2007 Age and Disabilities Odyssey Conference August 21, 2007 Duluth, Minnesota Impact of Hearing and Vision Loss on Independent Living Tracy Bell Koster Jan Radatz Deaf and Hard of Hearing Services

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 2 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 3 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 4 Case Study 1)Background about “Larry” DeafBlind Primary language: American Sign Language Home and education Work history How he came to live in nursing home

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 5 Diversity of Hearing Loss Born Deaf Born Hard of Hearing Becomes Deaf later Becomes Hard of Hearing later What if vision loss added?

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 6 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”

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 7 What isn’t deafblindness? Not deafness plus blindness Why not?  Usual compensation for hearing loss = vision  Usual compensation for vision loss = hearing  Exponential effect

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 8 Larry’s Hearing and Vision Usher Syndrome Born profoundly deaf Began losing his vision around age 12 Significant vision loss likely by age 25

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 9 Case Study 1)Background about “Larry” DeafBlind Primary language: American Sign Language Home and education Work history How he came to live in nursing home

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 10 Primary Language English (spoken / written language) Language of American mainstream society Common language with hearing / sighted people

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 11 Primary Language American Sign Language Language of Deaf Culture; not the language of mainstream American society Visual, spatial; not written English is second language

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 12 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 13 Alternative English Modes English (spoken / written language) Lipreading / speechreading Writing Writing in large print Braille Print-on-Palm

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 14 Alternative Sign Language Modes American Sign Language Tactile signing Close vision signing Limited signing space Fingerspelling

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 15 Larry’s Communication American Sign Language Limited signing space Learning tactile signing Home signs with family White board with black marker

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 16 Case Study 1)Background about “Larry” DeafBlind Primary language: American Sign Language Home and education Work history How he came to live in nursing home

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 17 Case Study Raised on a remote farm in rural Minnesota Parents, sister, other relatives hearing

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 18 Case Study Attended Minnesota State Academy for the Deaf (MSAD) in Faribault Immersed in American Sign Language and Deaf Culture Graduated from MSAD

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 19 Case Study 1)Background about “Larry” DeafBlind Primary language: American Sign Language Home and education Work history How he came to live in nursing home

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 20 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 21 Case Study Upon completing treatment, moved back to family farm Worked odd jobs (building, roofing, laying brick, peeling corn, etc.)

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 22 Case Study 1)Background about “Larry” DeafBlind Primary language: American Sign Language Home and education Work history How he came to live in nursing home

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 23 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 24 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 25 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 26 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 27 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 28 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 29 Greatest comfort level is in known surroundings with familiar people New environments are frightening Limited or no distance vision to “get your bearings” Safety Understanding the loss of distance senses

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 30 No motivation to meet new people; communication barriers Language Mode of communication Depression, trust issues, inadequate coping strategies dues to extreme isolation Understanding the loss of distance senses

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 31 Isolation of hearing loss and deafblindness Isolates individuals from: People Environment Communication Information

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 32 Effect on Self-Determination Difficulty accessing information; determining choices Limited world knowledge Self-determination requires cognitive ability and information/knowledge Limited life experiences

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 33 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 34 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 35 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 36 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 37 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 38 Determining what was needed first Larry needed access to information General opportunities for more independent living Specific options

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 39 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 40 Partners in Planning Guardian Deaf and Hard of Hearing Services Regional Office State Services for the Blind Nursing home County

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 41 Types of Supports Services Assistive Technology Home Modifications / Learning New Techniques for Daily Routines

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 42 Larry’s Support Services Support Service Provider Deaf Fluent in American Sign Language Purpose Exposure to language & communication Access to environment & information

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 43 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 44 Larry’s Support Services Psychologist Deaf Fluent in American Sign Language Purpose Address depression, anxiety, fearfulness Build self-confidence

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 45 Types of Supports Services Assistive Technology Home Modifications / Learning New Techniques for Daily Routines

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 46 ARRAY OF TECHNOLOGY

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 47 ARRAY OF TECHNOLOGY

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 48 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 49 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 50 Types of Supports Services Assistive Technology Home Modifications / Learning New Techniques for Daily Routines

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 51 Deaf & Hard of Hearing Services

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 52 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 thelighting State Services for the Blind

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 53 Types of Supports Services Assistive Technology Home Modifications / Learning New Techniques for Daily Routines

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 54 New Daily Routines - Resources

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 55 New Daily Routines - Resources

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 56 New Daily Routines - Resources Orientation & Mobility (O&M) Deafblind-specific independent living skills training Support Service Providers (SSPs) Interpreting services, real-time captioning (CART) DHHSD DeafBlind Consumer Directed Services program

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 57 Resources for Technical Assistance Deaf & Hard of Hearing Services Division DeafBlind Services Minnesota Duluth Lighthouse for the Blind

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 58 Resources for Technical Assistance MN State Services for the Blind MN Dept of Ed. DeafBlind Project Vision Loss Resources – Minnesota

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 59 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 60 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

2007 Age & Disabilities Odyssey Conference Impact of Hearing & Vision Loss on Independent Living 61 Thanks For Coming!