Supervised by Dr. Lauren
Scharff
Stephen F. Austin State University
This entire paper contains several sections: Introduction, Changes in Vision and Their Effects, Impact of Low Vision, Available Services, Obstacles to Services, the Need for Additional Services and an Interdisciplinary Approach, and References.
In larger cities, several organizations work to provide visually impaired senior citizens with services to help them maintain as much independence as possible. While services may be available in some large cities, most small towns and cities lack the variety of services found elsewhere (T. Steadman, personal communication, June 14, 2002).
This section will discuss many of the most common services available to the elderly. Specifically, the services address the four major areas of their lives in which their independence has been affected: transportation, social activities, health care, and self-care.
Many major cities offer free or inexpensive transportation to seniors via their local mass transit authority. Some local taxi businesses offer similar services with more flexibility because seniors can be taken directly to their destination as opposed to a bus stop. A taxi service may be more appropriate for elderly persons who might have trouble navigating the steps of a large bus, while a wheelchair accessible bus may be the more appropriate option for others.
Many smaller organizations offer transportation assistance to senior citizens as well. There are small businesses in existence to ferry low vision senior citizens on vans for a relatively inexpensive price. Some churches make drivers and vans available to members with transportation needs. For senior citizens in nursing homes, many facilities staff drivers to drive residents to their destinations. Senior citizens and caregivers should look for transportation services in their own local areas that can meet their specific needs.
After finding transportation to leave the home, the elderly are often still limited in the types of social activities in which they can participate. One of the most common places to find social activities adapted to low vision elderly persons is in local churches. Churches often have a variety of activities for senior citizens to keep them socially involved as well as to offer them opportunities to provide a service for others, which may help maintain their self-esteem. For example, churches often have senior choirs that utilize large print sheet music and offer members the opportunity to provide others with entertainment.
Additional modified social activities are also available at community centers. Recreation centers offer physical activities that are modified both for the physical abilities of seniors as well as their low vision needs. Some communities have centers specifically for senior citizens and offer a variety of activities designed for the elderly. For example, recreation and community centers may offer exercise classes designed for the elderly. These classes use brightly colored chairs, balls, and ropes. The colorful equipment is useful not only because the elderly can discriminate them, but also because they are more likely to avoid brightly colored obstacles in their path, reducing the risk of falls. Resources such as exercise classes are good because they offer the opportunity for physical exercise combined with social interaction. Again, senior citizens and their caregivers should look for local resources such as these to help keep the elderly socially active.
Different clubs are available both locally and nationally to help the elderly stay socially active. Senior Friends is an example of a national organization that serves the elderly population in a number of ways. For a small fee, usually around $15.00 per year, members of Senior Friends can enjoy lunch outings, community field trips, and weekly visits during hospital stays. Since Senior Friends is specifically for senior citizens, its activities are tailored to meet the needs of a generally low vision membership.
The elderly and their families can also choose to provide social interaction through home health organizations. Home health agencies that offer custodial care commonly offer companion services as well. For an hourly or weekly fee, the agency will match the client's interests with those of one of their employees and the client will have somebody available to visit them on a schedule they set. These companions offer social support by giving the elderly someone to tell their stories to, play games with, eat meals with, and many other social activities. These services are also available to senior citizens in medical facilities, such as hospitals and nursing homes, through service providers commonly referred to as sitters. The cost of a companion or sitter through a for-profit home health agency ranges from $12.00-15.00 per hour.
Home health agencies can also provide services to assist the low-vision senior citizen in his or her medical care. Certified nurse assistants are available to older people without a specific medical need that would require skilled nursing services. These certified nurse assistants can assist the elderly with many of the daily activities that have become difficult for them because of their vision impairments. For example, they can assist the client by organizing their medications to prevent any problems that might occur due to the fine print on labels or the indistinguishable qualities of pills. They can also assist clients by providing transportation to and from doctors' offices and clinics.
The elderly can also find assistance in understanding Medicare and insurance benefits by seeking out oral explanations instead of written explanations. Medicare typically sends information in a normal-size font print, not the large print which most elderly need to read easily. Senior citizens will obviously have a difficult time understanding writing that they cannot read. The same is true for supplemental insurance policies. Larger cities and towns often have private consultants who work to help patients understand their benefits and rights under different policies. This eliminates the need for the elderly to struggle with reading the fine print and also addresses a second impairment common in the elderly, cognitive loss.
If the cost of a private consultant is a burden for the senior citizen on a fixed income, other sources of assistance may be available. By giving statutory power of attorney to a close friend or family member, a senior citizen authorizes that person to act on his or her behalf in all or some business matters, including medical benefits. This means that someone else has the legal right to read and consent to any medical benefits on the senior citizen's behalf, again eliminating the need for the elderly to struggle with fine print.
There are also hotlines available toll-free which the elderly or their caregivers can call to ask the most common questions about Medicare benefits. When the volunteers cannot answer specific questions, they can refer the person to another agency's phone number where more assistance may be provided. For senior citizens with low vision, an oral explanation of benefits both allows them to understand their benefits without the use of reading and allows them the independence they need to maintain a healthy self-esteem.
Senior citizens can also maintain some independence while receiving assistance with their self-care. Again, home health care agencies offering custodial care are one of the most available sources of help for low vision elderly. Custodial caregivers are the caregivers responsible for assisting the elderly in non-medical daily care. Custodial caregivers, whether they are family members or paid nurse assistants, can help clients minimizes the risk of physical injury during bathing and toileting by assisting them in sitting on toilets or bathtub transfer benches. Once situated, the caregiver should allow the client as much privacy as is safely possible to care for his or her self until help is needed to safely get up. This type of assistance allows the individual the independence of caring for himself or herself but provides assistance in preventing accidents that can occur due to slow adaptation to lights at night, lessened depth perception, and poor contrast sensitivity.
Caregivers can also maintain the individual's independence while helping them dress appropriately. One option is to set aside several sets of clothing that are already color-matched and allow the elderly individual to choose which they prefer to wear. This ensures that the elderly are dressed in a manner that is socially acceptable while allowing them the independence and freedom of choice necessary to maintain a healthy self-esteem. Similar practices can help women apply their makeup. Caregivers can help them by letting the individual choose the makeup they would like to wear and have the caregiver help apply it. This prevents elderly women from wearing too much makeup. Although clothes and makeup may not seem at first like issues worth addressing, an unacceptable appearance may affect the way other people behave towards the elderly. Negative treatment will further their social isolation and lower their self-esteem.
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