<p>Age-related hearing loss is highly prevalent among older adults. Long-term care (LTC) residents are an especially vulnerable population, yet hearing accessibility and staff expertise in hearing care often remain insufficient. This study examines (1) the structural and acoustic accessibility conditions in LTC facilities, (2) the hearing-related knowledge and training needs of staff, and (3) staff assessment of feasibility and sustainability of a preventive training program. A mixed-methods study was conducted in 74 LTC facilities in Germany. Data were collected pre- and post-intervention and at one year’s follow-up. Data sources included questionnaires, quantitative surveys, room acoustic measurements, and qualitative interviews. Quantitative data were analyzed descriptively; qualitative data were interpreted via structuring qualitative content analysis. Most facilities (81%) lacked acoustic accessibility concepts. More than half of the staff had limited knowledge on hearing and communication and expressed high training needs on this topic prior to the training program. Post-intervention interviews highlighted organizational barriers, but also a strong increase of awareness. Follow-up findings indicated moderate improvements in hearing-related practices and communication after the training program, though structural acoustic changes remained difficult to implement sustainably. The results show that improving hearing accessibility in LTC requires an integrated approach that strengthens both acoustical conditions in the facilities and staff competencies.</p>