The Importance of Television Closed Captioning and Captioned Telephone Service for People with Hearing Loss

Learning Outcomes

Introduction

For today's presentation, we are going to discuss the findings of two different research papers. First, we will look at "The Benefits of Hearing Aids and Closed Captioning for Television Viewing by Older Adults with Hearing Loss," published in Ear & Hearing (Gordon-Salant & Callahan, 2009). Next, we will review "The Importance of Captioned Telephone Service in Meeting the Communication Needs of People with Hearing Loss," which was published in Hearing Review (Kochkin, 2013).

Brief History of Closed Captioning

Television closed captioning begins with Julia Child. The nation's first captioning agency, The Caption Center, was founded in 1972 at the Boston public television station, WGBH. The station introduced open television captioning to rebroadcasts of The French Chef with Julia Child, and began captioning rebroadcasts of ABC News programs as well, in an effort to make television more accessible to the millions of Americans who were deaf and hard of hearing.

Closed Captioning and the Law

In 1990, The Television Decoder Circuitry Act was passed, mandating that all televisions 13 inches or larger manufactured for sale in the U.S. contain caption decoders. Sixteen years later, the FCC ruled that all broadcasts and cable television programs must include captioning, with a few exceptions.

The Benefits of Hearing Aids and Closed Captioning for Television Viewing by Older Adults with Hearing Loss (Gordon-Salant & Callahan, 2009)

Not surprisingly, 95% of people 75 years and older watch television every day. Adults older than 65 years watch more television than younger age groups. However, there are some factors that may limit television viewing by older people. One such factor is hearing loss. In older adults with hearing loss, not only is their volume decreased, but the clarity of speech can be compromised as well. A second issue which may limit television viewing is that a person's ability to process auditory information is diminished and becomes slower with age. Other factors may relate to the viewer's listening environment.

A variety of assistive devices are available to improve speech understanding, the principle one being hearing aids. Although hearing aids are beneficial for improving speech in most environments, approximately 25% of older hearing aid users still report dissatisfaction with their hearing aids for television viewing. A second assistive technology that is potentially beneficial for understanding televised speech is closed captioning.

Objectives

Although watching television is a common leisure activity of older adults, the ability to understand televised speech may be compromised by age-related hearing loss. Two potential assistive devices for improving television viewing are hearing aids and closed captioning. The primary purpose of this study was to determine if older hearing-impaired adults show improvements in understanding televised speech with the use of these two assistive devices, as compared to conditions without these devices. A secondary purpose was to examine the frequency of hearing aid and closed captioning use among the sample of older hearing aid wearers.

Design

The investigation entailed a randomized, repeated-measures design of 15 older adults with bilateral sensorineural hearing loss who wore hearing aids. They also had to have worn their hearing aids for at least two months prior to the study, to increase the likelihood that the hearing aid benefit and acclimatization period had occurred. There were no restrictions on the degree of hearing loss, because the goal of this initial study was to sample the performance of a random clinical population. Participants had to be native English speakers, with a minimum of a high school education, and were required to have their vision corrected to 20/20. The final sample of 15 older adults consisted of nine men and six women, ages 59 to 82 years, with a mean age of 74 years. Hearing sensitivity ranged from mild to profound.

The participants viewed three types of televised programs: news, drama, and a game show. These programs were each edited into lists of speech segments and provided an identification response. Each participant was tested in the following four conditions: a baseline condition (no hearing aid and no closed captioning); a hearing-aid-only condition; a closed-captioning-only condition; and a hearing-aid-plus-closed-captioning condition. Also, pilot testing with young, normal-hearing listeners was conducted to establish list equivalence and stimulus intelligibility with a control group. All testing was conducted in a quiet room to simulate a living room using a 20-inch flat screen television. Questionnaires were administered to participants to determine the frequency of hearing aid and closed captioning use while watching television.

Test Group Characteristics

A chart was made, listing each member of the test group, along with their age, hearing characteristics, and length of hearing aid use. Individual four frequency pure-tone averages were shown for each ear (500, 1000, 2000 and 4000 Hz) as well as aided monosyllabic speech recognition scores. The average thresholds across frequency showed a moderate to severe gradually sloping sensorineural hearing loss, typical of presbycusis. The hearing aids worn by this group varied in style, power, and manufacturer, reflecting the range of hearing aids worn by a clinical population. The youngest participant was 59 years old, and had used a hearing aid for eight months. The oldest three participants were all 82 years old; their duration of hearing aid use ranged from nine months to five years.

Stimuli of Study

The stimuli included 124 sentences, or parts of sentences, from three different television programs: ABC World News Tonight (news), Jeopardy (game show), and The West Wing (drama). The programs were originally recorded in the fall of 2005 and winter of 2006. Four lists of 10 sentences each were recorded for each of the three shows, yielding 120 scorable sentences. Four additional practice sentences were recorded for screening purposes. Sentences contained at least four content words (i.e., nouns, verbs, adjectives, adverbs and prepositions) that all could be used for scoring. Each sentence was spoken by one person at a time. However, several different speakers were included in each set of sentence stimuli in a given list.

Pilot testing with the 11 young adult listeners with normal hearing was conducted to verify that the final sentence lists for each program type yielded equivalent scores when the sentences were presented without closed captioning. The audio signal was at 60 dB with the closed captioning sound off. The young adult listeners also had normal vision, with or without correction, as indicated by self-report. There were 50 scorable words for each final sentence list. Pilot data for the audio-only and closed-captioning-only conditions showed no significant difference between the lists for both viewing conditions, confirming list equivalence. The average scores across the four sentence lists and three program types in this pilot study ranged from 86% to 98% correct without closed captioning, and from 95% to 100% correct with the closed captioning.

All testing was performed in a quiet room. Participants were seated 80 inches from a 20-inch flat screen color television. They then viewed segments from three types of television programs in four different viewing conditions (as outlined earlier): baseline (no closed captioning and no hearing aids); hearing aids only; closed captioning turned on without hearing aids; and finally, hearing aids on and closed captioning on. The speech signal was presented through the speakers at an average conversational level of 60 dB, which was calibrated each day. Background noise was also measured and never exceeded 40 dB, which is typical for quiet rooms. The order of the viewing conditions was randomized across the listeners, as well as the assignment of sentence lists to the conditions. Thus, each listener received a unique assignment of sentence lists to the condition across each of the three shows.

Results

Post-talk analysis indicates that the scores obtained in the hearing-aid-plus-closed-captioning conditions were significantly higher than the scores obtained in the baseline and the hearing-aid-only conditions. Surprisingly, there was no difference in scores between the hearing-aid-plus-closed-captioning versus the closed-captioning-only conditions. Similarly, there were no significant differences in the scores measured between the baseline and hearing-aid-only conditions for all three programs. Furthermore, there was no significant difference between the hearing-aid-closed-captioning and closed-captioning-only conditions where that participant was not wearing their hearing aids. In my experience working with patients, they have a tendency to say, "I'm doing great with my hearing aids. I'm watching TV and I'm not missing anything." However, the data clearly shows that their viewing experience could be improved, simply by turning closed captioning on.

The results were as follows:

1. Baseline mean score: 23%
2. Hearing aid (HA) only mean score: 37%
3. Closed captioning (CC) mean score: 75%
4. Closed captioning plus hearing aid mean score: 81%.

Clearly, there was a significant difference between the hearing-aid-only condition and the closed-captioning-plus-hearing-aid condition.

The participants were also asked to rate the frequency of hearing aid and closed captioning use. Among the 15 participants, approximately 73% reported always or usually wearing their hearing aids while watching television. However, only 13% noted that they are always using the closed captioning while watching television. Surprisingly, 87% of the participants reported never using the captioning while watching television. Perhaps it's not that they didn't want to use closed captioning; it may be that they didn't remember to use it. When counseling patients during follow ups and fittings, we could remind them about using closed captioning as an option for better understanding while television viewing. 

The significant effect of viewing condition was observed for all programs. Participants exhibited significantly better speech recognition scores in conditions with closed captioning than those without closed captioning. Use of personal hearing aids did not significantly improve speech recognition of televised speech compared with the unaided condition. The condition effect was similar across the three different programs. Most of the participants (73%) regularly wore their hearing aids while watching television, while very few of them (13%) had ever used closed captioning.

Conclusion

As a result of this study, these researchers concluded that closed captioning results in a large and significant improvement in word recognition by older adults with varying degrees of hearing impairment. Most of the older adults indicated that they had never used closed captioning technology, despite its potential to improve understanding of television dramatically for older adults. Because the aging population is growing, and the prevalence of age-related hearing loss is high, primary care physicians, audiologists and hearing aid dispensers alike need to be aware of simple assistive tools that could enhance their patients' quality of life. Closed captioning seems to be an excellent option for a low cost, high quality assistive tool for older adults to improve their understanding of television, which is a common leisure activity of this population.  

Captioned Telephone Service

As defined by the Federal Communications Commission (FCC), "Captioned telephone service allows a person with a hearing loss, but who can use his or her own voice and has some residual hearing, to speak directly to the called party and then listen, to the extent possible, to the other party and simultaneously read captions of what the other party is saying." Current captioned telephones use the internet to send the captions to the phone, known as internet protocol captioned telephone service (IPCTS). Since they are using the internet, communication between parties is fast. This is an improvement over earlier devices that required multiple phone lines, or calling a second phone number to relay the phone call. They are able utilize their current existing phone number. They don't need a new phone number when using these services.

History of ADA

The Americans with Disabilities Act of 1990 allowed for all of these programs to be in place. Most people are aware of the issues around mobility that were addressed with this law. However, other disabilities in the law included covering hearing loss. The Americans with Disabilities Act led to the development of relay and captioned telephone services. Specifically, Title IV of the ADA required that assistive services be made available free of charge to qualified end users in any state, at any time. As technology advanced, telephone relay services, internet relay and video relay were developed, enabling those with hearing loss to communicate remotely with hearing individuals.

The Importance of Captioned Telephone Service in Meeting the Communication Needs of People with Hearing Loss (Kochkin, 2013)

Currently, just over half of consumers are satisfied with their hearing aids on the phone. In addition, consumers report that hearing aids provide, on average, only about 55% benefit during phone conversation. When asked, approximately eight out of 10 consumers rate improvement in hearing aid telephone utility as being highly desirable. While difficulty in hearing on the telephone is linearly related to degree of hearing loss, significant numbers of people with mild, moderate and severe hearing loss report great difficulty communicating on the telephone.

Due to technological advances in hearing aids today, hearing aids for the most part do an excellent job of helping people meet many of their communication needs. However, there are situations where assistive listening devices are needed. People with hearing loss experience more difficulty on the phone because the hearing loss makes the telephone signal softer, and therefore less intelligible. Furthermore, unlike face-to-face communication, there are no visual cues to help with understanding when talking on the telephone. Critical visual cues, such as eye contact, shifts in gaze or facial expressions to signal the end of an utterance or a new conversation turn, are not available. The talker's face of course also helps interpret emotions as well. Additionally, some hearing aids may not be compatible with some phones, resulting in feedback. Certainly, if the patient has a telecoil, it may not function properly, the patient may forget to use it, or they may not even know they have one.

Objectives

This study had several objectives:

1. To quantify the difficulty hard-of-hearing individuals have while conversing on the telephone.
2. To determine the importance of conversing on the phone compared to 18 other communication situations for people with hearing loss.
3. To document consumer satisfaction ratings with hearing aids on conventional telephones over the last 20 years, and measure subjective benefit with hearing aids on the phone.
4. To demonstrate that captioned telephone service is needed to serve a wide spectrum of hearing losses, not just the profoundly hearing impaired, and not just current hearing aid users.
5. To demonstrate that current hearing aid utility on the telephone is a significant obstacle to hearing aid purchase for hard-of-hearing people.

Method

The author of this paper developed a tracking survey of hard-of-hearing population and hearing instrument market in 1988. The survey was administered periodically, with extremely detailed surveys being conducted in 1991, 1994, 1997, 2000, 2004 and 2008. The latter two surveys were conducted while at the Better Hearing Institute in Washington, DC. Each survey contained questions designed to track many items longitudinally. 

Referring to the most recent survey in November and December of 2008, a short screening survey was mailed to 80,000 members of the National Family Opinion (NFO) Panel. The NFO Panel consists of households that are balanced to the U.S. latest census information with respect to market size, age of household, size of household, and income within each of the nine census regions, as well as by family versus non-family households, state (with the exception of Hawaii and Alaska), and the nation's top 25 metropolitan statistical areas.

The screening survey included the following items:

1. Whether physician/staff screened for hearing loss during their physical in the last year
2. Whether the household had one or more people “with a hearing difficulty in one or both ears without the use of a hearing aid”
3. Whether the household had one or more people who were the owner of a hearing aid
4. Whether the household had one or more people with tinnitus (ringing in the ears)
5. Perceptions of job discrimination in promotions and salary equity
6. Detailed quantification of employment status (beyond simpler NFO panel data)
7. Traffic accidents over the past five years and driving habits.

In January 2009, an extensive seven-page legal-size survey was sent to the total universe of hearing aid owners in the panel database (3789 people). Of those, 3174 completed surveys were returned, representing an 84% response rate. In February 2009, an extensive seven-page legal-size survey was sent to a random sample of 5500 people with hearing loss who had not yet adopted hearing aids. The response rate for the non-adopter survey was 79%.

Since hearing aid adoption and communication performance are related to degree of hearing loss, both aided and unaided subjects were asked to complete subjective measures of hearing loss. They were then segmented into one of 10 groups, called deciles, based on their response to five different measures of hearing loss. Those five different measures were:

1. Number of impaired ears (one or two)
2. Score on the Gallaudet scale (an eight-point scale in which the respondent indicated whether they can understand speech under different conditions)
3. Subjective hearing loss score (respondents subjectively evaluated their hearing loss on a scale from 1-4: 1 = mild, 2 = moderate, 3 = severe, 4 = profound)
4. Difficulty hearing in noise (a five-point scale that runs from extremely difficult to not difficult at all) 
5. BHI Quick Hearing Check (a 15-item, five point Likert Scale hearing loss inventory which is shown to be correlated with objective measures of hearing loss) 

Based on their score with all of these items, they were then placed into one of 10 hearing loss groups (deciles). Decile 1 being mild, all the way to Decile 10 being profound.

Results

The degree of hearing loss was documented for the 3109 hearing aid owners and 4209 hard-of-hearing non-HA owners. The results show that hearing aid owners are more likely:

• To have a bilateral hearing loss (87% versus 61%)
• To have a perceived loss of severe to profound (40% versus 12%)
• To have more difficulty hearing normal speech across the room without visual cues (64% versus 34%)
• To have difficulty hearing in noise (66% versus 34%)
• To score in the top quartile (75th percentile) of the BHI Quick Hearing Check (45% versus 17%)

Difficulty hearing on the phone is highly related to the degree of hearing loss. One out of 10 people with a mild hearing loss (Decile 1), four out of 10 with a moderate hearing loss (Decile 5), and nine out of ten with severe hearing loss (Decile 10) report difficulty hearing on the phone without the use of hearing aids. From this data, we can estimate the market size for assistive help on the telephone by multiplying percent need by the population for each decile. Ultimately, it can be extrapolated that approximately 16 million people nationwide would benefit from assistive help on the telephone. 

Both hearing aid owners and hard-of-hearing non-HA owners were presented with a list of 19 listening situations and were asked to indicate the importance of hearing in that situation using a four-point scale: very important, important, somewhat important, or not important at all. Communicating on the telephone was rated the second highest important listening situation, ranking just behind one-on-one conversation. A total of 57% of people with hearing loss indicated that communicating on the telephone was very important to them. Interestingly, difficulty hearing on the phone is the number two reason that people return their hearing aids. When you're thinking about that hearing aid sale, if you can eliminate a patient's frustration, you will more likely retain that patient and that sale.

The aforementioned consumer surveys measured consumer satisfaction with various hearing aid features, quality of hearing health service, and performance of the hearing aid in 19 listening situations, one of which was on the telephone. For the period of 1991 to 2000, all items were measured on a five-point Likert Scale, ranging from very satisfied to very dissatisfied. The 2004 and 2008 surveys expanded the scale to a seven-point Likert Scale, adding "somewhat satisfied" and "somewhat dissatisfied." Subsequent research has determined that "somewhat satisfied" is close to a neutral rating. It's no surprise that consumer satisfaction with hearing aids on the phone has improved from 37% in 1991 to 55% in 2008, as we have moved from analog to digital hearing aids. In a 2000 survey, 82% of hearing aid consumers indicated that hearing aids that work better on the telephone were either "desirable" or "very desirable."

For the milder hearing losses (Deciles 1 through 3), slightly less than 70% are satisfied with their ability to hear on the telephone while wearing newer hearing aids. For moderate hearing losses (Decile 5), 60% report being satisfied, while only 40% of those with the most severe hearing loss (Decile 10) are satisfied with their ability to hear on the telephone while wearing hearing aids.

What about benefit derived from hearing aids in improving speech intelligibility? In the survey, using a zero to 100% scale, consumers were asked to estimate the percent improvement they experienced specifically due to the use of their hearing aids in 10 listening situations, with one of the listening situations being the telephone. Hearing aid owners reported that hearing aids improved their ability to communicate on the phone by 55%, with the median being 50%. One in four people experienced a 90% or higher improvement, while one in 10 reported that they experienced no benefit at all.

Conclusion

As evidenced by the data collected in this study, people who are hard-of-hearing are at a distinct disadvantage compared to normal-hearing people when communicating on the telephone. Necessary visual cues needed for effective communication are not available to the listener on a normal telephone. Captioned telephones that are customizable to deliver a speech signal based on the unique needs of the hard-of-hearing, while quickly displaying the speech in text format, would appear to offer a viable, functional solution to those with hearing loss.

CaptionCall

The CaptionCall phone (Figure 1) offers users a number of interesting features, including:

• Large text, adjustable font sizes, screen brightness adjustability
• Wired or wireless internet capability
• Speaker phone for hands-free calling and ability to listen with both ears
• Customizable audio, allowing users to boost certain frequencies
• Saved conversations to save captions from a particular call

Figure 1. CaptionCall Phone.

CaptionCall also has an app that works specifically with the Apple iPad (Figure 2). The iPad app can be used anywhere you have Wi-Fi or cellular internet connection. An Apple iPad 2 or later is required for the app to work. With CaptionCall, it is easy to stay connected on the go, making it a great option for patients that travel.

Note: At the time of this webinar, the CaptionCall app is not yet available for iPhone or Android devices. 

Figure 2. CaptionCall Mobile for iPad.

Eligibility Requirements

To be eligible to receive the CaptionCall phone and the service, your patient must have:

1. A hearing loss that necessitates the use of a captioned telephone service.
2. An internet connection and a standard landline phone connection (or VOIP service).
3. A signed Professional Certification Form certifying the need for captions to use the phone effectively.

You may have patients with mild hearing loss that perceive a lot of difficulty on the telephone (e.g., older patients with poor word recognition). Conversely, you may have patients with severe hearing loss who think that they are able to hear great on the phone. Use your professional judgment to ascertain whether a patient would be a good candidate and would benefit from this service.

For the CaptionCall phone to work, the person most importantly must have an internet connection. The purpose of the internet connection is so that the captioning will be fast, with no delays. If you're talking to your patient and you're offering them the CaptionCall phone, ask them if they have internet. If they have a landline, we will utilize their existing phone number. If they don't have a landline, we will provide them with a landline at no cost. We will give that patient a landline phone number, and set them up with everything that goes along with it (e.g., voice mail, call forwarding and standard landline options). The landline is needed for CaptionCall, but if they don't have it, we will get them one at no cost.

The signed Professional Certification form is your certification that your patient has a legitimate need for captions to use the phone effectively, and that they qualify for CaptionCall based on their hearing needs. We want to install the phones for patients that will truly will derive benefit from them. The PDF form can be downloaded from our website (www.CaptionCall.com) under the "For Professionals" tab. The form can be submitted electronically (via email, fax or through Noah directly). Also, if you happen to have HearForm or some other office management systems, we do have an option to submit the Professional Certification form through some of those types of office management systems. Once you submit the form, our corporate office will call the patient within 24 to 48 hours to schedule their in-home installation within 10 days. If you're talking to the patient, tell them to expect a phone call from CaptionCall and to go ahead and schedule that appointment.

Qualified individuals can receive a CaptionCall phone at no cost with a certification form from a hearing care professional. There are no ongoing monthly fees or yearly fees for the captioning service. We don't collect any financial data on your patients at all. The only information that we have on your patients are the demographics included on that Professional Certification Form (name, address, phone number). Understandably, some patients are skeptical of our service. They may feel that if it's free, it must be too good to be true. There are a couple of things that you can use to reassure those patients. First, you can provide them with a CaptionCall brochure, which nicely spells out our funding source. If you don't have brochures, you can call our 1-800 number and have them shipped directly to your office, or talk to your regional account manager, if you have one. Using the brochure, you can explain to qualifying patients that every phone bill shows a tax labeled as "Federal Communications Commission." The amount may vary from state to state (in Florida, it's 22 cents). From every phone bill that you pay, that small amount of tax is deducted and goes to the FCC. The FCC is not only funding our program, but all of these programs that fall under the Americans with Disabilities Act. You can reassure your patients that they have already paid for this service through their taxpayer dollars.

Red Carpet Service

One thing that sets CaptionCall apart from other companies is our Red Carpet Service. CaptionCall strives to make using a CaptionCall phone at home a streamlined experience not only for you, the provider, but also for the patient as well. CaptionCall has hundreds of representatives across the country that offer free installation, free hands-on training, and free customer support. Many of your patients may need a little bit of "hand holding," and we are happy to walk them through everything, step-by-step. Our installers are background checked, drug screened and vetted. If you refer one of your patients to us, you can be confident in the fact that the installer is trustworthy.

We spend between one to two hours in the home, setting up the phone, going over all of the details. We ask the patient who they call on a regular basis, and we program all those numbers, including the hearing care provider's information, into their contact list. We'll set up the CaptionCall phone wherever they choose. That's why we offer wired or wireless installation. They may have an old-school computer that has "hard wired" internet, but they want the phone by their armchair in the next room. We will provide a wireless router at no charge. That way we can put the phone wherever they need it in the house, for their comfort and ease of use. We will provide them with an instructional booklet with big pictures and big words. That way after we leave should they forget something, it's always in there. If necessary, we can go back out and do re-instruction as needed, which sometimes happens.

Features

The CaptionCall phone has a speaker, because listening with two ears is better than one. Within the last couple of months, CaptionCall received a new certification called TIA-4953. That is a certification from an independent body indicating that we have the loudest captioning phone on the market, up to 58 dB of gain. You might have patients with profound hearing loss who want rhythm and intonation in speech, and not necessarily clarity. This is a great option for patients who want that volume.

We also have customizable audio. If you choose to submit the Professional Certification Form directly through Noah, you have the option of submitting the patient's audiogram for one ear or both ears. When you do that, the installer who goes into the home can input that customizable audiogram into the phone. It gives the patient a boost in the areas where they need it. 

One of the features I talked about earlier is the saved conversation feature. Patients can save any phone call, and go back later to re-read the text conversation. This comes in handy when a person needs to remember what was said in a prior conversation, such as directions or details about an upcoming appointment. One example where this proved useful was with an elderly woman who was receiving phone calls from someone trying to scam her. She had saved all of her conversations with this caller. Ultimately, through the saved conversations on her CaptionCall phone, authorities were able to identify and capture the culprit. As a result of this story, CaptionCall was featured in the Orlando Sentinel newspaper. 

Conclusion

CaptionCall was created by the founder of Sorenson Video Relay, the worldwide leader in video relay services for the deaf. That gentleman had a deaf brother, and he saw a need for improving the way he was able to communicate with his brother. He developed Sorenson Video Relay in a response to that need. Eventually, their work evolved into CaptionCall, as a way to help the hearing impaired communicate with ease and confidence. 

Hearing loss, if left untreated, has a significant impact on one's ability to stay connected. It makes face-to-face interactions difficult and using the telephone extremely frustrating. This often leads to loneliness and isolation, the precursors for many serious health issues. Everything we do at CaptionCall is a reflection of our mission statement: Helping people with hearing loss stay socially connected for a longer, happier, healthier life.

Feel free to reach out to CaptionCall if you have any questions, www.CaptionCall.com

Questions and Answers

How can we offer this to our patients? 

The wonderful thing is you don't have to be an expert in this, because that's why we are here. You have to be an expert in many other things, like your hearing aids, all their features and functions, and making the sale. If you're taking a patient's case history, there is a question that asks, "Do you have difficulty communicating on the phone?" If they check "yes", you can tell them about the CaptionCall phone. Just offer it to them like that. It doesn't have to be a complicated presentation. If you are a current CaptionCall provider, you may have a demo phone in your office that they can get their hands on to test it out. Be sure to tell them it's free, that an installer will set it up for them, and that it's easy to use.

Why offer the CaptionCall phone?

There are a lot of good reasons you would offer the phone, aside from the obvious reason that it helps your patient communicate better. There are multiple reasons that can be beneficial to your business. You can reduce the hearing aid return rate due to difficulties hearing on the phone. As stated earlier, difficulty hearing on the phone is the number two reason that patients return their hearing aids. Offering a CaptionCall phone can help reduce your return rate. Additionally, our product can help build customer loyalty. If you are providing another valuable service to your patient, something that your competitors are not offering, that is something that is going to set you apart. We like to think that our patients love us, and that they're automatically going to be loyal to us. However, sometimes price is a factor, and they'll go to a competitor because they can get a better price. If you are providing a valuable service for them, they're going to realize, "That's something that I use every day. My provider recommended CaptionCall." That association can help tie them to you.

The CaptionCall phone can also help drive new traffic through your doors. If one of your patients gets a CaptionCall phone, and one of their friends comes over for a visit, their friend may really like the phone and ask your patient where they got it. That friend could potentially be a new patient coming through your door. In order to certify them as eligible, what do you have to do? Give them a hearing test. That's an opportunity for you to drive some new referrals through your door by offering CaptionCall to your patients. You can ask your patients to refer their friends for CaptionCall. It's a softer way than asking, "Hey, do you have any friends that need hearing help?" In the back of the patient's mind, they're going to think that you are just trying to make a sale. If you phrase it such that you are asking them if they have any friends that would benefit from using this free CaptionCall phone, that is a softer approach to getting new patients through your door.

Finally, you can use it to generate new business. Let's say you're having a health fair or an open house. Bring your CaptionCall materials. Bring your CaptionCall phone. This product can be a pathway for a person who may not be ready for hearing aids, but who is interested in a free product that can benefit them now. That is still an option to get that patient through the door so you can get their information. They can meet you; they can come to your office; they can see you. Then, when they are ready, they're going to remember you.  

References

Gordon-Salant, S., & Callahan, J.S. (2009). The benefits of hearing aids and closed captioning for television viewing by older adults with hearing loss. Ear and Hearing, 30(4), 458-65. doi: 10.1097/AUD.0b013e3181a26ef4