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COVID-19: Medical Communication Access for Deaf and Hard of Hearing

News releases from TDI on Telehealth and from the National Association of the Deaf
Updated 4/20/20
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Source: TDI  https://mailchi.mp/tdiforaccess/covid-19-video-based-telehealth-accessibility?e=4a23a2f52c

Video-Based Telehealth Accessibility

During the coronavirus (COVID-19) pandemic, it may not be safe to go to your doctor’s office -- even for a routine visit. Your doctor may ask you to stay home and discuss your health through video conferencing -- this is called “telehealth.” Even though your appointment is done virtually, your doctor must still provide you with an interpreter or captioning so you can understand your doctor during your appointment. The best way for you to use telehealth is for you to see your doctor, the interpreter, and/or captions on the same screen. However, doctors have varying telehealth systems -- do you know what you can request and what your doctors are still required to provide during the pandemic?

To address this concern, a coalition of deaf and hard of hearing consumer advocacy organizations, deaf healthcare providers, and other experts worked together to provide special guidelines for deaf and hard of hearing

Telehealth Guidelines for Deaf and Hard of Hearing People

Telehealth Guidelines for Healthcare Providers

Both guidelines were developed by:

Association of Late-Deafened Adults (ALDA)*
Association of Medical Professionals with Hearing Loss
Christopher J. Moreland, M.D., MPH, Associate Professor of Medicine, UT Health San Antonio
Gallaudet University Deaf Health Communication and Quality of Life Center
Gallaudet University Technology Access Program/Deaf Hard of Hearing Technology RERC
Gallaudet University, Teresa Blankmeyer Burke, Ph.D., Bioethicist & Philosopher
Hearing Loss Association of America (HLAA)*
National Association of the Deaf (NAD)*
National Association of State Agencies of the Deaf and Hard of Hearing (NASADHH)
Robert C. Nutt, MD, MPH, Physician, Developmental & Behavioral Pediatrics, Atrium Health / Levine Children’s Network, Concord, North Carolina
Samuelson-Glushko Technology Law & Policy Clinic at Colorado Law (counsel to TDI)
Telecommunications for the Deaf and Hard of Hearing, Inc. (TDI)*
(*consumer advocacy groups that advocate for the rights of deaf and hard of hearing people)

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Source:  National Association of the Deaf:  https://www.nad.org/covid19-communication-medical-access-for-deaf-hard-of-hearing/
© 2020 National Association of the Deaf. All Rights Reserved

During the coronavirus (COVID-19) pandemic, how will you be able to talk to doctors, nurses and others at the hospital? This guide is to help you get ready for your hospital visit.

Going to the hospital will be very different during the pandemic.

In normal times, hospitals must give services that help you understand what is being said and are supposed to ask you what services you need. This might include in-person sign language interpreters, Video Remote Interpreting (VRI), lip-reading, written communications, hand-held amplification devices, captioning or CART, or speech-to-text apps.

Now, during the pandemic, most hospitals are seeing a large number of patients and often cannot provide the same services. Many hospitals will not allow in-person interpreters, family members, or visitors to come into the hospital. You may be alone for a long time when you are in the hospital.

Most doctors and nurses in hospitals now wear masks and gloves and may talk to you from behind a window or curtain, so it may be harder for you to understand them.

You have the right to decide your care. This means you will need to know a few things and bring your own communication tools to the hospital during the pandemic:

  • Print out a page saying you are deaf, hard of hearing, or DeafBlind and need hospital staff to communicate with you differently. A sample page is at the end of this document.
  • If you have a smartphone, load the apps you need to communicate, and bring your smartphone with you.
  • Before you go to the hospital, download several VRI apps and/or speech-to-text apps. Some of those apps are free.
  • A list of apps is available at the end of this document.
  • Test the apps at home before you go to the hospital.
  • Keep in mind you may have to use your smartphone using your cellular connection only[1] in case the hospital does not have WiFi.
  • When you get to the hospital, ask hospital staff to let you use their WiFi, and to put you in an area with strong WiFI.
  • Tell hospital staff to communicate with you through your smartphone with VRI or speech-to-text apps. 

If you do not have a smartphone, bring or ask hospital staff for something to write on and pens or markers.
Bring an emergency bag with items you need to communicate. Label the bag and items with your name. Leave space on the label to add your hospital room number. The emergency bag can include:

  • Paper and pens or markers
  • Plugs and chargers for your smartphone
  • Tablets and/or laptops and chargers
  • A cellular hotspot in case the hospital WiFi is not working
  • An extension cord or power strip in case your bed is far from an outlet
  • Extra eyewear supplies you might need, such as reading glasses to read the speech to text on a phone app
  • Extra batteries for your hearing aid, cochlear implant, or assistive listening device
  • A copy of your advance medical directive, if you have one. You can find more information and instructions to make an advance directive on AARP’s website
  • Emergency contact information for family members or friends
  • For DeafBlind people, Braille device and charger and extra gloves for an interpreter to use

If the hospital staff refuses to talk with you or respect your wishes, demand an “ethics consultation.” You can also contact ConsumerGroups@DHHCAN.org for help.

List of Advocacy Groups and Contributors to this Document

This guide was developed by deaf and hard of hearing groups, deaf doctors, and other experts:

(*consumer advocacy groups that advocate for the rights of deaf and hard of hearing people.)

List of Technology Tools[2]
While we do not endorse any specific tool or vendor, we are sharing a short list of known applications in alphabetical order. There are separate lists for people who use sign language, people who speak, listen and lip-read, and people who are DeafBlind. It is important to test and practice using any application before you go to the hospital.

For People who Use Sign Language
For face-to-face communication, you may want to consider supplemental speech-to-text options for understanding hearing people. You also may want to consider options for typing text back as a backup option. Some tools can translate between different languages.

Video Interpreting

Speech to Text

Typing Back

  • Big Note (iOS, Android)
  • Cardzilla (iOS, Android)
  • Google Keep (iOS, Android)
  • Sorenson Buzz Cards (iOS, Android)

For phone calls[3], you may want to consider having more than one video relay service (VRS) provider’s app on your phone, in case your provider of choice experiences technical difficulties. You also may want to consider text-based relay services if you can’t get a reliable internet connection.

Text-based fallback options for phone calls

  • IP Relay (iOS, Android)
  • Mobile TTY or real-time text (RTT) calling 711 (iOS, some Android)
     

For People who Speak, Listen and/or Lip-Read

With face-to-face communication tools, you may want to consider speech-to-text options for understanding hearing people. You also may want to consider options for typing text back, as an emergency back-up option, even if you feel comfortable speaking. Some tools can translate between different languages.

 

Speech to Text

Typing Back

  • Big Note (iOS, Android)
  • Cardzilla (iOS, Android)
  • Google Keep (iOS, Android)
  • Sorenson Buzz Cards (iOS, Android)

For phone calls[4], you may want to consider having more than one captioned telephone provider’s app on your phone, in case your provider of choice experiences technical difficulties.

Text-based fallback options for phone calls

  • IP Relay (iOS, Android)
  • Mobile TTY or real-time text (RTT) calling 711 (iOS, some Android)

For People who are DeafBlind

In addition to the tools above, DeafBlind people may want to load an application that can display text in large type.

DEAF/HARD OF HEARING/DEAFBLIND MEDICAL PLACARD

I AM DEAF/HARD OF HEARING/DEAFBLIND.

I DO NOT UNDERSTAND YOU WITH YOUR MASK ON.

MY NAME IS                                                   .

HERE IS MY IDENTIFICATION CARD / DRIVER’S LICENSE.

PLEASE SPEAK INTO MY SMARTPHONE. I AM USING IT TO UNDERSTAND YOU.

PLEASE RESPECT MY LEGAL RIGHT TO UNDERSTAND YOU AND PARTICIPATE IN MY CARE BY ALLOWING ME TO USE THE SMARTPHONE.

IF MY SMARTPHONE IS NOT WORKING WELL OR AT ALL, PLEASE WRITE DOWN WHAT YOU ARE TELLING ME.

  • Download a .docx of the Placard
  • Download a .PDF of the Placard

Footnotes
[1] Data charges may apply.

[2] Some communications applications work by making audio recordings of what speakers are saying and transmitting them to Internet-based services for translation to text or sign-language. Because the recordings may contain sensitive, private medical information about the patient, patients should bear in mind the potential impacts on their privacy.

[3] The FCC currently prohibits the use of VRS when all parties to a call are in the same room. If parties are not in the same room, VRS is allowed. Patients should comply with all FCC rules.

[4]  The FCC currently prohibits the use of VRS when all parties to a call are in the same room. If parties are not in the same room, VRS is allowed. Patients should comply with all FCC rules.

© 2020 National Association of the Deaf. All Rights Reserved