The diagnosis that gets made too fast
They tell you she is going downhill. She does not join in, does not answer when spoken to, stays in her room. Somebody uses the word confused, perhaps the word dementia.
Before accepting that, ask a much simpler question: can she hear? Uncorrected hearing loss looks a great deal like cognitive impairment — the same withdrawal, the same answers that do not fit, the same impression that she no longer follows. The difference is that it can be fixed.
And it is not a comfort matter. Untreated hearing loss is associated with faster cognitive decline, with depression and with isolation. In an eighty-eight-year-old in residential care it is probably the commonest reversible problem there is, and the least often dealt with.
The program most families never use
Australia has something worth knowing about, and it is chronically under-used in residential aged care. The Australian Government funds a hearing services program for eligible people — typically pensioner concession card holders and Department of Veterans' Affairs cardholders — which covers a hearing assessment and fully subsidised hearing devices, with no gap for the standard range.
Three parts of it matter for someone in a care home:
- The device is covered. There is a fully subsidised range that suits most older people. Top-up devices exist and cost extra, but "we cannot afford it" is not the reason she has no aid.
- Maintenance is covered too. For a small annual fee there is a maintenance arrangement that covers batteries, repairs and servicing. This is the part that matters most in a care home, because the problem is almost never the initial purchase — it is what happens in year three.
- Providers visit. Contracted providers see clients in residential aged care. She does not have to be taken anywhere. Somebody just has to make the call.
So the question to the manager is precise: is she registered with a hearing services provider, when did they last visit, and is the maintenance agreement current?
The three dumb causes, in the order to check them
The battery. Start here, because this is where it usually is. An aid in the bedside drawer with a battery that went flat in March is an ordinary scene. Nobody decided to give up on it; nobody was made responsible for it. Ask in exactly these words: who changes the battery, how often, and where is that recorded?
Earwax. Impacted wax alone can cause significant hearing loss, and people who wear aids get more of it, not less. It is missed constantly.
The tubing and the mould. A split tube or a blocked mould makes a perfectly good aid useless — a few minutes' work for the audiologist on their next visit.
And her eyes
- The glasses. Lost, broken, or somebody else's. Get them labelled with her name, like everything else.
- The eye test. Optometry consultations are covered under Medicare, and many optometrists visit residential aged care. Glasses themselves are not covered federally, but most states and territories run a spectacle scheme for concession card holders — worth asking about rather than assuming she must pay privately.
- Cataract surgery. One of the highest-value procedures in older people — brief, day case, immediate effect on independence and on falls. Living in aged care is not a contraindication, and neither is age. Public waiting lists can be long, which is a reason to get on one now rather than to give up. If someone says "at her age it's not worth it", ask the ophthalmologist to say it themselves.
The link to falls that nobody makes
Poor vision and poor hearing both raise the risk of falling — one because she does not see the obstacle, the other because the inner ear is part of balance and because she cannot hear what is behind her. Falls prevention is something providers are accountable for under the quality standards. If she has fallen and nobody checked her hearing and vision afterwards, that review is incomplete, and saying so in writing is hard to brush aside.
If she is living with dementia
Hearing loss and dementia together are much worse than either alone, and the aid is usually abandoned at exactly the point it matters most, because she pulls it out. That is a reason to ask the audiologist for a different solution — different mould, different style, better retention — not a reason to stop. Ask before the aid disappears into the drawer for good.
Six questions to ask this week
- Who changes her hearing aid battery, how often, and where is it recorded?
- Is she registered with a hearing services provider, and is the maintenance agreement current?
- When did the audiologist last visit her here?
- When were her ears last checked for wax?
- When was her last eye test, and does an optometrist visit the home?
- After her last fall, were her hearing and vision assessed?
If you get nowhere
Put it in writing to the facility manager: one question, one date — and get it onto the care plan so it is documented rather than discussed in a corridor. If that does not resolve it, the Aged Care Quality and Safety Commission takes complaints from family members, including anonymously, and a resident whose hearing aid has not worked for months is squarely a quality-of-life and clinical-care issue. Free independent advocacy is available through the national aged care advocacy network.
Where to start
This week, do one thing: open the bedside drawer and see whether the aid is there and whether it works. It is the highest-return action in this article.
If you are still choosing a home, ask before the tour how hearing and vision are looked after and which providers visit. Few families ask, and the answer is revealing.
If you would rather not run it alone, we can. For A$109 we take down your mother's situation, look for the homes in your area that answer these questions properly, and report back what they told us, with names and dates. Start here
This article is for information and does not replace medical advice on your own situation. Eligibility rules, subsidised device ranges and state spectacle schemes change: check the current position with the hearing services provider and her GP. Curalune does not allocate beds and does not guarantee availability.