What Audiologists Need to Know About the Updated Americans with Disabilities Act (ADA) and Inclusion of Assistive Listening Technologies

Author: Steve Thunder

Think of an instance when you don’t need to hear clearly. After careful consideration, you might reach the same conclusion I did — only when you are alone. Hearing connects us to other people. Hearing allows us to communicate with one another, listen to a story, or learn something new. Every audiologist has the responsibility to enhance the clarity of sound for each individual. The tool of choice is typically a hearing aid. However, even with the latest hearing aid technology, helping patients hear clearly can be a difficult task. Sound clarity is degraded each time the sound bounces off a wall, when a person talks too fast, when background noise masks sounds, or sometimes when all of the above occur. Hearing aids do a great job restoring clarity in situations where the sound is not too degraded, but adverse acoustics is still a challenge in many environments that patients encounter. Hearing aids are becoming increasingly fine-tuned for the variety of environments that patients will face. As smartphone-controlled hearing aids become the norm, the ability to change settings and adapt the hearing aid for that environment is growing, but hearing aids are likely to always be limited by microphone placement, which is usually very far from the sound source. As many people know, the clearest sound is that which is closest to the source. Audio-visual (AV) experts know this, as many have spent their careers deciding the best way to capture sound with a microphone. But AV experts have the advantage of placing large microphones virtually anywhere in the room. So why not use the clear, direct sound from these microphones instead of the acoustically degraded sound from the hearing aid microphone? This is exactly what public assistive listening systems do.

The typical hearing aid user is changing. Twenty years ago, the typical user may have just needed his or her hearing aid to help with one-on-one conversations, but today’s hearing aid users are much more active, with greater expectations. A typical hearing aid user may expect to have enhanced hearing at the movie theatre, the playhouse, the city council assembly area, the local library, museums, sports stadiums, a local lecture hall, a concert hall, or even a convention center. What do all of these places have in common? They are defined as “assembly areas” under the Americans with Disabilities Act (ADA). The law states that every patron has the right to hear clearly in every environment, even when audio is broadcast over an AV system. While the original law was passed in 1990, the update in 2010 strengthened and simplified the law in regards to assistive listening. Included in the update, was an amendment that gives patients the right to access clear sound with their hearing aids via their t-coil. In addition, new laws have been passed in the last year in various cities and states, namely New York City and Minnesota, to continue to enhance access for hearing aid users.

With the changing landscape in hearing health, amid the discussion of over-the-counter hearing aids, it may be more important than ever for clinicians to address every environment that patients encounter. In order to do this, it is crucial for a clinician to understand the technology a hearing aid offers to enhance listening in noisy places, the laws patients can use to their advantage, and the solutions that patients will encounter on their journeys, which can help to provide exceptional listening experiences.
The Law
The Law In 2010, the ADA requirements went through some significant updates. While the original version had complex wording and formulas for seating capacity to determine if an assembly space needed assistive listening, the new version is decidedly simple.

219.2 Required Systems. In each assembly area where audible commuication is integral to the use of the space, an assistive listening system shall be provided.
While I’m no attorney, the law boils down to this very simple question: Is there an installed sound system for communication? If it’s a public space, and there is an installed sound system for communication, then there should also be an installed assistive listening system. The reasoning is quite simple: If there is an audio or AV system, sound is likely an important component of communication in that space, and, if it is important, then all people should have access to that sound, regardless of how many people there are, or what disabilities they may have. This applies for all “assembly areas” as defined below, which is a very long list. Only a few spaces that attract more than a few people are excluded from this list. The largest notable exception is houses of worship. Luckily, however, most houses of worship choose to voluntarily install assistive listening, and in some cases (like renting out space to the public) they still may be required to install it.

Assembly Area. A building or facility, or portion thereof, used for the purpose of entertainment, educational or civic gatherings or similar purposes. For the purposes of these requirements, assembly areas include, but are not limited to, classrooms, lecture halls, courtrooms, public meeting rooms, public hearing rooms, legislative chambers, motion picture houses, auditoria, theaters, playhouses, dinner theaters, concert halls, centers for the performing arts, ampitheaters, arenas, stadiums, grandstands, or convention centers.
The consequences for facilities that do not comply are significant. Not only are fines high, starting at $55,000 and ranging to as much as $150,000, but the social consequences are increasing as advocacy groups such as the Hearing Loss Association of America (HLAA) become more vocal about their desire for specific technologies, namely hearing loops. At the same time, the ability to find facilities that best accommodate listening needs is supported by websites and smartphone apps such ALDLocator.com. In addition, there is a growing movement advocating to adjust local building codes and/or enforcement policies so that facilities would not be granted building permits without showing compliance with the assistive listening section of the ADA — just as most buildings would not be allowed to open today without proper wheelchair access ramps or sufficient accessible parking spaces.

Based on seating capacity, facilities are required to have a certain number of assistive listening receivers with headphones and a smaller amount that are “Hearing-aid compatible” via a neckloop. This second part is very important because if clinicians outfit their patients with devices that have t-coils, they are also outfitting their patients with the legal right to use their hearing aids in any public space with a sound system, via that t-coil. As noted above, that is a lot of spaces. The functionality of a hearing aid goes up immensely with a t-coil. If you care to calculate how many receivers are needed for a space, I recommend the Listen Technologies ADA Calculator App or web tool. Table 1 also shows an approximation of the number of receivers needed to cover various seating or assembly areas. Also, note that when a hearing loop is installed, neckloops are not required because the connection to the hearing aid’s t-coil already exists by the nature of the hearing loop.
Table 1. The number of receivers per seating capacity in a listening area
Capacity of Seating in Assembly Area Min Number of Required Receivers Min Number of Required Receivers to be Hearing-Aid Compatible
50 or less 2 2
51 to 200 2, plus 1 per 25 seats over 50 seats1 2
201 to 500 2, plus 1 per 25 seats over 50 seats1 1 per 4 receivers1
501 to 1000 20, plus 1 per 33 seats over 500 seats1 1 per 4 receivers1
1001 to 2000 35, plus 1 per 50 seats over 1000 seats1 1 per 4 receivers1
2001 and over 55, plus 1 per 100 seats over 2000 seats1 1 per 4 receivers1

Unfortunately, not all venues consider the importance of inclusion, or are aware of the number of people who are hard of hearing (about 1 out of 5 with measurable hearing loss) or the requirements of the ADA specific to hearing. If your patient encounters a facility that is in violation, they should inform management about the situation and explain how adding an assistive listening system would help them and others who are hard of hearing. Many times, the facility will be supportive and willing to help; management simply did not realize that hearing assistance was needed. Patrons can file a complaint against non-compliant facilities with the Department of Justice (DOJ) through the website ADA.gov if necessary, but most facilities owners and management just need some education about the impact of hearing loss and the requirements of the ADA law for assistive listening. There are many affordable systems, and even tax credits or deductions available to assist businesses with meeting requirements. Furthermore, many facilities elect to install systems with potentially more upfront investment, like hearing loops, because they recognize the enhanced experience it brings for their patrons. Places like Steppenwolf Theatre in Chicago, the new Hale Center Theatre in Salt Lake City, or every classroom in a new building at Purdue University come to mind. To help find places and venues, tools such as the new ALDLocator.com or the ALDLocator app can assist. Within the website and app there is the ability to search by the type of venue and/or the type of technology (i.e. loop, radio frequency or infrared). One of the new additions to this tool is the ability to rate a facility’s assistive listening so that the best facilities can be targeted for visits.

Also, note that the ADA law is a minimum; state and city governments are adapting their laws to go beyond the ADA law. For example, in California and Texas, houses of worship are required by law to provide assistive listening. Earlier this year, New York City passed a bill requiring city-funded renovation or new construction projects to specifically install hearing loops as the assistive listening system. The state of Minnesota passed a similar law requiring the installation of hearing loops for all state-funded projects. The American National Standards Institute (ANSI) has gotten involved too, updating its standard to include language that requires hearing loop installations to meet a separate international performance standard (IEC 60118-4). This updated ANSI standard will presumably be adopted by building codes, thus making it a legal requirement that an installed hearing loop meet the IEC (International Electrotechnical Commission) performance standard.
The Technology
What technology might a hearing aid user encounter when using any of these “assembly areas”? Barring the recently passed laws specific to hearing loops, most facilities have their choice between three traditional types of systems (hearing loop, radio frequency, or infrared) — all with their advantages and disadvantages. There are also other technologies that can enhance hearing, but may or may not qualify as assistive listening to meet legal requirements.

Hearing loops transmit clear audio directly to t-coils in the hearing aids (or loop receivers with headphones), providing one of the best user experiences because of the hassle-free nature and ease of use. Hearing loops are generally regarded as the preferred option among hearing aid users because of the quality of sound and discrete listening experience. However, hearing loops do take careful design and installation to ensure proper performance that meets the IEC standard. The installation of hearing loops is generally more labor intensive than other systems. However, hearing loops typically have the highest usage rate, meaning they might have the lowest lifetime cost per user. Additionally, because hearing loops only provide a single channel, they are easy to use, but require tight design and precise installation in order to control the overspill of the loop signal to adjoining rooms.

Radio frequency (RF) systems, also commonly referred to as FM systems, use a radio transmitter to send the audio signal to receivers. Users can then choose to listen either with headphones or with their hearing aids via a t-coil and neckloop. These systems are easy to install for facilities and provide multiple channels for either multiple rooms or multiple languages. Keep in mind that not all receivers and neckloops are created equal. Receivers have become smaller, lighter and easier to use with rechargeable lithium-ion batteries and charging trays. Preferred receivers are “smart”, and can detect when the neckloop is plugged in and adapt for clearer sound through the neckloop.

Infrared (IR) systems use light to transmit the signal to receivers. Just like RF systems, users can then choose to listen either with headphones or with their hearing aids via a t-coil and neckloop. These systems have shorter range than RF systems, but are generally considered confidential because it is difficult for the infrared light signal to leave the room. Like RF systems, they also have multiple channels. IR systems are generally the easiest to implement in large buildings with many rooms that need assistive listening, because there are none of the overspill/interference design factors that hearing loops or RF would have. Traditionally, IR has been considered by many to be expensive or unreliable compared to RF systems, but recent advances in IR technology has changed that paradigm. Some of the most advanced receivers boast the same advantages listed above for the RF receivers, but are also the more sensitive and therefore more reliable than ever before. Even experienced AV professionals are generally shocked to find out they are IR receivers and not something else because of the high reliability without dropouts. Additionally, the cost of installation for IR systems has gone down as transmitters and radiators are combined in to a single unit.

There are new emerging technologies in the areas of personal listening. Keep in mind, assistive listening is referring to the technology that meets the requirements and intent of the ADA law, and is designed specifically to help those with hearing loss; whereas, personal listening is a technology that provides an enhanced listening experience for anyone. So, it is possible for a device to function more as assistive listening, personal listening, or both.

A newer technology is audio delivered via Wi-Fi. This technology allows a smartphone user to listen to a number of different audio sources with an app and connection to the facility Wi-Fi. This type of system can offer a person who is hard of hearing a great experience as well, and works great for the right applications. Wi-Fi audio really shines when connected to TVs in restaurants, fitness centers, corporate lunch rooms, etc. While a dedicated traditional assistive listening system may still be the preferred option in typical applications, these systems are now in their second generation with a much lower cost. The ideal approach may be to install both options: A traditional assistive listening system and a personal listening system. It also opens the doors for new unique personal listening options that weren’t previously available. For example, a house of worship could offer several recorded prayers or messages on the different channels. This would allow users to pick which messages or prayers connected with them most at that time. Expect to hear more about Wi-Fi systems as the technology gains in popularity and venues look to enhance their patrons’ experiences.

Bluetooth is often asked about, because of its use in the home, and its ability to connect various audio devices to hearing aids. While the Bluetooth standards continue to evolve, currently there is not a version that offers wide area public use, or meets the receiving device requirements of the ADA law. Current devices have too short of a range, possibly too much delay, and still require pairing, making Bluetooth not applicable for assistive listening applications. It might be possible for a local facility to devise a way to connect a Bluetooth transmitter to the sound system, and for it to work diligently to pair some users and seat them in the right locations. However, Bluetooth technology is not fail proof, and should not be mistaken for ADA-required assistive listening—nor would it be as easy for the facility to implement and for their users to use, as traditional assistive listening.

New technologies that best bridge the gap between assistive listening and personal listening include a system originally designed as a very easy to use two-way communication system for guided tours, but is also finding applications as an entry communication system. ListenTALK is an example of an all-in-one device that very easily pairs to other units to create up to 10 two-way communication groups, with an unlimited number of devices in each group. The group leader’s voice is clearly transmitted to the other units so that users can easily listen in environments with adverse acoustics, like high background noise or reverberation. Those users can also talk back to the leader with the simple push of a button. So, while this system was designed to target any type of user as a personal listening system, it can also be implemented as a portable assistive listening system.

In this changing landscape of new laws and new technology, audiologists should stay up to date on these changes so that they can continue to inform their patients about their rights and what expectations they should have in their community and across the United States. Many people who use the hearing loop systems only wish that they knew about them earlier – they would have been happy to donate money, advocate for their installation, or just know to look for systems (appropriate assistive listening signage is also required by the ADA law). In addressing all of the environments that patients will find themselves, the clinician should spend time educating their patients that they have a legal right to clear sound, explaining what type of technology they may encounter, and how to use it with their hearing aid. With increased education and advocacy, we can create a world where a person who is hard of hearing can readily hear clear sound no matter where he or she chooses to go. We already have the laws, we already have the technology—we just need more people who are informed to bring the two together.    
Steve Thunder is Hearing Loop Sales Engineer for Listen Technologies Corporation in Bluffdale, Utah.. He can be contacted at steve.thunder@listentech.com.