JUDY O’GORMAN ALVAREZ
Hearing impaired lipreaders already face challenges making their way in a hearing world. Close-caption TVs, light-activated alarms and TTY (Text Telephones) help in daily life, but when a pandemic like COVID-19 hits requiring everyone – from children to senior citizens – to don masks covering their noses and mouths, lipreaders can be thrust even further into isolation.
The pandemic – and the regulations and practices imposed to keep us safe – can result in added challenges to those with disabilities.
COVID-19-inspired procedures and guidelines may not apply to everyone: drive-thru testing or even finding an ADA-compliant sink for frequent hand-washing may not be easy for the mobility impaired. Support groups, including Alcoholics Anonymous, Weight Watchers and countless others, thrive on consistency and camaraderie, but there are no high-fives or slaps on the back in the virtual world.
Monmouth Medical Center successfully transitioned its Cancer Support Community (CSC) program to an online format in April. The program includes all support groups, educational workshops, mindfulness programs and experiential classes. Physical activities have been modified and include chair stretching, chair tai chi and qigong, easy-seated Zumba moves and chair yoga.
“Feedback has been overwhelmingly positive as members feel supported and connected with CSC and with each other,” said Joan Hogan, program director. “A former CSC member who had moved to Florida has rejoined us remotely and attends almost every class. Members appreciate accessing the program from the comfort of home and have asked us to continue to offer remote access.”
The medical center also offers a monthly Bariatric Surgery Patient Support Group and new patient lecture virtually. Maternity tours and childbirth and parenting education classes are also offered remotely by most medical centers.
Alex Binder, vice president of the Advanced Care Institute, part of VNA Health Group, said their patients are older, typically homebound with limits to physical mobility, so physicians make old-fashioned house calls.
Telehealth has been utilized for some time but the pandemic, especially during the height of restrictions, has made it even more crucial for many patients. Fortunately, according to Binder, Medicare loosened some regulations to make it more accessible to patients who may not have access to computers. For example, utilizing Face-Time on a cellphone is now permitted.
“Telehealth is very valuable in some scenarios and it’s limited in other situations,” he said. “You can ask the patient to speak a sentence and determine if they’re short of breath. But you can’t really touch that patient, fully assess or listen to their lungs. It has its limitations.”
Situations such as a rash or a recurrence of a problem the physician is familiar with can be easily handled through telehealth. But follow-up visits, to see if the rash has cleared or the edema subsided, are especially helpful. “We’re seeing more value on that end.”
“When it’s puzzling, such as an abdominal pain, it may require more testing,” he said.
Marisa Priolo, PT, DPT at db Orthopedic Physical Therapy in Lincroft realizes the added challenges her patients with disabilities may encounter when coming for treatment for an injury or condition.
“Once we determine the easiest way to communicate with the patient,” said Priolo, who has worked with hearing impaired and visually impaired patients, they can make accommodations. “With lipreaders, a face shield is usually the easiest way. I need to make my whole face available.”
Many of Priolo’s patients are aged and dementia sometimes plays a role. “With the memory component it’s a little difficult at times” getting them to remember new safety guidelines due to the pandemic, she said, “such as getting them to understand why we have to stay six feet apart. The biggest challenge is making sure all our patients are comfortable.”
Sara Leonard, MD, medical director for Visiting Physician Services, part of the VNA Health Group, said she and physicians can utilize masks with clear windows to aid hearing impaired patients. “You realize how all our facial expressions are lost with masks,” she said.
With patients who may not be deaf, but rely on lipreading or picking up on facial cues, she said, “I find myself trying to communicate, using a lot more words. I tell them you can’t see it, but I’m smiling beneath this mask.”
“One of the things we have to be mindful with the pandemic is how our homebound patients are getting their needs met,” she said, such as making sure there are groceries and medications in the house.
“Sometimes their helpers are not available,” she said. Even their loved ones may stay away for fear of exposing them to the coronavirus. “Or they’re not comfortable with too many people in the home. A lot of patients are medically vulnerable, and then they lose that support – and the socialization.”
Isolation can be a huge problem, especially for those with disabilities, which has pushed Leonard to go above and beyond her usual duties. “I feel I need to spend some extra time,” she said. “A couple of extra check-in phone calls by clinicians or physicians, just so there’s a friendly voice on the other end of the phone to help them not feel so alone,” she said. “I’ve even brought out the garbage when needed.”
This article originally appeared in the Sept. 3, 2020 print edition of The Two River Times.
