Although Canada is considered a wealthy country, the fact is that 9.5 % of Canadians live in poverty according to Statistics Canada.¹ The high cost of hearing aids makes the technology inaccessible to seniors whose maximum annual income, from Old Age Security and Guaranteed Income Supplement, falls under $20,000 per year. Hearing aid cost presents a significant barrier for low-income individuals even when they have access to programs that cover a portion of the cost.

The Dalhousie Hearing Aid Assistance Program (DHAAP) was established in 2011 in partnership with the Nova Scotia Hearing and Speech Centres (NSHSC) and the Society for Deaf and Hard of Hearing Nova Scotians (SDHHNS), under the direction of Dr. Rachel Caissie. DHAAP (pronounced dee-hap) provides donated hearing aids to Nova Scotians, particularly seniors, who are not able to afford their own, and who do not have any other source of funding for hearing aids. The main purpose of the program is to give audiology students hands-on experience fitting hearing aids and providing follow-up care and audiological rehabilitation services, while at the same time offering a service to the community. Through collaborations with NSHSC, with whom our School is affiliated, we were able to expand our program outreach beyond residents of the Halifax Regional Municipality to low-income individuals living throughout the province. In these instances, hearing aids are tested and cleaned at the School with student involvement, matched to patients, and then shipped to a NSHSC audiologist for fitting and follow-up care in the patient's own community.

In 2017, DHAAP was successful in obtaining funding from the Government of Nova Scotia's Department of Community Services to provide hearing aids to Halifax residents who receive Income Assistance. This government funding allowed us to hire Dr. Sarah Mason as the audiologist in charge of Community Services-DHAAP as well as to purchase hearing aids that are prescribed for eligible patients.

Prospective patients are required to fill out an application form and submit either proof of annual income or proof that they are recipients of Income Assistance. For low-income seniors, where government funding is not available, the hearing aids are either donated by hearing aid manufacturers or are used hearing aids that are in very good condition. The Lions Clubs in Nova Scotia help collect used hearing aids. Obviously, not all used hearing aids donated to the program can be re-fitted as some are not working or are simply too old; we even received an old Zenith Ambassador BTE from the 1950s that was still working! The Lions Clubs in Nova Scotia and Lions Clubs International have also been instrumental in raising funds for purchasing equipment and a clinic management software system.

All Dalhousie University audiology students participate in the DHAAP clinic. First year students observe patient care as part of their introduction to clinical services and 2nd and 3rd year students participate in patient care under clinical supervision. The clinic also offers some fieldwork hours for intern and extern students. Speech language pathology students have the opportunity to obtain audiology minor hours through the program as well. A few audiology students also volunteer as program assistants to help with clerical duties such as patient scheduling, correspondence with patients, and database maintenance.

The program provides students with exceptional learning experiences. As a former student states, “DHAAP really allows us to put classroom learning into practice, refine our skills and practice our techniques. These real-world learning situations help me build confidence when it comes to skills like interviewing patients. This will be invaluable to my future career as an audiologist.” Students have a huge opportunity to be exposed to issues associated with hearing aid management, and health care in general, for individuals living with financial burden. The impacts of poverty on adults are numerous: higher risk of mental illness and other disabilities, inability to afford medical prescriptions, housing and food insecurities, etc. The patients, particularly those seen through Community Services-DHAAP, can be very challenging for students. Moreover, a high proportion of recent immigrants and former refugees come through our door. Students learn to work with language interpreters, social workers, and culturally diverse families. This helps students better prepare for fieldwork placements outside the university environment. As a current student states, “Participating in DHAAP was such an amazing learning experience. It helped prepare me for my fieldwork placement because I learned specific skills, like how to troubleshoot hearing aid problems and how to perform administrative duties in the clinic. I think all students in the program would benefit from taking part in DHAAP.”

It is a win-win situation for all. For students, their learning experiences are enriched by working with low-income individuals and challenging populations. For low-income seniors, hearing loss treatment may become more accessible and can produce vast changes in their lives as some examples of patient feedback illustrate: "I cannot overstate my gratitude for my hearing aids. They opened up a whole new world for me" and "Thank you for the hearing aids. It has changed my life completely".

References

1. Canadian Income Survey 2017 (released 2019-02-26), The Daily. Retrieved from: www150.statcan.gc.ca/n1/daily-quotidien/190226/dq190226b-eng.htm