By Daniel Morgan-Williams, Founding Director, Visualise Training and Consultancy Ltd.
Picture an experienced senior carer on a busy ward or in a care home. At handover she asks a colleague to say it again. She holds the rota at arm’s length, and leaves the care records until the end of the shift because they take her so long. She avoids the telephone. By the end of the day she is exhausted. Her manager sees someone who is tired, or perhaps losing interest, and starts to wonder whether a conversation about performance is needed.
Sometimes that is the right reading. But it is worth asking whether she is struggling to see or to hear. In nursing and care, where experienced staff are hard to replace, that question can save a good member of the team.
Why this matters now
The adult social care workforce in England is older than the working population as a whole. Skills for Care’s 2023 workforce report found that 29 per cent of workers were aged 55 or over in 2022 to 2023, compared with 21 per cent of the economically active population. Among registered nurses working in adult social care, 36 per cent were 55 or over. A summary of that report published by King’s College London says that almost a third of the care workforce is likely to retire within the next ten years. Skills for Care’s most recent report, published in June 2026, puts the vacancy rate at 6.2 per cent, the lowest since 2015 to 2016 but still around 96,000 vacancies on any given day.
Hearing loss becomes more common with age. RNID research, quoted by NHS Employers, says that over half of people aged 55 or over have hearing loss. In an older workforce, some change in hearing or sight among staff is therefore to be expected. That is an interpretation of the figures, not something the reports state, but it is a reasonable one. Keeping experienced people in post matters, and a small adjustment is often cheaper and quicker than recruiting and training a replacement.
Why people do not say anything
The National Deaf and Hard of Hearing NHS Staff Network says that some staff fear unfair treatment if they disclose a hearing loss, and that hearing loss can contribute to early retirement. NHS Employers adds that over two thirds of deaf people and people with hearing loss have experienced negative attitudes or behaviours at work.
The NHS Workforce Disability Equality Standard report for 2024, which draws on the 2023 NHS Staff Survey, found that 74.5 per cent of disabled NHS staff said their employer had made reasonable adjustments to enable them to do their work. In the same survey, 26.6 per cent of disabled staff said they had felt pressure from their manager to come to work when they did not feel well enough, compared with 18.5 per cent of non-disabled staff. These are figures for NHS trusts. No equivalent published figures for care homes were found, and that is a gap worth noting.
What it can look like on shift
NHS Employers, drawing on the experience of deaf and hard of hearing NHS staff, lists several barriers: masks and visors that stop lip-reading, background noise, video call quality, lighting and where a workstation is placed. For sight loss, the barriers are often found in small print on rotas and records, screens that are hard to read, low lighting and information that is only ever shared on paper or in passing. None of this means a person cannot do the job. Each of these is a barrier in the environment or the way information is shared, and most can be changed.
Patterns worth a conversation
A manager should never try to diagnose. But a combination of the following, especially if it is new, is worth a supportive conversation before anything formal: asking for things to be repeated, missing instructions or messages at handover, avoiding the telephone, holding documents close or moving to a brighter spot to read them, relying on colleagues to read things out, withdrawing from group conversations, or seeming very tired by the end of a shift. Each has other possible explanations. The point is to ask, not to guess.
What the law expects, and what helps
Under the Equality Act 2010, employers have a duty to make reasonable adjustments for disabled staff. NHS Employers gives examples for hearing loss that are just as relevant to a care home: portable hearing loops, amplified phones, thought-through desk placement and noise levels, clear visors or removing masks when speaking where it is appropriate to do so, captions and transcription in online meetings, and regular check-ins, including during onboarding. For sight loss, common adjustments include screen settings and magnification, better lighting, accessible versions of rotas and records, and sharing information in advance. Access to Work may fund some support beyond what an employer is expected to provide.
This article is general information, not legal advice. Whether a particular adjustment is reasonable depends on the circumstances, including the size and nature of the organisation.
How to ask without accusing
Have the conversation privately and informally. Describe what you have noticed in neutral terms, then ask an open question: has anything been making the work harder recently? Do not ask whether the person is going deaf or losing their sight. Make it clear that the aim is to find out what would help. If sight or hearing comes up, thank them, ask what would help, and agree a next step. Medical details are not required, and whether colleagues are told anything is the employee’s choice.
Where the picture is unclear, a specialist workplace assessment looks at the person’s role, environment and equipment together and gives the employer practical recommendations to act on. That is more reliable than trial and error on a busy shift.
Questions for registered managers and HR
Has anyone asked the member of staff what would make the work easier? Have sight and hearing been considered, without assuming? Has a specialist assessment been considered? And have adjustments already agreed been put in place, with time to use them? If the honest answer to any of these is no, there is probably more to try before treating the difficulty as a performance issue.
If you or someone in your team has sight loss or hearing loss and would like expert, tailored support to stay productive and comfortable at work, visit our workplace assessments page to arrange a workplace assessment.
Frequently asked questions
Can nurses and care workers with sight loss or hearing loss keep working?
Many do, with the right adjustments. The duty to make reasonable adjustments applies to disabled staff in nursing and care just as it does elsewhere, and what is reasonable depends on the person, the role and the setting. A workplace assessment can set out the options.
What reasonable adjustments help care staff with hearing loss?
NHS Employers lists examples including portable hearing loops, amplified phones, careful desk placement, clear visors, captions in online meetings and regular check-ins. The right combination depends on the individual.
How should a manager raise a possible sight or hearing problem?
Privately, describing what has been noticed and asking whether anything is making the work harder, without suggesting a diagnosis. The aim is to find out what would help.
Related resources
- Before You Start a Capability Process, Check the Adjustments: Sight Loss, Hearing Loss and Performance
- Communicating with Deaf Employees and Employees with Hearing Loss
- When a Performance Dip Is Really Hearing Loss: What HR and Occupational Health Should Ask First
Sources
- King’s College London, Action: Ageism impacts older workers retention, Skills for Care (6 February 2024), summarising Skills for Care, The state of the adult social care sector and workforce in England (October 2023)
- National Health Executive, Adult social care vacancy rate falls to decade low (24 June 2026), reporting Skills for Care’s 2025 to 2026 data
- NHS Employers, Employing deaf and hard of hearing staff in the NHS (9 June 2025)
- NHS England, NHS Workforce Disability Equality Standard: 2024 data analysis report for NHS trusts
Photo by Age Cymru on Unsplash.