Seven Steps for Creating an Accessibility Project to Reduce Barriers for People who are Hard of Hearing in the Community

With Janine Verge, AuD, Aud(C) Anne Griffin, M.Sc. Audiology, R.Aud (NL) Dana Song, MSc., Aud(C), Reg. CASLPO Taylor Burt, B.Sc. (Hons) Psychology; M. ClSc Audiology, R.Aud (NL)

We have arrived at an exciting time with the passing of Bill C-81:  The Accessible Canada Act.

The purpose of the Accessible Canada Act is to benefit all persons through the progressive realization of a barrier-free Canada, which includes people who are hard of hearing. It requires the Government of Canada and Federally regulated public and private sectors to identify and remove barriers and to prevent new barriers, that hinder the full and equal participation in society of persons with disabilities. It focuses on barriers in the areas of employment, the built environment, information and communication technologies, the procurement of goods and services, the delivery of programs and services, transportation, and other designated areas.¹

To support improvements in accessibility, we will need as many audiologists, members of the community, and supporters as possible to become leaders, activists, and advocates to promote change and to join those who have already been working hard to improve the lives of Canadians who are hard of hearing across Canada. This article hopes to outline seven steps to help create an accessibility project in your community.

Step One: Define Why Accessibility is Important

When approaching others about an accessibility project idea, you will need to know some facts about why accessibility for people who are hard of hearing is important. Here are a few you can use to strengthen your case:

• When talking about communication:
• Hearing loss can negatively affect interpersonal communication, psychosocial well-being, and quality of life.^2–7
• Hearing loss is an invisible disability so at times may be overlooked compared to other more visible disabilities.
• The aging population is also at risk of downstream conditions from hearing loss such as dementia,⁸ social and emotional isolation, loneliness,⁹ depression,¹⁰ changing family and community engagement,¹¹ and increased risk of falls and other physical disabilities.¹²
• When talking about educational and work environments:
• 39.8 % of respondents with a hearing loss reported it influenced their choice of courses or careers and 20.3% discontinued their formal education because of it.
• Regarding the workplace, 33.2% of employed respondents reported hearing loss limited the amount or kind of work they could perform and 32.3 % made it difficult to advance or change jobs.
• Of the 23.4% not participating in the labour force, 62.5% reported they were completely prevented from working, while 29.0% stated it affected their ability to look for work.
• Of those respondents who were retired, 39.7% reported their retirement had not been voluntary and 51.3% were completely prevented from working as a result of their hearing loss.¹⁶
• When talking generally:
• Hearing loss is the third leading cause of years lived with disability⁸ and the WHO estimates the annual cost of unaddressed hearing loss to be about US$750 billion globally.⁹
• The frequency of hearing loss is high in our society. Audiometry results from 2012 to 2015 Canadian Health Measures Survey (CHMS) indicate that 40% of adults aged 20 to 79 had at least slight hearing loss in one or both ears. Hearing loss was more prevalent in older age groups. Adults aged 60 to 79 were significantly more likely to have hearing loss (78%) compared with younger adults aged 40 to 59 (40%) and 20 to 39 (15%).¹⁵

These outcomes demonstrate that people who are hard of hearing represent a significant percentage of the population and that based on these education and workplace outcomes more work needs to be done to provide access in the community.

Step Two: Communicate that People who are Hard of Hearing have Human Rights

Understanding and complying with accessibility laws is essential for all businesses, non-profits, public sector, municipalities, educational institutions, and community groups such as banks, pharmacies, libraries, airports, recreation centres, hospitals, nursing homes, health care clinics, and universities. It is the foundation of why accessibility projects are important – because they are a part of basic human rights.

In 1948, the United Nations created the Universal Declaration of Human Rights which recognized the inherent dignity and equal and inalienable rights of all members of the human family as the foundation of freedom, justice, and peace in the world.¹⁷ The Canadian Charter of Rights and Freedoms (1982) states it is unconstitutional for any government or law to discriminate based on a physical or mental disability.¹⁷ It states it is a discriminatory practice in the provision of goods, services, facilities or accommodation customarily available to the general public to “deny, or to deny access to, any such good, service, facility or accommodation to any individual.”

Requirements for assistive listening compliance are also prepared under a National Building Code (2015).¹⁹ Provinces that use or have adopted to the standards of the National Building Code are Saskatchewan, Manitoba, Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and Labrador, and all three Territories. The National Building Code requires that assembly rooms, classrooms, auditoria, theatres, and meeting rooms greater than 100 square metres will have an assistive listening system. Signage is also required to identify the availability of assistive devices in both official languages.

It is therefore important for audiologists and members of the hard of hearing community and their supporters understand and promote these laws as a fundamental right to improve accessibility in all areas of society.

Step Three: Define the Issues that Create Barriers in the Community

A big myth some people have is that hearing aids alone are enough to provide accessibility across all listening environments for everyone with hearing loss. This is not true. MarkeTrak IX reported the listening situation with the lowest satisfaction level across all groups surveyed was ‘trying to follow a conversation in the presence of noise’ (50% satisfaction for owners with hearing aids 6+ years old; 67% satisfaction for aids <5 years old). Non-owners were the least satisfied (25% satisfaction) with their ability to hear in this environment, indicating speech in noise was a universal problem. It was noted classrooms and large lecture halls were more problematic than other venues.²⁰

Examples of barriers in the community that can affect the ability to hear, increase cognitive effort, or limit access to information for people who are hard of hearing include:

Background noise: It often “masks” the desired signal (e.g., background noise, music, the sound of other conversations)

• Increased distance between the listener and speaker (e.g., sitting in the back row of a house of worship or conference) reduces the volume of the speaker and degrades the signal (high-frequency sounds of speech do not travel as far as low-frequency sounds of speech)
• Room acoustics (e.g., reverberation, unwanted machine noise) often distorts the quality of sound or masks the wanted signal
• The face of the speaker being obstructed from view due to distance, seating position, talking behind a glass partition which may reduce facial and speech reading cues
• The volume of the speaker lowered due to privacy concerns (e.g., the softer voice may make it harder to hear in a pharmacy, library, or bank when discussing private matters)
• Poor lighting (e.g., dark rooms or having a conversation in front of a bright window) may make getting information from facial cues or speech reading more challenging
• No ASL or LSQ interpreters
• No captioning on videos or real-time captioning (CART)
• Poor communication skills from communication partner (e.g., talking while obscuring face, poor repair strategies, not talking at a reasonable speed)

To ensure people who are hard of hearing have access to community services and to support a healthy aging community, the onus of accessibility needs to shift from being solely on the individual to society itself.

People who are purchasing hearing aids need to be made aware of t-coils and universal receivers that could connect them to accessible community technologies (e.g., counter loops, DM classroom audio distribution system). Another barrier is the limited uptake of hearing aids from people who are hard of hearing. Having assistive listening devices at the community level provided to the public (e.g., loop listeners that connect to an installed hearing loop system, assistive listeners that connect to a DM, FM, or IR systems, personal assistive listening devices in hospital settings to communicate with doctors and nursing staff) would go a long way to reducing some of these barriers.

Step Four: Identify Specific Barriers in your Community and Pick a Project to Improve Accessibility

There is no shortage of ideas when it comes to accessibility projects. Part of the decision on what to choose depends on your interests, resources and barriers in your community that you think need help. Ideas include:

• A hearing loop in a local church, or counter loops for a service counter at a local coffee shop
• Closed captioning of a video being shown in a museum
• Personal assistive listeners for a palliative care unit in a hospital
• Creating a video in ASL and/or LSQ to improve access to information on a website
• A DM system for a public meeting room space in a library or university setting with hand-held microphones
• Re-modeling to improve the acoustics or background noise in a reverberant or noisy space
• Alerting devices for fire safety in a recreation centre, or the use an UBI-Duo for hearing people communicate with someone who does not have access to a sign language interpreter

The possibilities are endless but every time you notice an environment or service that does not address the barriers discussed in tip three, it provides an opportunity as an accessibility project idea. When determining if a project is worthwhile, focus on whether or not the project reduces barriers or sends a message that people who are hard of hearing matter in society and the onus of accessibility is not just on the individual but on society as a whole.

Another resource for project ideas is reviewing the Spotlight on Invisible Disabilities Community Consultations on Accessibility Legislation Project recommendations from the Canadian Hard of Hearing Association on page 68: https://www.chha.ca/wp-content/uploads/2018/04/PAP_CHHA_Spotlight_ReportY1_EN_WEB_Final.pdf

Step Five: Develop Partnerships and Work towards Developing an Accessibility Team for your Project

Partnerships are key when working on an accessibility project. You do not have to know how to execute an entire accessibility project on your own, ask questions and consult others when it comes to decisions! Depending on the project members of the team could include experts such as an audiologist, an AV expert, a loop installer, a member of the government, a website developer, hearing aid or assistive listening device manufacturer or distributor, and/or a member of the Canadian Hard of Hearing Association.

A member of the hard of hearing community should always be included or consulted with. This sentiment is perfectly expressed in the slogan "Nothing About Us Without Us!" which is used to communicate the idea that no policy should be decided by any representative without the full and direct participation of members of the group(s) affected by that policy.

If technologies are being used, working with members of your team who can provide site assessments and quotes ahead of time before applying for grants can be very helpful. Also, some grants ask for proof of community support so making connections from local government officials or non-profit groups who support hard of hearing groups ahead of time might be required.

Step Six: Promote the Business Case for Accessibility, and Become Knowledgeable about Funding Resources

Funding is often a limiting factor for businesses or organizations to purchase accessible technologies that may be part of your accessibility project. Promoting the economic benefits of becoming more accessible could be an important message when meeting with local businesses to discuss getting involved in your project idea. A focus on accessibility is the smart thing to do from a retail model perspective because it meets legal requirements of federal/provincial accessibility laws, improves quality of service, improves retention and loyalty, demonstrates corporate social responsibility, creates an advantage over competitors, and improves the bottom line. The Conference Board of Canada reports²¹:

• The number of Canadians living with a physical disability between the ages of 17–67 that impairs their mobility, vision, or hearing will rise from 2.9 million to 3.6 million over the next 13 years, nearly double the pace of the population as a whole.
• Real spending by this group will rise from 14 to 22% of the total consumer market.
• Improvements to workplace access would allow 550,000 Canadians with disabilities to work more, increasing GDP by $16.8 billion by 2030.

Audiologists who fit hearing aids as part of their business practice would be very smart to enhance their accessibility services, especially if they educate their patients about t-coils and universal receivers. Can you imagine the marketing potential in a private practice audiology business funding a local hearing loop system, counter loop, or DM system in a classroom or meeting room space? Including a plaque with the project with your business name on it shows you support accessibility, the listening needs of your patients, and extends the use of the products you are selling. This kind of marketing also shows the community where to go for help if they want to get hearing aids to help connect with the donated assistive technology.

Several grants provide partial or full funding for accessibility projects. It is important to keep in mind that timing can be critical when applying. Grants can have fast turnaround times so getting organized and doing some up-front work before the grant becomes available can be helpful.

Grants may require information about what barriers are present for people who are hard of hearing and how your accessibility project will reduce those barriers. Use the information provided in the other tips to help fill it out. If you need extra help answering this question, ask your local audiologist.

Please see appendix one for a list of some of the grants that are available in Canada.

Step Seven: Believe that You Can Make a Difference in the World

Mahatma Gandhi once famously said, “Be the change that you wish to see in the world.” Participating in accessibility projects directly impacts society and makes the world a better place by changing attitudinal and cultural barriers, reducing physical barriers, and creating a more inclusive society for people who are hard of hearing. Helen Keller once wrote, “Alone we can do so little; together we can do so much.” Let’s work together to create a more inclusive society!

Appendix One: Examples of Accessibility Grants

Federal

Enabling Accessibility Fund
https://www.canada.ca/en/employment-social-development/programs/enabling-accessibility-fund.html

The Accessible Technology Program
https://www.ic.gc.ca/eic/site/118.nsf/eng/home

Opportunities Fund for Persons with Disabilities
https://www.canada.ca/en/employment-social-development/programs/opportunity-fund-disability.html

Canada: Canadian Tire Jumpstart Accessibility Grant
https://jumpstart.canadiantire.ca/content/microsites/jumpstart/en/community-accessibility-grants.html

Canada: Senior/mobility renovation grants and loans
https://www.canadiancontractor.ca/canadian-contractor/seniors-living-home-renovation-grants-loans-across-country-available/1003279208/

Canada: The Canada Cultural Spaces Fund (CCSF)
https://www.canada.ca/en/canadian-heritage/services/funding/cultural-spaces-fund.html

Canada: Canadian Association for the Advancement of Women and Sport and Physical Activity
https://www.caaws.ca/grants-and-recognition/other-funding/

Provincial

Alberta
Alberta Funding for Seniors Organizations and Communities
https://www.alberta.ca/funding-seniors-organizations.aspx

Alberta Human Rights and Multicultural Grants
https://www.albertahumanrights.ab.ca/grants/Pages/financial_assistance.aspx

British Columbia
Rick Hansen Work Grant Program
https://www.rickhansen.com/Our-Work/Grant-Programs

List of Civic British Columbia Grants
https://www.civicinfo.bc.ca/grants

Manitoba
Manitoba Grant Programs
https://www.gov.mb.ca/chc/grants/

Newfoundland
Newfoundland Children, Seniors, and Social Development
https://www.cssd.gov.nl.ca/grants/

Recreation Newfoundland and Labrador
http://www.recreationnl.com/grant-funding-opportunities/

Nova Scotia
Nova Scotia Age-friendly Communities Grant
https://novascotia.ca/age-friendly-grant/

List of N.S. community and municipal accessibility grants
https://novascotiaconnect.cioc.ca/bresults.asp?PBID=73

Nova Scotia Community ACCESS-Ability Program
https://cch.novascotia.ca/investing-our-future/community-funding-and-awards/community-access-ability-program

Nova Scotia Business ACCESS-Ability Grant Program
https://cch.novascotia.ca/business-access-ability-grant-program

Ontario
The EnAbling Change Program
http://www.grants.gov.on.ca/GrantsPortal/en/OntarioGrants/GrantOpportunities/PRDR006997

The Ontario Trillium Foundation
https://otf.ca/what-we-fund/investment-streams/capital-grants

Prince Edward Island
Inclusive Communities Program – Rural Growth Initiative
https://www.princeedwardisland.ca/en/information/rural-and-regional-development/inclusive-communities-program-rural-growth-initiative

Saskatchewan
Saskatchewan Grants
https://suma.org/grants

References

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2. Mason A and Mason M. Psychologic impact of deafness on the child and adolescent. Prim Care 2007;34:407–26. doi: 10.1016/j.pop.2007.04.003.
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6. Venail F, Vieu A, Artieres F, et al. Educational and employment achievements in prelingually deaf children who receive cochlear implants. Arch Otolaryngol Head Neck Surg 2010;136:366–72. doi: 10.1001/archoto.2010.31.
7. Schroeder L, Petrou S, Kennedy C, et al. The economic costs of congenital bilateral permanent childhood hearing impairment. Pediatrics 2006; 117:1101–12. doi:10.1542/peds.2005-1335.
8. Global Health Metrics. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet;392:1789–858. DOI: https://doi.org/10.1016/S0140-6736(18)32279-7.
9. World Health Organization. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report. Geneva; 2017. Licence: CC BY-NC-SA 3.0 IGO. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/254659/9789241512046-eng.pdf
10. Thomson RS, Auduong P, Miller AT, and Gurgel RK. Hearing loss as a risk factor for dementia: A systematic review. Laryng Investigat Otolaryngol 2017;2(2):69–79. http://doi.org/10.1002/lio2.65.
11. Weinstein B, Sirow LW, and Moser S. Relating hearing aid use to social and emotional loneliness in older adults. Am J Audiol March 2016(5)54–61. doi:10.1044/2015_AJA-15-0055
12. Li C-M, Zhang X, Hoffman HJ, et al. Hearing impairment associated with depression in US Adults, National Health and Nutrition Examination Survey 2005–2010. JAMA Otolaryngol Head Neck Surg 2014;140(4):293–302. Retrieved from http://doi.org/10.1001/jamaoto.2014.42
13. Pichora-Fuller MK, Mick P, and Reed M. Hearing, Cognition, and Healthy aging: social and public health implications of the links between age-related declines in hearing and cognition. Semin Hear 2015;36(3):122–39. Retrieved from http://doi.org/10.1055/s-0035-1555116
14. Lin FR and Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med 2012;172(4):369–71. Retrieved from http://doi.org/10.1001/archinternmed.2011.728
15. American Speech-Language-Hearing Association. 2015. Type, Degree, and Configuration of Hearing Loss. American Speech-Language-Hearing Association, Audiology Information Series. Available at http://www.asha.org/public/hearing/Degree-of-Hearing-Loss/
16. Statistics Canada. The 2006 Participation and Activity Limitation Survey: Disability in Canada. Statistics Canada Catalogue no. 12-89-628-X. Ottawa. Version updated Feb 2009. Ottawa; 2010. Retrieved from https://www150.statcan.gc.ca/n1/pub/89-628-x/2009012/fs-fi/fs-fi-eng.htm
17. Amnesty International UK. The Universal Declaration of Human Rights; 1948. Retrieved from: https://www.amnesty.org.uk/files/udhr_simplified.pdf
18. The Canadian Encyclopedia. The Canadian Charter of Rights and Freedom; 2018. Retrieved from: https://www.thecanadianencyclopedia.ca/en/article/canadian-charter-of-rights-and-freedoms
19. NRC Canada. National Building Code of Canada; 2015. Retrieved from: https://nrc.canada.ca/en/certifications-evaluations-standards/codes-canada/codes-canada-publications/national-building-code-canada-2015
20. Abrams HB and Kihm J. An introduction to MarkeTrak IX: A new baseline for the hearing aid market. Hear Rev 2015;22(6):16. Retrieved from http://www.hearingreview.com/2015/05/introduction-marketrak-ix-new-baseline-hearing-aid-market/
21. Gibbard R, Desormeaux M, Persaud P, and Wright R. The Business Case to Build Physically Accessible Environments. Conference Board of Canada; 2018. Retrieved from: https://www.conferenceboard.ca/temp/ab4e1174-7848-454e-aa54-7c3ec2c3c8a4/9434_Accessible-Environs_RPT_Accessible.pdf
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