Impact of Hearing and Vision Loss
on Independent Living
Tracy Bell Koster
Jan 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, selfdetermination, 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
2
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
3
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
4
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
5
Terminology
• Deafblindness
• Dual sensory loss
• Combined hearing
and vision loss
2007 Age & Disabilities
Odyssey Conference
• Deaf, hard of
hearing & vision
impairment
• “I don’t hear so
good or see that
well anymore”
Impact of Hearing & Vision Loss
on Independent Living
6
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
7
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
8
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
9
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
10
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
11
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
12
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
13
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
14
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
15
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
16
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
17
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
18
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
19
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
20
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
21
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
22
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
23
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
24
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
25
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
26
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
27
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
28
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
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
29
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
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
30
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
31
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
32
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
33
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
34
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
35
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
36
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
37
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
38
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
39
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
40
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
41
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
42
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
43
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
44
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
45
ARRAY OF TECHNOLOGY
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
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
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
48
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
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
49
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
50
Deaf & Hard of Hearing Services
www.dhhsd.org
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
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State Services for the Blind
www.mnssb.org
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
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
52
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
53
New Daily Routines - Resources
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
Deafblind-specific
independent
living skills
Support
training
Service
Orientation Providers
& Mobility (SSPs)
(O&M)
2007 Age & Disabilities
Odyssey Conference
DHHSD DeafBlind
Consumer Directed
Services program
Interpreting
services, real-time
captioning (CART)
Impact of Hearing & Vision Loss
on Independent Living
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Resources for
Technical Assistance
• Deaf & Hard of Hearing Services
Division
www.dhhsd.org
• DeafBlind Services Minnesota
www.dbsm.org
• Duluth Lighthouse for the Blind
www.lighthousefortheblind-duluth.org
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
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Resources for
Technical Assistance
• MN State Services for the Blind
www.mnssb.org
• MN Dept of Ed. DeafBlind Project
www.dbproject.mn.org
• Vision Loss Resources – Minnesota
www.visionlossresources.org
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
58
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
59
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
60
Thanks For Coming!
2007 Age & Disabilities
Odyssey Conference
Impact of Hearing & Vision Loss
on Independent Living
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