Supervised by Dr. LaurenScharff
Stephen F. Austin State University
This entire paper contains several sections: Introduction,Changes in Vision and TheirEffects, Impact of LowVision, Available Services,Obstacles to Services, theNeed for Additional Services and anInterdisciplinary Approach, and References.
In larger cities, several organizations work to provide visuallyimpaired senior citizens with services to help them maintain as muchindependence as possible. While services may be available in somelarge cities, most small towns and cities lack the variety ofservices found elsewhere (T. Steadman, personal communication, June14, 2002).
This section will discuss many of the most common servicesavailable to the elderly. Specifically, the services address the fourmajor areas of their lives in which their independence has beenaffected: transportation, social activities, healthcare, and self-care.
Many major cities offer free or inexpensive transportation toseniors via their local mass transit authority. Some local taxibusinesses offer similar services with more flexibility becauseseniors can be taken directly to their destination as opposed to abus stop. A taxi service may be more appropriate for elderly personswho might have trouble navigating the steps of a large bus, while awheelchair accessible bus may be the more appropriate option forothers.
Many smaller organizations offer transportation assistance tosenior citizens as well. There are small businesses in existence toferry low vision senior citizens on vans for a relatively inexpensiveprice. Some churches make drivers and vans available to members withtransportation needs. For senior citizens in nursing homes, manyfacilities staff drivers to drive residents to their destinations.Senior citizens and caregivers should look for transportationservices in their own local areas that can meet their specificneeds.
After finding transportation to leave the home, the elderly areoften still limited in the types of social activities in which theycan participate. One of the most common places to find socialactivities adapted to low vision elderly persons is in localchurches. Churches often have a variety of activities for seniorcitizens to keep them socially involved as well as to offer themopportunities to provide a service for others, which may helpmaintain their self-esteem. For example, churches often have seniorchoirs that utilize large print sheet music and offer members theopportunity to provide others with entertainment.
Additional modified social activities are also available atcommunity centers. Recreation centers offer physical activities thatare modified both for the physical abilities of seniors as well astheir low vision needs. Some communities have centers specificallyfor senior citizens and offer a variety of activities designed forthe elderly. For example, recreation and community centers may offerexercise classes designed for the elderly. These classes use brightlycolored chairs, balls, and ropes. The colorful equipment is usefulnot only because the elderly can discriminate them, but also becausethey are more likely to avoid brightly colored obstacles in theirpath, reducing the risk of falls. Resources such as exercise classesare good because they offer the opportunity for physical exercisecombined with social interaction. Again, senior citizens and theircaregivers should look for local resources such as these to help keepthe elderly socially active.
Different clubs are available both locally and nationally to helpthe elderly stay socially active. Senior Friends is an example of anational organization that serves the elderly population in a numberof ways. For a small fee, usually around $15.00 per year, members ofSenior Friends can enjoy lunch outings, community field trips, andweekly visits during hospital stays. Since Senior Friends isspecifically for senior citizens, its activities are tailored to meetthe needs of a generally low vision membership.
The elderly and their families can also choose to provide socialinteraction through home health organizations. Home health agenciesthat offer custodial care commonly offer companion services as well.For an hourly or weekly fee, the agency will match the client'sinterests with those of one of their employees and the client willhave somebody available to visit them on a schedule they set. Thesecompanions offer social support by giving the elderly someone to telltheir stories to, play games with, eat meals with, and many othersocial activities. These services are also available to seniorcitizens in medical facilities, such as hospitals and nursing homes,through service providers commonly referred to as sitters. The costof a companion or sitter through a for-profit home health agencyranges from $12.00-15.00 per hour.
Home health agencies can also provide services to assist thelow-vision senior citizen in his or her medical care. Certified nurseassistants are available to older people without a specific medicalneed that would require skilled nursing services. These certifiednurse assistants can assist the elderly with many of the dailyactivities that have become difficult for them because of theirvision impairments. For example, they can assist the client byorganizing their medications to prevent any problems that might occurdue to the fine print on labels or the indistinguishable qualities ofpills. They can also assist clients by providing transportation toand from doctors' offices and clinics.
The elderly can also find assistance in understanding Medicare andinsurance benefits by seeking out oral explanations instead ofwritten explanations. Medicare typically sends information in anormal-size font print, not the large print which most elderly needto read easily. Senior citizens will obviously have a difficult timeunderstanding writing that they cannot read. The same is true forsupplemental insurance policies. Larger cities and towns often haveprivate consultants who work to help patients understand theirbenefits and rights under different policies. This eliminates theneed for the elderly to struggle with reading the fine print and alsoaddresses a second impairment common in the elderly, cognitiveloss.
If the cost of a private consultant is a burden for the seniorcitizen on a fixed income, other sources of assistance may beavailable. By giving statutory power of attorney to a close friend orfamily member, a senior citizen authorizes that person to act on hisor her behalf in all or some business matters, including medicalbenefits. This means that someone else has the legal right to readand consent to any medical benefits on the senior citizen's behalf,again eliminating the need for the elderly to struggle with fineprint.
There are also hotlines available toll-free which the elderly ortheir caregivers can call to ask the most common questions aboutMedicare benefits. When the volunteers cannot answer specificquestions, they can refer the person to another agency's phone numberwhere more assistance may be provided. For senior citizens with lowvision, an oral explanation of benefits both allows them tounderstand their benefits without the use of reading and allows themthe independence they need to maintain a healthy self-esteem.
Senior citizens can also maintain some independence whilereceiving assistance with their self-care. Again, home health careagencies offering custodial care are one of the most availablesources of help for low vision elderly. Custodial caregivers are thecaregivers responsible for assisting the elderly in non-medical dailycare. Custodial caregivers, whether they are family members or paidnurse assistants, can help clients minimizes the risk of physicalinjury during bathing and toileting by assisting them in sitting ontoilets or bathtub transfer benches. Once situated, the caregivershould allow the client as much privacy as is safely possible to carefor his or her self until help is needed to safely get up. This typeof assistance allows the individual the independence of caring forhimself or herself but provides assistance in preventing accidentsthat can occur due to slow adaptation to lights at night, lesseneddepth perception, and poor contrast sensitivity.
Caregivers can also maintain the individual's independence whilehelping them dress appropriately. One option is to set aside severalsets of clothing that are already color-matched and allow the elderlyindividual to choose which they prefer to wear. This ensures that theelderly are dressed in a manner that is socially acceptable whileallowing them the independence and freedom of choice necessary tomaintain a healthy self-esteem. Similar practices can help womenapply their makeup. Caregivers can help them by letting theindividual choose the makeup they would like to wear and have thecaregiver help apply it. This prevents elderly women from wearing toomuch makeup. Although clothes and makeup may not seem at first likeissues worth addressing, an unacceptable appearance may affect theway other people behave towards the elderly. Negative treatment willfurther their social isolation and lower their self-esteem.
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