of hearing services under NDIS
Executive Summary
We live in a complex and dynamic world where hearing is one of the key factors to cognitive development, social interaction and an active lifestyle. From the newborn baby to the active senior advanced hearing technology is a necessity for people suffering from hearing loss to develop, stay active and engaged in our community and be productive contributors to our economy.
William Demant Holding (WDH) subsidiary companies in Australia welcome the opportunity to support the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) – Inquiry into the provision of hearing services under the National Disability Insurance Scheme (NDIS).
WDH believes that the current hearing health care system in Australia is effective in its provision of hearing healthcare to many Australians. However it can be improved to ensure that it is able to meet this increasing demand for hearing healthcare caused by our ageing population and the increased environmental and medical impacts on the younger generations’ hearing. The Government must explore opportunities to close the current gaps for Australians who have been identified as low socio economic and vulnerable groups.
The new role of the National Disability Insurance Scheme (NDIS) in the provision of hearing healthcare to those with permanent and enduring hearing health diagnoses ensures that these Australians have access to a dedicated program that relies on a competitive market of quality suppliers of hearing healthcare.
WDH recognises that NDIS’s entry into the hearing healthcare market in Australia was always going to be protracted and present a number of system and operational challenges for stakeholders, the Government and most importantly the participants. These challenges are all the more pronounced as the new operational team are challenged with a lack of knowledge and resources to deliver on requirements. WDH has in-depth experience in interacting with the NDIS team and has outlined these difficulties and identified solutions within this submission.
Many Australians are not eligible for the current government subsidised programs, particularly if they are over 26 or under 65 years old and do not hold private health insurance. It is these Australians who are disadvantaged as hearing health is a precursor to living a full and productive life. There is extensive evidence that supports the consequences of poor hearing health, including its contribution to a range of physical and mental health illnesses. Prevention and early intervention in hearing health care will provide substantial savings for the Australian health system and increase national productivity if the current programs are expanded to include those we now know are at risk.
WDH is unique in the extent of its comprehensive support and involvement in every aspect of the Australian hearing health industry. Several WDH subsidiary companies have been providing hearing health care in Australia for over 70 years.
WDH provides all-inclusive technological, clinical diagnostic and rehabilitation services for all Australians. WDH’s extensive network of services is supported by Australian-based research, development and manufacturing of hearing devices and diagnostic equipment. The company has a strong investment program in education, awareness, research and development to nurture the future of Australia’s hearing healthcare programs.
The Australian Government’s Office of Hearing Service (OHS) Hearing Health programs underpin the success of Australia’s hearing health sector, providing easy to access hearing healthcare for a large group of Australians. It is the backbone of the sustainability of the hearing sector, and has achieved many good clinical outcomes. It is now complemented by the inclusion of hearing healthcare in the NDIS.
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WDH has an important role to play in the future provision of hearing health care in Australia. To this end we have provided 3 recommendations to the Inquiry for consideration. WDH would welcome an opportunity to discuss these recommendations with the Committee in 2017.
As a highly experienced provider of Hearing Services and Devices under the OHS, it is WDH’s aim to support the NDIS through the transition and growth phase. WDH shares the vision that NDIS can evolve into a scheme that connects closely with the strong and effective OHS to form a cohesive lifetime support network delivering outcomes that optimise the potential of all hearing impaired Australians.
Yours Sincerely,
Janet Muir
Managing Director, Retail, ANZ
Contact Details
Janet Muir
Managing Director, Retail, ANZ
Page 4| William Demant Holding – Submission to the Parliamentary Inquiry into provision of hearing services under NDIS
Summary Recommendations
WDH has identified three recommendations for the Committee’s consideration with respect to the provision of hearing services under NDIS and the hearing health and wellbeing of Australians. Throughout this submission WDH has provided background, identified issues and posited potential solutions to the Committee, framed around the Terms of Reference.
Importantly, these recommendations are not intended to suggest that the current system is “broken” or that it is not currently meeting any needs among the hearing impaired population of Australia. Rather, it is a series of recommendations on how these existing services might be improved in order to better provide services to a broader range of people.
Recommendation 1: Criteria
a) Reject the concept of a minimum hearing loss decibel measurement as a single point basis for entry to the scheme for those with hearing loss as their only significant disability. Set a minimum average hearing loss consistent with that used by the OHS (known as Minimum Hearing Loss Threshold or MHLT) as criteria 1 and introduce a second level criteria by developing or adapting an equitable and robust tool to measure hearing disability.
b) Provide a safety net of hearing health care service provision for vulnerable and disadvantaged people or those from low socio-economic backgrounds who do not fall within the disability or hearing loss permanency criteria for NDIS, but where the additional burden of hearing loss may have more impact.
Background: WDH has observed inconsistencies around eligibility (it is unclear whether this is location based) where people with similar degrees of hearing loss and evidence of impact on everyday activities are differentially granted eligibility status. It is important to note that the current NDIS criteria is not aligned with OHS which adopts best practices.
Recommendation 2: Alignment
Enhance the NDIS registration and compliance processes for providers by:
a) Streamlining processes to gain approval as a registered provider for both NDIS and OHS into the one set of requirements.
b) Expediting the National Quality and Safeguards Framework Background: Hearing healthcare businesses who wish to register to provide NDIS supports must currently register in each state, even if they are a national company, and already accredited to provide hearing services under the OHS program
All hearing care providers who are accredited to deliver hearing services as part of the OHS program already have a high level of regulation around the standards of service and continuous improvement they must provide and the business practices they have agreed to.
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Recommendation 3: Knowledge and Resourcing
a) Allocate a resource within NDIS who has expertise in the provision of hearing care and its associated processes and in doing so, develop consistent guidelines around hearing health care issues that are understood and adhered to by planners in all regions. This would allow providers or prospective providers, as well as internal NDIA planners, access to information that is consistent and informed. This resource would also understand the unique relationship of OHS to the NDIS and have knowledge of the hearing healthcare industry.
b) Engage a wider cross section of hearing care providers to contribute to discussions regarding the design of NDIS post 2019 and as the scheme evolves towards its full capacity in 2019-20.
Background: As a currently active NDIS provider, there has been little direct engagement offered to WDH to provide input into design of the future NDIS hearing program.
When contacting NDIS, WDH has been with multiple contact points, repeated processes and conflicting information from different NDIS staff. As a result, this can be time consuming and confusing for the participants and the hearing health care provider.
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William Demant Holding
The company today known as William Demant Holding A/S (WDH) was founded by Hans Demant in 1904 in Denmark. Since 1995, WDH has been a listed company on the Copenhagen Stock Exchange, and is globally connected to a group of companies across more than 30 countries. More than 2,000 clinics and just under 12,000 staff are part of the global group. WDH’s hearing technology is now used in more than 130 countries, including right across Australia.
WDH is one of the world’s leading hearing healthcare companies, and is the only company that covers all areas of hearing health care. From diagnostic instruments and traditional hearing aids to implants and bone-anchored hearing solutions.
WDH has a strong commitment to ongoing funding of hearing research, and the capability to manage the development, delivery and roll out of innovative technology. WDH’s majority shareholder, the Oticon Foundation, supports social and educational programmes, publications, conferences, cultural activities and campaigns for researchers (including NAL), the IDA Institute (an independent, not-for profit organisation located in Denmark and funded by a grant from Oticon Foundation), hearing care professionals and the general public. WDH also owns and manages the world renowned Eriksholm Research Centre.
In Australia over $2.2 million in funding has been donated towards the Macquarie University, Melbourne University and Flinders University Master of Audiology training programs, facilities and research. The Foundation has also sponsored a mobile Ear Health bus that is used to diagnose and treat ear disease in children in under-serviced regional parts of Western NSW.
The WDH group of companies aims to alleviate the negative burden associated with hearing loss by providing both diagnostic and rehabilitation solutions across the hearing spectrum. The WDH brands are continually working towards expanding the role of rehabilitative and diagnostic audiology in order to benefit the wider community.
WDH is comprised of many different brands covering four main areas of Hearing Healthcare: Hearing
Devices, Hearing Implants, Diagnostic Instruments and Personal Communication. All WDH companies
work closely together to create innovative, high-technology solutions which incorporate micro electronics, micro-mechanics, wireless technology, software and audiology, as well as providing support and solutions to customers.
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William Demant in Australia (WDH)
Several WDH subsidiary companies have been providing hearing health care in Australia for over 70 years. WDH is unique in its comprehensive support and involvement in every aspect of the Australian hearing healthcare industry.
WDH provides all-inclusive technological, clinical diagnostic and rehabilitation services for all Australians. WDH’s extensive network of services is supported by Australian-based research, development and manufacturing of hearing devices and diagnostic equipment. The Australian group has ongoing investments in education, awareness, research and development to nurture the future of Australia’s enviable hearing health programs.
The benefits to Australian hearing impaired consumers are many and various; access to the latest innovative and high quality hearing devices and implants, hearing and balance diagnostic equipment, and clinical hearing services through its four brands which are all involved in delivering the Australian Government’s Hearing Services Program.
WDH has a long history of working collaboratively with the Australian Government Hearing Services Program leadership, both directly and indirectly through the peak industry associations The Hearing
Aid Manufacturers and Distributors Association of Australia (HAMADAA) and Hearing Care Industry
Association (HCIA), advocating for improvement in both technology and service delivery provision for Australia’s hearing impaired population.
People First
Client choice and the best outcomes for the client are the bedrock of all of WDH policies and practices in Australia and around the world. Every prescription and recommendation must take into consideration the clinical and lifestyle needs of the client, and offer the right solution or set of options for each individual case. The hearing device is only one part of helping people hear well. Rehabilitation and counselling are core components. Best clinical practice dictates that the device prescription cannot be uncoupled from the ongoing support and rehabilitation provided by a qualified Clinician. For further information on Audiologists and Audiometrists, refer to Appendix 1.
WDH aims to help all Australians who are suffering from hearing loss achieve a better quality of life. This comes through in the strong commitment to raising community awareness through the Hearing Wellness Campaign (i.e. everyone over the age of 50 years should have a hearing check), and supporting the development of policies that support the community needs.
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WDH Retail
Currently, WDH has just over 456 clinics across Australia operating under four retail brand names –
AudioClinic, Hearing Life, Western Hearing Services, and Adelaide Digital Hearing Solutions (188
permanent clinics, 270 visiting clinics). As some communities would not be able to sustain a permanent hearing clinic, WDH has established 270 visiting clinics to provide small, rural and regional populations with hearing healthcare services. Regardless of which WDH clinic a person seeks help from, they can be assured of the highest quality clinical support and being supplied with the hearing devices that are best for that specific individual.
WDH aims to raise community awareness about hearing loss at both clinical and care level – providing information to promote and educate about hearing health’s role in wider health care. WDH believe that every person over the age of 50 should have a hearing check every year.
One of the key emphases of WDH efforts is to normalise the process of hearing tests, making it somewhat akin to a visit to the optometrist, or to the doctor for a general check-up. WDH also involves family members and/or friends in the testing process as frequently as possible, enabling these stakeholders to gain an insight into what the affected person is undergoing, while also allowing the person with hearing loss to see how their hearing impairment may be affecting those around them.
WDH undertakes periodic community outreach programs in order to raise greater awareness of the prevalence and effects of untreated hearing loss, as while major urban centres are reasonably well serviced in Australia, many rural or remote areas are drastically underserviced.
WorkCover
WDH is a key supplier and service provider to the NSW, SA and VIC State Government WorkCover programs for workers with Noise Induced hearing loss. WDH Retail has a dedicated Work Cover hearing business unit that specializes in hearing impairment caused by industrial noise exposure. There is a commitment to helping clients to make the right choice about their hearing.
Current Scope of WDH Engagement in the NDIS Program
William Demant Holding (WDH) and its subsidiary hearing care companies have a long term commitment to providing optimal best practice clinical care and technological support to all Australians with hearing impairment.
To this end our clinicians have been actively supported by WDH to assist adult NDIS participants and potential participants with advice and provision of hearing services since May 2015 in trial areas in the Hunter region in NSW, the ACT and the Perth Hills regions in WA. Since the national rollout began in July 2016, we have permanent sites and visiting sites across most areas of Australia that are currently NDIS active for those aged 26 to 64 years. Our service provision includes plans on how we can deliver best practice hearing supports during the roll out of the full scheme in 2019-20 and into the future.
As a highly experienced provider of Hearing Services and Devices under the OHS, it is our aim to support the NDIS through this transition and growth phase. We share the vision that it can evolve into a scheme that connects closely with the strong and effective OHS programs to form a cohesive lifetime support network delivering outcomes that optimise the potential of all hearing impaired Australians.
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Criteria
This section is addresses the Committee’s Terms of Reference relating to NDIS eligibility criteria.
A fixed pure tone average hearing loss level has been mentioned as a possible single eligibility criteria in the future.
Issues where hearing loss is the only significant disability It is our experience that under the current arrangements for proof of disability, success appears to be primarily dependent on the self-awareness of the applicant and their ability to articulate their experiences, often in the context of entrenched lowered expectations of what they may be able to achieve in life.
We have observed inconsistencies around eligibility (it is unclear whether this is location based) where people with similar degrees of hearing loss and evidence of impact on everyday activities are differentially granted eligibility status. It is important to note that the current NDIS criteria is not aligned with OHS which adopts best practices.
Introduction of a fixed pure tone average hearing loss level as evidence of disability goes against a significant body of evidence demonstrating there is only a weak connection between audiometric thresholds and self-perceived handicap (Lutman et al. 1987). If the Government through the NDIS persists with this approach, they are likely to ensure inconsistent service delivery and further disadvantage those Australians who require help through NDIS.
Other challenges and considerations in setting eligibility criteria include:
Hearing loss and its impact may not be static and can change over time
The impact of hearing loss is highly dependent on the applicant’s hearing and communication needs which are in turn affected by current lifestyle, life aspirations, family and community connections, carer responsibilities, support networks etc.
The interaction with other health issues such as mental health, cognitive function, vision, mobility and dexterity related conditions which may not be seen as a disability in their own right, but intensify the impact of even mild hearing loss.
The effect of untreated mild and moderate hearing loss on psychological health, cognitive function and the resultant health care costs.
Recommendation 1: a.) Reject the concept of a fixed pure tone average hearing loss level measurement as a single point basis for entry to the scheme for those with hearing loss as their only significant disability. b.) Set a minimum average hearing loss consistent with that used by the OHS (known as Minimum Hearing Loss Threshold or MHLT) as criteria 1 and introduce a second level criteria by developing or adapting an equitable and robust tool to measure hearing disability. c.) Provide a safety net of hearing health care service provision for vulnerable and disadvantaged people or those from low socio-economic backgrounds who do not fall within the disability or hearing loss permanency criteria for NDIS, but where the additional burden of hearing loss may have more impact.
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Alignment
This section is addresses the Committee’s Terms of Reference relating to Delays in receiving services.
The information for providers regarding most aspects of the NDIS is generic to all disability types and support needs. For registration there is a current requirement to satisfy and comply with quality and safeguarding requirements relevant to the State or Territory in which the disability services are being provided. All hearing care providers who are accredited to deliver hearing services as part of the OHS program already have a high level of regulation around the standards of service and continuous improvement they must provide and the business practices they have agreed to, yet this accreditation is not recognised by the NDIS or participating State and Territory governments.
Issues
Hearing health care businesses who wish to register to provide NDIS supports must currently register in each state, even if they are a national company, and already accredited to provide hearing services under the OHS program.
For purposes of registration, in the case of WDH, we have 2 parent registrations and up to 3 trading names in each state, this amounts to 13 different State level requirements which have to be met sometimes for each registration group applied for.
Recommendation 2: Enhance the NDIS registration and compliance processes for providers by:
a) Streamlining processes to gain approval as a registered provider for both NDIS and OHS into the one set of requirements
b) Expediting the National Quality and Safeguards Framework. Page 11| William Demant Holding – Submission to the Parliamentary Inquiry into provision of hearing services under NDIS
Knowledge and Resourcing
This section is addresses the Committee’s Terms of Reference relating to Liaison with key stakeholders in the design of NDIS hearing services
WDH welcomes the opportunity to be involved in building a sustainable and high quality hearing health care system for the future. For a detailed overview of Australia’s hearing health care system, refer to Appendix 2.
Issues
When contacting NDIS, WDH has experienced interactions with multiple contact points, repeated processes and conflicting information from different NDIS staff. As a result, this can be time consuming and confusing for the participants and the hearing health care provider.
The WDH internal support team have identified a number of NDIA practices which have created cause for concern including the below items with some examples:
delays in providing information and approving services to participants. For example, the time taken to process Access Request Forms – WDH has had reports from potential participants who have been told by NDIA that their Access Request Form could take 6 to 9 months to process.
lack of availability of appropriate staff to assist with planning and enquiries. For example, access to planners once eligibility has been established. WDH has experienced a range of time taken for participants to progress from the date of their first plan to the date of being supplied with their hearing technology is 1 to 7 months, with most being around 4 to 5 months. WDH clinics regularly experience NDIS applicants coming in to see clinicians often very distressed as they have not heard from a planner yet.
lack of clear, transparent and efficient processes. For example, attempts made by potential participants to apply for eligibility by contacting NDIS not being followed up or recorded by National Disability Insurance Agency (NDIA) staff - one clinician has reported this has occurred for 2 or 3 clients. When the clients called NDIS to check on why their Access Request form had not been sent, they were told there was no record of their earlier contact
incorrect advice from NDIA staff
inconsistent decisions and advice from NDIA staff
lack of cohesion, knowledge sharing and common processes between regional engagement offices
ongoing functionality issues with the portal system
lack of a help desk for portal and claiming related problems
approvals for WDH device recommendations are being referred (including all client details) to “objective audiologists” who currently work at Australian Hearing for opinion and approval
non-complex adults over 26 years of age being referred by planners directly to Australian Hearing and not given choice to access other registered hearing care providers
The delays currently being experienced are a contrast to the time efficiencies under the OHS program where eligible pensioners can access the voucher scheme, once they have medical clearance from a GP, within a few moments online via the OHS portal. The claimable hearing assessment then
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determines if they require rehabilitation, assistive technology, etc. The level of hearing loss is required to meet minimum hearing loss criteria before this can proceed.
As a current active NDIS provider, there has been little direct engagement offered to WDH to provide input into design of the future NDIS hearing program. Our staff attended the advertised transition workshops run in September 2015 in a few States. WDH has actively sought to speak with the Expert Reference Group for Hearing but no one that we reached by phone in NDIA knew of such a body.
Recommendation 3:
a) Allocate a resource within NDIS who has expertise in the provision of hearing care and its associated processes and in doing so, develop consistent guidelines around hearing health care issues that are understood and adhered to by planners in all regions. This would allow providers or prospective providers, as well as internal NDIA planners, access to information that is consistent and informed. This resource would also understand the unique relationship of OHS to the NDIS and have knowledge of the hearing healthcare industry.
b) Engage a wider cross section of hearing care providers to contribute to discussions regarding the design of NDIS post 2019 and as the scheme evolves towards its full capacity in 2019-20.
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The adequacy of funding for hearing services under the NDIS
Compared to the over 65 years age group that OHS currently manages, the funding of adults aged 26 to 64 years is expected to result in higher costs of supports particularly with respect to assistive technology. This is because of their different life stages involving different communication needs such as raising families, engaging in adult education, working, and community involvement. In addition younger hearing impaired people are likely to demand and be able to take advantage of and benefit more from technologically advanced devices and accessories.
Issues
The review of Service Items and Fees that is currently underway aims to provide benchmark pricing for a standard suite of hearing services depending on the age group. It should be noted that the principles of the NDIS emphasise that everyone’s needs and goals are different and this will be reflected in different levels of supports being required to reach these goals even within the same age group. WDH cautions against regulating prices on a one size suits all basis as this will undermine this strong core principle of NDIS.
The accessibility of hearing services, including in rural and remote areas
Australians expect and were promised an NDIS which is accessible and equitable for all participants.
Issues
Hearing impaired participants have been informed that they will receive a call from a planner to construct their first plan over the phone. It should be noted that the very nature of a hearing impairment makes phone conversations one of the more difficult communication tasks for some participants to undertake confidently.
Access to timely and high quality supports for rural and remote participants’ demands tele-health infrastructure need to be available and supported to deliver cost effective hearing services, including both devices and rehabilitation.
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REFERENCES
Lutman M, Brown EJ, Coles RRA 1987. Self-reported disability and handicap in the population in relation to pure-tone threshold, age, sex and type of hearing loss. Br J Audiol. 21 (1), 45-58. Monzani D, Galeazzi GM, Genovese E, Marrara A, Martini A. 2008. Psychological profile and social behaviour of working adults with mild or moderate hearing loss. Acta Otorhinolaryngol Ital. 28 (2), 61-6. Access Economics, 2006. Listen Hear: The economic impact and cost of hearing loss in Australia. Barnett., C., Veran, D. & Huijnen, J. 2016. Hearing Care across the Life Span. Whitepaper,
OticonFonden
Ives, T. 2015. Improved Speech Understanding When it Matters Most. White Paper on Brain
Hearing Technology Research. Kongebakken, Denmark
Keren, R., Helfand, M., Homer, C., McPhillips, H. & Lieu, T. 2002. Projected Cost-Effectiveness of
Statewide Universal Newborn Hearing Screening. Pediatrics. Volume 110, Issue 5
Lamb, Archbold, O’Neill. Spend to save: Investing in hearing technology improves lives and saves society money. The Ear Foundation October 2016. www.earfoundation.org.uk/news/articles/553 Laureyns M, Best L, Bisgaard N and Hougaard S Getting our numbers right on Hearing Loss; Hearing Care and Hearing Aid Use in Europe, Joint AEA, EFHOH, EHIMA report Shanaz, N., Bork, K., Polka, L., Longridge, N., Bell, D. & Westerberg, B. 2009. Energy reflectance and tympanometry in normal and otosclerotic ears. Ear and Hearing, 30 (2), 219-33.
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Appendix 1: Hearing Healthcare Workforce
The hearing healthcare industry is serviced by three main types of clinical professionals – Audiologists, Audiometrists, and Ear Nose and Throat specialists. Though Australia offers an excellent standard of hearing care, the ability to expand the scope of existing hearing healthcare system is hindered by a lack of qualified professionals. The current levels of hearing healthcare delivered in Australia is already under constraint due to these workforce limitations. Low public awareness of hearing health – and hence low rates of student engagement, interest and enrolment – have contributed to this present situation.
Audiologists
Audiologists have broad responsibilities and expertise in all areas of hearing services, including training in anatomy and physiology, hearing aids, cochlear implants, electrophysiology, acoustics, psychophysics, neurology, counselling and sign language.
Only audiologists can manage complex hearing and vestibular (dizziness and balance) issues. These may include a variety of specialist services, such as hearing tests for babies and toddlers, advanced physiological testing and auditory brainstem responses, and more advanced hearing rehabilitation programs, involving implantable devices like cochlear implants, bone anchored hearing systems (BAHS) and middle ear implants.
Qualified audiologists must complete a 3-4 year university degree, with a 2-year master’s postgraduate qualification in audiology. Additionally, they must spend a minimum of 12 months as a supervised graduate clinical intern in the workplace. Currently, Macquarie University, University of Queensland,
Flinders University, University of Western Australia, Melbourne University and La Trobe University
offer the relevant degrees for audiology training.
Audiologists are eligible to be accredited to provide adult rehabilitation through the Australian Government Hearing Services Program (the Program).
Audiometrists
Audiometrists are hearing care professionals who specialise in the assessment and management of communication difficulties caused by hearing loss, including counselling and rehabilitation. They conduct hearing tests to determine if a hearing loss is present, the nature and degree of loss, and its impact, fit hearing devices and provide rehabilitation.
Audiometrists are qualified through a Diploma of Hearing Device Prescription and Evaluation, plus a further 2 years training and supervision with a qualified practitioner. There is also a 2-year Bachelor of Audiometry degree through the University of New England, open to students who are studying or have completed the diploma.
Audiometrists provide crucial care and services, and often work as part of a clinical team with an Audiologist. Though Audiometrist training is available via online study through TAFE and OTEN, there is low awareness among prospective students that this is the case.
Audiometrists are eligible to be accredited to provide adult rehabilitation through the Australian Government Hearing Services Program (the Program).
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Breadth of Clinical Services provided Audiologists and Audiometrists provide a comprehensive range of hearing care clinical services. These include (but are not limited to):
Comprehensive adult hearing assessments and screening tests
Pensioner and veteran government subsidised comprehensive hearing assessments
Lifestyle needs assessments e.g. COSI
Hearing device prescription and fitting
Assistive listening device prescription and fitting
Post device fitting aural rehabilitation and communication training
Pensioner and veteran government subsidies hearing tests
Paediatric assessments
Pre- and post-employment and monitoring assessments
WorkCover hearing assessments
Baseline audiological assessments
Central auditory processing disorders (CAPD) assessments
Speech discrimination testing
Otoacoustic emission testing
Impedance testing
Tympanometry
Diving and pilot audiograms
Track access audiogram
Outcomes assessment
Hearing device repairs and maintenance
Yearly hearing and rehabilitation plan review
Tinnitus Testing, Diagnosis and Treatment:
A comprehensive assessment of hearing health history Ear health examination Tinnitus pitch and loudness test for sound tolerance assessments Tinnitus retraining therapy (TRT) Tinnitus hearing aid prescriptions Tinnitus hearing aid fittings Routine hearing and speech tests
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Workforce Shortages
There is a shortage of clinically trained Audiologists and Audiometrists in Australia, which is limiting the industry’s capacity to support an increasing number of Australians who need hearing healthcare. WDH is working closely with Australian universities and other tertiary institutions to increase the pipeline of graduates to promote Audiology and Audiometry as a specialisation that has strong employment prospects and is a long term clinical healthcare career.
In the meantime, WDH (like many other employers) is recruiting Audiologists and Audiometrists from overseas who have similar training and education. Recruits are currently primarily sourced from the Philippines and Canada, due to the relative ease of transferring qualifications, cultural similarities and fluency in English. Working in Australia is highly attractive for clinicians from both these territories – however, the process is currently slow and is still not meeting the demand for qualified healthcare professionals in this field. Australia needs to increase awareness of hearing health amongst the wider Australian community. In its current state, the industry would struggle to meet the forecast demand.
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Appendix 2: Australia’s Hearing Health
Economic Impact
The continuous growth of Australia’s proportional ageing population will increase the need for hearing services. Other health issues that are often associated with ageing (e.g. prolonged exposure to industrial noise in the workplace) are also likely to lead to increased demand for hearing services.
According to the Access Economics report, hearing loss was estimated to affect 3.55 million Australians in 2005 – an estimated 1 in 6 Australians – including: 10,268 children aged up to 14 years, and 3,534,963 adults (15 years and over). For children, the effects of hearing loss can include delays in language and psychosocial development, impacting on their educational achievements and future employment. This creates additional costs for the individual and government. These adverse effects can be substantially mitigated by timely diagnosis and early intervention.
The prevalence of hearing loss is forecast to increase from 17% in 2005 to 25% by 2050. This forecast of increased prevalence of hearing loss is driven by a combination of factors, including: Australia’s ageing population, increased exposure to extended periods of loud noise via smartphones (specifically, their music capabilities) alongside other health issues.
There are also considerable economic issues caused as a result of hearing loss in Australia; in 2005, the economic costs to Australia caused by hearing loss were estimated by Access Economics to be $23 billion. The largest element of this cost – more than half – was lost wages and productivity among people with hearing loss. This finding shows the importance of a correctly implemented hearing healthcare system, including timely and appropriate services that support people with a hearing loss to remain in the workforce or return to work as soon as possible.
Hearing Care is Healthcare
Hearing loss has a negative impact on overall health and is associated with an increased use of healthcare. A report by Lamb, et al. (2016) on hearing loss as well as the benefits to society of investing in hearing technologies, showed the overall cost of not providing hearing technologies is greater than providing them.
Hearing care has a positive effect on both physical and mental health, as well as employment and social engagement. Conversely, the consequences of not providing hearing care for the hearing impaired have negative effects. Elderly people with hearing loss have a higher risk of mental health issues such as depression and dementia. Studies also show that hearing loss is associated with increased mortality rates. Furthermore, hearing loss also has an effect on communication and interaction, and often leads to isolation and higher unemployment rates (Barnett et. al., 2016).
Implementation of hearing healthcare results in large social and economic benefits for societies. Current estimates indicate that the prevalence of hearing loss at birth is between 2 and 7 per 1000 newborns. Although there are very few economic evaluations of universal newborn hearing screening, the general consensus is that screening programs reduce costs related to lifetime healthcare needs and education, and increase lifetime productivity (Barnett et. al., 2016).
In Australia the real financial cost of hearing loss was AU$11.75 billion or 1.4% of GDP in 2005. This does not take the net cost of loss of wellbeing associated with hearing loss into account, which is a further AU$11.3 billion. Productivity loss is the largest financial cost component with 57% of the real financial costs. Keren et al. (2002) demonstrate that in United States of America there is saving of $2.33 billion due to universal hearing screening during any given year.
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Years before taking action It is typically only once the client reaches the 3rd stage of the journey – ‘preparation’ – that they are ready to speak to a professional. This may take several years. As can be seen below, whilst a majority of people with hearing loss took action to acquire hearing aids within three years of becoming aware that they were experiencing difficulties, for some it can take more than six years.
Chart source: Getting our numbers right on Hearing Loss; Hearing Care and Hearing Aid Use in Europe, Joint AEA, EFHOH, EHIMA report
This chart does not capture those that are ‘unaware’ of hearing loss. Many Australians are unaware of their hearing health, and the impact that poor or damaged hearing has on their lives.
There is also a social stigma associated with the wearing of a hearing device in the community. Unlike spectacles or dental devices, hearing devices are still misunderstood by many in the community. Given the hearing loss prevalence rates, this is unacceptable. In a global context, the percentage of Australians wearing hearing aids is significantly higher than other key markets. This can be attributed to the success of the Australian Government hearing programs through OHS.
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Typical patient journey WDH’s Ida Institute compiled the following chart that characterises a common decision making journey for a patient with hearing loss. When looking at this journey against the chart depicting the average number of years between diagnoses and being fitted with a hearing device, the delay can sometimes exacerbate the level of hearing loss experienced by the patient.
•The hearing impaired person is experiencing communication problems but may be “managing” without acknowledging the problem. They may also feel bewildered or frustrated. Family and Pre- friends may begin to notice the person’s hearing difficulties contemplation •The client realizes that hearing loss is impacting his or her social and work life. They may recognize their hearing loss and begin to map the problems it causes. The client may “self-test” by raising the TV volume or by attempting to control other environmental sounds
Contemplation
•The client actively seeks referral to a hearing care professional. They meet a hearing care professional for an interview and case history, hearing test, and recommendations, leading to decision making.
Preparation
•The person with hearing loss takes action, seeking counselling, treatment, hearing solution fittings and considering other assistive devices. The client develops new communication strategies and may accept or reject of the Maintenance recommendations of the hearing care professional.
•The client undergoes a process of adaptation and change. They observe the social impact and continue to self-evaluate Relapse or the success or failure of the treatment outcome. The problem is resolved or the client becomes aware of new
problems. Permanent Exit
.
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