INVESTIGATING HEARING CARE IN CARE HOMES FOR OLDER PEOPLE IN SCOTLAND THROUGH THE TRANSFORMATIVE WORLDVIEW

Abstract

Communication is a human right and a critical enabler of other human rights. The 2021 World Report on Hearing states that age-related hearing loss should be recognised as a public health priority, owing to its impact on brain health and communication. Prevalence of deafness in care homes for older people is around 90%, yet is largely undetected and untreated. Recommendations to address these issues include hearing screening and staff training. However, solutions are not presented in the context of any legislative health and social care improvement framework.

The Public Services Reform (Scotland) Act 2010 transformed the care home sector to enhance safeguarding practices for older people. In addition, the Scottish Government’s See Hear Strategy pledges support for older people living with deafness to experience equality of access to health and social care services. This thesis investigated hearing care in care homes for older people through the lens of the Scottish Government’s framework for health and social care, using a two-stage mixed-methods design, underpinned by the Transformative worldview.

Stage 1 explored the landscape of hearing care in care homes using documentary analysis. Sources of evidence centred on the regulatory organisations involved in the care sector. Online focus groups with the Care Inspectorate were also conducted. It was established hearing care training is not mandatory for care home staff and no regulatory framework for hearing care scrutiny exists in which to safeguard the sensory needs of older people in Scotland’s care homes.

Stage 2 formed an instrumental case study of a single care home for older people in which the real-life context of hearing care was explored through documentary analysis, questionnaire, focus groups with staff and hearing assessments with residents. Results revealed there was no policy for identifying residents living with deafness nor any core workforce learning structure related to hearing care. Staff identified knowledge gaps and welcomed more opportunities for training. The prevalence of deafness across 21 residents was between 76-90%.

Integrating the results of Stage 1 and 2 suggests Transformative reform is required at the level of both the care home workforce and the wider organisations involved in service improvement and regulation, to meet the recommendations of the See Hear Strategy and achieve equality for older people. The See Hear Strategy will be refreshed in 2025 and the Scottish Government is preparing major reforms through the launch of a National Care Service by 2026. This thesis is therefore timely, highlighting the need for hearing care to be recognised as a priority in care homes, and embedded in any new framework for social care to further social justice and reinforce the human right to communication.