Failure to Assist Resident in Obtaining Hearing Aids and Coordinate Insurance Barriers
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to assist a resident in obtaining needed hearing devices through available resources. The resident reported being hard of hearing and stated she had been trying to get hearing aids but her insurance would not cover them. Her care plan included a hearing deficit focus with an intervention for staff to validate her messages by repeating them aloud. The MDS assessment documented a BIMS score of 7/15 indicating severely impaired cognition, diagnoses including heart failure, depression, and bilateral hearing loss, and noted she required supervision with several ADLs while being independent with others. Despite this, the MDS documented she had adequate hearing without hearing aids or other appliances, and staff CNAs reported needing to speak to her in an elevated voice because they did not think she could hear well. Appointment notes showed that on one occasion the facility was waiting for the ENT provider to supply a phone number for the insurance company regarding hearing aids, and later was waiting for a response from a mobile hearing service to schedule a hearing test. A CMA reported that the ENT provider had given a list of hearing aid providers contracted with the resident’s insurance and that she made multiple attempts to contact the insurance provider, was told she would receive a call back, and then forgot about the issue when no call was returned. She also stated she did not know of any official process for communicating insurance barrier situations and usually spoke with the DON or MDS coordinator when expecting return calls. The assistant administrator, DON, and MDS coordinator all stated they were unaware of the ongoing hearing aid insurance barrier or process delay until the day of the survey interviews, and the DON later stated staff should have notified her or the MDS coordinator of the ongoing communication attempts, demonstrating a lack of effective follow-through and communication in assisting the resident to obtain hearing devices.
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