Impact of Hearing and Vision Loss on Independent Living Tracy Bell Koster Jan Radatz Deaf and Hard of Hearing Services

Impact of Hearing and Vision Loss on Independent LivingTracy Bell KosterJan Radatz Deaf and Hard of Hearing Services 2007 Age and Disabilities Odyssey Conference August 21, 2007 Duluth, Minnesota

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 Impact of Hearing & Vision Loss on Independent Living

Case Study • Background about “Larry” • Determining what was needed to enable Larry to live more independently • Getting the needed supports in place Impact of Hearing & Vision Loss on Independent Living

Case Study • Background about “Larry” DeafBlind Primary language: American Sign Language Home and education Work history How he came to live in nursing home Impact of Hearing & Vision Loss on Independent Living

Diversity of Hearing Loss • Born Deaf • Born Hard of Hearing • Becomes Deaf later • Becomes Hard of Hearing later • What if vision loss added? Impact of Hearing & Vision Loss on Independent Living

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” Terminology Impact of Hearing & Vision Loss on Independent Living

What isn’t deafblindness? Not deafness plus blindness Why not? • Usual compensation for hearing loss = vision • Usual compensation for vision loss = hearing • Exponential effect Impact of Hearing & Vision Loss on Independent Living

Larry’s Hearing and Vision • Usher Syndrome • Born profoundly deaf • Began losing his vision around age 12 • Significant vision loss likely by age 25 Impact of Hearing & Vision Loss on Independent Living

English (spoken / written language) Language of American mainstream society Common language with hearing / sighted people Primary Language Impact of Hearing & Vision Loss on Independent Living

American Sign Language Language of Deaf Culture; not the language of mainstream American society Visual, spatial; not written English is second language Primary Language Impact of Hearing & Vision Loss on Independent Living

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 Primary Language Impact of Hearing & Vision Loss on Independent Living

English (spoken / written language) Lipreading / speechreading Writing Writing in large print Braille Print-on-Palm Alternative English Modes Impact of Hearing & Vision Loss on Independent Living

American Sign Language Tactile signing Close vision signing Limited signing space Fingerspelling Alternative Sign Language Modes Impact of Hearing & Vision Loss on Independent Living

Larry’s Communication • American Sign Language • Limited signing space • Learning tactile signing • Home signs with family • White board with black marker Impact of Hearing & Vision Loss on Independent Living

Case Study • Raised on a remote farm in rural Minnesota • Parents, sister, other relatives hearing Impact of Hearing & Vision Loss on Independent Living

Case Study • Attended Minnesota State Academy for the Deaf (MSAD) in Faribault • Immersed in American Sign Language and Deaf Culture • Graduated from MSAD Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

Case Study • Upon completing treatment, moved back to family farm • Worked odd jobs (building, roofing, laying brick, peeling corn, etc.) Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

Understanding the loss of distance senses • Greatest comfort level is in known surroundings with familiar people • New environments are frightening • Limited or no distance vision to “get your bearings” • Safety Impact of Hearing & Vision Loss on Independent Living

Understanding the loss of distance senses • No motivation to meet new people; communication barriers • Language • Mode of communication • Depression, trust issues, inadequate coping strategies dues to extreme isolation Impact of Hearing & Vision Loss on Independent Living

Isolation of hearing loss and deafblindness • Isolates individuals from: People Environment Communication Information Impact of Hearing & Vision Loss on Independent Living

Effect on Self-Determination • Difficulty accessing information; determining choices • Limited world knowledge • Self-determination requires cognitive ability and information/knowledge • Limited life experiences Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

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 Impact of Hearing & Vision Loss on Independent Living

Determining what was needed first • 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 Impact of Hearing & Vision Loss on Independent Living

Determining what was needed first • Larry needed access to information • General opportunities for more independent living • Specific options Impact of Hearing & Vision Loss on Independent Living

Partners in Planning • Guardian • Deaf and Hard of Hearing Services Regional Office • State Services for the Blind • Nursing home • County Impact of Hearing & Vision Loss on Independent Living

Types of Supports • Services • Assistive Technology • Home Modifications / Learning New Techniques for Daily Routines Impact of Hearing & Vision Loss on Independent Living

Larry’s Support Services • Support Service Provider • Deaf • Fluent in American Sign Language Purpose • Exposure to language & communication • Access to environment & information Impact of Hearing & Vision Loss on Independent Living

Larry’s Support Services • Orientation & Mobility Instructor • Expert in deafblindness • Fluent in American Sign Language Purpose • Teach navigation skills • Develop confidence and trust for independent travel Impact of Hearing & Vision Loss on Independent Living

Larry’s Support Services • Psychologist • Deaf • Fluent in American Sign Language Purpose • Address depression, anxiety, fearfulness • Build self-confidence Impact of Hearing & Vision Loss on Independent Living

ARRAY OF TECHNOLOGY Impact of Hearing & Vision Loss on Independent Living

ARRAY OF TECHNOLOGY • 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 Impact of Hearing & Vision Loss on Independent Living

ARRAY OF TECHNOLOGY • 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 Impact of Hearing & Vision Loss on Independent Living

Impact of Hearing and Vision Loss on Independent Living Tracy Bell Koster Jan Radatz Deaf and Hard of Hearing Services