New research maps the barriers and motivators that determine whether nursing home residents get the hearing care they need.

Hearing loss is ubiquitous in nursing homes. Surveys consistently show that over 80 percent of long-term care residents have some degree of hearing impairment. Yet most go undiagnosed and untreated. Family members complain that their aging relatives become withdrawn and isolated. Staff struggle to communicate. Preventable accidents occur because residents cannot hear warnings or alarms. The problem is not a shortage of hearing aids or professionals, but rather a complex web of organizational, behavioral, and systemic failures. Understanding why requires looking beyond the resident and the audiologist to the entire ecosystem of decision-makers, workflows, and incentives.

A comprehensive systematic review published in The Gerontologist maps the actors and behavioral factors influencing hearing and vision care in long-term care communities worldwide. The findings reveal patterns of neglect, opportunity, and leverage points for change across a complex system.

Background: Why the Researchers Looked at This

Long-term care facilities (nursing homes, assisted living communities, residential aged care) house millions of older adults with high rates of sensory impairment. Hearing and vision loss are major drivers of falls, depression, cognitive decline, and reduced quality of life in these settings. Yet systematic hearing screening, fitting, and device management remain sporadic at best. Family members report that residents' hearing aids sit in drawers unused. Staff lack time and training to support device use. Facilities often lack incentives to prioritize hearing care as part of their quality metrics. The result: a population with some of the greatest hearing loss and fewest resources to address it.

Prior research identified individual barriers (resident denial, staff knowledge gaps) but did not map the broader system. The researchers sought to understand the organizational, policy, and interpersonal factors that either enable or obstruct sensory care across long-term care globally.

How the Study Was Done

The team conducted a systematic review of 23 articles spanning January 2013 to September 2024. They extracted data on sensory care behaviors in long-term care (screening, referral, care receipt, device use, communication adaptation) and coded findings against the COM-B framework. COM-B is a behavioral science model that organizes change factors into three domains: Capability (knowledge and skills), Opportunity (environmental and social factors), and Motivation (goals, values, incentives).

They then mapped identified actors (residents, families, care staff, facility management, hearing and vision professionals) and the factors influencing their behaviors. The result was a behavioral systems map showing feedback loops and intervention points.

What the Researchers Found

The analysis identified 31 factors across the COM-B framework affecting five sensory care behaviors. But not all factors stand alone: 18 were interconnected, affecting multiple behaviors. The map revealed 10 feedback loops, meaning that addressing one barrier often creates cascading benefits elsewhere in the system.

Among the most salient cross-cutting factors were collaborative care (involving residents, families, and professionals in decision-making), family engagement, infrastructure investment, and organizational perception of value. For example, when a facility invests in hearing screening as a quality measure, multiple outcomes improve: detection rates rise, referrals increase, family trust builds, and resident outcomes improve. Conversely, when hearing care is seen as optional or peripheral, screening drops, devices go unused, and residents remain isolated.

The study identified specific barriers within each COM-B domain. In Capability, care staff often lack training in device troubleshooting and communication strategies. In Opportunity, facilities typically lack structured protocols, dedicated time, or access to audiologists. In Motivation, competing priorities (infection control, medication management) push hearing care to the margins. Yet the map also identified solutions: staff training, standardized screening protocols, visiting audiologist services, family involvement, and quality metrics that make sensory care visible and valued.

What It Means for People with Hearing Loss in Long-Term Care

For residents and their families, this research is a call to action. Hearing loss in long-term care is not inevitable neglect; it reflects systemic failures with known solutions. Families who recognize unaddressed hearing loss in a loved one have leverage: they can ask whether the facility conducts baseline hearing screening, whether residents with devices receive device management support, and whether staff are trained in communication strategies. Facilities that can answer yes to these questions deliver measurably better quality of life and fewer behavioral crises.

The study's behavioral systems map implies that change requires multi-level intervention. No single fix—no single product or policy—solves the problem. Rather, facilities that excel in sensory care combine staff training, resident and family engagement, accessible audiology services, and leadership commitment. They measure sensory care as a quality metric. They involve residents in goal-setting and self-care. They build partnerships with community hearing healthcare providers.

Why Accessible, Self-Managed Hearing Solutions Support Independence in Aging

The systems map reveals a critical insight: long-term care facilities often cannot depend on traditional audiology models (infrequent visits, complex fitting protocols, ongoing clinical oversight) for their entire population. Instead, facilities benefit from a tiered approach. For residents with cognitive capacity and motivation to self-manage, over-the-counter hearing aids offer an accessible entry point that can be initiated quickly and supported by trained care staff. Panda Stealth exemplifies this model. With its discreet, nearly invisible design, self-fit capability, and low cost, it removes barriers that have historically kept frail older adults from trying hearing support. The charging case doubles as a wireless remote, simplifying use for those with dexterity or cognitive challenges. A 45-day return window and 5-year warranty provide security. For facilities with staff trained to support device use, Panda Stealth can complement clinical audiology services by filling gaps and accelerating access. Learn more about Panda Stealth.

Limitations of This Research

As a systematic review, this work synthesizes existing literature but does not test interventions directly. Most published studies come from high-income countries with established hearing healthcare systems, so generalization to low-resource regions remains uncertain. Additionally, the behavioral systems map is complex; implementing all identified changes simultaneously is unrealistic for most facilities. The evidence base on which specific combinations of changes yield the highest return on investment is sparse. Finally, the review does not distinguish between device access problems (no hearing aids available) versus device utilization problems (aids available but unused), though both matter for outcomes.

Where This Leaves Us

The behavioral systems map provides a roadmap for long-term care facilities, policymakers, and hearing healthcare providers to redesign sensory care. Rather than viewing hearing loss in nursing homes as intractable, the evidence shows it as a systems problem with systems solutions. Facilities that invest in screening protocols, staff training, family partnerships, and accessible device options see measurable improvements in resident engagement, safety, and quality of life. For a population with high hearing loss and limited resources, this research offers both hope and a practical path forward.

Anantharaman, D., Meyer, C., Nisar, M., Kumaran, S., Keay, L., McAvoy, S., & Dawes, P. (2026). The ABCs of hearing and vision care in long-term care communities: A systematic review and behavioral systems map of actors, behaviors, and COM-B factors. The Gerontologist, 66(5). https://doi.org/10.1093/geront/gnag020