2007 Age and Disabilities Odyssey Conference August 21, 2007 Duluth, Minnesota Impact of Hearing and Vision Loss on Independent Living Tracy Bell Koster.

2007 Age and Disabilities Odyssey Conference

August 21, 2007 Duluth, Minnesota

Impact of Hearing and Vision Loss on Independent Living

Tracy Bell KosterJan Radatz

Deaf and Hard of Hearing Services

2007 Age & Disabilities Odyssey Conference

Impact of Hearing & Vision Loss on Independent Living

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What you’ll learn today

• Impact that hearing and vision loss have on independent living, self-determination, and community integration

• Technology and service resources

• Tools and resources that can be used in the support planning process



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Case Study

1) Background about “Larry”

2) Determining what was needed to enable Larry to live more independently

3) Getting the needed supports in place



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Case Study


DeafBlindPrimary language: American Sign LanguageHome and educationWork historyHow he came to live in nursing home



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Diversity of Hearing Loss

• Born Deaf

• Born Hard of Hearing

• Becomes Deaf later

• Becomes Hard of Hearing later

• What if vision loss added?



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Terminology

• Deafblindness

• Dual sensory loss

• Combined hearing and vision loss

• Deaf, hard of hearing & vision impairment

• “I don’t hear so good or see that well anymore”



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What isn’t deafblindness?

Not deafness plus blindness

Why not?Usual compensation for hearing loss =

visionUsual compensation for vision loss =

hearingExponential effect



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Larry’s Hearing and Vision

• Usher Syndrome

• Born profoundly deaf

• Began losing his vision around age 12

• Significant vision loss likely by age 25



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Case Study1) Background about “Larry”

DeafBlind

Primary language: American Sign LanguageHome and education

Work history

How he came to live in nursing home



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Primary Language

English (spoken / written language)

• Language of American mainstream society

• Common language with hearing / sighted people



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Primary Language

American Sign Language

• Language of Deaf Culture; not the language of mainstream American society

• Visual, spatial; not written

• English is second language



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Primary Language

• Hearing loss makes it difficult to access spoken language and sound

• Visual means of communication required

• Age of onset and degree of hearing loss influence primary language



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Alternative English Modes

English (spoken / written language)

• Lipreading / speechreading

• Writing

• Writing in large print

• Braille

• Print-on-Palm



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Alternative Sign Language Modes

American Sign Language

• Tactile signing

• Close vision signing

• Limited signing space

• Fingerspelling



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Larry’s Communication

• American Sign Language

• Limited signing space

• Learning tactile signing

• Home signs with family

• White board with black marker



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DeafBlind

Primary language: American Sign Language

Home and educationWork history




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Case Study

• Raised on a remote farm in rural Minnesota

• Parents, sister, other relatives hearing



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Case Study

• Attended Minnesota State Academy for the Deaf (MSAD) in Faribault

• Immersed in American Sign Language and Deaf Culture

• Graduated from MSAD



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DeafBlind

Primary language: American Sign Language

Home and education

Work historyHow he came to live in nursing home



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Case Study• Gainfully employed in a blue collar

job in a large metropolitan area until age 28

• Then moved back to family farm; worked in small towns near farm

• Developed alcoholism

• Treatment program at RTC



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Case Study

• Upon completing treatment, moved back to family farm

• Worked odd jobs (building, roofing, laying brick, peeling corn, etc.)



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DeafBlindPrimary language: American Sign LanguageHome and education Work history




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Case Study

• Larry became dependent on his mother as he became legally blind and could no longer work

• Father passed away in 1985, sister passed away in 1993

• Mother’s health deteriorated and she was moved to nursing home in 1996



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Case Study• Larry had no opportunity to develop

independent living skills as a deafblind person

• He could not manage family farm; moved to nursing home with mother

• Mother passed away in 2001; Larry remained in nursing home



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Case Study

• Larry did not meet criteria of being full-time nursing home resident

• Staff at the nursing home did not know sign language

• Larry’s routine consisted of smoking, eating, watching TV, laying in bed, sleeping



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Case Study

• Attempts to move Larry to live with nephew or uncle in Kansas unsuccessful

Fearful of leaving known environment

Nephew, uncle did not know ASL



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2)Determining what was needed to enable Larry to live more independently

3) Getting the needed supports in place



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Understanding the loss of distance senses

• “The world becomes the size of an outstretched arm”

• Difficulty seeing or hearing people or objects or traffic approaching

• Difficulty identifying individuals if not in close proximity



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• Greatest comfort level is in known surroundings with familiar people

• New environments are frightening

• Limited or no distance vision to “get your bearings”

• Safety




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• No motivation to meet new people; communication barriers

• Language

• Mode of communication

• Depression, trust issues, inadequate coping strategies dues to extreme isolation




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Isolation of hearing loss and deafblindness

• Isolates individuals from:

People

Environment

Communication

Information



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Effect on Self-Determination

• Difficulty accessing information; determining choices

• Limited world knowledge

• Self-determination requires cognitive ability and information/knowledge

• Limited life experiences



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The “Unpredictability” Effect

• Illness effects functional use of vision & hearing

• Vision or hearing changes day to day

• Lack of sleep effects ability to concentrate

• Communication techniques that worked yesterday may not work today



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Impact on Larry

• Comfortable only within the nursing home and spent most of his time within his room

• Very limited communication with staff

• Very limited exposure to outside environment sources of information



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Impact on Larry

• High level of fear to travel outside the nursing home, even with assistance

• No instruction on alternative communication modes to accommodate his deteriorating vision



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Determining what was needed first

• Before Larry could consider moving out of the nursing home, he needed to:

• Learn to use his remaining vision

• Learn to use tactile sign language

• Learn techniques for independent travel, independent living



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• Larry also needed to:

• Resolve his depression

• Experience new environments

• Develop confidence in his ability to do more than was expected in the nursing home



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• Larry needed access to information

• General opportunities for more independent living

• Specific options



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Case Study


2) Determining what was needed to enable Larry to live more independently

3)Getting the needed supports in place



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Partners in Planning

• Guardian

• Deaf and Hard of Hearing Services Regional Office

• State Services for the Blind

• Nursing home

• County



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Types of Supports

• Services

• Assistive Technology

• Home Modifications / Learning New Techniques for Daily Routines



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Larry’s Support Services

• Support Service Provider

• Deaf

• Fluent in American Sign Language

Purpose

• Exposure to language & communication

• Access to environment & information



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• Orientation & Mobility Instructor

• Expert in deafblindness


Purpose

• Teach navigation skills

• Develop confidence and trust for independent travel



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• Psychologist

• Deaf


Purpose

• Address depression, anxiety, fearfulness

• Build self-confidence



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Types of Supports

• Services





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ARRAY OF TECHNOLOGY



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ARRAY OF TECHNOLOGY



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Common products for vision loss:

•Large-print wristwatches •Large-print check registers •Large-print playing cards/crossword puzzles •Large-print kitchen timer •Extra-long oven mitts •Large-print computer software

ARRAY OF TECHNOLOGY



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Common products for hearing loss:

•Hearing aids•Assistive listening devices•Amplified telephones•Loop or infrared listening systems•Alerting systems (doorbell, baby-cry, smoke alarms) with amplification or flashing lights

ARRAY OF TECHNOLOGY



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Types of Supports

• Services





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Deaf & Hard of Hearing Serviceswww.dhhsd.org



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TIPS FOR THE HOME• Workstations can be set up in each room. Gather together

the most frequently used items so they’re handy. • Puffy paint and raised bump dots are handy for marking

thermostat settings, security system keypads, radios or TV stations settings or other controls that may be hard to see.

• Color contrast makes items more visible (for example, put dark placemats under white plates).

• Maximize lighting in all rooms. Direct the light at the

State Services for the Blindwww.mnssb.org



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Types of Supports

• Services





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New Daily Routines - Resources



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Orientation

& Mobility

(O&M)

Deafblind-specific

independent

living skills

trainingSupport

Service

Providers

(SSPs)

Interpreting

services, real-time

captioning (CART)

DHHSD DeafBlind

Consumer Directed

Services program



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Resources forTechnical Assistance

• Deaf & Hard of Hearing Services Divisionwww.dhhsd.org

• DeafBlind Services Minnesotawww.dbsm.org

• Duluth Lighthouse for the Blindwww.lighthousefortheblind-duluth.org



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Resources forTechnical Assistance

• MN State Services for the Blindwww.mnssb.org

• MN Dept of Ed. DeafBlind Projectwww.dbproject.mn.org

• Vision Loss Resources – Minnesotawww.visionlossresources.org



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Where is Larry Today?

• Moved from small town nursing home to group home in large metropolitan area

• Lives with 3 other individuals who are deaf and use sign language

• Staff fluent in sign language

• Works part-time in sheltered workshop



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Where is Larry Today?

• Built a birdhouse in woodworking class that teaches special techniques for people who are blind

• With Support Service Provider, traveled to another state to visit nephew

• Participates in social events with other deafblind people



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Thanks For Coming!

2007 Age and Disabilities Odyssey Conference August 21, 2007 Duluth, Minnesota Impact of Hearing and Vision Loss on Independent Living Tracy Bell Koster.

Documents

primary language hearing

vision loss deaf

degree of hearing loss

diversity of hearing

significant vision loss

minnesota impact of

larrys hearing

primary language slide