La perte auditive au Canada
La perte auditive est la maladie qui croît le plus rapidement et qui est l’une des affections chroniques les plus répandues chez les Canadiens aujourd’hui.
En 2012-2013, on estimait que 4,6 millions de Canadiens âgés de 20 à 79 ans (19%) avaient une perte auditive qui affectait leur capacité à entendre un discours normal.
Un adolescent sur cinq, âgé de 12 à 19 ans, a un certain degré de perte auditive,
La surdité mesurée a augmenté rapidement après l’âge de 40 ans pour atteindre 65% entre 70 et 79 ans.
Les malentendants ne peuvent souvent pas entendre dans les endroits où l’information est transférée
Pharmacies
Bureaux d’admission
Cliniques
Banques
Les Enjeux national de l’AMEC
L’AMEC National préconise, au nom de ses membres, d’améliorer la sensibilisation et la législation qui ont une incidence sur les problèmes des personnes ayant une déficience auditive.
En 2016, lors de l’atelier Leadership en action, les dirigeants des sections et des sections de l’AMEC ont défini les objectifs suivants pour les initiatives de défense des intérêts de l’Association des malentendants canadiens.
Mandat national de plaidoyer au sein de l’AMEC
L’AMEC est reconnue comme la voix nationale pour la perte auditive
Bâtiments sans barrières
Sensibilisation et éducation du public
Pour atteindre ces objectifs, de nombreuses initiatives de plaidoyer sont en cours.
CHHA Position Statements
- The high cost of hearing aids and related developments in consumer hearing products to which there is already strong response in the United States.
- 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
- 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
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.
Disability Tax Credit
- 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.
Holistic Hearing Health Care
Holistic Hearing Health Care
CLIENT-CENTRED CARE
Care which shifts the sole focus from hearing aids to treating the person and their hearing loss.
In the United States, the National Academies of Sciences, Engineering and Medicine reported findings of the Committee on Accessible and Affordable Hearing Health Care for Adults in a report entitled ‘Hearing Health Care for Adults: Priorities for Improving Access and Affordability’, released June 2016. CHHA supports these findings. Its recommendations to the Food and Drug Administration could be paralleled in Canada to the appropriate authority.
Report Summary
- Hearing is vital to communication, health, function, and quality of life. Individuals need to be alert to their hearing health, as hearing loss can range from mild to profound and tends to increase with age, onset can be gradual, and each individual’s hearing needs are unique.
- Hearing health care involves a wide range of services and technologies with ever-expanding and evolving options; however, many people do not have access to these options or cannot afford them.
- Hearing loss is a public health and societal concern; engagement and action are needed across the spectrum of relevant stakeholders, including individuals and families, professionals, non profit organizations, industries, government, and the health care community.
Report Recommendations
Given the vital nature of hearing to communication and overall quality of life, as stated in their report, the committee made the following 12 recommendations, which the FDA, other governmental bodies and professional organization can take into consideration:
The recommendations from this American report (not prioritized) provide a foundation for suggested changes to the model of hearing health care in Canada. CHHA can be instrumental in assisting government to implement these changes.
- Improve population-based information on hearing loss and hearing health care
- Develop and promote measures to assess and improve quality of hearing health care services
- Remove FDA’s regulation for medical evaluation or waiver of that evaluation prior to hearing aid purchase
- Empower consumers and patients in their use of hearing health care
- Improve access to hearing health care for underserved and vulnerable populations
- Promote hearing health care in wellness and medical visits for those with concerns about their hearing
- Implement a new FDA device category for over-the-counter wearable hearing devices
- Improve the compatibility and interoperability of hearing technologies with communications systems and the transparency of hearing aid programming
- Improve affordability of hearing health care by actions across federal, state, and private sectors
- Evaluate and implement innovative models of hearing health care to improve access, quality, and affordability
- Improve publicly available information on hearing health
- Promote individual, employer, private sector, and community-based actions to support and manage hearing health and effective communication
The complete 379-page report can be accessed here.
Barrier-Free Cities Projects
Barrier-Free Cities Projects
This is a project initiated by the United Nations Convention on the Rights of Persons with Disabilities to encourage cities and other municipalities to reduce barriers and make for a better living environment. The winter 2016 issue of Listen Magazine featured a report on this project. Committees have been established across Canada to help determine what infrastructure, technological, and signage improvements are needed, both long and short term, in order to provide equal access to all. This is an opportunity for Hard of Hearing ( HOH) branches/chapters to participate on these committees.
Canadian Transportation Agency Accessibility Advisory Committee Meeting
On June 20, 2016, the Canadian Hard of Hearing Association participated in the Canadian Transportation Agency (CTA) Accessibility Advisory Committee Meeting with 27 other organizations. This meeting was called to facilitate discussion on the Regulatory Modernization Initiative, with the goal of holding stakeholder consultation prior to updating the CTA’s accessibility policies for federally regulated travel.
The Regulatory Modernization Initiative is spearheaded by the CTA in a concerted effort to update their regulations with input from several disability organization stakeholders and carrier representatives. Updates to their regulations are needed as customer needs and expectations have changed, and to reflect changes to the transportation industry in general. Presently, federally regulated carriers (i.e.: airline companies, maritime businesses such as ferries, and railway industries), are following voluntary codes of practice – however, these codes are sometimes irregularly implemented, and there is a need for greater oversight and formal regulations to ensure a cohesive standard of practice in this industry.
This meeting is the first step in the updating process, including consultations with several disability related consumer organizations. Between mid to late 2017, CTA aims to have completed drafting new regulations, and hopes to implement in 2018. All redrafted regulations require two sets of approval; first from the board of the CTA, and then from the Office of Disability Issues (ODI) in order to be passed.
During the redrafting of the new regulations, there are three objectives that must be met: 1) that all obligations are clear and consistent with best practices currently in use 2) ensure set obligations for compliance are high enough to meet public policy without undue burden to carriers, and 3) that new regulations facilitate corrections in cases of non-compliance.
Several recommendations were made by the represented organizations in attendance, including a push to embrace a modern definition of disability that reflect Human Rights provisions, to ensure that a broad range of disabilities are included and that regulatory impact is wide. These concrete elements should be included in the updated regulations, such as space and clearance requirements, the use of captioning and sign language as alternative modes of communication provided by carriers, signage and visual element requirements, the provision of specific services or adaptations be made available in given circumstances, oversight of both built environment and customer service elements, and consultation with the Canadian Human Rights Commission in the development and implementation of these new regulations.
Also recommended, was continued input from disability groups throughout the process, a full review of complaints submitted in recent years to seek out trends, and an open review of the regulations prior to submission to the CTA and ODI. CTA has confirmed that they are listening closely to these recommendations and will be transparent throughout the process of consultation, and during the development of these new regulations.
For more information on the Regulatory Modernization Initiative, CTA has launched a dedicated website to help consumers keep abreast of all new developments: https://www.otc-cta.gc.ca/eng/publication/regulatory-modernization-initiative
Age-friendly Cities Projects
Age-friendly Cities Projects
This is a project initiated by the World Health Organization, and many Canadian cities, large and small, have joined the WHO’s Global Network of Age-friendly Cities, where cities work to better meet the needs of older residents, but their projects will benefit people of all ages by promoting social inclusion and barrier free access. This is an opportunity for Hard of Hearing (HOH) members or representatives from their branches/chapters to participate in this process.
See http://www.who.int/ageing/projects/age_friendly_cities_network/en/
Public Consultations on Federal Accessibility Legislation
Public Consultations on Federal Accessibility Legislation
In September 2016, the federal government initiated a series of national federal accessibility consultations across Canada. People living with a variety of disabilities face barriers to being able to fully integrate into society. The federal accessibility legislation is their opportunity to advise government what needs to be done to improve their lives.
CHHA members were encouraged to participate in these consultations. Individual invitations were sent to those in the cities where the consultations were being held and notices were included in the bi-weekly iListen newsletter.
CHHA was also awarded funding to conduct public consultations with its stakeholders to contribute to this new legislation. CHHA partnered with 20 national organizations to expand the reach of these consultations. The focus of this project was on invisible disabilities. See: Spotlight on Invisible Disabilities project report here.
For more information on the federal consultations visit http://www.esdc.gc.ca/en/consultations/disability/legislation/index.page
You may also want to read the article at http://www.accessibilitynewsinternational.com/what-does-an-accessible-canada-mean-to-you/
Public Consultations for a New Health Accord for Canada
Public Consultations for a New Health Accord for Canada
The National Association of Federal Retirees, in partnership with the Canadian Medical Association is undergoing a series of town hall meetings across Canada to discuss seniors’ health care needs with Members of Parliament, media, members of the Canadian Medical Association, and provincial Ministers of Health. You are invited to the town halls to share thoughts and priorities and the National Association of Federal Retirees will collect feedback and present it to federal and provincial health ministers.
Reach out to the local chapter of the National Association of Federal Retirees and ask them to include your views and thoughts. To find a chapter in your area, click on https://www.federalretirees.ca/
Letter by the Prime Minister to the Health Minister: (see http://pm.gc.ca/eng/minister-health-mandate-letter). Please note that in the letter, Prime Minister Trudeau has tasked Minister Philpott with “engaging provinces and territories in the development of a new, multi-year Health Accord with long-term funding agreement
Captioned Telephone Service in the USA
Captioned Telephone Service in the USA
Here are the links that will help you learn more about the CapTel service being offered in the U.S.
Information about the CapTel service and FAQ:
http://www.captel.com/faqs.php
http://www.sprintrelay.com/captel.htm
How CapTel is different from TRS:
CapTel is operated by Sprint’s CapTel vendor, Ultratec, on their unique call center system. All Sprint CapTel calls are directed to this special platform system at this time for scales of economy. Ultratec’s platform uses special voice recognition technology run by specially trained captioners. These captioners hear everything the “hearing” caller says to the CapTel user, then re-voices into the platform system exactly what they heard (instead of typing). This allows the system to recognize the captioner’s voice and word-for-word change everything spoken into text. That text is them transmitted to the CapTel user.
This is MUCH faster than typing. In the US, the minimum required typing speed for TRS is 60 words per minute (WPM). For CapTel, the captioners are trained to meet 125 WPM but often they can go much higher. This speeds up the conversation significantly. The CapTel user speaks for themselves and controls the speed of the conversation. There is never any interaction with the captioner as they are invisible to both parties except for the captions to the CapTel user. Again, this is all done on a unique system that Sprint controls a significant portion of the US marketshare on.