Enjoy life! Guidance on helping older people with sight and hearing problems Nicholas Parsons I am delighted to support Sense’s ‘Fill in the Gaps’ campaign and so ensure that all older people affected by sight and hearing loss can lead full and active lives. Not being able to see or hear well in later life can be a real challenge. Getting out of the house, taking part in favourite leisure activities, keeping in touch with friends and family are all made more difficult by sensory loss. Yet, as we grow older, keeping active is increasingly important for staying well. Being active mentally can certainly keep us active physically, and keep us young in mind and body. There are many ways to stay active, and often people are not aware of them. Sense’s ‘Fill in the Gaps’ campaign aims to raise awareness of the support that is available to make sure older people with hearing and sight loss are able to live full and active lives. You can still enjoy life! If you are reading this booklet you probably have a relative who doesn’t see and hear too well. They may be struggling with daily life and you may not know how best to support them. This booklet aims to help you understand what your relative is going through, how you can help, where to go for more support and how you can fill in the gaps that have appeared in their life. Understanding Hearing and sight loss As we age our hearing and sight will deteriorate. At first we may just need glasses or to turn the TV up a little. But if our hearing and sight get worse, things can become more difficult. If you lose your sight so that it is hard to cross the road safely, you may need to ask for help. But how will you do that if you can’t hear what people say to you in a noisy street? If you find it hard to hear what someone is saying, you watch their lips and facial expression for extra clues. But if you become partially sighted, how will you understand what is being said? Too often people think this is just something which happens with age and assume nothing can be done. But even if there is no cure for the sight and hearing problems, support is available so that people can continue to live full and active lives. Having both hearing and sight loss makes it doubly difficult to find ways to cope. People will usually have difficulty with communication, getting around and keeping in touch with friends and family. It is important to get the right support at the right time if people are to continue to enjoy life. Keeping in touch Blind in her later years, Marcelle also wore a digital hearing aid in her left ear to make the most of her remaining hearing. Marcelle moved in with her daughter’s family when her husband passed away determined to make a new life for herself. As a very lively sociable person with many interests, it was important for her to keep in touch with other people. By going to a number of social clubs, including one run by a local society for blind people she was able to try things like pottery and weaving for the first time. She also went to a social club in the village where she made a number of new friends. The loop system in the village hall meant that she could hear and join in conversations and have a laugh. Using headphones to listen to things like Talking Books she was also able to follow her passion for opera by listening to Radio 3. “I wish I could see and hear but I can’t so I just accept it. I haven’t given up and I just try to get on with it,” she said. Different ways to Communicate One of the first problems faced by individuals who don’t see and hear too well is communicating with other people. They may struggle to hear and often misunderstand what is being said. It is boring to have to keep asking for things to be repeated and many older people don’t like to be ‘a bother’. They may give up or pretend they understand when they do not. Most people will continue to use speech, provided it is clear speech (a little slower and louder than usual with clear lip patterns). Here are some ways to make communication easier. Communicating using these methods will probably be slower, but not so frustrating for you or your relative. Before you start * Make sure you have the person’s attention. * Check that hearing aids or other equipment are turned on and working. Where to talk * Between 3-6 feet apart, and at the same level if the person is lip-reading. You may need to move closer, or to the side if hearing is better in one ear. * Good light is important. Face the light so that your full face can be seen. * Avoid background noise. Turn off the TV or radio or move somewhere quieter. Clear speech * Speak clearly. * Talk a little more slowly than usual, but keep the natural rhythm of speech. * Speak a little louder, but don’t shout as this distorts your voice and lip patterns. * Try to make your lip patterns clear, but don’t over-exaggerate. * Keep your face visible. Don’t smoke, eat, or cover your mouth. Help them understand * Make the subject clear from the start and if you change the subject, make sure the person knows. * Use gestures and facial expressions to support what you are saying. * If necessary, repeat phrases. If this doesn’t work, try re-phrasing the whole sentence. Some words are easier to lip-read than others. * Don’t hurry, take your time. * Be aware that communicating can be hard work. Stop if the person gets tired. * Be aware that if a person is smiling and nodding it doesn’t necessarily mean they have understood you. Amplifying speech Hearing aids amplify sounds but don’t always make things as easy to hear as they were before the person lost their hearing. A loop works with a hearing aid to amplify specific sounds. They are used in many settings – e.g. in the home to amplify the television in a living room. Personal amplifiers also enable one- to-one conversations. Some can be used by those who don’t have hearing aids. Get professional advice before buying any system. Help is available from a local authority technical officer or local societies or associations – see page 11. Both systems have drawbacks. The user only hears sound that is directed at the system, which means that other sounds, such as the doorbell or telephone, may be missed. Other communication Learning a new method of communication is challenging, so don’t expect quick results. You may need specialist help. Here are some tips... Block For some people, drawing out block letters on the palm of the hand is the easiest way to communicate. The block alphabet is shown on page 29. This is fairly easy to learn provided the person has sufficient sensitivity in their palm to distinguish the letters. Deafblind manual This is another way to spell out letters onto the hand – see page 28. It is easy for you to learn but much harder for your relative to learn to receive. It is best to learn while they can still hear some speech, but this needs to be raised sensitively because the person may not want to admit that their hearing is getting worse. Writing things down Even if someone doesn’t see too well they may still be able to read large clear letters in thick pen, maybe even with the help of a magnifier. Experiment with different sizes of letters and different colours of paper and pen. Access to Information Having access to information is vital – whether this is telling the difference between the coffee and sugar jars, or knowing what is going on in the news. Keeping the mind active is important as we age. This can be hard if radio, TV, newspapers and books are all hard to follow. Audio tape and CDs For people who can still hear speech, audio tape and CDs – perhaps with good headphones which cut out background noise and allow high volume without disturbing others – can be useful. Audio books allow people who can no longer read to continue their interest in fiction or learning. Audio newspapers are also available (see page 27 for how to get these). Many organisations produce information in this format as a requirement of the Disability Discrimination Act. Large print and magnifiers Many older people will be able to read if large print is used – usually 14 point bold or above. Most libraries provide books in large print and many service providers – such as banks – will offer large print on request. There are also a wide range of magnifiers available which can help an older person to continue to read magazines, food labels etc. Braille Braille is hard to learn, but don’t assume just because a person is older they cannot learn. We know of people in their 70s who have enjoyed learning braille. It can give access to many print materials such as books and leaflets. With the right equipment it can also give access to computers including email and the internet. It is extremely easy to produce stick-on braille tape to label jars and tins, and dangerous cleaning chemicals are labelled in braille by manufacturers. There are also a range of other labelling products available. Moon Moon is much easier to learn than braille as it is based on the written alphabet. However, there is less information available in Moon and it doesn’t give access to the internet. However, it is very useful for labelling things. Keeping in touch Various groups and social clubs are available, including Sense’s Hearing and Sight Impaired (HSI) group. Sense, Deafblind UK and some local social services run social groups and forums in some areas. There are also many local societies for visually impaired and hearing impaired people where older people often get together to socialise. Deafblind UK produce information for members in a range of formats (membership is free to people with hearing and sight problems). See page 27 for Deafblind UK contact details. Sense has a membership scheme for people with hearing and sight problems and their relatives. Contact the Sense membership team for details – see page 27. Ways of Getting around If you have been used to using your sight to find your way around for most of your life it can be very harrowing not to be able to do so any more. Even a partial loss of sight can have a big impact on the ability to get around or cross roads safely. But it is important that people don’t stop being active. In the home Most people will get around their own homes well enough but will need help to learn basic routes if they are in a new and unfamiliar place, such as a relative’s home or a day centre. Walk them through the route pointing out features on the way which will help them locate themselves, for instance the textured wallpaper in the corridor with the bathroom. A useful technique for walking around safely is to hold one hand ahead while trailing the back of the other hand against a wall. Out and about If someone could make a simple journey unaided, to the local shop for instance, help him or her explore the route. Walk the route with them, pointing out key features to help orientate them such as changes of pavement surface or the number of gates they need to count. Talk to your local social services about assistance with mobility. Find out about any local transport schemes for people with disabilities, such as ‘dial-a ride’. Your local council will tell you about these. Some train operators offer special help to disabled passengers and concessions to the person accompanying them. Communicator-guides A communicator-guide is a person trained in communication and guiding skills to work with people who have both hearing and sight loss. They will assist a person with a range of activities, such as dealing with mail or going to the shops. Some people can get this service from their social services department. Others purchase a service from local voluntary organisations, including Sense. Please contact us or your local authority sensory team (see p26) for further information. How to guide * Offer your arm for them to hold and allow them to follow you. Don’t grab, push or pull a person. * Judge the speed the person feels safe walking. If he/she has not been guided before they will probably want to go slowly. They may also have other physical problems such as arthritis which make walking difficult or painful. * Sudden changes of direction are best avoided. * Let them hold the handrail on stairs and walk in front of them, waiting at the top or bottom to guide them. * When you are showing a person to a seat or chair, put their hand on the arm or back of the chair and let them sit down. Don’t try to push them into the seat. Maintaining home Independence People with hearing and sight loss can be helped to maintain their independence by the careful use of equipment, adaptations and support. Training from a specialist is recommended – ask your social services department where to get this. Some things you could try: * Improve the level of lighting o suit the person. Most people prefer high levels of light and good task lighting, but for others you will need to dim the lighting and eliminate glare, by putting in sun blinds for instance. Lighting needs to be carefully thought out on steps and stairs. * Use colour contrast to high-light features and make them easier to find. For example put contrasting tape on the edge of stairs and round plug sockets. Paint door frames and skirting boards a different colour from the doors, walls and carpets. Choose crockery that contrasts with worktops and tables. * Move obvious hazards such as coffee tables in the middle of a floor, things that jut out at head height, or things that can be tripped over such as rugs and waste bins. * Use tactile clues to help people distinguish things. For instance, put one rubber band round the tinned tomatoes and two round the peaches; bubble wrap on some door handles and string on others. * Scented clues can help too. Put lemon-scented soap in the sock drawer and lavender bags with the jumpers for instance. There is a wide range of equipment available such as textphones, tactile watches and alarm clocks that vibrate under your pillow. For people who find it hard to hear the doorbell or telephone, vibrating pagers that alert to these are available. There are literally hundreds of items to choose from to suit most people’s basic needs. There is information about useful equipment on the Sense website – www.sense.org.uk/technology RNIB and Action on Hearing Loss stock a range of useful items. Flashing or vibrating fire alarms are also available and many fire services will install these free of charge. When you come to visit don’t * Offer a plate at mealtimes without saying what is on it. * Leave things, like your bag, where it could be a hazard. Doors should be left fully closed or fully open, never half open. * Move furniture or objects in someone’s home without discussing it first. The tea caddy you moved is as good as lost! * Leave someone without explaining that you are going, or they could end up talking to an empty space. Getting specialist Support Social Services Although you may not think of your relative as ‘deafblind’ this does not mean completely deaf and blind. Being considered ‘deafblind’ can help as it gives rights to particular services as a result of guidance issued to local authorities called ‘Social Care for Deafblind Children and Adults’ LAC(DH) 2009(6). Ask your local authority for a specialist assessment under the Deafblind Guidance. Most local authorities have a sensory team, and in many cases they have specialist workers for people with both hearing and sight loss. They are likely to be called ‘deafblind worker’ or ‘dual- sensory loss worker’. Not everyone will be entitled to services from social services, and some will be asked to pay towards the cost. If a person has a certain level of income or savings they may not be entitled to social services. However, they are still entitled to advice about what would help and where to get support. Another reason a person might be refused services would be if their needs are not considered high enough to qualify. If this happens, make sure the person who made that decision knows about the problems caused by having both hearing and sight loss. If they don’t, your relative may have been wrongly assessed. If your relative is entitled to support from social services they can receive this as a service, or as direct payments. Direct payments provide a person with money to buy their own service from whoever they wish to use. They can’t be used to pay a member of your family who lives in the same house as the service user. If your relative would prefer to have direct payments they should ask for this. For more information on how to get support from social services contact the Sense Information & Advice Service (see page 26 for contact details). Voluntary organisations There are many different voluntary organisations that might be able to help. What is available depends partly on where you live. In some areas Sense, Deafblind UK or local associations for the blind may provide communicator-guide services. In many areas local voluntary organisations can provide information, advice, possibly even equipment you can look at to see if it is suitable. Your local sensory impairment team should be able to advise, or you can call the Sense Information & Advice Service who can let you know what is available in your area. Private care providers If social services cannot offer any help to your relative (and you have decided not to appeal against this) it may be worth considering using a private care agency if you can afford this. You may be able to use certain benefits to pay for this – see page 24. Care agencies can offer different care packages to help someone to keep their independence. However it is important that this is monitored to make sure you are happy with the quality of service offered. How best to Enjoy life One of the greatest challenges for older people with hearing and sight loss is to fill the time when reading, television and other activities may be difficult or impossible. However, it is possible to adapt some activities; gardening, for instance, is enjoyed by older people with impaired sight and even totally blind people. Cooking can be fun again for people who enjoy it, and people with some sight may be able to use large print knitting patterns for example. For those with some hearing, audio-taped books and audio newspapers are available. For people with very severe sensory loss, the solutions have to be tactile. RNIB sells a number of tactile games, such as dominoes and playing cards which can be played with sighted and hearing people too. Some museums, galleries and cathedrals offer ‘touch tours’ for people who cannot see exhibits. Some organisations run holiday hotels offering special services to people with sensory problems. Don’t assume your relative has to give up activities they once enjoyed. Look for ways to make them accessible, and ask for specialist help if necessary. Look for new activities that your relative may enjoy. There may be social clubs for people with sight loss or even people with both hearing and sight loss. Sense provides local forums. Keeping active is vital in keeping healthy as we get older. Dealing with depression and other problems Hearing and sight loss can be extremely frustrating and many people become depressed, angry or withdrawn. Often these difficulties arise because they have no means to communicate their feelings and anxieties. Establishing a workable way of communicating is therefore very important. It is also very time- consuming and requires a great deal of patience, but it will reap dividends. Talking to a sympathetic listener can often help people move on in their lives and adapt successfully to their new situation. Deafblind UK run a helpline for deafblind people. Severe depression may require medical help. Contact Sense for advice on where to go for help with depression. Extra money Older people with impaired sight and hearing will almost certainly qualify for Disability Living Allowance, or Personal Independence Payment (for people up to 65), or Attendance Allowance (for people over 66). Other benefits such as council tax concessions and housing benefit may also be available. The benefits system is not easy to understand so we encourage everyone to get specialist advice; Sense’s Information & Advice Service can help (contact information is on page 26). These benefits are there to help with the extra costs of disability. Where to go for more Information Your local sensory team Social services in every area have sensory specialists who will be able to help with advice and information and may be able to provide services. Contact your local council for their details. They will be able to tell you about local associations for the blind and local deaf associations Sense’s Information & Advice Service Sense’s Information & Advice Service offers accurate, comprehensive and up-to-date impartial information and advice for deafblind people, their families, professionals working with deafblind people and anyone who has a general enquiry about Sense or any aspect of deafblindness. The service covers England, Wales and Northern Ireland. Contact the Information & Advice Service: Tel / textphone: 0845 127 0066 Fax: 0845 127 0061 Email: info@sense.org.uk Web: www.sense.org.uk Sense 101 Pentonville Road London N1 9LG Tel / textphone: 0845 127 0066 info@sense.org.uk www.sense.org.uk RNIB 105 Judd Street London WC1H 9NE Tel: 0303 123 9999 helpline@rnib.org.uk www.rnib.org.uk Action on Hearing Loss 19-23 Featherstone Street London EC1Y 8SL Telephone: 0808 808 0123 Textphone: 0808 808 9000 informationline@rnid.org.uk www.actiononhearingloss.org.uk Deafblind UK National Centre for Deafblindness John and Lucille van Geest Place Cygnet Road Hampton, Peterborough Cambridgeshire PE7 8FD Helpline tel/text: 0800 132 320 www.deafblind.org.uk Talking Newspapers T.N.A.U.K. National Recording Centre, Heathfield, East Sussex, TN21 8DB Tel: 01435 866102 Fax: 01435 865422 Email: info@tnauk.org.uk www.tnauk.org.uk This booklet is for people with an older relative or friend who doesn’t see and hear too well. They may be struggling with daily life and you may not know how best to support them. It aims to help you understand what they are going through, how you can help and where to go for more support. Sense 101 Pentonville Road London N1 9LG Tel / textphone: 0845 127 0066 Fax: 0845 127 0061 Email: info@sense.org.uk Web: www.sense.org.uk/content/older-people