The Invaluable Hearing Aids, aka Me? Wrong? You Betcha!

In June, 2001, when I started a new job at Jefferson University Hospital in Philadelphia, I was a Technical Trainer and Compliance Administrator, all by myself, for close to 15,000 people. The compliance system we had consisted of reading a set of compliance regulations, like Fire Procedures, Hazardous Materials, and Safety in the Workplace, and answering a series of questions about what they read. 

As soon as July rolled around in '01, a high level meeting took place with the CEO, CIO, President of the Health System, and other muckety-muck types.  I was furtively taking notes because it was my responsibility and I didn't want to miss anything, but I missed half of the discussion and didn't even know it. I felt an arm in my ribs. 

"They're talking to you," a new friend whispered.

I looked up, but I could barely hear the discussion around me. "Yes?" I asked.

The Chairman of the Board repeated the question and I was reading his lips. Then about 10 minutes passed and it happened again. That's when I first learned I was hard of hearing.

A month before when I was hired, it turns out that I was put in a room where, unbeknownst to everybody (at least, no one who admitted it) there were blocked vents, mice droppings and roaches galore. And one of my top allergies, I found out later, was roach dust. I didn't say anything because it was a new job. And I was already a late-blooming 51. I went back to the job and a room that held contagion for me every day until I couldn't. Then I said something and I was moved to little table in another room which I shared with the manager and the training assistant.

I soon had an office when my manager resigned because she couldn't handle me (the final straws were: asking for time off to celebrate the Jewish High Holidays and the manager, aghast at my not knowing you have to ask for time off at least two weeks ahead of time, let me go begrudgingly, and when 9/11 hit, she demanded that I stay in the office, but I said that I had to use the ladies room as a faux excuse in order to call my sons where one who was going to school near D.C. and the other one in Pittsburgh, both places where some of the disaster struck), but that is another story for another day. L. was a disaster as far as managers go. It's a hell of a story.

Anyway, I realized that I needed hearing aids for 11 years. But I waited because I thought they would make me look older, but they don't. They are practically invisible. I can't say enough about my relatively new hearing aids. So apologies all around for the people whom I asked to repeat themselves. When you can't hear, and the words are muffled, it's a fuckin' mess.

No American insurance policy covers hearing aids like they do glasses. Hearing loss is just as important as deficient eyesight, but the insurance masters don't think so. In other parts of the world, industrialized countries supply free or heavily-discounted hearing aids through their publicly-funded health care system.

From a website that dwells on derivations of words, hard of hearing came from the Greek kratos (strength)  from root *kar-/*ker meaning "difficult to do" which is placed c.1200 BC. The term then transferred to the obsolete Middle English meaning "sense of having difficulty in doing something."

I only wish I had a dollar for everybody who asked me (and there were a lot), "Did your hearing aids come about when you had a stroke?" And my answer is always the same: "I got my hearing aids a year and a half after my stroke." Sigh.

A hearing aid is a small electronic device that fits snugly into the ear, consisting of a tiny microphone to pick up the sounds, an amplifier that increases the volume, and a tiny speaker that transmits sounds to the ear, usually with the goal of making speech more intelligible. In the US, hearing aids are considered medical devices and are regulated by the Food and Drug Administration.

But sudden hearing loss for no reason was studied in 2008. The American Heart Association links a relationship between sudden "sensorineural" hearing loss, more easily called SSNHL, and stroke. The SSNHL study, conducted in Taiwan, showed a profound relationship between the onset of sudden hearing loss and stroke. Published in the American Heart Association Stroke Journal, the study implies that sudden loss of hearing might be an precursor to stroke, an actual cerebrovascular event, aka stroke, as much as two years later.

The study, conducted by Dr. Herng-Ching Lin and colleagues at Taipei Medical University, took place over five years and monitored 1,423 patients who had been hospitalized for mysterious and acute sudden hearing loss. Also included as a control group for comparison purposes were 5,692 patients who were admitted for appendectomies. The first group indicating an acute hearing loss was more than 150% more likely to experience a stroke within the two year limit when compared to the control group for appendectomies, leading the researchers to conclude that the number fell "well outside the margin of error." In other words, among patients with sudden hearing loss, 12 percent of strokes occurred within 3 months, 31 percent occurred in the first year, and 51 percent by the end of the second year. That's not coincidental.

Let's take these findings in perspective. In the website "Healthy Hearing,"

• Increasing age (the older you are, the more apt you are to have a stroke, though even young people are susceptible.

• Men are more likely to experience a stroke in their lifetimes than women.

• African-Americans are more likely to experience a stroke than other races and ethnic groups.

• Those with a family history of stroke are at higher risk.

• People with high blood pressure (hypertension) have increased susceptibility.

• Diabetics have more strokes.

• Smoking contributes to the likelihood of a stroke and recently has been tied to hearing loss.

• High levels of cholesterol could mean an impending stroke.

• Obesity is a contributing factor.

So visit your physician or nearest medical center as soon as possible if you have sudden hearing loss. Although there is no standard procedure in treating sudden hearing loss, many physicians will treat with steroids like Prednisone. But you should have more tests for stroke risk. As I say in my book, "The Tales of a Stroke Patient" (the same name as this blog), "If you go to your private doctor, if he or she hasn't thought of it already, demand these tests:

* CBC (This is a routine test to determine the number of red blood cells, white blood cells, and platelets in your blood are A-OK).

* Coagulation tests (PT, PTT, and INR measure how quickly your blood clots. An abnormality could result in excessive bleeding or clotting leading to a stroke).

* Blood chemistry tests (These tests measure the levels of normal chemical substances in your blood).

* Blood lipid tests (This test measures Cholesterol, total lipids, HDL, and LDL, particularly 'bad' cholesterol, or LDL, because it's a risk factor for heart disease and stroke).

Those tests should be enough. If the doctor suspects anything, he or she will send you for additional tests."

Keep this in mind: there's more than a 150% risk of stroke in that patient group that experienced sudden hearing loss when there's no reason. You hear and then you don't. Don't ignore that sign.

You Never Know What Will Bite You in the Ass Next

If I had to recall the most dominant memories of my parents, they are these: My mother who was overly plump always talked about the next meal, and my father who had a short fuse always yelled at me when I couldn't solve a math problem. That was pretty much it. But both my parents shared something in common. They never talked to me about death. So as a result, I thought I could live forever.

My  friend always says, "You were born to die." I always say, "You were born to live." Who's right? Maybe we both are. I used to daydream that I would be the breakthrough person who be subject to cryogenics intentionally, aka frozen in time, and I would wake up to a planet that seemed more like the Jetsons, a cartoon where everything was in the future like Rosie the Robot and flying saucers. But ever since my stroke, I knew that all of us--even me--have to die. It took me 60 years to realize that.

Many people don't know about long-term health care insurance (LTC), an insurance that kicks in once you're chronically disabled. They have exclusions, of course, and each long-term policy differs. In my case, if I had a stroke (which I did), I need skilled assistance with simple activities such as bathing and eating, so I'm covered. Chronic illnesses or other conditions requiring specific needs on a daily basis over an extended period of time are also covered. The thing about insurance is this: Consider yourself lucky if you don't use it. But that doesn't mean you don't need it. Thinking it won't happen to you, especially if you haven't experienced significant health problems in the past, is foolhardy.  

Analysts estimate that by the year 2040, over a million people in the US will exceed 100. Currently, it is estimated that 8 million Americans have LTC.  

You must qualify for LTC. Because health changes as you grow older, it's best to look into LTC before you reach retirement age. Somewhere around a person's late 40s is considered the best time to begin. Premiums among providers of LTC can vary significantly, but each insurer has "sweet spots" in pricing to make the policy more affordable. Most likely, a person is only going to buy an LTC once because it's almost never economically clever to go from one LTC provider to another. As my title says, you never know. Nobody does.

If you're working, employer-based health coverage will not pay for daily, extended care services. Medicare will cover a brief stay in a sub-acute facility or nursing home, or a small amount of in-home care, but it's not without strict conditions. That's where LTC comes in, to help cover long-term (the optimal word is long) care expenses. Some long-term care policies will even assist with the costs in modifying your home so you can be more safe in your familiar surroundings.

But as with everything, there's a wrench. Long-term care insurance options are dwindling. In fact, that's the title of the article written by Emmet Pierce for Insure.com in 2012. It all comes down to economics for insurance providers.

"The market is changing fast because of concerns over profitability," says Mike Skiens, the chairman of the National Long-Term Care Network group. "It’s getting harder to find LTC policies that offer lifetime benefits, leaving policies that offer only several years of protection."

LTC has strong attraction to people who are attempting to protect their estate from losing value. Care covered by LTC policies generally isn’t covered by Medicare, which primarily targets short-term services and rehabilitation, says Pierce.

“Now the carriers are saying there is too much risk associated with them. When you look at the increasing incidents of dementia claims, you can see why [some] carriers are no longer offering those, but they are still offering two-year, three-year, five-year, seven-year plans,” Skiens says.

The baby boomers, who are living longer, bless their ever-lovin' souls,
are the reason for the change. It's not their fault, per se, but the insurers have to worry about their profits. Consequently,  LTC may become prohibitive to the middle class or, in current terms, the 99%. According to the National Long-Term Care Insurance Price Index in 2012, prices for LTC policies today are between 6 and 17 percent higher than comparable coverage only a year ago and have less options.

Allianz, Guardian, MetLife and Unum Group in the last 3 years left the LTC business, according to CBS News. When Genworth Financial, a major provider of LTC, said it was reducing LTC operations, that announcement sent shivers through the industry. None of the companies, by the way, that left the LTC market, will stop honoring the LTC policies they already have sold. (Whew!)

In the early years, insurers were less concerned with potential losses. “There was a tremendous amount of unlimited benefits being purchased,” says one analyst. “I call that the open checkbook.”

The longer you live, the more likely you are to use your LTC policy, but not everyone should buy one, says AARP. If you have to use money that otherwise would be spent on such necessities as food, shelter, and clothing, the necessities come first.

So how much is LTC? The average annual premium for a policy with four or five years of coverage sold in 2010 to someone age 55 to 64 is $2,261. While the policies are not cheap, not having LTC coverage can be even more expensive. The average annual private pay cost of nursing home care this year is about $88,000 and exceeds $100,000 in 10 states, according to AARP’s Long-Term Care Insurance 2012 update. 

The base price for assisted living facilities averages $41,000 annually. Adult day services, which allow people to remain in their homes, average $66 per day. Companies that provide licensed home health aides not certified by Medicare charge an average of $20 hourly, according to the AARP report. Many insurers now will continue offering LTC policies, but they won’t be as comprehensive.

On the theory that something is better than nothing, I bought the cheapest LTC policy. That policy was all I could afford. I'm glad that I have LTC, purchased in time, when a short time later, the whole world, as I knew it, would come crashing down.