Advocacy

1. The high cost of hearing aids and related developments in consumer hearing products to which there is already strong response in the United States.
2. The need for changes to the definition used by the Canada Revenue Agency in determining eligibility for the Disability Tax Credit (DTC) under the Income Tax Act
3. Holistic Hearing Health – Client-centered care: care which shifts the sole focus from hearing aids to treating the person and their hearing loss.

High Cost of Hearing Aids

Consumers are at the mercy of manufacturer-owned retailers and such retail outlets put the focus on sales, to the detriment of aural rehabilitation services.

• In Canada, the market for hearing aids is dominated by six, very large, foreign companies: Starkey (U.S.A.), Sonova (Switzerland), Siemens (now called Sivantos, Germany) as well as GN ReSound, Widex, and William Demant Holding (all three, Denmark).
• While the cost of hearing aids varies, they are generally considered to be expensive, often costing thousands of dollars and having a useful life of about 3 to 5 years, which means they need to be replaced regularly.
• It is interesting to note that hearing examinations are not covered under the Public Service Health Care Plan (PSHCP) while eye examinations are covered every two calendar years.
• Under the PSHCP, the purchase and repair of eyeglasses/contact lenses is covered up to $275 every two calendar years, while expenses for the purchase/repairs of hearing aids are covered up to $1,000 every 60 months (five years).
• Given that hearing difficulties can cause a range of problems in relation to communication and safety, for example, as well as psychological ones, it would seem to be important and useful to detect and assess such difficulties.

Recent Developments in the U.S.:

• In the United States, there is currently a strong movement and support from organizations such as the Food and Drug Administration (FDA) that advocates for those living with hearing loss to allow hearing devices (such as personal amplification devices like the RCA Symphonix, the HearPal, Able Planet, and others) that are not labelled as hearing aids to be sold over-the-counter or on the Internet.
• This would have a substantial impact on the audiology profession in terms of monopoly on the sale of hearing devices, as well as on other services such as the provision of audiological exams, and the sale of assistive listening devices
• There is a need to keep abreast of developments in the S. and to plan for any effects that may be felt in the Canadian market as a result of changes in the U.S. In part, this is to avoid a situation where U.S. residents have access to better-priced hearing devices than those that are available to Canadians from hearing aid companies.
• Opening up of the market for hearing devices is expected to bring the cost of hearing devices down, which is what CHHA, other organizations involved with those who live with hearing loss, and people who have a hearing loss have desired for some time.

Background information on hearing aids

• All hearing aids are a benefit to the hard of hearing when properly fitted and adjusted be the hearing aid care provider
• In most cases, the best a hearing aid can do is to get back 60% of the lost hearing
• Hearing aids work well up to a distance of about 1.5 meters only
• Hearing aids are ineffective in public areas as all sound are picked up and amplified resulting in decreased speech intelligibility
• Many hard of hearing citizens will not attend church, go to theatres, attend public presentations and are isolated as hearing in public is very difficult and many times impossible.

Assistive listening devices are required to eliminate back ground noise or what is termed clutter

CHHA Position

• Establish legislative/policy changes that shift care from the sole focus on hearing aids to a focus on a holistic approach to treating the person and their hearing loss.
• To improve affordability of hearing health care by actions across federal, provincial, and private sectors.
• To legislate greater transparency in the pricing of hearing aids and a comparison between technology offered by the various manufacturers. This is beneficial to consumers and clinicians with better –informed clients able to choose the product that meets their lifestyles.

Move toward the stance adopted by the U.S.. Food and Drug Administration (FDA) by enabling legislation so that assistive devices not called hearing aids will become available in Canada as they will in the United States. At a minimum, Canada should actively monitor the legislative and regulatory situation in the U.S. and be ready to act so as not to put Canadians living with a hearing loss at a disadvantage.

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• The Disability Tax Credit (DTC) attempts to address, through the tax system, the added costs of living with an ongoing disability.
• Unlike other tax credits, the DTC must be applied for before the tax return is filed and cannot be claimed until the application has been approved by the CRA.
• The current CRA definition with respect to hearing, which is used in determining eligibility for the DTC is:

“A person is considered markedly restricted in hearing if, even with the use of appropriate devices:

• he or she is unable or takes an inordinate amount of time to hear so as to understand another person familiar with the patient in a quiet setting and
• this is the case all or substantially all the time (at least 90% of the time)

The CHALLENGE: ISSUES WITH CRA CRITERIA:

• The CRA definition lacks clarity with respect to what exactly “in a quiet setting” means, thereby posing problems for health practitioners in completing the Disability Tax Credit Certificate that must be submitted to and approved by CRA in order for the individual living with a hearing loss to obtain the tax credit.
• As well, it is the view of CHHA and other organizations such as the Canadian Academy of Audiology and the Canadian Hearing Society that this definition is not realistic, as it does not take into account the situation of people living with a hearing loss under noisy circumstances such as those found in public places, schools, sporting venues, and many work environments, or the difficulties they may have in communicating due to background noise, overlapping voices, a poor acoustic environment, and speaking with someone who has an unfamiliar voice or speech pattern.
• It is the view of CHHA that modifying the definition used by CRA would reduce confusion and provide appropriate access to the credit for Canadians living with a hearing loss. A change to the CRA definition would avoid/be preferable to making changes to the Canada Health Act, a more difficult and lengthier alternative.

REQUEST to the CRA:

• To consider tabling an amendment to the Income Tax Act that the eligibility criteria for the DTC be revised to include:
  • Redefining quiet setting to normal setting;
  • Changing the requirements to reflect understanding another person vs. a person familiar to them; and
  • Assessing the degree of hearing loss while not wearing an assistive listening device.

CHHA recommends that CRA adopt a definition of “quiet setting” that closely follows the law in Barber[1]: a “quiet setting” refers to a situation in which a person with the same characteristics as the individual would find themselves during the context of conducting their life.

A quiet setting does not mean a setting where there is an extraordinary amount of noise, but nor does it mean merely a sound booth in an audiologist’s office.

Examples should focus on “quiet settings” in the context of the person’s occupation, education, home life, interaction with public services, and extracurricular activities.

CHHA’s Role to Date

CHHA has advocated for changes to the Disability Tax Credit since 2015. It encouraged member participation in Petition E-503

Petition E-503 to change the Disability Act of the Govt of Canada (closed November 30, 2016)

CHHA members across Canada were actively involved in this petition that closed November 30, 2016). The petitioners asked for an amendment to the Income Tax Act to change the requirements for a person with a hearing loss to qualify for the Disability Tax Credit, citing that

The current regulations in regard to access to the Disability Tax Credit for people with hearing loss are overly restrictive and do not accurately reflect the challenges that these Canadians face; and

The requirements for the Disability Tax Credit need to be more inline with the lived reality of persons with hearing loss and provide more equitable access to this tax credit.

For more information read the position details here.

[1] Barber v. The Queen, 2001 CanLII 863 (T.C.C.), [2001] T.C.J. No. 127, Margeson J.T.C.C.