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 a care home it is probably the commonest reversible problem there is, and the least often dealt with.
The good news, which most families do not use
In this country the money is not the obstacle, and that is worth saying clearly because families assume otherwise. NHS hearing aids are provided free of charge, and so are batteries, repairs and replacement tubing. Not subsidised — free, on loan, indefinitely. If her aid has stopped working, that is not an expense to be weighed up. It is a phone call.
The same applies to her eyes. She is entitled to a free NHS sight test, and if she cannot leave the home unaccompanied she is eligible for a domiciliary sight test — the optician comes to her, tests her in her own chair, and can supply glasses there. Optical vouchers help with the cost of the glasses themselves for those who qualify.
Audiology services in many areas will also see care home residents on site, or run a route that visits homes. So the honest question to put to the manager is not whether it can be afforded. It is: who has arranged it, and when?
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 in a care home. 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? Batteries come free from the audiology department or by post — running out is an organisational failure, not a cost.
Earwax. Impacted wax alone can cause significant hearing loss. People who wear aids get more wax, not less. Removal arrangements vary between areas — some GP practices no longer do it and it goes to a community service — which is precisely why it needs someone to chase it rather than to mention it.
The tubing and the mould. A split tube or a blocked mould makes a perfectly good aid useless, and it is a five-minute repair at an audiology clinic or by post.
And her eyes
- The glasses. Lost, broken, or somebody else's. Get them marked with her name, like everything else.
- The prescription. Glasses from 2016 are not correcting anything in 2026 — and the domiciliary test exists precisely so that this does not require a trip.
- Cataract surgery. One of the highest-value procedures in older people — brief, day case, with an immediate effect on independence and on falls. Living in a care home is not a contraindication, and neither is age. 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 assessment is a standard expectation in care homes. If she has fallen and nobody checked her hearing and vision afterwards, that assessment is incomplete, and saying so in writing is difficult to brush aside.
One more thing, if she is living with dementia
Hearing loss and dementia together are much worse than either alone, and the aid is often abandoned at exactly the point it matters most, because she pulls it out. That is a reason to ask for help from audiology — different moulds, different retention, a different type of aid — rather than a reason to stop. Ask before the aid disappears permanently into a drawer.
Six questions to ask this week
- Who changes her hearing aid battery, how often, and where is it recorded?
- When were her ears last checked for wax, and who does removal in this area?
- When did audiology last see her, and do they visit the home?
- Has she had a domiciliary sight test, and when?
- Has cataract surgery been considered, and who ruled it out?
- After her last fall, were her hearing and vision assessed?
If you get nowhere
Put it in writing to the manager: one question, one date. If the barrier is clinical access, the GP practice that covers the home is the route to audiology and to wax removal. If the barrier is that nobody in the home is taking responsibility for a device the NHS has already paid for, that is a quality-of-life issue for the Care Quality Commission, and it is worth raising at the residents and relatives meeting too — there is never only one resident in the building with a hearing aid that has not worked for months.
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 sight are looked after, and whether audiology and opticians visit. Few families ask, and the answer is revealing.
If you would rather not do it alone, we can. For £69 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. Entitlements and local service arrangements differ across England, Scotland, Wales and Northern Ireland and change over time: check the current position with the GP practice and audiology service. Curalune does not allocate beds and does not guarantee availability.
