In response to a broad range of concerns raised by the veteran community regarding hearing services, the Department of Veterans’ Affairs (DVA) established the ESORT Hearing Services Working Group (HSWG) in 2016.The ESORT HSWG included senior representatives from DVA, the Department of Health, Comcare and ESOs. Three meetings of the ESORT HSWG were held between March and November 2016. Matters considered included:
- the arrangement between DVA, and the Department of Health (responsible for the Hearing Services Program (the Program)), for the delivery of hearing services to DVA clients;
- perceptions within the veteran community that individual circumstances of hearing impaired DVA clients are not being considered;
- the exclusive availability of Assistive Listening Devices (ALDs) to veterans through DVA’s Rehabilitation and Appliances Program (RAP) and access to these;
- the hearing device dispensing policy for the Safety, Rehabilitation and Compensation Act 1988 (SRCA) clients under Comcare; and
- the potential impact of the National Disability Insurance Scheme (NDIS) on DVA clients in relation to hearing services.
Issues and perceptions raised
ESO members of the ESORT HSWG raised the following issues:
- Prior to 10 December 2013, DVA clients with eligibility under SRCA, often received hearing aids from the partially subsidised schedule. These were referred to as ‘top up’ hearing devices. Since that time these clients have received treatment through DVA treatment card arrangements and replacement aids are provided from the Program’s fully subsidised range. Some veterans have expressed the view that fully subsidised hearing aids are basic and insufficient for veterans with active lifestyles. This has led to the perception of a reduction in entitlements;
- Concern that public servants received an extended range of services and devices through Comcare, as compared to DVA SRCA clients;
- Need for more information on the availability of services that will be available to those eligible under the NDIS, and how these may differ, or be similar, to current Hearing Services Program arrangements; and
- Some hearing service providers recommend devices from the partially subsidised range of hearing aids. These aids have additional features that are considered extra to those necessary to manage hearing loss. Some providers market enthusiastically to sell these devices as they receive a mark-up. As DVA will not reimburse the additional cost of purchasing these devices, there can be a substantial cost to the client.
As at June 2016, there were approximately 73,000 active DVA clients who received services under the Hearing Services Program that year, with a total of 180,000 DVA clients (VEA, SRCA and MRCA) registered under the Hearing Services Program in the same period.
While the causes of veteran hearing loss may be different from the broader community, there is no difference in how hearing loss manifests or how it should be managed. However, there are issues that may exacerbate the complexity of hearing loss for veterans, including tinnitus; complex psychological and interpersonal needs; and high levels of expectation with respect to service delivery.
There is scope under 11.5.4 or 11.5.5 of the Military Rehabilitation and Compensation Act (MRCA) Treatment Principles for Commissions to use their discretion in relation to funding the cost of more expensive hearing devices in certain circumstances. However, the Military Rehabilitation and Compensation Commission is only in a position to consider a request for meeting the financial costs of a hearing aid where all of the criteria in paragraph 11.5.4 of the MRCA Treatment Principles have been met. This includes that the required hearing aid is unable to be supplied to the DVA client under the Hearing Services Administration Act, 1997 or the Hearing Services Act, 1991, and that prior approval was sought and given before the required hearing aid was purchased.
Eligible veterans are entitled to a unique hearing package consisting of:
- hearing aids from the fully subsidised schedule of the Program (including the provision of ALDs from the RAP);
- maintenance of these devices; and
- rehabilitation programs.
These are provided at no cost to eligible veterans. This differs from the general community, who can either receive hearing aids or an ALD from the Program at no cost, but not both. Additional technology is also available to veterans on the RAP, such as a remote microphone radio frequency system. This technology is not available to the general voucher clients of the Program. The general community is also required to contribute to maintenance costs of their hearing aids.
Some ALDs on the RAP require prior approval and not all hearing service providers are aware that these are available for eligible veterans.
Professor Harvey Dillon (then Director of Research, National Acoustics Laboratory) presented the latest research on hearing aid technology to the ESORT HSWG in June 2016. Professor Dillon advised that the combination of a radio frequency ALD worn with hearing aids provides superior performance in noisy environments and over distances than is possible from any hearing aid alone. Also:
- hearing aids with directional microphones, available on the Program’s fully subsidised and partially subsidised device schedules, generally provide about a 2dB improvement in signal-to-noise ratio over hearing aids with omni (all) directional microphones;
- hearing aids with super directional (or ‘beam forming’) microphone technology give about a 5dB improvement in signal-to-noise ratio. Super directionality is an emerging technology available in some partially subsidised hearing aids; and
- ALD wireless remote microphone units give up to a 15dB improvement when used correctly in conjunction with a hearing aid.
Discussion also focused on the importance of linking the dispensing of ALDs to DVA clients’ individual rehabilitation program.
Dr Christopher Lind (Senior Lecturer in Audiology, Flinders University and researcher in the fields of speech pathology and audiology) raised the importance of communication outcomes and the role of education, training and rehabilitation as a ‘hearing system’ in optimising hearing devices and communication goals.
Dr Lind advised that intervention services for hearing loss should address functional need, which primarily relates to everyday communication. While hearing devices are critical, these are often the only intervention recommended or in many cases provided. Education, training, rehabilitation and importantly, a family centred approach, will together achieve the optimal communication outcome for veterans.
- DVA raised with Comcare the perceived inequity between the arrangements for public servants and veterans with hearing impairment under SRCA since December 2013.
- DVA met with Comcare and the Department of Health in July 2017 to review decision processes as they relate to hearing. It was confirmed that across the Australian Government, there are consistent decision making processes to manage and support hearing loss.
- The issue of potential differences in services for clients of the NDIS and DVA clients was raised.
- DVA clients are eligible for services under both the NDIS and DVA arrangements, provided the services received are not duplicated. DVA continues to work with the NDIA and the Department of Health on any impacts of the NDIS for the Program and DVA clients.
- The issue of up-selling by hearing service providers was raised with the Department of Health.
- DVA became a member of the Hearing Expert Reference Group, which in partnership with the audiological industry, including the Practitioner Professional Bodies, developed an industry self-regulation framework to establish appropriate codes of practice for all hearing service providers. The framework has been completed. Management of the new Service Delivery Framework for Hearing Care Services in Australia has been transferred from the Department of Health to the Health and Safety Quality Commission. Further work is planned to include hearing services in the development of the National Safety and Quality Health Services Standards for primary care settings.
- DVA will consider whether further research into maximising the ‘hearing system’ would be of value in supporting veterans (and their families), to better meet their communication goals and manage their hearing loss and associated comorbidities.
- DVA is continually reviewing existing research literature and research projects in hearing loss and hearing management techniques and devices.
- DVA will undertake a review of the RAP schedule to ensure the currency of ALD technology and is working, with the Department of Human Services (DHS) to streamline access to ALDs through DVA’s Rehabilitation and Appliances Program.
- DVA’s review of the RAP is underway, including a comprehensive examination of the RAP schedule. This will be completed in late 2018. DVA has confirmed its technology requirements with the Department of Human Services (DHS). Relevant ALD business rules have been reviewed by allied health advisers and DVA’s audiology adviser.
- DVA is undertaking an enhanced communication package to increase the awareness of the total hearing services package currently available to veterans.
- DVA is developing a range of supporting communications activities to raise awareness of hearing services packages available to veterans with health industry bodies and professionals. This includes a revision of current DVA resources such as newsletter articles and fact sheets.
- DVA will assist ESOs to communicate messages on the unique hearing services available to their members including the benefits of accessing all aspects of the hearing system. This includes ensuring that SRCA clients who have transferred into the broader arrangements under the Program are fully aware of the options and services available to them to assist the management of their hearing loss.
- In addition to the communication measures described above, an information package is available to assist ESOs to provide advice and guidance on veteran entitlements to hearing services and key programs for managing hearing loss.