A descriptive analysis was conducted on the 400 returned survey questionnaires as reported below.
Characteristics of care home and respondents
The Care Quality Commission (CQC) in England rates the quality of care provided by the specific care homes. These ratings were found for 66 out of 74 care homes; 15 required improvement (22.7%), 44 were reported as good (66.6%), and seven were outstanding (10.6%). The responses of staff from each home were collated to determine the number of respondents from each care home, this ranged from one person to 36 people, with 26 care homes having over five respondents.
The type of care home where the respondent worked was requested from each respondent and they were able to select more than one type. Analysis found however that many respondents from the same care home reported different care home types for their home. Due to these disparities, all care home classifications were checked against the care home manager’s response and standardised across all respondents from that home; for those where no manager participated, the care home website was reviewed to provide a more accurate and standardised record of what type of care home it was. Those responding were most commonly from nursing homes (45%) followed by residential care homes (36%)
There was a significant correlation found between job role and length of time that respondents worked in care homes (P = 0.000), with care home managers reporting the longest length of service and health care assistants working the least. A significant relationship was also found between care home type and job role (P = 0.000), with a greater proportion of respondents from nursing homes being qualified nurses, and a greater proportion of those classifying themselves as ‘other’ being from residential homes.
Descriptive analysis
Table 1 shows the percentage of responses given to the existence of certain practices for assessment and treatment of hearing loss and vision loss. Of the 400 responders, the vast majority reported that both hearing and vision impairments are recorded in residents’ care plans (91.3%; 93.5%), and that hearing aids and glasses are checked/cleaned regularly by staff (84%; 91.8%). In addition, a majority report that their care home has suitable environment adaptations such as quiet places for residents (79.5%), that the care home they work in is well lit (88.3%), and that specific adaptions to the environment (such as contrasting colours for signs) exist (67.8%). In addition, the majority said that annual vision check-ups by optometrists are conducted in the home (85.3%).
However, Table 1 also shows that some practices were less commonly used. A total of 46% of participants mentioned not using screening tools for hearing assessment; and 43.8% not using vision screening tools. Hearing assistive devices were only reported by 16%; and only 23.8% of care homes provided other vision assistive devices. Less than half responded that annual hearing check-ups are conducted by audiologists (46.8%), and that all residents’ glasses are labelled (48.8%).
Table 1
Hearing and vision practices implemented in care homes
Practices (%) | Yes | No | Not sure | Sometimes | When residents bring their own |
Hearing |
Hearing Screening Tools | 16 | 46 | 38 | | |
Care plan (Hearing) | 91.3 | 0.3 | 2 | 6.5 | |
Quiet places | 79.5 | 14.2 | 25 | | |
Hearing Aids checked regularly | 84 | 20 | 44 | | |
Access to other hearing devices | 15 | 29.8 | 18.8 | | 36.5 |
Annual hearing check-ups | 46.8 | 25 | 28.2 | | |
Vision |
Vision Screening Tools | 23.8 | 43.8 | 32.5 | | |
Care plan (Vision) | 93.5 | 0.5 | 2.5 | 3.5 | |
Well-lit rooms | 88.3 | 5.3 | 6.5 | | |
Adaptations to environment (Vision) | 67.8 | 21.8 | 10.5 | | |
Glasses cleaned regularly | 91.8 | 4.5 | 3.8 | | |
Access to other vision devices | 45 | 8.3 | 13.5 | | 33.3 |
Annual vision check-ups | 85.3 | 2.8 | 12 | | |
Glasses labelled with owner’s name | 48.8 | 7.2 | 4 | 40 | |
In addition, 103 out of the 400 respondents reported that all of their residents are willing to use their hearing aids (25.8%), and only 83 stated that their residents are able to take care of their own aids (20.8%). Furthermore, the majority of all respondents reported that some assistance in caring for residents’ hearing problems are provided by family members (96%). In addition, when these questions were assessed for vision, only 118 out of the 400 respondents reported that all residents are willing to use their glasses (29.5%), with 359 having reported that family members provide assistance (89.8%).
A free text question asked about other practices that the care home used to assist with the identification and management of hearing and vision difficulties. The hearing practices suggested included signing professionals, nurses carrying out ear syringing, links with relevant charities, communications devices such as IPads, and staff training. Examples given of vision practices not listed included: contacts with relevant charities, input from a variety of outside professionals, volunteers, one on one care, Specsavers visits and staff assistance and training.
Table 2 further highlights the percentage of respondents who considered themselves to be confident in their knowledge of different aspects of hearing and vision care. For all questions, over 50% reported being confident to some extent in their knowledge of that particular aspect of hearing and vision care. In addition, the majority of respondents strongly agreed that they were confident in cleaning glasses (57.5%) and communicating with the hearing or visually impaired residents (63.5%; 70.5%). However, less than 25% strongly agreed that they were confident in recognising various hearing and vision conditions (17.5%; 8.3%), assessing whether a resident has a hearing or vision impairment (24.8%; 14%), assessing hearing or vision impairment in the cognitively impaired (21.5%; 14.5%) and cleaning hearing aids (23.8%).
Table 2
Staff knowledge of hearing and vision care
Knowledge (%) | Strongly Agree | Agree | Disagree | Strongly Disagree |
Hearing |
Knowing the difference between hearing conditions | 17.5 | 56 | 24.5 | 2 |
Assessing whether a resident has a hearing impairment | 24.8 | 60 | 13.3 | 2 |
Assessing hearing impairment in the cognitively impaired | 21.5 | 55 | 21.3 | 2.3 |
Cleaning hearing aids | 23.8 | 54 | 18.5 | 3.8 |
Communicating with the hearing impaired | 63.5 | 30 | 5.5 | 1 |
Vision |
Knowing the difference between vision conditions | 8.3 | 43 | 42 | 6.8 |
Assessing whether a resident has a vision impairment | 14 | 59.3 | 25 | 1.8 |
Assessing vision impairment in the cognitively impaired | 14.5 | 51.7 | 30.8 | 3 |
Cleaning glasses | 57.5 | 39.5 | 2.3 | 0.8 |
Communicating with the vision impaired | 70.5 | 25.8 | 3.5 | 0.3 |
When asked whether the respondent would like more information on how to effectively identify and manage hearing and vision loss, 89.5% agreed that they would like more information on hearing loss, and 85.3% agreed they would for vision loss.
For all homes with more than five staff who responded (n = 26), a range of responses were provided about the practices the care home was implementing. Whilst some working in the same home agreed that certain practices took place in their care home, others from that same care home disagreed; This highlights uncertainty amongst staff of the practices the care homes they worked in were actually implementing.
The relationship between demographics and participant responses
Survey responses were also compared to respondents’ job role, their length of time working in care homes, the care home type to which they worked in and also the size of the home by applying Chi Square correlations. Table 3 shows which of these care home/staff factors were significantly related to participants' response to questions about hearing and vision practices.
Table 3
Relationships between variables
Relationships between variables | Job Role | Length of work | Care Home Type | Size of Care Home |
Hearing |
Use of screening tools | 0.000 | 0.000 | 0.005 | 0.099 |
Annual professional assessment | 0.000 | 0.000 | 0.002 | 0.014 |
Access to quiet rooms | 0.138 | 0.000 | 0.387 | 0.058 |
Aids checked regularly | 0.338 | 0.000 | 0.000 | 0.829 |
Access to other aids | 0.000 | 0.002 | 0.003 | 0.308 |
Knowledge of cleaning hearing aids | 0.008 | 0.014 | 0.480 | 0.736 |
Knowledge of how to communicate | 0.114 | 0.067 | 0.000 | 0.542 |
Want for more information | 0.078 | 0.071 | 0.003 | 0.244 |
Residents willing to use aid | 0.003 | 0.07 | 0.000 | 0.004 |
Can residents take care of own aid | 0.000 | 0.1 | 0.000 | 0.554 |
Family members assist | 0.094 | 0.937 | 0.577 | 0.003 |
Vision |
Use of screening tools | 0.000 | 0.000 | 0.153 | 0.311 |
Annual professional assessment | 0.000 | 0.000 | 0.133 | 0.073 |
Environment well lit | 0.265 | 0.010 | 0.652 | 0.002 |
Aids checked regularly | 0.1 | 0.010 | 0.269 | 0.825 |
Glasses labelled | 0.003 | 0.000 | 0.000 | 0.063 |
Access to other aids | 0.000 | 0.000 | 0.014 | 0.04 |
Knowledge of cleaning glasses | 0.003 | 0.013 | 0.005 | 0.194 |
Knowledge of different vision problems | 0.000 | 0.232 | 0.264 | 0.311 |
Residents willing to use glasses | 0.291 | 0.694 | 0.000 | 0.106 |
Job roles
As shown in Table 3, of the 33 questions about hearing and vision practices and staff knowledge, six hearing questions and six vision questions were significantly associated with job role. A significant relationship between job role and whether screening tools were used in the home for both hearing and vision were found (P = 0.000). Also, whether residents had access to other assistive devices (P = 0.000); and whether visiting professionals conduct annual assessments (P = 0.000). Health care assistants and those classifying themselves as ‘other’ reported greater uncertainty regarding whether the care home adopts these practices in comparison to care home managers and nurses. Activities coordinators reported a level of uncertainty similar to that of health care assistants for questions about hearing practices. However, the certainties reported by this group of staff regarding practices for vision loss were similar to that of care home managers and nurses.
Job role was also found to be significantly associated with reported knowledge of cleaning hearing aids (P = 0.008). A greater proportion of health care assistants, activities coordinators and those classifying themselves as ‘other’ reported that they were not confident in cleaning hearing aids in comparison to care home managers and nurses. This group were also more likely to report that all residents were willing to use their hearing aids in comparison to care home managers and nurses (P = 0.003). In addition, care home managers seemed to report stronger disagreement in residents being able to take care of their own aid in comparison to all other job roles (P = 0.000).
There was also a significant association found between staff knowledge of the different vision problems and job role (P = 0.000). Care home managers and nurses reported having better knowledge than health care assistants, activities coordinators and those classified as ‘other’. In addition, care home managers were reportedly more confident in their knowledge of cleaning glasses than all other job roles (P = 0.003). Care home managers and nurses were also more certain of whether glasses were labelled with residents’ names in comparison to those from all other job roles (P = 0.003).
Length of time working in care homes
There were five significant associations found between questions about hearing practices and the length of time the care home staff members had worked in care homes, and six significant associations between the questions about vision practices and length of time working. For both hearing and vision there were again significant associations found between length of work and the reporting of screening tools (P = 0.000), professional assessments (P = 0.000) and also whether residents have access to other additional assistive devices (P = 0.002 - hearing) (P = 0.000 - vision). This effect again seems to be associated with the amount of uncertainty among staff. There is a linear trend in all three questions’ responses with those reporting having worked at the care home less than two years being most likely to be uncertain about whether these practices were implemented in their care home, whereas those working in the care home for over 10 years were the most certain of which practices are used.
Significant associations were also found in the reporting of whether hearing aids are checked regularly (P = 0.000) and whether the care home has quiet rooms available to residents with hearing difficulties (P = 0.000), with greater uncertainty reported by those who have worked in the care home for less than two years in comparison to all other groups. The heightened level of uncertainty among this group can also be seen in the reporting of whether residents’ glasses are labelled (P = 0.000), whether residents’ glasses are checked regularly by staff (P = 0.010), and whether the care home is well lit to aid those with vision difficulties (P = 0.010).
Type of care home
Whilst in all categories the majority of staff agreed they wanted more information, those in dementia only care homes reported a higher percentage of staff disagreeing in comparison to all other care home types (P = 0.003). Residents in dementia only homes were reported as being less likely to be willing to use their prescribed aids (P = 0.000), and the least likely to be able to take care of their own prescribed aids (P = 0.000). However, as can be seen in Table 3, type of care home also affected the accessibility to other assistive devices and dementia only care homes were reported as being the least likely to have access (P = 0.003). Residents in a dementia only home and those classed as other were also reported as less likely to have professional assessments than those reported as being in nursing or residential homes (P = 0.002). Those identifying as a nursing home or nursing and residential together were also more likely to report using screening tools than all other types of home (P = 0.005).
Dementia only homes and those classed as other were more certain on the whether their staff checked hearing aids regularly in comparison to the other types of care home (P = 0.000), however the percentage of those reporting that they did check hearing aids was similar for those in dementia only homes as reported in all other homes. Furthermore, whilst the majority of staff working in care homes reported confidence in communicating with residents with hearing difficulties (93.5%), those identifying as other were less likely to be confident in this ability (P = 0.000).
Types of care home again had an effect on numerous responses. Dementia homes reported residents as least likely to be willing to use their prescribed aids (P = 0.000), and respondents from dementia only homes were also the most likely to report that residents’ glasses were labelled (P = 0.000). In addition, dementia only homes and those classed as other were the most likely to strongly agree in their confidence to clean residents’ glasses effectively in comparison to the other homes (P = 0.005).
Size of the care home
A linear trend can be seen whereby those with a capacity of 30 or less residents were more likely to report that all their residents were willing to use hearing aids, with the lowest proportion of respondents noting this willingness coming from care homes with a capacity of over 60 (P = 0.004). Furthermore, if respondents reported to be working in a care home with 30 or less residents, they were also more likely to report having assistance from family members than those in care homes with more than 30 residents (P = 0.003).
For the questions about vision practices, the size of the care home was only significantly associated with whether the care home was well lit to cater for those with vision impairments (P = 0.002); with those care homes with less than 30 residents reporting more ‘no’ and ‘not sure’ responses than those with 30 + residents.