Better Access to Hospitals for the Deaf, Hard of Hearing and the Deaf-Blind

Better Access to Hospitals for people who are
Deaf, Hard of Hearing and Deaf-Blind:
Pittsburgh takes initiative in improving the services
for the disabled communities

Wednesday, April 29 2009

Richard Meritzer/ ADA Coordinator
Department of City Planning, City of Pittsburgh

Ying Lee/ Intern Fall 2008
Master of Product Development, Carnegie Mellon University

Department of City Planning, City of Pittsburgh April 29, 2009 Presentation designed by Ying Lee. All rights reserved.

The mission of the City of Pittsburgh-Allegheny County Task Force on Disabilities
is to advise the Mayor and County Executive on City and County policies that will
benefit persons with disabilities. This City/County Task Force is concerned with the
issues of independent living for all persons with disabilities. The purpose of the
Task Force is to integrate individuals into community activities and employment
of their choosing, with the goal of eventually eliminating the need for such a Task
Force. The Task Force will also advise the Mayor and County Executive on state and
federal issues that impact upon the dignity of the lives of people with disabilities.

Executive Committee Other Members

Paul O’Hanlon, Chairperson Aurelia Carter Milton Henderson
Katherine D. Seelman , Ph.D., Co-Chair Linda Dickerson Richard McGann
John Tague, Treasurer Janet Evans Jeff Parker
James “Chris” Noschese, Sarah Goldstein
Executive Board Member At-Large Liz Healy


Mayor Ravenstahl is creating a Pittsburgh with a vibrant
economy and 21st century job growth.

He is:
• implementing his public safety action plan

• working to attract and retain residents and
businesses

• serving as one of the key creators of the
recently announced Pittsburgh Promise, an
innovative student scholarship program

Mayor Luke Ravenstahl

Mayor Ravenstahl reinstituted the ADA Coordinator position
in September 2008 after a previous administration had
eliminated it during budget cuts.

Department of City Planning
City of Pittsburgh
The Department of City Planning sets the
framework for the City’s development
through policy and development
review by the Planning Commission
and through administration of the
zoning ordinance. The department
pursues community development
by facilitating community planning
processes, supporting community-based
and technical assistance organizations
and programs, and administrating the
Community Development Block Grant
(CDBG) funds.

Noor Ismail, AICP
Director


Special Thanks to
Leslie Cooke, intern summer 2007
Michelle Corkum, intern summer 2008
Kim Mathos, Ph.D
Teresa Nellans
James Chris Noschese
Susan Schaeffer, Ph.D
Katherine D. Seelman , Ph.D
Tanya Ulrich


“...Imagine being taken all over the hospital
and having things done to you and you
have no idea why — because you can’t
hear anything. You are reading notes here
and there from different people that say:
scheduled; rescheduled; you can’t eat; you
have to; sorry; don’t know; will see; I’ll ask; try
to find out; wait.

...I was never able to talk to
my wife again. She died the
following day.”

--Clyde, Letters to the Editor, Jan 30 2009

A Sad Story from Ohio.com

Americans with Disabilities Act
III-4.3200 Effective communication.

In order to provide equal access, a public accommodation is required to
make available appropriate auxiliary aids and services where necessary
to ensure effective communication. The type of auxiliary aid or service
necessary to ensure effective communication will vary in accordance
with the length and complexity of the communication involved.

ADA Title III Technical Assistance Manual
Covering Public Accommodations and
Commercial Facilities


Project Time Line
January and February 2007 – Issue brought to the City of Pittsburgh /
Allegheny County Task Force on Disabilities by residents.

June and July 2007 – Problem identified and confirmed through survey
community of members by intern.

August of 2007 – Intern finished the Preliminary Report. The hospitals
received copies of her report.

June and July 2008 – follow-up meetings were held with the hospitals to
discuss the report and provide technical assistance.

September through November 2008 – resurveyed people who are
Deaf, Deaf-blind and Hard of Hearing to evaluate what, if anything, had
changed.


Preliminary Report Issue
CPAC Task Force Meeting January 2007

The issue of accommodations in hospitals for patients who are deaf and hard
of hearing was first broached to the City of Pittsburgh / Allegheny County
Task Force on Disabilities. A 10-week research consisted of questionnaires for
hospitals and consumers was then initiated by the Department.


Preliminary Report Survey Methodology
The intern sent out questionnaires to the hospitals in the area asking them
to evaluate elements of accessibility with 13 questions.

Another survey was sent out to members of the community asking about
there hospital visits. The survey had 20 questions and was designed with
input from people who are Deaf and Hard of Hearing.

The results of these two groups of questionnaires were compared and
reported on.


Preliminary Report Findings
Many consumers suggested staff should be more knowledgeable about:
- Deaf culture
- American Sign Language
- assistive listening devices
- other assistive devices for better communication with people who are
hard of hearing, deaf or deaf-blind.

Example of inadequate communication with hospital personnel:
“They write to me- too many words, too little, hard to understand. Had
them call my therapist-she explained why I needed and interpreter and
TTY.”

Approximately 30% of the consumers reported:
“…no effort was made from the medical
personnel in contacting an interpreter to
come to the location.”

For the rest of this presentation we will be discussing two hospital systems
which operate almost all the hospitals in City of Pittsburgh/ Allegheny
County.

Hospital System A is a leading American healthcare provider and institution
for medical research. Systemwide, It is a $7 billion non-profit organization that has 48,000 employees,
20 hospitals, 400 outpatient sites and doctors’ offices, a 1.2-million-member health insurance division,
as well as commercial and international ventures. It consistently ranks in U.S. News & World Report’s
“Honor Roll” of the approximately 15 best hospitals in America. On that annual list, it has appeared eight
consecutive times from 1999 through 2007. As of 2007, it ranks 13th among the best hospitals by U.S.
News & World Report. (From Wikipedia)

Hospital System B is comprised of some of the oldest and best-known names
in health care in western Pennsylvania. From their inception, the system’s hospitals have been in the
vanguard of patient care, medical research and health sciences education. It is comprised of two tertiary
and four community hospitals, offering a comprehensive range of medical and surgical services, the
hospitals serve Pittsburgh and the surrounding five-state area, house nearly 2,000 beds and employ
more than 13,000 people.
Together, its hospitals admit nearly 79,000 patients, log over 200,000 emergency visits and deliver
more than 4,000 newborns each year. Combined, the hospitals are among the leaders in percentages
of total surgeries, cardiac surgeries, neurosurgeries and cardiac catheterization procedures performed
throughout the region. (Hospital System Web Site)


Hospital System A has a director of their Disabilities Resource
Center who acted as a single point of contact and coordinated their
response.

Hospital System B had various hospital and departmental
representatives working with us.


Meetings with Hospitals
Hospital System A
The deaf and hard of hearing consumers
suggested:

• clearer signage throughout the hospital
systems
(consumers who are deaf and hard of
hearing)
• training for staff on the locations of
accommodation equipment

Hospital A agreed to:

• implement strobe alarms and door knockers;
• adapt ADA picture books
http://www.abledata.com/product_images/images/92A0276.jpg
http://www.drillspot.com/pimages/11/1163_300.jpg


Meetings with Hospitals
Hospital System B
The consumers reported:

• Patients waited hours for interpreters.

Hospital B agreed to:

• obtain American’s With Disabilities Act (ADA) picture books
• educate staff on accommodations for hard of hearing and deaf patients.


Reassessment Methods
Online Survey via Survey Monkey Respondents :

22 consumers
19 were deaf
3 were hard of hearing

7 family members or friend
5 were hearing
2 were deaf

12 hospitals

Participants recruited via:
The City of Pittsburgh/ Allegheny County Task Force on Disabilities
ADA Coordinator’s e-mail list, Center For Hearing And Deaf Services,
School For The Deaf, local universities and others


Reassessment Feedback on general visits
How was your most current visit?

communication

accommodation

treatment very poor
poor
neutral
good
very good
in general
0 2 4 6 8 10


Reassessment
Feedback on assistive devices

Most consumers did not request for accommodating
devices or the devices were not applicable to their
situations.
One deaf consumer suggested that the
hospital acquire flashing alarm clock for
deaf patients.

“When the nurse wake me
up, I got scared. I would like
to have a flasher before the
nurse wake me up. A lot of
deaf people (do), too.”
http://uk.gizmodo.com/loud%20alarm%20clock.jpg


“Recently during son’s Emergency
Hospital visit and stay, nurses
did not feel the need to call an
interpreter and flat out refused
telling me and my wife that they
would tell us and we could tell our
son what they said. Very ignorant!”

image source: http://www.mmc.org/images/mmc_services/deaf.jpg

Reassessment Feedback on interpreters
Many consumers requested a certified visiting interpreter but not every
request was served.

Of the 6 family/friends capable of communicating in ASL, 5 of them were
often compelled to be the “family interpreter.”

Department of City Planning, City of Pittsburgh Fall 2008 Presentation designed by Ying Lee. All rights reserved.

Reassessment Feedback on interpreters
Decreased services received might have resulted from:

• Small subject pool
• Increasing use of assistive devices

Preliminary Report 2007 Current Survey Result
Service received without request 29% 7.7%

Service received with request 60% 30%

Request declined --- 23.1%

Not applicable/ Didn’t think --- 30.8%
about requesting one

Department of City Planning, City of Pittsburgh Fall 2008 Presentation designed by Ying Lee. All rights reserved.

Reassessment
Feedback from Hospital System A
Most accommodations are provided upon request, including,

TTY/TDD,
hearing-aid compatible amplified phones,
captioned televisions, and
videos

However,
video phones and
video relay services
are still not provided.

http://www.prattville.com/Sites/Prattville/Images/Main/t2_img_relay.jpg


Reassessment
Feedback from Hospital System A
Hospital System A is still investigating if the strobe frequency would inter-
fere with other equipment, therefore

• strobe door knockers ordered, not installed
• strobe fire alarms are installed in hallways, not in individual rooms

http://www.abledata.com/product_images/images/92A0276.jpg
http://www.drillspot.com/pimages/11/1163_300.jpg


Reassessment
Improvement since 2008

“Some improvement. I see the problem as staff turnover in the
hospitals. When new staff is hired they are not informed of the
law for providing interpreters when requested by my parents/
siblings.” (hearing family member)


Reassessment
Suggestions from consumers

“WORKSHOPS, INSERVICE training, Sensitivity training for the
office managers- most of the office manager are responsible
to cover for the interpreting fees due to their responsibilities
with billing and requesting for any kind of services, etc. and
also doctors and nurses- to learn how to accommodate and
work with the deaf patients. “

American Sign Language (ALS) is different from English. The syntax is different and

some words are different as well. And some English words don’t exist in American Sign

Language. It is like comparing French and Spanish.


Reassessment Recommendations
• Hospitals have what the consumers need, yet these services
are not always effectively provided.

• Often an effective distribution channel is missing

• When designing, distributing and preparing reports
on surveys, always include consumers who are deaf,
deaf-blind and hard of hearing and their respective
organizations in the early and at all stages to avoid
revisions, incorrect identification, and omission of different
methods of communication and equipment accommodations.


Reassessment Other recommendations
Communication cards

The Behavioral Health Task Force for Persons who are Deaf,
Deaf-blind and Hard of Hearing in Pittsburgh is developing a
communications card that people can carry and show. It will
specify the consumer’s preferred method of communication.
We support this card as a way to aid in treatment and
communication and recommend it be used nationally.


Reassessment
Changes for future surveys

Apply different surveying methods
Written English is not effective with consumers who are deaf
or deaf-blind who only communicate in ASL.

Explore different channels of engaging consumers
If available, future online survey should incorporate ASL video
clips or other forms of ASL communication tools.


The Compliance Manual
This Compliance Manual provides information on standardizing
procedures for admitting patients who are deaf, hard of hearing and deaf-
blind. It is our hope that this Compliance Manual will become a standard
for hospitals to use across the nation as a way of providing equal care to
people who are deaf, deaf-blind and hard of hearing.

The Compliance Manual will be available upon request. Please send your
request to:

Department of City Planning
Attn: Richard Meritzer, ADA Coordinator
200 Ross Street – 4th Floor
Pittsburgh, PA 15219


President Obama’s Agenda on disabilities
“... end discrimination and promote equal opportunity by
restoring the Americans with Disabilities Act, increasing
funding for enforcement, supporting the Genetic Information
Nondiscrimination Act, ensuring affordable, accessible health
care for all and improving mental health care.”

--The Agenda. Disabilities http://www.whitehouse.gov/agenda/disabilities/


Thank You
Questions and comments.


Better Access to Hospitals for the Deaf, Hard of Hearing and the Deaf-Blind

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