Independent living for learning disabled people with visual impairments

People with learning disabilities who are visually impaired have unique needs as they move towards independent living. Vern Pitt reports on a project that supports this transition

Have you ever taught someone to make a cup of tea in the dark? That is one of the challenges facing staff trying to move residents with learning disabilities and visual impairments out of NHS campuses into the community.

The government has set itself the task of closing all NHS campuses by the end of 2010. As of April this year, they housed 1,000 people in group homes run by the health service.

It believes many of the residents, who have severe learning disabilities, can have a better standard of living and more independence in the community, notably in supported housing.

However, people with a learning disability are between 8.5 and 200 times more likely to have a visual impairment than the rest of the population, so maximising independence for this group of campus residents poses a big challenge.

Improve support

The charity SeeAbility has been working with West Sussex Council in helping to re-house campus residents as part of its eye2eye scheme to improve support for people with visual impairments and learning disabilities.

Overcoming the challenges required improved communication between the council’s learning disability and visual impairment rehabilitation teams, which provide equipment and adaptations so that service users can retain their independence.

“The danger was that people might have missed out on accessing support with their visual impairments because staff weren’t too sure what was the role of their colleagues,” says Stephen Kill, eye2eye community development officer.

Share expertise

Bringing the teams together for a day to share their expertise resulted in 13 new referrals for rehabilitation assessments within weeks.

Improved communication between the teams also enabled better understanding of the communication needs of clients.

“People with learning disabilities often use visual aspects to understand what’s happening and if you have a visual impairment that form of communication isn’t available to you,” says Nicky Lambert, care manager with the learning disabilities team.

When the learning disabilities team spoke to a client they would sometimes find them unco-operative or agitated without knowing why. Often it was a visual impairment that would cause the person to become uncomfortable in lower lighting.

Further complication

People with learning disabilities can find it difficult to communicate abstract subjects. Sight is one. Only by tapping the expertise of the rehabilitation officers for people with visual impairments (Rovi) can learning disability staff arrive at a clear picture.

Kill says service users with multiple disabilities face a further complication. “Professionals can perceive one disability as having more of an impact on that person than the others so other things do not get as much attention,” he says.

Having identified the needs of the service user, adjustments can be made to their new home, such as fitting hand rails, introducing colour contrasts between furniture and floors and removing patterned carpets, which can confuse. Then it is over to the rehabilitation team to plan support and brief staff in the new accommodation.

Rovi Ruth Osborne says: “With someone who is [only] visually impaired you’d ask, ‘Can you pour a kettle into a cup?’. For someone [also] with a learning disability we ask, ‘Do you know where the kettle is? Do you know how to fill it up?’ because some people have never done that for themselves.”

Kill is clear that the process is about the keys to a new level of independence not just to a new house. “If people are given opportunities to do different things and learn new skills often they thrive on it. They appreciate those opportunities and can often surprise you in what they can do.”

CASE STUDY

‘Disruption to George’s life was minimised’

George Marston* is in his sixties and has moved from an NHS campus into a care home in West Sussex.

He has no perception of light so SeeAbility’s Stephen Kill provided advice on Marston’s needs to staff in his new home because they had not worked before with a resident with such severe visual impairment.

“We installed a hand rail which helped him to find his way about safely within his own home which was difficult for him because of his level of visual impairment,” says Kill.

Trip hazards in Marston’s room were removed but little orientation was needed because the layout of the property was similar to where he had previously lived.

“Because of the ongoing support he received he has settled very well into his new home,” says Kill. “The level of change, insecurity and disruption to his life have been minimised because of the support that he received.”

*Not his real name.

Tips for practice

● Ask whether the client’s visual impairment is new or whether they have had it a long time. They may have ways of coping.

● Find out what they can do and what skills they have.

● Remember frequent repetition is the best way for people to learn new skills.

This article is published in the 29 October 2009 edition of Community Care under the headline “It all becomes clear”