 10.02 we gave stragglers a little bit of extra time to get here. I'd like to introduce myself in case there's anybody here who doesn't know me. I'm Ann Thomas and I'm the president of the HLAA Diabla Valley Chapter. I'd also like to introduce our other board members who are here today. Zoher Chiba is our vice president. Jill McFadden is our secretary. And Walt Bateman is our treasurer. Excuse me, can you have them say a word so we can see their picture? We can't see you. If you're saying you can't see people, what you need to do is click in the upper right hand corner, the grid that allows you to see everybody. No, Ann? Yep. What they were saying is when you were introducing them, they couldn't see who you were introducing. So if they said something, then their picture would show up. They know who that person would be. Okay, so we'll do it again. And so everybody's going to have to unmute yourself. So our vice president is Zoher Chiba. And Zoher, everybody wants you to say something so the yellow box goes around you. Hi, I'm Zoher Chiba. Welcome to the HLAA meeting. Our secretary is Jill McFadden. Good morning. Nice to see all of you. And our treasurer is Walt Bateman. I am Walt Bateman. I have a yellow box around me. Thanks, Walt. Okay, so we're very happy that everybody is here today and really, really, really excited to have Sherri Ebert's national advocate for all of us who has a blog with us today. Now, as we get started, the first thing that we want to do is make sure that everybody is comfortable using Zoom. The COVID virus is not going away anytime soon. And even after that happens, I'm pretty assured that we're going to keep using Zoom as a medium of communication because we can communicate with anybody all over the world. So we have directions on how to bring you up to speed quickly with Zoom on your desktop. So some of the things that we're going to talk about are turning on the captions, viewing the full transcript, using the chat window, and we request that everybody raise their hand for our Q&A. So for all of us, the most important thing probably is how to turn on the captions. And if you look to the bottom of your screen on the toolbar, you'll see what looks like that black box. And the item that says CC, and actually now it might say live transcript because Zoom keeps updating their toolbar. When you click on that, the CC, another window will open up. And in order to activate the captions on your side, you need to click on show subtitle. You can increase the size of the font that's used for the captions. And in that same window for the CC, the bottom one says subtitle settings. And once that opens up, there's a slider bar. And so most of us, I'm assuming, you're like me, like it larger rather than smaller. So please take advantage of that option. The next thing you can do is you can have a running transcript. So right now we have the default is that the captions are at the bottom of your screen. Well, you only get to see about one sentence or so of that. Well, if you turn on viewful transcript, another window will open up in the side, and it has a running transcript of everything that's being said in the meeting. So let's say something was said, and you know, the sentence is half over when all of a sudden you realize that you missed one of the key words. Well, if you have the viewful transcript open, you can easily look back to see what that connected to. We'd like to ask that you open the chat window. And the reason is, at an earlier time, if you didn't open the chat window, what used to always happen was if people chatted in there, the chat window would bump, pop up and down on top of where the captions were. Now we've left this here, even though Zoom has now made it so that if you click on that caption window, you can move it anywhere around the screen. So you can move actually move the captions, but it's a good idea just to open up the chat window anyway. Once you open it, you may have difficulty moving that chat window. If you do, there's another little window there at the top, and it's the picture that's on this slide, and see the downward facing carrot? If you click on that, it'll give you an option to pop out the window, and when you do that, you'll be able to move the chat window anywhere. We'd like to let you know to feel free to use the chat to ask technical questions. We'd like, or even to chat with somebody else who's here, we'd like that you identify yourself by your name and your chapter name or location. So people have some idea who you are, because I already know I see other people who are here today who aren't from our chapter. Some of them are from Wisconsin and other places. So at the moment, there are two options that are available to raise your hand, and it depends on which version of Zoom that you happen to have on your computer. If you've updated, and we always recommend that every person update as soon as possible, so that you have the latest features. So what happened in the latest version of Zoom is that they moved where the raise your hand feature is. It's now in reactions, and when you click on reactions, you'll be given an option at the bottom to raise your hand. And if you look at Barbara Bottomley's thumbnail right now, she has her hand raised. So Barbara, I am assuming you were just trying that and you're not. I've lowered it. Okay. I'm assuming that you weren't really asking a question. And if by something happens, you're able to lower your hand also. So after you've asked your question, the old raised hand feature is in participants, and it will look something like this. When you click on the participants in the bottom left hand corner is there a hand, and you just click on the hand. Now this is a feature that is very helpful for everyone so that they can see the presenter as well as the presentation that's happening. So in the middle of your screen there, there are some lines that run like three up and down. Maybe it's only two up and down lines. You can drag that side to side. And so then you're able to make the thumbnail of the presenter and the presentation to your liking. We'd like to remind everybody to speak a little slower than normal. It helps our captioner be able to caption the most accurately they possibly can. And it also helps all of us be able to understand easier. If you happen to have an external microphone, we'd like to ask that you please use it for either this virtual meeting, or if it's inconvenient to get it for this one, make sure to think about it ahead of time because it increases the clarity for everybody. And of course, you know, that's what we all want, right? Clarity. We want to be able to understand that. So now I'd like to introduce Sherri Ebertz. Oh, before I do that, does anybody have any questions? Okay, I'd like to introduce Sherri Ebertz. And she's a hearing health care advocate writer and a blogger. She's also an HLAA board member. And she's currently one of the editors of the Hearing Health and Technology Matters. If I call that a blog or a column? I think a column. Okay. And almost everybody knows Sherri, and if you are not signed up for her blog yet, I will send out an email later. And she's absolutely wonderful. So Sherri, it's all yours. Take it away. All right, excellent. Well, thank you, Anne, for that nice introduction and very excellent Zoom instructions. I am impressed with that. So I am excited to be here with all of you today. It's great to see some familiar faces. And I am from New York City, so I tend to speed up as I talk. So I'm going to do my best to keep my pace at a good pace, but feel free to interrupt me if I speed up. So my first challenge is to share my screen. And I'm going to stop your screen sharing and put my screen on here. Okay, great. And can everybody see that? Okay. Actually, okay, good. Yeah. So we've got that down. So that's good. So the topic of my talk today is patient, the patient perspective on person-centered care in audiology. And I give this talk a lot to groups of audiologists. So I can share the patient perspective that they seem to not understand as much as we always hope. But today, we're going to focus on what we as people with hearing loss need to understand about person-centered care so that we can get the most out of our audiologist care. And I thought what I would do is share a little bit of my story first because I always feel like it's great to just learn more about each other and our individual journeys because each of us has such a unique journey. And my hearing loss story started when I was in my mid-20s. I was a graduate student and pretty quickly into the first semester, I started to miss things in class. It was a comment that someone made as an aside or under one's breath. And sometimes the whole class would just burst out laughing. And I'd be left looking around the room trying to figure out what was so funny. And I'm sure everyone on this call has had that experience in one way, shape or form. And I knew what the problem was. I was losing my hearing. My father had developed hearing loss as a young adult. And his mother had as well. I had been hoping that it was going to skip my generation, but obviously no such look. And I felt like I was entering a path from which there was no escape and one that had really destroyed my father's happiness. And I remember being just so scared at that time. I remember my father at a family event one time just sort of sitting off in the distance and his back was, you know, to the festivities. And when I asked him why was he sitting all alone by himself, he said, if people want to talk to me, they know where to find me. And as a child, I didn't think too much about it. I thought, okay, maybe he's shy or he's not feeling well today. But once I developed hearing loss, I understood the truth. And he probably couldn't hear in that space with all the background noise. And he was just too exhausted to keep trying. And knowing how stigmatized he was by his hearing loss, I imagine he was worried that others were going to discover his secret as well. And I'm not sure it was such a secret anyway, but to him keeping his hearing loss a secret was very, very important. So my experiences with my father were really impacting how I felt about my hearing loss and how I felt about hearing aids and getting hearing aids. And I knew that I needed them. But I really was not excited about it. And once I did get them, I hated wearing them. And I avoided wearing them as much as possible. I remember at work, I would kind of sneak them in, you know, before important meetings, and then I would rip them out as quickly as possible afterwards. And I never wore them at home, socially. And I was really following in my father's footsteps just embarrassment and shame and isolation. But then I had children of my own. And everything really changed for me. Because my hearing loss is genetic, I worried that I might have passed it on to them. And I saw them watching me, hiding my hearing loss and laughing at jokes that I hadn't heard and being embarrassed by it. And I saw that I was passing on this same cycle of stigma and I knew something had to change. And so I just kind of went cold turkey and decided I was going to accept my hearing loss. I started wearing my hearing aids all the time. And I started working to educate myself, as well as my family and my friends about how they could help me hear them better. I started requesting quieter tables and using hearing loops and caption readers at the movies and doing all the things that we talk about as important self advocacy tools. And I met other people with hearing loss through hearing loss association of America. And that was just such a huge turning point for me in terms of seeing others doing such a wonderful job living with their hearing loss that it gave me confidence that I could do the same. And now I still see my children watching me. But this time, they're learning the self advocacy tools that they'll need if they develop any hearing issues themselves. And through my advocacy work, I hope that I can help others to live more comfortably with their own hearing issues like I had to learn to do. Okay, so let's turn to person centered care. And this is a topic that I guess, you know, sounds maybe a little technical and something that, you know, audiologists or doctors should worry about. But why is it important for us that people with hearing loss to understand what it is and how to look for it? And there really are many reasons for that. The first is that it helps us to be an educated consumer. The more that we know about what to expect from our care, the better we'll be at making sure that we get it. And we all have to remember that we deserve quality care and our expectations should be high that we're going to get it. Secondly, it teaches us what to look for in a good audiologist. And I hear stories from many of my hearing loss friends how their audiologists don't seem to listen or to care about their needs as much as they really would hope. And this is not acceptable. And if we know that, then we can feel comfortable taking action to make sure that we're getting the care that we deserve. And the third reason is that it puts us in charge of our own care. An audiologist that practices person-centered care is really going to partner with you in your care about your hearing. And I find this very empowering. And I think it increases the chances that we're going to receive the best advice that we need to navigate our specific challenges. And I think this part is even more important during the pandemic because many of us had to really step up and take a lot more responsibility for our own hearing and for our own ability to hear in challenging situations. And we always had that audiologist as our partner. But I think that we had to learn to rely on ourselves a little bit more. And that's an important empowerment piece that I hope we carry forward in our relationships with our audiologists going forward. And that's an important part of person-centered care is to have that two-way dialogue and take some of that responsibility on for yourself. So what is person-centered care? So person-centered care is about focusing care on the needs of the person, of the individual rather than focusing on a product. And it ensures that people's preferences, needs, and values guide clinical decisions and that prescribed care is respectful and responsive to each person's needs. And this approach applies to all types of medical care. So you may have heard that term used in many different contexts. But when I give my talks to audiologists, I really discuss four main parts of person-centered care as it applies to audiology. And I'll just list these four here now and then we'll go into more detail about each one. The first is to partner with your patient. And this means that each person's hearing loss journey is unique. So a one-size-fits-all approach is not going to work. And it's their job to focus on what's important to the individual person with hearing loss so that they can be most satisfied with their care. The second is to make your office hearing loss friendly. And I urge audiologists to remember that we are there because we have trouble hearing. And sometimes it feels like they or their staff have put that aside. So I feel like this is a very important part of person-centered care. Third is to embrace creativity. And I find audiologists sometimes get trapped in a hearing aid-only approach. And this is not truly effective as many of us know on this call. Linking aids to other assistive listening devices gives us greater access in a wider variety of situations. And then fourth is to think beyond the technology. So I always encourage audiologists to teach people with hearing loss best practices for communication that they can share with their family and their friends. And I find that sometimes small changes in behavior alone can have just as much benefit as some of the technology fixes. So let's talk about each one of these in more detail. Okay. So first is partner with your patient. And I want to share just a little case study with you that I think will demonstrate the importance of this piece of it. So it was my second trip to see an audiologist. And I remember my name was called and I kind of jumped. And I was there to get my hearing tested again. It wasn't the first time but I knew that my hearing problems had gotten worse. And so this time it was likely that they were going to recommend hearing aids. And thinking back to my story about my father, obviously I did not want them. But I knew that it was time. And at that time I didn't know very much about hearing loss or the different types of hearing aids that were available. And I had never heard of a assistive listening devices or best practice communication tips. So I expected them to ask me a lot of questions about where and when I had trouble hearing. But the conversation really centered on the hearing aids. Did I want them to look a certain way? What was my budget? What programs did I want? I didn't even know what programs were frankly. But these were the types of questions that I was getting. So I walked in very scared, impressionable, and really looking for help. And I walked out feeling a little bit the same way although I had a pair of hearing aids on order. So it was a successful visit I think for my audiologist but maybe not so much for me. And once my hearing aids arrived I had little motivation to wear them and a limited understanding of other things I could do to help my chances of better communication. And all of this I think could have been avoided if my audiologist had practiced person-centered care especially this first tenant. So let's talk about why partnering with your patient is so important. And hopefully some of the reasons for this are obvious. Each person's hearing loss is unique. I shared my story. I'm sure if everyone on this call shared their story it would be slightly or even vastly different from each other's. You know some people have had hearing loss since they were born. Others developed it in adulthood. And the severity can vary widely as well as the curve of the audiogram. And some people are strong lip readers even without realizing it while others are not. And just like in the regular population our lifestyles differ as well. So some of us may need to communicate more with people at work. Others are retired or work independently and you know may need just captioned telephones and things like that. Some of us are more into music or theater. So again each of us is a unique individual and so a one-size-approach is not going to fix everyone's hearing problems. And while patient characteristics differ widely many of us share some of those same feelings about hearing loss. Fear and anger or frustration and taking time to really listen and understand each person's journey and story is going to show compassion and respect for the individual. And they will also learn very important details about our lifestyle and our hearing goals. And when they combine this information with analytical tools like audiograms and speech and noise tests they can tailor their technology recommendations to our specific needs. And that's what person-centered care is really all about. So how do you know if your audiologist is following this part of person-centered care? So what should you look for? And the first thing really is it do they ask for your input? So the best ones will have you prepare especially for a first appointment but really all their appointments all your appointments you should have some prep work to do ahead of time. And sometimes they can ask you to fill out a questionnaire that will identify your most challenging communication problems and maybe the top three situations where you desire improvement. And if they don't ask you how are they going to know where it is that you need help? The second is that they listen to your priorities in addition to the test results. And again I'm the audiogram and these other tests are very very important so I'm not saying that they aren't important they are but they don't reveal the outside factors like a person's work environment or what coping strategies we're already using. So make sure that they're focusing on your individual situations not what worked for other people with similar test results. The third thing to look for is if you're building your treatment plan together and this is where really that empowerment piece comes in that I think we have all you know been forced to develop during this pandemic which I think is actually hopefully a positive for our care in the future. And humans nature just you know suggests that when you're involved in creating a plan you're going to be more likely to support its goals and implement it. So when you build a treatment plan together it really increases your motivation I find to take the steps that are needed. The fourth thing to look for is if they are empathizing with your journey. So I think that respect and compassion are just critical pieces of developing trust and rapport so make sure that your audiologist is taking the time to know you and what communication situations are most important to you and frankly this is just smart business for them because the happier you are with their care the more likely you are to recommend their services to a friend. The fifth thing to look for in terms of partnering with your patient is if they include your family. I think family engagement is critical you know obviously your family is your most important support network and they need to be informed about your hearing issues so they know how to help. And sometimes unfortunately family members can be skeptical I think being you're just ignoring them or you know maybe you're not trying your heart hard enough to hear but learning about your difficulties from an expert like an audiologist can really nip some of those feelings in the bud. And plus your audiologist I think gains a lot because they'll be able to learn directly from your most common communication partners what challenges you really are having. Okay so let's move on to the next segment which is to make your office hearing loss friendly and so I have another case study example for this one. So this time it was my tinnitus that was flaring up and I wanted to get a doctor's opinion about it so I made an appointment with an ENT and I arrived at the office early like I always do you know just to make sure that you know I can hear and then make sure I scope out the situation and the trouble really started almost immediately. I remember leaning over the receptionist desk and just trying to understand what she was mumbling into her computer. I didn't know if I was supposed to take a seat or fill out forms or if she was even talking to me you know I wasn't sure but I was very disappointed and surprised. This was a doctor's office that specialized in auditory issues and my appointment was to see the doctor and have my hearing tested by an audiologist so I had expected them to understand my communication challenges and unfortunately checking out was more of the same you know the receptionist continued kind of whispering into her computer even though I told her I could not hear what she was saying and I remember just feeling embarrassed and exhausted and really disrespected and I never went back to that doctor or that office again. So why is their office important and this is an aspect I think of person-centered care that is really very commonly overlooked by audiologists and the ones when I do my talks with them that they're always like giving me the most pushback which I think is is sort of strange because these are some of the easiest things I think to implement and it's also an aspect of person-centered care that you'll be able to tell right away when you walk in whether they're doing it or not and when your audiologist's office is hearing loss friendly you'll feel respected and understood right away and it will also show that they emphasize with your communication challenges and give you confidence that they understand things about assistive listening devices in addition to the hearing aids that you'll need. So these are the things that you should look for and I think it starts right away with making the appointment so using the phone can definitely be challenging for many people with hearing loss I think especially at the beginning of their experience. So they need to really train their receptionist to speak slowly and clearly especially when talking on the phone and even better if you're allowed to make or confirm or change an appointment by email or using an online system then we can just avoid that whole issue entirely. The second thing to look for is a quiet and well-lit office. As we all know background noise is very uncomfortable for some people with hearing loss and it makes it harder to hear so using carpet and other sound absorbing materials will minimize sound and just show that they care about your ability to hear and a well-lit office obviously will help with lip reading. Third is to look for relevant literature in the waiting room. So look if they have information and brochures from local hearing loss support groups and if they recommend that you seek one out they should subscribe to relevant magazines like Hearing Life which is published by HLAA as we all know and magazines show us, magazines like this show us that we're not alone with our struggles which I personally find very helpful. Fourth is that they follow hearing loss friendly office procedures. So we all know the situation of going to a doctor's office and waiting to hear our name called and it can be very stressful because sometimes you don't hear your name so you're kind of sitting there you know at alert at attention for you know the time that that you're waiting and I think in an audiologist office they can do it differently so they should alert you personally when it's your time to go in and see the audiologist and even in a small office you know we might have difficulty hearing our name being called so maybe a tap on the arm is all that's needed or they can send you a text you know now we're not allowed to touch each other but they can text you that it's your turn to go in and in today's COVID world maybe that means something different if you're doing a telehealth appointment it means making sure that there are captions available or making sure that they are wearing a clear mask for all in-person visits and if they have a TV in the waiting room then the captions are on so these are all small things but very easy to implement. The fifth part of this is to make sure that important information is supplied in writing and I know for me and I'm sure many of you you know sometimes we miss important details about our care but maybe we're just too tired or embarrassed to ask for a repeat and so the best audiologists will provide a summary of your visit in writing and this would include test results maybe a list of recommended action items or recommended devices or assistive listening devices and this way you can easily share it with your family and you can refer back to it if you have questions after the appointment and then the last piece of it is an easy and stress-free checkout so this is the final touch point of the visit where you're going to pay or you're going to make your next appointment and for this to go smoothly your audiologist should present all financial details in writing so that you can review them clearly and without worry and even better is if the reception desk is looped or has other hearing assistance available it's an opportunity not only for you to have good communication but for you to check out some of those new technologies. Alright so we are up to number three embrace creativity and I've got another case study for you but I'm just going to take a little sip of water for a second okay so embrace creativity so I love my hearing aids now thank goodness after my rocky start and obviously I wear them all the time and they help me hear better everywhere I go at home at work with friends and family but you know sometimes hearing aids are not enough until other assistance is needed like when I used to go to the movies and I would get those caption readers to put you know into the little cup holder or I would use a hearing loop at the theater or more recently I have you know my speech to text apps that I can use for zoom when we're not lucky enough to have captions but in many situations you know these assistive listening devices are big help but when I ask my audiologist about them I don't get a lot of information and you know they might suggest that I use a different program on my hearing aid or I adjust the volume but rarely do I get more creative solutions most of the innovations that I use today I learned from other people with hearing loss or from experimenting on my own and I think this is just a huge huge missed opportunity for audiologists they could diversify their practice and it's also an easy way to increase patient satisfaction and you know I think the pandemic has showed us how important it is for creative solutions to be implemented okay so why is it important and you know really there's no excuse not to be creative anymore the only constant in technology and patient care is change and so that really means that audiologists need to be creative and stay up with the times and like I said COVID-19 I think has really highlighted this how important you know creativity really is in an audiologist as new listening situations came to light for example talking to people with face masks audiologists can't just prescribe the same old solutions they don't work and I think it's been encouraging to see that a lot of audiologists have been have been programming something called a mask program into hearing aids so I don't know if you all have that in your hearing aids but a mask program will boost that the high pitches which are the pitches that are most often muffled by some of the the masks so if you haven't heard about that we can talk about it more in the Q&A but I would encourage you to ask your audiologists about a mask program but so that's a great example of how creativity can really help us in the moment in a new situation as it arrives and being creative is hard but I think it also demonstrates real caring and a real focus on world world issues and that's what that's what we want okay so what should you look for and on this one I think I'm a little bit of a broken record but I think it's important to reiterate that they need to embrace assistive listening technology hearing aids are great and I love my hearing aids but sometimes they are not enough in all situations so the best audiologists will suggest a variety of assistive listening technologies depending on the situation and some of these like Roger Penns will be made by traditional manufacturers but other of them might be direct consumer devices or hearables or even apps and so that leads me to the second one that you should be looking for is that they share their favorite apps and innovations maybe they keep a portable hearing loop at the reception desk like we were talking about and this not only helps with checking patients in and out but it lets you try it and it can be used to demonstrate that functionality very easily maybe they use a corner of the waiting area to highlight tv connectivity tools or caption telephones or even just apps like otter or live transcribe these are the things that really can make a difference for people living with hearing loss day to day the third thing is to promote tea coil technology and I know that tea coils are not new but many audiologists still do not make patients aware of this very useful technology and they really should since tea coils can be life changing for many hearing aid wearers and I think more so especially as looping systems are becoming more prevalent globally and I know we have on this call at least one if not more big hearing loop advocates so thank you for all the work that you're doing on that front the next thing is that they encourage us to use accommodations when we're out and about so the first time that I ever saw a cart and many of my hearing loss friends the first time we ever heard about it or saw it was at a chapter meeting and this happened well years into my hearing loss journey and this really should not be the case I think the best audiologists must educate us about this life changing technology and others that we can request when we're out and about and the more that these technologies get used the more common they will become so it's very important that audiologists are committed to this as much as we are and the last thing is that they are willing to teach so the best audiologists are not only experts in hearing aids they are also counselors and teachers and as technology changes you know they must be willing to stay current for themselves but also so that they can teach us the things that we need to know as technology is changing we all know it can be very complicated and and it's great to have a guide to the the best and newest technologies okay so as much as technology is important the fourth aspect is making sure that our audiologists also think beyond the technology and I have one last case study example so my poor family because I know that I sound like a broken record right please face me when you're talking to me let me sit in the corner so I can avoid the background noise and the list goes you know on and on and while hearing aids and other assistive listening devices provide significant help communication best practices are also critical both for the people with hearing loss and their communication partners and for years I was really unaware of many of these tricks so you know my conversations with family and friends would sometimes feel a little bit stilted since I would only hear part of the conversation and I'm sure that's what my father was experiencing you know all those years ago sitting by himself at the table you know I would often try to fake it or use context clues to keep the dialogue going but as we all know that is just exhausting and really unsatisfying for both sides and sometimes I would just you know withdraw in defeat but over time I learned tips and tricks for my hearing loss friends or through trial and error but I still wonder you know why I didn't learn them from my audiologist at the very start of my hearing loss journey person-centered care and especially thinking beyond the technology could have prevented years of unsatisfying conversations with loved ones and it just makes me sad to think of that missed opportunity okay so why is thinking beyond the technology so important so for most of us when we were first starting off struggling with our hearing loss the audiologist is the first person that we call and while using communication best practices probably seems obvious to us now yes I know I have to tell everyone to face me and to not cover their mouth but these things were not obvious to me or my family and I think not too many people who are new to hearing loss but utilizing them can really turn many a frustrating listening situation into something that's productive and when our audiologist thinks beyond the technology we develop a wider array of tools to use to achieve our communication goals and this of course is the primary purpose of person-centered care so what should you be looking for okay well the first thing obviously is that your audiologist shares these best practice communication tips with you and you can share them with your communication partners to help them understand the ground rules for good communications I think the best audiologist will give them to you in a written list so that you can hand them out and share them very easily with your friends and family and we all know now that these include things like getting the person's attention first letting them know the context if the subject is changing speaking in a clear and steady manner and again you know these may seem obvious now but they probably were not to you and they may not beat other people at the beginning of their journey the second thing is that they teach you to be a better listener and so communication we all know is a two-way street and many of the communication best practices we rely on are communication partners to make the accommodations but there are things that we as people with hearing loss should be doing as well examples of this are scheduling important meetings for the morning when we're freshest with our hearing I always find that I hear better in the morning because I haven't had a whole day of listening to get my brain exhausted I think it's also important to make sure that we ask for what we need in a very specific way and our audiologists can help us to learn how to do that and I think it's also important for us to stay up to date on news and happenings so that when we hear a name in conversation it may not be the first time that we've heard it I find it's always hard to follow a name of a new movie or a new actor or a new political figure if I haven't read about it beforehand the next thing is is that they should help us manage our hearing loss exhaustion so I know I feel exhausted at the end of a long day of listening and I'm sure many of you do as well and I wish my audiologist had warned me about this and only by comparing with other people with hearing loss did I realize that this was normal and that I needed to learn how to pace myself to maintain my energy throughout the day the fourth thing is that they should promote self-advocacy skills so excuse me I'm sorry it's so cold here in New York it's like very damaging oh the vocal cords okay so the fourth thing is that they promote self-advocacy skills excuse me so we have to learn to ask for the assistance that we need from our communication partners and this can definitely be tricky at first but I think our audiologists can empower us by teaching us ways to do that and this can include setting ground rules for conversations up front or using non-verbal cues like just you know placing your hand behind your ear I find is a really good way to let a speaker know that you're having trouble hearing that person and it's a way to sort of get them to raise their voice and their loudness level but not interrupt the flow of the conversation the fifth thing is that they should really encourage us to use caption readers hearing loops and other accommodations and ask for captioning at webinars and other online events and the more that these types of devices are requested and utilized in public spaces the more commonplace they will come become and the more that we as a group demand captions the more that they will become the new norm and I certainly hope that as we emerge from the pandemic the the captioning that we have come to request will become more and more commonplace many of you my or some of you might know that I have been advocating for free asr captions on zoom for people with hearing loss so I appreciate all the the support on that and thank you for sharing the petition and signing the petition and I could put that in the chat if you haven't had the opportunity but captioning can make all the difference as we know today without captions we would not be able to enjoy visiting with each other on zoom as easily and cart is great for a presentation but I think that on one-on-one small conversation sometimes cart is not financially possible and that zoom should be providing an opportunity for everyone with hearing loss to have asr captioning so we will continue that fight I'm meeting with their chief product officer next week and so I'm hoping that I will be able to make the case strongly so you know wish me luck and fingers crossed okay and the last thing is that your audiologist thinking beyond the technology should recommend hearing loss support groups and for me meeting other people with hearing loss um just helped me build my confidence and it really helped me overcome my feelings of stigma and like I've said before I learned so many of the tips the tips and the tricks that I use today to navigate my life from other people with hearing loss and so I only wish I had learned about the joys of hearing loss peers sooner okay so person-centered care sounds great doesn't it and it seems like this would be fairly simple for audiologists to implement so let's just talk a little bit about why this doesn't happen at every appointment and there are several barriers and these are a lot of the things that when I make this presentation to audiologist groups they will say yes but and these are some of the things that they that they mentioned so the first is that there's not enough time in the appointment so audiologists worry that they won't have the time to do all the tests that they need to do if they get caught up in extended conversations with their patients and you know I think this is a valid consideration when they have you know stacks of patients lining up at the door but I think it's one that's easily resolved by asking patients to do a little bit of homework either filling out questionnaires in advance or at least taking the time to think about their hearing goals ahead of time so that the conversations in the office are more efficient. The second thing is that for a lot of people emotional discussions can make people uncomfortable and sometimes when we're talking about our hearing loss it can be very frustrating and sometimes it can be sad and I think that audiologists are just not used to dealing with these emotional discussions so more training on counseling is probably needed both as a part of the initial audiology degree but also as continuing education. The third thing that I hear is that you know well my patients have always done fine without it so you know many audiologists have been practicing for many many years before person centered care thinking really became more common and it's hard to teach an old dog new tricks especially if they think that their patients have always done fine without it in the past but I would remind them that the standard of care is always changing and evolving and that they must keep up and I think stellar person centered care is also a way for them to set themselves apart from their competition. The fourth thing that they often push back on is that selling hearing aids is their livelihood and so current pricing models where the cost of the follow-up care is included in the price of the hearing aid keeps audiologists really focused on selling rather than on counseling. Unbundling the fees would allow audiologists to charge separately for rehabilitation and counseling and those are the things that you know are really important to us in addition to the hearing aids and it would also simplify the pricing of the devices so we would have a better understanding of okay this is what I'm paying for the actual hearing aids and this is what I'm paying for all the audiologists time and the counseling services so I'm really hoping that unbundling of these fees is something that will become more common in the future and the last barrier really is you know a barrier to almost everything which is that change is hard and we all know that um I think person centered care is touched upon in many audiology programs but the primary focus of their training is really centered on the devices and on the testing and the audiogram and this is changing slowly um but I think it's up to us to help accelerate that change by demanding that person centered care is used by our hearing care professionals and hopefully now that you know what to look for you can help support the ones that are doing it well and encourage those that aren't that they need to catch up so that is what I was hoping to share with you today and thank you for your attention this is how you can connect with me you can see my website where my blog is and my email and my social media and you know I always love to hear from people with hearing loss so don't be shy to connect with me and with that I will stop sharing my screen and I'm happy to take any questions or hear any of your comments so I'll turn it back to you and for that part unless you do you want me to do the questioning that's fine too okay I see sherry sherry perisole has a question hi sherry hello um thank you sherry for this excellent presentation I can't begin to say how much you've done to educate the industry and to bring about change and to an awareness so your advocacy has just been outstanding and amazing and in so I just like to thank you for that and then the next thing is everything that you've said is just really resonated with me and I I'm actually not sure even where to begin in terms of commenting or asking questions but one thing that kind of came to me through this whole process is that you know like you my hearing loss is genetic and it really became obvious in my young adult years and so for me I have worn hearing aids for over 40 years and during that time I've seen a lot of change in the industry and seen a lot of transmission and I think you know it's interesting that I almost feel like I received a better quality of care back in the 1970s the early 80s than what I'm receiving than what I have received during this transition period because I think at that time there was much less emphasis on what the technology could do I think that the um professionals realize that the limitations of the hearing aids much more so than they do today and you mentioned that they seem to be the end all let me get you a hearing aid and you're going to be fine and and so I think you know what you're saying is I'm seeing that today's professionals many of them don't do but they did way back when and I think way back when they were much more eager to say go out and join the hearing loss support groups and today they seem to want to be they want to own that whole piece rather than sharing that and I think it's just a transition of how do we get there so I don't really have any like well questions other than how can we maybe clone you and get you into every audiologist office that that exists I mean how do we get that message out so thank you no thank you for that perspective and I think that's so interesting that the industry has evolved in the wrong way because of that focus on the hearing aid and I think also the fact that hearing aid companies have consolidated and they have a lot of power in the industry and a lot of them are actually buying up audiology offices so you find that audiologists are getting loans or other financial assistance from hearing aid companies and so that's why you see some audiologists are only selling maybe one or two brands but I'm hoping that with the over the counter market starting you know hopefully as the FDA gets some of their guidelines published and some of the companies can get their products out there I'm hoping that that's going to start turning the tide a little bit because I think that you know while those products might not work for many of us on this call if our hearing loss is not mild to moderate it's still going to create a lot of new energy around hearing and around hearing care and I feel like it's a way for audiologists to not be so focused on the devices they sell but maybe learning how to assist patients with other devices that they may purchase in other locations and so again maybe it comes back to that unbundling of those fees if they have a different financial model if they are getting a benefit from providing that counseling again once again perhaps I'll start to do that more so thank you Sherry for bringing that up because it's just such an interesting transition for the industry and I'm hoping that the trends will be going back the other way the other thing I'd mention is Ida Institute if you are not familiar with Ida Institute it's a nonprofit based in Denmark and they are all about person centered care and they hold workshops and trainings for audiologists and really trying to teach audiologists about person centered care and how to implement it so we have a very strong partner on our side as well thank you a minute Chatterjee you're next okay and I'm here I'm here so I type my questions in the chat window I'm going to read from what I typed okay I would like to and I said the 1043 mark in the chat window so I wrote I would like to hear more about the mask option that some hearing aids have and I have three questions question one which are the hearing aids that have the mask option two does this mask option need to be programmed and set by the audiologist or is it pre-programmed into these hearing aids and three also some general information about this mask option two please thank you absolutely and I love this mask option because it's just so creative and it really was something in the moment that we needed and audiologists figured out how to do it so my understanding is that it's available on many different hearing aid brands but that the audiologist does need to program it and set it up into your hearing aids so for some hearing aid brands they can do that remotely so you could do a telehealth appointment and they can figure out how to connect to your hearing aids without being in that same location and they can load that program on to you and by understanding of what it does is you all know that the face masks obviously take away are the lip reading cues but they also dampen the sound and different types of masks dampen the sound to different degrees actually the clear masks which help the most with lip reading are the worst in terms of dampening the sound so it's sort of a trade-off you know I find for people who use maybe more of their residual hearing versus the lip reading the clear mask can sometimes make it harder but for people who are relying more on the lip reading than they're a lifesaver it's a it's just a challenge with the masks all around but you would need to speak to your audiologist specifically about getting a program placed on your specific hearing aid it's it's more a programming issue than a type of hearing aid issue so if I if I ask my god one second sherry so are you suggesting that the mask program replaces one of the potential programs in your hearing aids um I don't know if it would have to replace it it couldn't it be an additional program if there was a limit to the number of programs then I guess each individual could make a choice you know maybe they're not using the restaurant program currently because you know we're not going out to the restaurants but that the mask program might be more important and then you know when things open up they could switch it back but I don't know that it's an either or it's just an additional program I think that you can add and so all you'd have to do is just switch that program when you're out and about and speaking to people with masks and I think it's it's provided some assistance to to people it's not gonna it's not gonna solve the problem but hopefully it will give a little bit extra boost to those high frequencies if the mask is blocking so if I speak to my audiologist and ask about the mask option will my audiologist know what I'm talking about or do I need to educate my audiologist about this and how do I educate myself about the programming for this mask option right yeah that's a great question I you know some audiologists probably know about it and some audiologists don't there has been a number of articles written about it on hearingtracker.com I can try and follow up and maybe and I can find one and send it to you so you can give it to the group and that way you would just need to explain it or maybe show that article to your audiologist and I don't think it's you know I'm not an audiologist but it seems to me that it wouldn't be that you know complicated of a plan right of a program it would just be sort of boosting up some of those pitches that are masked by the mask. Becadod you're next. Thank you. Please unmute yourself. Who's next? You. Okay great sorry my son is being very distracting. Shari thank you so much I loved your presentation and I only wish I could find the kind of audiologist you're describing I've been to probably five or six in my life since I've known that I've had my hearing loss for 20 about 22 years and I've never found anything close to what you're describing so it's so great for all of us to have this information but it seems like audiologists need to have it even more so it's like a utopia that you're describing that I would love to find I really honestly haven't found an audiologist that provides even 50 percent of what you've described so yeah I guess I would just second maybe what the first person said like where do you find this you know how how can we how can we get the message out and I guess like a lot of health care in America the problem is that it's for profit so it's just I find it very hard to trust I've had the audiologist disappear without any notice and the office doesn't have any information about them and won't provide any sort of forwarding information and then um they I don't know really why they disappear um but anyway it's just been a little bit hard I guess for for from the experiences I've had with them to feel that I can really trust them and I do find that most of the time they have hearing aids in stock that they want to sell that aren't necessarily those the ones that they're trying to promote rather than listening to your unique situation and what your hearing needs are right now it's very frustrating and that's why I am I try to speak as as um at many audiology conferences it's been harder to do a lot of them have been canceled recently but I think it's so important for all of us as advocates to really take our message to the audiology community because I think that I do think that you know the vast majority of them are trying to do their best you know I think there are a lot of financial implications and it's it's very hard to be an audiologist I mean a lot of the things that they are trying to do and a lot of the things in person centered care not necessarily covered by insurance and so it's really asking that patient to pay for these counseling services out of pocket which I guess it's a hard thing to do since we've all been trained that the cost of those services is free once we buy the hearing aid and nothing is free it's just that it's all been put together so I feel like if there could be some kind of change in the way the pricing and the business model works they would have different incentives and so hopefully those incentives would be beneficial for for all of us the other thing I was thinking while you were talking is how do you find an audiologist like this right because it's it's hard to do and I think there two ways that I can suggest and the first is really you know through HLAA is to share with one another right and to create that peer support and that peer information if somebody has an audiologist that they're really happy with scream it from the you know rafters and let other people know about it and the other thing is that Ida Institute is trying to has created a program called inspired by Ida and it's IDA and what they're doing is having audiologists go through a training program and then once they've completed that training they get a little sticker like a you know a certificate that says they are an inspired by Ida audiologist and so it's it's a small program now it's growing but you know maybe you would get lucky and have an audiologist in your area that has gone through that training program and the other thing is that you know now with telemedicine you know perhaps audiologists won't be as limited by their local market and if there are some audiologists that are very very strong perhaps they can do at least some of that care you know over zoom with captioning or google meet or something like that Julie Olson okay I think I unmuted myself um I've been around so long that I have so much history and I thoroughly enjoyed your presentation cherry and you and I are like mirror images with our experience it's just fascinating to hear more about you I hope I get to meet you personally sometime but I wanted to share a couple of things that go way back to my time on the national board which was in the 80s and 90s and the audiology profession at during those years up until a certain year and I cannot tell you which one it was was not allowed to sell hearing aids they were only allowed to prescribe them and they came to us and they wanted change and they wanted to be able to prescribe hearing aids they also wanted the doctorate degree to be their entry level into the profession and you know we had a lot to think about because we also know that rural areas did not have enough audiologists and people were not being served so to limit you know to limit the participation in the educational process of becoming an audiologist was kind of unnerving but after a lot of discussion one of the things we came to was we could support this if they included counseling as part of their training and not just a class but a big portion of it and the argument coming from them was always about time but it also came back from them as saying well if we can be doctors we will be able to get insurance covered and I think that was probably the key factor in HLAA which was SHHH then coming back and saying well if you get the counseling and you can get insurance coverage the profession will grow because more people will get hearing aids but this is I mean this is ancient history this goes back to the 90s and we are still facing and fighting so many of the same battles and you know just the fact that hearing loss is so prevalent and yet such a small percentage of people have hearing aids and so many people need them and we know the reasons for that and one other thing I just one last statement when you made your comment about the comments the barriers that you were getting from the audiologist and I've done quite a few presentations too over the past those same five things are exactly the same things that I heard I mean and I'm in the business to sell hearing aids I don't want to change my patients don't need that your hearing loss is worse than most of my patients and they don't need what you need that is the same kind of stuff somehow we need to break that barrier and get in and talk to more of them and let them know we really we know what we're talking about because we do that's enough thank you for letting me speak I am dealing with five degree below zero temperature here in Wisconsin I've got my fleece on thanks Julie that's like Geneva Ralph hello everybody Geneva up in Eugene Oregon um Sherry this is so frustrating and I'm I don't have hearing loss but my background is actually special ed so coming from IEPs individualized education plans you start from a student centered perspective and I don't understand this damn profession that it's like it's it's not about devices it's about people it makes you want to stand outside the door of every audiologist that says and and as new people come in say did you check this person out yet because what you're implying about finding an audiologist to deal with the information you've just given everybody means you've already had a lousy experience somewhere else and learned about something's missing in my life so I the frustration just must be enormous but my question is we're talking about audiologists we're talking about people who have made a a commitment at least to a two and now four-year degree so there's some pre-service work that that we're all doing I think trying to communicate with universities but what about all these people that are also hearing specialists and what's the percentage of those people out in the community because they're dispensing a lot of product without anything person-centered either how do we reach those people and I'll tell you having talked to a lot of people audiologists got a really black eye because they charge six thousand instead of 2500 and what are you paying for and I don't know sorry I'm just sort of going off but yeah no I feel I feel your pain I think a lot of us definitely feel that frustration and you raise a really good point about sort of the hearing instruments specialists and many people especially in areas you know more rural areas where they may may not be audiologists that sort of that's their option you know whether that's at a Costco or wherever it is and the funny thing is that some of them are great and some of them aren't so it's sort of a similar experience that you get within audiologists as well I mean I would expect more from audiologists because they do have higher levels of training but it seems to come down to the person you know is the person motivated to just sort of check boxes and and follow steps like a technology product or is it a person that connects with the other person and so it's a hard thing to teach right and I know that they are trying to teach it I've been started I'm trying to speak at audiology student groups like at schools for audiology because I feel like if you get them young then you know maybe that's how they develop but what I hear from them is that they're learning about it in their programs but then they go and they do their internships with audiologists in the field and the audiologists are saying well we don't have time to do all that that's great but we don't have time to do it so it is frustrating I think all we can continue to do as people with hearing loss and advocates is just keep talking about it and you know till we're blue in the face and coughing needing water because we just have to keep educating hearing loss is such an invisible disability and so we need to just find ways to make it more visible so I don't know if that answers your question but I appreciate you bringing up those points I think one of the things that's very wonderful about zoom there's the least one silver lining is that this session is being recorded and the you know you've got Wisconsin online you've got Oregon online probably other states we need to blast this all over rather than having you have to do this 400 times we can absolutely multiply the message by sending these to everybody not just I mean but it's so great to have it on recorded great thank you Susan Beck unmute yourself please thank you very much sherry the presentation was fantastic and really helpful I just had a question about unbundling the price for the hearing aid I wonder if a lot of people would get the hearing aid and not get the follow-up care that they need and then be just satisfied with their hearing aid and not wear them you know because a lot of people at such a big expense that if they could get it for a smaller amount then they just let the rest slide that's a great question um yeah that's definitely a possibility I would hope that when they unbundled it they would explain that when you buy the hearing aid this is the price of the hearing aid and these are the price of these sessions and perhaps some of those sessions need to be mandatory you know but at least seeing the price difference of sort of what they're actually paying for I think would be a way for audiologists even to understand the value of those counseling services and so they could maybe provide those separately from the hearing aids to other people who might have gotten their hearing aids somewhere else so not having the actual devices linked to that other segment of what they're doing that other part of what they should be providing to their patients and their customers might help them think about it in a different way but you're right there is a risk that if patients are given to the chance like you know okay I'll just grab the hearing aids and run and figure it out myself and that's not good either because we do need the assistance and the advice of the audiologists so you know I mean we would just have to be sort of a I think a happy medium where you see the different itemized pricing and some of those sessions would have to be I guess mandatory or you know sort of you have to have at least three sessions that come along with it and then if you wanted additional ones you know hopefully the patient would see the value in them once they've had a couple that they might be willing to pay a little extra if they needed more assistance but yeah it's tough it's definitely a tough challenge. Thanks Susan Barbara Bottomley. Oh hi thank you Sherry I really enjoyed your talking this was so wonderfully organized and so easily followed it was really a delight to listen to I just wanted to comment that one of the easiest things that an audiologist could do that takes no training or any time really is to recommend HLAA to their patients once they have given them hearing aids the hearing aids made a huge difference in my life but without HLAA I would have been a different person and I don't know why they're so reluctant I know they don't want to endorse anything I know there's there's difficulties there but somehow if we could work as an organization of getting the approval of the audiologist to just give out the local address or the now you just need the email address to find your local one I mean there's so many more options now that offer as an organization such an invaluable that of of enrichment in our hearing and hearing impaired life and it's only gotten better in the 30 40 years that I belong and now you guys have done such a fantastic job at national and everything before I just remember I don't want to get emotional but how life-changing it was the first HLA meeting and I want other people to have that experience and they just don't think they need it well nobody recommended it to me I don't need another support group blah blah blah blah I say just try it that's all thank you and thank you for all your efforts thank you I couldn't agree more I know in New York City our chapter has had a big initiative to read to reach out to local audiologists and audiology schools and we invite the students to come to our chapter meetings I mean it used to be in person I guess now we invite them to come virtually but I wonder if that's something that local chapters take on as well is just reaching out within their local community and just if you just even get that one or two audiologists to start coming to the meetings it would just it would be so eye-opening for them that I think they would have to start recommending it so you know it's just getting them in the room so that they can experience it and understand what it would mean yeah and even now virtually I mean it's not exactly the same but yet just getting them virtually and then maybe to get them in small groups and once you know this is over but you know it's just you know I just anyway that was that was all I wanted to say it would be wonderful if you could get but we'd all like a doctor that would give us five more minutes to tell them what was really on our mind any doctor but they don't have the time but we have the time because we love to share our stories and that's true with any support group that whatever the issues that you have the beauty of a support group is that they have the time and want to share the experiences okay thank you and thank you for your kind for all your efforts you're wonderful so I want everybody to know that all of the students at the audiology program for the university of the pacific in san francisco and all of the interns at ucsf were all invited today oh um we received positive in in communication back from the director and also the head of the ci center at ucsf and sherry there may be a chance that they're going to ask you to come talk excellent thank you that's great sherry peris holy so I would just like to try to peek you back on the previous conversation about reaching the audiologist and um in reaching out you know individually from your chapter um I'm going to say um I do have an amazing audiologist now and um and I found her when she was the president of the washington state academy of audiology and she it happens to be one of those really empathetic um hearing care providers her mother had hearing loss which is why she went into the profession and so I feel very fortunate to have her I do drive an extra 40 minutes to see her so she is not you know within my 15 minute distance but um in reaching out to the washington state of academy academy of audiology we uh we joined our state organization joined and as part of that we've been invited to their state conferences and that gives us an opportunity to present certainly not as well as you present but but to talk from a patient's perspective and and so that has been I think a really key point and then in terms of finding someone that you really like I just wanted to say that last week I had an ear of the real ear measure and I know that that's something that we really talk about as being important but it's been many years since I've had one and so it was really awesome for me to see the difference in each time she took a look at what the real ear measure did from the prescription from um resound versus the prescription that I actually needed and every time she made the adjustment I could really tell a difference and so I came out of that appointment both of us feeling really really good about the changes that she'd made um and then I just wanted to say also finally in washington state we had a board of hearing and speech and I'm assuming other states have something similar they have a list of all the providers in washington state and we made a request a very formal request in writing to obtain a list of these providers so that we could share information with them and we were denied that request because we did not qualify as a educational um piece uh we didn't meet that requirement uh we probably could have taken them to court but of course that requires a lot of extra time financial resources that that we didn't have so you know it's it's not as easy as just going online and looking up who are all the providers in your state it is a real challenge and to get this information and so I think it would be great if we could find a way to break down that barrier just to find out who who are the providers in the state so yeah good good dialogue today thank you very much for promoting it um so for those of you who are in california in california um as long as you're willing to pay for the list it's public knowledge but because they're licensed but the list is pricey thank sherry um I don't see any other hands raised so for sure we have two sherrys today right so sherry evers I'd like to thank you we have some other pieces here I know it's close to the time we said that we have an extra half an hour though that we pay for our captions so we can stay to do that and Barbara Bottomley you should be doing the next slide you should do it for me you actually probably did it and that's everybody needs to renew their hla a membership renew or join and it's really easy to do all you need to do is to go to our website we have a tab that says the membership click on the membership tab and join today we also have some poll questions and the purpose of the poll questions is because we think that there's nothing more important than we can be doing at this time than ensuring that we have communication access at the COVID vaccination sites so we have some poll questions about that and the first one is oh oh sorry I'm gonna have to do my polls on the okay can you understand people who are wearing face masks we don't see the poll oh thank you now do you see it yes okay there are more than 15 people here everybody needs to vote okay so I'm gonna end the poll so you can see the results for that so everybody at least has a problem sometimes some people here oh my god you're so lucky they can understand a person on a face mask but we're seeing that by this at least the majority of people are having some problems okay let me see if I can get to our second question have you received a COVID vaccination okay 18 people have responded so just about half of people have received their vaccination okay if you received your vaccination could you understand the directions of the vaccination site so the majority of people who said they'd gotten their vaccination said that they could oh sorry they could understand did any of you who couldn't understand ask for communication access so only three people answered and two said no and one said yes and our final question is did the vaccine if you asked for it did the vaccination site have communication access for people with hearing loss so we had a couple more people answer this than in the last question so three people said no and one person said that they didn't know so for those of you who don't know I'm a recent CI recipient I was implanted in December and although I'm hearing over the chart what I heard before I still can't understand anybody with a face mask and so this is really important to me and since we all know that there are the majority of people who are hard of hearing don't have any hearing devices at all it's really important for me that we advocate for accessibility at the vaccination sites and this past week I began communications with entities and contacted at least 20 different entities from the White House to the state of California Department of Public Health to my county's Department of Public Health to the city of San Francisco's Department of of Public Health because they're projecting that they're going to be giving 10,000 COVID-19 shots a day contacted all of our county supervisors now I have no oh contacted the state of California they have a commission for COVID protocols contacted the department that's in charge of that now I don't have any idea if I'm going to get any response from anybody so I'm hoping that somebody responds and I'm personally going to keep advocating until we get some attention from someone I don't know how how we might proceed on this I'm open to suggestions if anybody knows anybody in the county at the state at the federal government level I think it's just over they just didn't think about it so I am we're I'm looking for some help looking for some ideas I hope that somebody who's here today will want to join us join me okay we have our polls which we finished and thank you very much we have some upcoming events so the HLA North Bay of California is next Saturday on the 13th is the East Bay oh excuse me that 11th is not on Saturday but anyway the East Bay chapter meeting is the 13th there's a special HLAA meeting that's going to be on February 23rd and it's called enough and it's a love story between an HLAA member and their partner and he's a musician it should be really wonderful we'll be sending out more invitation information about that and our meeting next month is on March 6th the same date as today but one month later we'd like to thank our wonderful over-the-top captioner Cory Dostey and this is our how you can get ahold of us for any further questions and I wanted to update our ADA logo here but the new one for this year comes out in two weeks so until then it's because this this will be the 31st year for the ADA and I'd like to remind everybody that this is a really long time advocating for the rights that are required for us by law and we're kind of like the step children of the disability movement. Sherry Parazoli has her hand up again Sherry please comment okay so well I'm sorry I didn't realize my hand was up but yes as someone who has come into my hearing loss before the ADA and having lived through all of this process I would just like to say you know by 30 years later I certainly thought that I would have communication access wherever I would go and I think it's really frustrating because we do have the tools we have the technologies we have everything that's in place we have laws tools technologies but unfortunately the onus is on all of us to make that ask so what do we do to remove that barrier how do we remove that request for accommodations it's simple to incorporate the technologies as a universal design element so you know there could be hearing loops can be built into every single new building captions can be included on every single video virtual program why not is it not why is it not included everywhere same thing for information counters and doctors offices so you know how do we get us there and I think that we really have to make our voices heard we have to make that ask and in when we don't receive the accommodations the process requires that we file a complaint we that's the process and and I think that we all have to kind of learn to do that and feel like that that's okay because that's the process that's how we make change so thanks sherry e boots I just wanted to make a quick comment not about this although I agree everything you just said sherry excellent let's do it is that there were some questions about the articles about the face mask program so I have included those in the chat so if anyone wanted those there are two articles in the chat so take a look for those thank you and thank you everyone for your attention and making this such a great group for the presentation thank you and does anybody have any other questions or comments we'd like to thank everybody for coming it's nice to see everybody I hope that my email starts getting a little activity on some other people who would like to join me in advocating for communication access at the vaccination sites I think the easiest way for that to be accomplished would be by visible communication tools on plastic laminated letter size paper that you could they would point to what they were asking you so that you could answer and it would serve us as well as the deaf community and it's not a pricey thing for them to do there's no excuse for them not being able to do that so thank you again see you next month bye