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Accommodations of Specific Disabilities Accommodations of Specific Disabilities

Working Effectively with Persons Who Are Hard of Hearing, Late-Deafened, or Deaf

Revised Date: 2002
Original Date: 1994
Article Outline:
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Who is Considered Hard of Hearing or Deaf?

Hearing loss ranks with arthritis, high blood pressure, and heart disease as one of the most common health conditions. While it is true that the prevalence of hearing loss increases with age, with one out of three individuals over the age of 65 having difficulty hearing, the majority of people with hearing loss (60%) are working-age adults (i.e., 21 to 65 years of age). Approximately 36 million (17%) American adults report some form of hearing loss.1

There are several systems for classifying people who have difficulty hearing. One method is the audiological classification, which classifies an individual based on his/her degree of hearing loss (i.e., minimal, mild, moderate, moderate to severe, severe, and profound). While this classification system provides an objective account of the severity of a person’s hearing loss, it does not provide information about the day-to-day functioning of the person.

Another system is based on a functional classification. In this classification system, people who have hearing loss fall into three main subgroups: (1) those who are hard of hearing; (2) those who are deaf and became so in adulthood; (3) and those who are born deaf or became deaf early in life. Although these three groups all share impaired or absent hearing, they are very different in many ways and have a variety of different characteristics, needs, desires, and ways of communicating.

A major problem with the functional classification system is that there is frequently an overlap between categories, with many individuals fitting into more than one category. For example, there are individuals who were born profoundly deaf or acquired a profound hearing loss early in childhood but communicate using oral means rather than American Sign Language. In addition, an increasing number of individuals today have cochlear implants. When the implant device is turned off, they may be profoundly deaf; however, when the unit is turned on, they function as hard of hearing.

1 See the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, at www.nidcd.nih.gov/health/statistics/quick.htm for more statistics.

Hearing Loss and Understanding Speech

It is important to realize that understanding speech is the key issue, and that this is different from hearing other sounds. Many persons who can hear certain sounds, such as a door slamming or a car horn, are nevertheless unable to hear and understand speech, which is quieter and involves more complex patterns of sounds. Persons with hearing loss are often aware that someone is speaking, without necessarily being able to understand all of what is being said.

Moreover, the use of hearing aids does not “fix” a hearing loss in the same way that glasses “fix” a vision problem for most people. Hearing aids can often help to some degree, but they do not restore normal hearing in the way that glasses usually restore normal 20/20 vision. This is because hearing loss is not just about loudness, but also about the clarity or understandability of what comes through, even with hearing aids or other devices. The experience of listening with a hearing loss has sometimes been compared to listening to a very fuzzy, “static-y” radio, or to listening to a cell phone conversation in an area of poor reception, where the speech sounds “break up” or fade in and out randomly and unpredictably. Of course, for some people, those who are born deaf or become deaf as adults, the radio has effectively been turned off or turned to a pure static channel.

Hearing Loss and the ADA

Title I of the ADA protects qualified individuals with disabilities from employment discrimination. Under the ADA, an individual with a disability is a person who:

  • Has a physical or mental impairment that substantially limits one or more major life activities;
  • Has a record of such an impairment; or
  • Is regarded as having such an impairment.

“Substantially limits” means that the person is substantially limited in the ability to perform a major life activity compared to an average person in the general population. Major life activities include functions such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. Hearing loss is therefore a physical impairment that may substantially limit the major life activity of hearing, depending on the degree of severity. One determines whether an individual’s hearing loss rises to the level of a disability under the ADA by examining the individual’s specific impairment, without consideration of mitigating measures, such as medication, medical equipment or coping mechanisms.

In order to be protected under the ADA, the applicant or employee with a disability must also be qualified for the position held or desired. The ADA defines a qualified individual with a disability as a person with a disability who satisfies the requisite skill, experience, education, and other job-related requirements of the employment position and who, with or without reasonable accommodation, can perform the essential functions of the job.

The ADA requires employers to provide necessary reasonable accommodations for qualified individuals with a disability. A reasonable accommodation is a modification or adjustment to a job, the work environment, or the way things usually are done that enables a qualified individual with a disability to enjoy an equal employment opportunity.

Reasonable accommodations for individuals with disabilities should be implemented, as necessary, in all phases of employment, including the selection process, training and orientation, performance of job tasks, meetings with co-workers and supervisors, career advancement and planning, business social events, and eventual resignation and retirement. An employer is not required to provide a reasonable accommodation, however, that would impose an undue hardship upon the operation of the business. To make this determination, one examines, among other things: the nature and net cost of the accommodation; the number of employees, type of operations, and financial resources of the facility and the larger business entity of which it may be a part; and the impact of the accommodation on the operation of the facility. Generally, the concept of undue hardship encompasses actions that are unduly costly or disruptive.

An employer is also not required to provide an accommodation that is primarily for personal use (e.g., hearing aid or cochlear implant). Reasonable accommodations refer to modifications or provisions that specifically assist an individual in performing the designated duties of a particular job. If a person does not own a hearing aid or cannot benefit from a hearing aid, then the employer may be required to provide a reasonable accommodation that will enable effective communication within the workplace and allow the employee to perform his or her job.

Working with Persons Who Are Hard of Hearing

The term “hard of hearing” refers to a hearing loss from 25 decibels (abbreviated “dB”), which is a mild loss, to about 90 dB (a severe loss). Persons who are hard of hearing represent roughly 26 million people, or about 93% of all people who have some hearing loss. Although a hearing loss in the hard of hearing range can begin at any age, the majority of such losses begin in adulthood, often between the ages of 30 and 40. The percentage of people with hearing loss increases with age. Many such hearing losses are progressive, meaning that they may begin as a loss in the mild-to-moderate range, and become more severe as the years go by. Occasionally, a person’s hearing ability drops suddenly, but more often the progression is slow and gradual, occurring over a period of years. Frequently, the person with a progressive hearing loss will not be aware initially of his or her own hearing loss until it reaches a level at which communication difficulties become apparent. Often, it is family and friends who first begin to notice that something is not quite “right” based upon the person’s inappropriate responses – or failure to respond – in communication situations. It is partly for this reason that people with hearing loss wait an average of seven years before seeking help.

An individual with a hearing loss in the hard of hearing range usually communicates using a combination of strategies that rely on the person’s remaining degree of hearing ability, perhaps enhanced by a hearing aid or an “assistive listening device” (discussed below), and supplemented by speech-reading (lip-reading) or other visual means as the loss moves toward the severe end of the spectrum.

Hearing ability varies according to the situation:

Something that is hard for most people to understand and appreciate is that, for persons who are hard of hearing, the ability to hear is very dependent upon the specifics of the situation. A person who is hard of hearing may be able to communicate and understand very well in a one-to-one meeting in a quiet, well-lighted but glare-free room, and when rested and calm. The same person may have great difficulty understanding during a group meeting, when several people are talking, where there is background noise (e.g., air-conditioning or ventilation systems that are noisy), when the speaker is standing or sitting at a distance, when the speaker is speaking softly or rapidly, or speaks with a foreign accent, where there is glare or poor lighting, and/or when s/he is fatigued or stressed. Thus, an important factor in working with people who are hard of hearing is to determine how favorable the specific situation is for that individual, and what changes might improve the situation. For example, participants in a group meeting might be asked to speak only one at a time and to be sure the person who is hard of hearing knows who is speaking. Seating might be rearranged so the person who has a hearing loss is nearer to the speaker(s) and does not have to look at speakers who are back-lighted against a window or other source of glare. In addition, written material for discussion should be presented in advance, such as the meeting agenda, course materials, and names of participants. Sometimes, simply having the individual with the hearing loss sitting next to a good (and legible) note taker can help fill in the gaps, if information is missed. Inevitably, the person who is hard of hearing sometimes will miss something and will ask for a clarification. If a simple repetition does not work the first time, it is important to re-phrase the comment rather than to frustrate all involved with multiple verbatim repetitions that still don’t help. If all else fails, a quick written note may save the day. It is particularly disrespectful and often offensive to say, “Oh, it wasn’t important,” or “It doesn’t really matter.” The person who is hard of hearing wants and is entitled to be included in the conversation as much as anyone else. These are simple accommodations that can make a large difference in understanding for the person who is hard of hearing. In fact, many of these accommodations are potentially beneficial to all employees, not just those who are hard of hearing.

Speech-reading (lip-reading):

On the one hand, speech-reading (often also called lip-reading) can be a valuable tool to assist a person who is hard of hearing or deaf to understand more of what is being said. On the other hand, there is a lot of “mythology” about this subject, which often implies that speech-reading can be an avenue to full understanding of a conversation, and that all persons with hearing loss are somehow automatically able to speech-read. Speech-reading is a skill that can be learned, but like all skills, there is great variability from person to person in how well they can learn or use that skill. One fundamental fact is that many speech sounds are made in the mouth or throat and are not at all visible externally (for example, “uh” or “k”). Another fundamental fact is that different sounds that are visible look the same on the lips (for example, “b” versus “p”). As a result, even a perfect speech-reader can actually “see” only about half of what is said. A person with excellent speech-reading skills can sometimes “fill in some of the blanks” by knowing the context of the situation or conversation, or because of general knowledge of the world (for example, in “the dog was ****ing loudly,” chances are the missing word is “bark”). In general, while speech-reading can be a useful in some conversations, it cannot be relied on to carry the full weight of a conversation, either for the person with hearing loss or for that person’s conversational partner(s).

Assistive listening devices:

Certain accommodations involve various kinds of “assistive listening devices.” A common example is an amplified telephone handset for a worker who is hard of hearing, but still able to use the telephone. Another example is a hearing-aid-compatible phone. Many hearing aids have what is known as a “telecoil” or “t-switch” that improves the ability to hear on the telephone – but only if the phone is designed to be compatible with hearing aids. Federal regulations have made almost all wire-line phones hearing aid compatible, but the situation is less consistent with cordless and cellular phones.

Individuals whose hearing loss is more severe, and who have difficulty using the telephone even with a “t-switch” or an amplified handset, may elect to use a text telephone (frequently referred to as a TTY or TDD). Such devices include a keyboard, like a computer or typewriter, and allow communication over the telephone lines with anyone else who also has a text telephone. To allow communication between persons who use a text telephone and those who do not have such a device, every state has a telephone relay system. Such systems provide an intermediate operator who transfers printed text to speech and vice versa in order to make a telephone conversation possible. TTY calls can also be made using internet-based relay services. When using a PC or wireless device, calls can be made over the Internet using the relay service without the use of a TTY device. Relay service is a free service through which individuals who are deaf and hard of hearing can communicate with individuals who are hearing who don’t have TTYs.

Some individuals with hearing loss who prefer to use their own voice when talking on the phone may feel more comfortable using a “voice carry over” (VCO) phone. This type of phone device receives TTY messages directly from the caller or via the relay service, but the individual with the hearing loss responds to the caller using his or her own voice rather than typing.

Another phone option for individuals who have hearing loss and prefer to use their own voice rather than communicate via a text is a “captioned phone.” This phone works like a standard phone but it displays live captions of the conversation. When a call is initiated or received, the phone automatically connects to a captioning service where a trained operator transcribes what is being said using voice recognition technology. The individual who is deaf or hard of hearing responds using speech. The person on the other end of the line does not need any special equipment or need to use the relay service to initiate a call. This service is also available over the Internet.

For individuals who are deaf who prefer to communicate on the telephone using sign language rather than text, a variety of options now exist. Video relay calls are made using the Internet and a videophone connected to either a TV or through a personal computer equipped with a Web camera and video relay software. The individual who is deaf signs to a video interpreter who then communicates using speech with the hearing person via a standard phone line.

Further information about these and similar systems, their availability, and (usually modest) cost can be obtained from the resources listed later in this brochure.

Other assistive listening devices, such as magnetic induction loops, FM systems, and infrared systems are designed to improve the ability to hear in group or audience situations. Some individuals who are hard of hearing may wish to use personal portable amplification devices, perhaps with a directional microphone. These are especially helpful when there is background noise or many speakers, such as in a restaurant or company lunchroom.

Working with Persons Who Became Deaf as Adults (“Late-Deafened”):

The term “deaf” generally refers to a hearing loss greater than 90 dB (profound hearing loss). Persons are generally considered “deaf” if they are unable to hear and understand speech (even with a hearing aid), and so must rely on vision for communication. Persons who become deaf in adulthood are often called “late-deafened” to distinguish them from persons who were born deaf or who became deaf early in life. Deafness beginning in adulthood is a low prevalence condition, believed to affect approximately 1.5 million persons in the US. Because of their dependence on the visual mode for communication, their situation is very different from that of persons who are hard of hearing.

Persons who are late-deafened generally have easy-to-understand speech because they grew up as hearing persons and learned spoken language as children. They are also generally comfortable communicating via print, whether by writing notes, on a computer, or by captioning (more on this below). Some late-deafened persons also use a form of sign language that is closely based on English.

Although some late-deafened persons continue to use hearing aids to assist with environmental sounds or awareness that someone is speaking, by definition they are not generally able to hear and understand speech even with such assistance. Most late-deafened persons will therefore use a text telephone or TTY or VCO phone, will depend on speech-reading or lip-reading (though this is generally a very limited and unsatisfactory means of communication on its own), and will need some form of print or visual communication to interact with others. Because of their reliance on vision for communication, the points made above about proper lighting, avoidance of glare, and good sight lines become even more critical. For group or audience situations, there is an important service known as CART (Computer Assisted Real-Time Transcription). A CART-trained court reporter uses a stenotype machine (like that used to record proceedings in the law courts) connected to a laptop computer and a projector. As each speaker speaks, the CART operator keyboards what is being said, the computer translates the keystrokes into printed words, and the projector projects the resulting text onto either a screen or laptop monitor that can be seen by the late-deafened person. With a skilled operator, this system provides essentially real-time access to a spoken conversation for the person who is late-deafened. Remote CART or “online captioning” is also now available. The individual with a hearing loss connects a computer to the Internet, and then connects to the CART captionist who, using a stenograph machine, is located off site, listens to the meeting through a telephone or computer-connected microphone, and instantly sends the live text to the employee’s computer through the Internet.

Working with Persons Who Became Deaf Early in Life:

If a person is born deaf, or becomes deaf very early in life before learning to speak fluently (before about age three), the impact of the deafness on language and speech is much more profound than if the loss occurs later in life. Children learn to speak a native language by hearing others speak it, and by hearing their own voice as they learn to produce the words and phrases of that language during the first years of life. If deafness intervenes at this early stage, the individual never learns what the language sounds like, as spoken by others or by themselves. As a result, despite average or above average intelligence, the individual may never fully master the language the way a native speaker does, either in spoken communication or in reading and writing the language. This set of facts determines the communication needs and preferences of persons with early onset deafness. Written notes and company memos are often expressed in a level of English that is easy and natural for native English speakers, but that can be very difficult for persons who are born deaf (and for other non-native speakers of the language).

In the United States, persons who are born deaf or lose their hearing at an early age generally prefer to communicate using American Sign Language (ASL). Those persons who use ASL and become members of the community of persons who are deaf are now commonly referred to as “Deaf” (with a capital “D”). There are also some individuals who have been born deaf, but who do not know sign language, and who communicate using oral means (speaking and speech-reading). When communicating at work with an individual who is Deaf and relies on ASL to communicate, it is often appropriate to employ the assistance of a professional sign language interpreter. Other appropriate measures include providing note-takers (one cannot use vision to watch a speaker or sign language interpreter and simultaneously use vision to write notes), providing basic sign language classes for hearing co-workers and supervisors, and ensuring that written company documents are understood by the Deaf person whose command of English may not be equivalent to that of a native speaker.

On-the-job needs for anyone who is hard of hearing, late deafened, or Deaf:

On the job, the key issue is to determine the communication needs and preferences of the person who is hard of hearing, late-deafened, or Deaf, and then to provide the necessary communication assistance. As discussed above, communication assistance may involve technological devices and/or communication supportive services such as interpreters or CART operators. Whether communication assistance is provided as a reasonable accommodation required under the ADA or whether an employer voluntarily provides an accommodation in order to help an employee with a minimal degree of hearing loss perform at his/ her full potential, the employer is engaging in good business practices. Human resources policies that maximize every person’s potential and keep valued employees in the workforce contribute to a company’s success.

What Type of Jobs Are Held By Persons Who Are Hard of Hearing, Late-Deafened, or Deaf?

Persons who are hard of hearing, late-deafened, or Deaf can perform the majority of jobs available. However, factors that create communication barriers can limit their participation or success in the workplace. These factors include physical and environmental barriers such as noise, light and glare levels within a room, and distance from the speaker. Attitudinal barriers can also limit the job participation or success of persons who are hard of hearing, late-deafened, or Deaf. Such barriers include stereotyping, ignorance, and a focus on disabilities (limitations) rather than abilities (strengths).

With few exceptions, persons who are hard of hearing, late-deafened, or Deaf, when given appropriate training and accommodations, have the same range of job options as any other person. There are indeed no jobs that are just for persons who are hard of hearing, late-deafened, or Deaf. They are employed in as diverse a range of jobs as are people who hear. In recent years, several have been successful in high profile jobs that require excellent communication skills, including screen actors (Marlee Matlin) and President of the United States (Ronald Reagan and Bill Clinton).

Given their capabilities and the provision of appropriate communication accommodations, persons with hearing losses can be productive employees in most any job. Persons who are hard of hearing, late-deafened, or Deaf have been successful as architects, artists, computer programmers, managers, entrepreneurs, physicians, psychologists, lawyers, teachers, telecommunications technicians, and judges, as well as many other positions.

Success on the job depends largely on the skills and attitudes of the worker, as well as on the willingness and ability of the employer to identify and resolve communication barriers encountered in the workplace. Appropriate accommodations can be implemented in all phases of employment, from participation in the selection process to training and advancement. Once an employer learns that an applicant or an employee is hard of hearing, late-deafened, or Deaf and in need of an accommodation, the employer needs to be aware of its potential obligations under the Americans with Disabilities Act, as well as the benefits of keeping all of its employees performing productively.

Accommodating the Person Who is Hard of Hearing, Late-Deafened, or Deaf During the Employee Selection Process

During the selection process, employers must determine if the hard of hearing, late-deafened, or Deaf person is capable of performing the essential functions of the job. It is critical to obtain an accurate picture of the applicant and his/her background, skills, and abilities to do the job. Typically, this process involves two steps: screening written job applications and interviewing prospective applicants.

Some applicants who are Deaf may have difficulty in reading and comprehending written applications, especially those that are heavily loaded with complicated English phrases or unfamiliar terms (note that this is not likely to be a problem with persons who are hard of hearing or late-deafened). Appropriate accommodations in this case may include such strategies as allowing the person to take an application and obtain their own assistance in filling it out, allowing more time for completion, or providing a sign language interpreter. When an applicant notifies you about their hearing loss, the simplest strategy is to ask the applicant what appropriate accommodations are needed.

Accommodations may also be required during selection interviews. At a minimum, interviewers should be sensitive to the range of communication abilities of persons who are hard of hearing, late-deafened, or Deaf. Simple accommodations may include conducting the interview in a quiet, well-lit environment with minimal visual or auditory distractions. The interviewer must be willing to use the interviewee’s assistive listening device (such as a portable microphone), if one is used. Talk at a normal pace and at a normal volume. If asked, be willing to converse at a different pace or volume, or to try other strategies like note-writing. If asked to repeat a question or comment, do so. If the interviewee asks for a second repetition, it is usually not helpful to repeat the exact same words or phrases yet again; instead, rephrase the question or comment in other words. Avoid sitting in front of bright lights, windows, or other sources of glare, which make it difficult to see the face and thus to speech-read.

If requested, use an effective professional sign language interpreter or CART operator. When using either of these services, speak directly to the applicant, not to the interpreter or CART operator. The role of the interpreter or CART operator is to facilitate communication, not to explain or to participate in the interview. All information shared in the interview is confidential, and will not be disclosed by the interpreter or CART operator to other parties. Referrals for professional sign language interpreters or CART operators may be obtained from public or private agencies such as the local office of the state Vocational Rehabilitation department, the state commission for persons who are deaf or hard of hearing (if there is one), or by consulting the telephone directory (under “Translators and Interpreters,” “Transcribing Services,” or “Reporters – Court”).

If group interviews are conducted, it is very important that only one person speaks at a time. Be sure the person who is hard of hearing, late-deafened, or Deaf knows who is about to speak before that individual begins speaking. The goal in a job selection interview is to obtain an accurate picture of the person’s skills, experiences, and capabilities to do the job. The interviewer should be alert for communication difficulties and take steps to address any that might arise so that important information about the applicant is not obscured or completely missed.

Enhancing Productivity on the Job

Research has also documented that employers frequently rate persons who are hard of hearing, late-deafened, or Deaf as better or about the same as hearing co-workers in task performance (e.g., quality/quantity of output, attendance, safety, working without supervision). Workers give themselves similar ratings. However, both groups prioritized the following factors as critical to job retention and advancement:

  • Access to periodic training to upgrade skills
  • Access to staff meetings and small group meetings
  • Reassignment of job duties if necessary to accommodate the hearing loss
  • Use of interpreters or CART operators
  • Availability of amplified telephone handsets/headsets and/or text telephones (TTY or TDD) and other assistive listening devices (ALDs)
  • Rearranging rooms to insure good visual communication and to minimize conflicting noise

On-the-Job Accommodations to Enhance Communication

Enhancing the performance of the employee who is hard of hearing, late-deafened, or Deaf does not necessarily have to be expensive or require a great deal of equipment. In many instances, communication accommodations may be useful to all employees, not just those who have a hearing loss. The first step is to identify the communication situations in which the employee with a hearing loss is experiencing difficulty. The responsibility to improve the situation and minimize communication barriers in these situations is equally shared by all persons in the workplace, that is, those who are hearing, hard of hearing, late-deafened, and/or Deaf. The following are examples of accommodations that can facilitate communication in a variety of situations.

Face-to-Face Situations

  • Ensure that t
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