Title: The housing and support needs of people aged 18-55 with sight loss (2006)
Authors: Research team led by Julienne Hanson
Affiliations: University College London
The study explored the housing and support needs of people of working age with visual impairment. The housing needs of this group are often addressed only as part of generic studies of disability.
Individual interviews and workshops were held with key individuals from 90 organisations providing housing and support services in London, Tyneside, the West Midlands and Bristol, focusing on how to improve service delivery. Finally, 121 individuals with sight loss in London completed a questionnaire about their housing and support situations, and 30 of this group plus a further 110 from the other three areas participated in guided focus groups and telephone interviews.
The study revealed that people wanted accommodation in a familiar area, close to public transport, to employment and leisure opportunities, and to local amenities. The location of housing can be critical to the degree of independence that is attained. Adequate space was another top priority for adults with sight loss.
Space was needed for low vision aids and assistive technology, to allow people to move around safely, to house a guide dog, and to accommodate guests or carers. Other aspects of the housing space were also important: good lighting and contrast in colour and tone tailored to individual requirements, and the facility to adapt the space as an individual’s needs change. People felt secure in their accommodation when there was some control on access. This might be perimeter fencing with a locked security gate, external security lighting and porch lighting, CCTV, an entry-phone or intercom, secure locks on doors and windows, and burglar and smoke alarms.
A key choice for individuals is whether they opt for a mainstream housing option or for some form of specialist provision. Seven out of 10 visually impaired people were in rented provision compared to three out of 10 in the rest of the population; visual impairment however often did not merit housing points. Shared ownership could be an attractive option for those with sufficient income and security to sustain it.
Respondents spoke of both pros and cons in terms of specialist housing support. It could provide a supportive stepping stone but could also act as a constraint to self-reliance. Provision was not considered sufficiently diverse.
Interviewees responded positively to specialist housing providers creating flats of various sizes for people with sight loss, either converted or purpose-built; this was seen as preferable to more institutionalised options. Indeed a range of specialist options were suggested including extracare housing for people with a sight loss, transitional housing as a springboard to independence, supported housing for visually impaired parents with young children, intermediate care housing that offers rehabilitation, and housing for a mixed ability community or for a mix of sighted people and individuals with visual impairment.
A prerequisite for any of these options was the availability of basic information on options and access. For example waiting lists and points systems for tenancies. Knowledge of these was low, and information was often not available in accessible formats. The study also identified the need for:
● Flexible procedures in moving to independent housing such as allowing trial visits.
● Flexible procedures in respect of family issues, for example offering accommodation in close proximity that allows someone to move from the family home.
● Recognition of the housing implications of the additional disabilities of many individuals with sight impairment.
The study identified some reluctance among individuals with visual impairment to identify themselves as service users and to be linked to social services departments but three-quarters of those interviewed required support in at least three areas of their life. An essential prerequisite is a holistic assessment, identifying the specific needs of the individual and responsive to change over time. Groups were also identified who were particularly likely to experience disadvantage: those not in paid work, individuals with multiple disabilities or late onset of sight loss, and those from ethnic minorities.
Lack of understanding of need limits the support services that are provided. Service providers wanted to improve case working practices, to see active leadership from the sensory impairment team, and to promote a person-centred approach based on rights and entitlements rather than disability and needs.
The authors make 30 recommendations based on the research. These relate to gathering information on prevalence, developing a national policy framework, holistic and ongoing needs assessment and the use of direct payments, a more proactive approach to meeting communication needs, development of partnership working, provision of in-service and disability awareness training for housing staff, and design of the built environment.
One study (Morjaria-Keval and Johnson, 2005) sought to respond to findings such as those outlined above by attempting to target information at individuals at particular risk of exclusion.
It outlined the development of a capacity building project in Birmingham to explore ways of more effectively delivering services to people with visual impairment from ethnic minorities.
People from African-Caribbean and South Asian heritage experience higher levels of visual impairment, glaucoma in the first group and cataracts in the latter. A group of community facilitators were trained to conduct focus group discussions at which information about sight loss was given.
A series of sight loss fairs were then organised, targeted at six of the main ethnic groups. Details were provided about eye health and related services in the hope that the information would be passed on to those in the community who might need it.
This project highlighted several important issues. As with the study outlined above, the provision of information was a key requirement. There could be a “learned helplessness”, the result of attempts to use services that had proved not to be culturally sensitive, to be no longer available, or to have language barriers. Stigma, shame or pride could also be factors, a fear of seeking support or a tradition of self-help. Low expectations could be a barrier to accessing services and religion could also feature in that some individuals may believe that sight loss is “given by God”.
Alison Petch is director of Research in Practice for Adults. Ripfa promotes the use of evidence informed practice in the delivery of adult social care services. More at
LINKS AND RESOURCES
● The research outlined above was published as Occasional Paper 7 (2006), Thomas Pocklington Trust, and also reported in Percival J, Hanson J and Osipovic D (2006) “A positive outlook? The housing needs and aspirations of working age people with visual impairments”, Disability and Society 21,661-675.
● Hanson J, Percival J, Zako R and Johnson M (2002), The Housing and Support Needs of Older People with Visual Impairment, Research Findings No 1, Thomas Pocklington Trust
● Sawyer L and Reader M (2003) Domiciliary Support for People with Sight Loss, Research Findings No 2, Thomas Pocklington Trust
● Ross K (2003), Helping People with Sight Loss in their Homes: Housing-Related Assistive Technology, Research Findings No 4, Thomas Pocklington Trust
● Morjaria-Keval A and Johnson M (2005) Our Vision Too: Improving the Access of Ethnic Minority Visually Impaired People to Appropriate Services: Building a Supported Community Referral System, Research Findings No 8, Thomas Pocklington Trust
● Hodges L and Douglas G (2007) Hearing and Sight Loss: A Review of the Issues Affecting Older People, Research Findings No 14, Thomas Pocklington Trust
Raising the profile
Many services claim to be “Cinderella”. Visual impairment however is particularly prone to be overlooked and to fall in the shadow of more visible disabilities. Professionals should work to counter any notion of a hierarchy of disabilities. The specific needs of individuals with visual impairment should be recognised and not subsumed within generic disabilities.
All new building, whether for housing, for community or for commercial use, should be developed in accordance with inclusive design principles. Housing to be used by individuals with visual impairment requires additional storage space for assistive technology equipment. Use of assistive technologies should be maximised.
The provision of information is essential to allow individuals with visual impairment the opportunity to access necessary support and preferred housing options. Information must be in accessible form, either large print, Braille or talking books. For people from ethnic minorities, the provision of information in minority languages and through trusted routes is key.
Holistic assessment and provision
An inclusive approach should be adopted by those assessing individuals with visual impairment, acknowledging the full range of an individual’s needs and their social and family networks. Core facilities such as hospital eye clinics should adopt a more expansive approach, offering advice and information and providing access to a wider range of support beyond the diagnostic.
A variety of models of housing provision should be encouraged, allowing individuals to locate their preferred option for any particular stage of their life. Transition between models should be facilitated.
This article appeared in the 2nd August issue, under the headline “Housing needs of people with visual impairment”