[The following article is presented to help seniors who have had a recent vision loss to understand that there are individuals who can assist them to maintain an independent life style. For local information contact: Ben Prows at BJProws@comcast.net or Kaye Kipp at firstname.lastname@example.org ]
New Approaches to Consider: Suggestions for Individuals with Recent Vision Loss
by Ramona Walhof
How much will life change? It is not necessary for a person who has low vision to be helpless or dependent. With proper training, encouragement, and opportunities, that person can be active, self-sufficient, and productive.
The most important thing to do is to gather information about how to function effectively using some new approaches. This includes the use of daily living skills and work-related skills. Most alternative methods that people with low vision need are simple, common sense methods. Not much special equipment is required. Some simple tools will be helpful, and there are expensive devices available also. Most of the appliances, tools, and equipment you have been using will still be what you need.
For example, some women whose vision has deteriorated have expressed concern about using their good dishes. You will learn to take reasonable precautions with breakable objects as you gain experience. You should guard against trying to do everything visually. If, for instance, you wish to place a serving dish in the middle of the dining room table put it on the corner first. Then use your hands to find a clear spot in the middle of the table. You may wish to fill the water glasses from a pitcher after the people are seated, or let them pour their own water. If you are serving dessert, no one should mind if you touch a shoulder in order to know exactly where to put the dessert plate in front of the person.
Another example would be lighting a match. You can hear it ignite and feel through the match itself when it touches a candle wick or hear the ‘poof’ when a gas stove burner is lit. An activity such as lighting a match may be frightening at first, but will become easier with practice. We give this as an example of when it is not desirable to get close to ‘see’ what you are doing. Most blind and visually impaired individuals continue to use matches safely.
You need to remember that you have a lifetime of experience to offer your family, friends, and the rest of the world. Just because you have lost some vision does not mean that you don’t still have a lot to offer to other people. Some new techniques, such as those discussed here, are required. Learning to read and write Braille takes time and motivation. Using records and tapes instead of reading with your eyes takes some getting used to. Finding and learning to work with readers is a skill to be developed. Budgeting money to pay readers or finding volunteers is a new approach. Using public transportation and arranging for drivers are also changes.
These adjustments require an optimistic attitude, and this will make it possible to continue a variety of activities. You will come to understand that everyone has needs and that the needs of
people with low vision are not necessarily greater than those of others. Most people find ways of giving to others, as well as getting others to help them. You will feel better about yourself with low vision when you realize that you still have a lot to offer to others. It is easy to become overwhelmed by your own needs and forget that the greatest need of all is to continue giving.
How can I read?
When an individual begins to lose vision, the first thought is often to get a magnifying glass. Enlarging print is one way to read for a person with low vision. There are literally hundreds of different magnification devices on the market. Optometrists and ophthalmologists should know of some local sources. It is desirable to try magnifiers before purchasing, since personal preference will mean that not everyone will wish to use the same sort of device. Lighting is also important. For example, you may wish to exchange 60 watt bulbs for 100 watt bulbs. You will probably wish to place reading material directly under a good light. Some large magnifiers come with lights attached. Others require you to arrange your own lighting. It is generally desirable to keep glare to a minimum, but you will need to experiment with lighting and magnification.
There are several other ways to read and write with low vision. CCTV (closed circuit TV enlarger) includes a moving platform on which reading material can be placed and a screen (like a television screen) on which words and numbers are displayed. As the platform underneath is moved side to side and front to back, the reader is able to read the part of the page he or she wishes to see on the screen. This device magnifies the print many times its original size. It is rather expensive, but many people with low vision use these machines very successfully.
These devices are especially useful for reading mail and paying bills. Books, magazines, and newspapers are generally available in other forms that will be preferable to most.
Many public libraries have begun to include large-print books as a part of their collections. Some also include a collection of books recorded on cassettes or CDs. These collections are generally small, but may be borrowed by anyone with a library card.
In this country, there are regional libraries for the blind and physically handicapped. The books for the blind program at the Library of Congress produces books on tape and in Braille for distribution through this nationwide network of libraries which circulate books recorded on cassette tapes to individuals who are legally blind. They also lend a cassette player to readers. It is desirable to borrow this player from these libraries because the books they provide are recorded on four tracks per cassette instead of two as commercial cassettes are produced, and at a slower playing speed. This makes it possible to include much more reading material on each cassette. Many of these libraries also distribute large print books. Both recorded books and large print books may be mailed free of postage from the libraries to the readers and back again. Thus, this service is truly a free library service.
If you are interested in material published by your church, there may be quite a bit available on recorded tapes or in large print. You will need to inquire through your pastor or other church leaders. A limited number of translations of the Bible have been recorded, but they are available through your regional library and some other private providers. Many denominations have special publications for the blind and visually impaired.
Directory assistance is the service offered by the phone companies for those who cannot use standard phone books. 1-[area code]-555-1212 will get directory assistance anywhere. There may be other local numbers in various towns and cities. You will need to fill out a form to become qualified to receive directory assistance without charge on your home phone. This form is available though your local phone company. This service is available to the blind because we do not read the phone book. The National Federation of the Blind demonstrated to the phone companies that the phone books are free to the sighted, so directory assistance should be free for those who cannot read the phone book.
Newspapers may be read by the blind by telephone. This service is called NFB-NEWSLINE and is described in the resource section of this booklet.
Any individual who can no longer read print will need to depend on other people for some reading. Often family members serve as readers for mail and bill paying. Sometimes it is possible to find a volunteer to help in this way. Some blind people hire readers to do a variety of reading. When working with a reader, it is helpful if the reader understands that he or she should be responsive to the needs and wishes of the blind person. If you wish to find information in a bill or magazine, it is not for your reader to tell you whether that is important or not.
The more you work with one individual, the better you work together. It is possible to have a reader describe items in a catalog and fill out the order form. It is possible to teach a reader to skim for you by telling him or her to jump to the next paragraph or next page if you wish to do so. Most readers try to do as asked. Since you have been reading print all your life, you can make intelligent guesses about what to tell your reader to look for. At first, working with a reader may seem awkward, but the more you do it, the easier it becomes.
It is respectable to be blind.
You may choose to use the terms “low vision,” “visually impaired,” “sight impaired,” “partially sighted,” or something else. These are all appropriate terms. So is “blind.” From time to time it will be necessary to explain to friends and associates what you can and cannot do, whatever language you use. Occasionally, people will think you are more dependent than you are until you explain that they have not totally understood your situation. Try to remember to smile when this occurs. As you know, a smile usually makes everyone more comfortable.
Whether you are telling others that most blind people have a little usable vision or that you have lost some sight, the end result is very similar. You still have the experience, knowledge, interests, skills, and goals that you have always had. The changes you make as your vision worsens are small changes. The more you are expecting to continue with your former activities, the more you will find ways to do so.
Who needs a white cane?
A long white cane is a tool that a person with poor vision or no vision can use to find obstacles, landmarks, and general information about the sidewalk, corridors, and other areas where he or she is walking. Getting information is an important reason for carrying a white cane, but it is not the only one. The white cane helps to identify a person who is legally blind. It may increase courtesy and understanding of those who meet a blind person. It also may increase safety if drivers and others realize the person with a cane in hand does not see everything others see. If a person carrying a white cane does not respond to a hand signal or a wave, others generally realize that this person is not just ignoring those around him or her. Rather, we do not see them.
Where can you learn the best methods for using the white cane?
A small book entitled Care and Feeding of the Long White Cane may be purchased in large print or on cassette from the NFB Independence Market. This book goes into much more detail about techniques for using the white cane. Most rehabilitation agencies for the blind employ teachers who should be able to teach cane travel techniques. It may also be possible to enroll in a full-time residential program of training to learn cane travel, Braille, use of computers with speech output, and much more. Three excellent facilities of this kind are operated by the National Federation of the Blind. For more information about them, contact your state or local president of the NFB.
If the cane is to be used for support, a white one still indicates poor vision. If you do not need a cane for support, you will probably choose a longer straight white cane. Long canes may be made of fiber glass, carbon fiber, or metal. Most people who depend on the cane prefer a rigid one, but folding canes are also available.
Certain techniques can be used to gather information. The cane is swung from side to side in front of the person using it. The width of the arc should be a little wider than the person’s shoulders. Generally, it is desirable to tap the cane on the floor or pavement at the outside edge of each swing. It is possible to drag the cane one way when looking for grass, a sidewalk going to one side, a retaining wall, etc. There are other techniques to be used for ascending and descending stairs.
A person who still has some reliable vision may wish to vary the technique slightly depending on lighting, the density of a crowd, the speed with which he or she is walking, and other things. The length of the cane may also vary depending on the height of the person, the speed at which he or she travels, and personal preference. Some people feel more need for the white cane at night or in bright sunlight. White canes may be ordered from the NFB Independence Market and are listed in the descriptive order list included in this material.
Who can use a guide dog?
Today it should be possible for anyone who wishes to use a guide dog to do so. However, many seniors do not choose to get a guide dog. Guide dogs are usually medium-sized dogs, such as German Shepherds or Labrador Retrievers. Therefore, it is also a good idea for the person using the dog to have enough strength to control the dog if discipline is necessary. Although guide dogs are associated with the blind, many people who have partial vision use them successfully.
The blind person is always in charge. The dog can provide information about an approaching flight of steps, the location of street crossings, and sometimes find an outside door. It is trained to go around obstacles. But perhaps the most important thing the dog learns is to stop and wait until the person determines the reason for the stop and instructs the dog to go forward. The dog may memorize a route, such as where a friend lives or the way to work, but the blind person may not always follow the same route, so the dog must take instructions. The blind person listens to traffic and decides when it is time to cross a street. The dog walks slightly in front of the blind person who holds the handle of the harness in his or her left hand.
Guide dogs are trained at special schools across the country. Any of these schools will provide information to an individual who is considering the acquisition of a guide dog. The school will be able to describe the training required by the person and the care required by the dog. Guide dogs are not pets, but there is generally a very close relationship between the guide dog user and the dog. If you are considering a guide dog as a travel assistant, the president of your state affiliate will be able to tell you which schools are most commonly used by blind individuals in your area. Guide dog schools are generally financed with public funds, so there should be little or no charge for the dog or training to use it. Of course, dog food and veterinary care are the dog owner’s out-of-pocket expenses.
Who can learn Braille?
Braille is a system of dots to be read with the fingertips. It is not more difficult to learn than print, just different. A child who learns to read using Braille picks it up at about the same rate of speed as a child learning to read print. When an adult loses vision, it is possible to learn Braille, but it may take a little longer to acquire a rapid reading speed.
Standard Braille is written with about 200 signs, but it is perfectly reasonable to write and read some Braille without these signs. The memory work is less if you simply learn the alphabet and the numbers. This makes it possible to keep phone numbers, addresses, recipes and other small notes in Braille. Braille is a convenience for anyone who knows it. If you are motivated to do so, the earlier you begin learning Braille, the better you are likely to be at reading and writing. Some men and women who lose their vision late in life do not learn Braille. Whether this is desirable or not is a matter for debate. There is a card showing the Braille and print alphabets included in the Low Vision Resource Kit.
When reading Braille, an individual needs to keep his or her fingers light on the dots. New Braille readers often feel as though they need to push down to feel the Braille better. To the contrary, pushing down makes it harder to feel the dots. Brushing the fingers lightly across the lines makes the Braille much clearer.
Braille can be written with the Braillewriter, which is expensive. Or it can be written with a slate and stylus, which consists of a frame as a guide and a punch which is used to push the dots down through the paper.
Hadley School for the Blind, 700 Elm St., Winnetka, IL 60093, (800) 323-4238, offers a correspondence course in Braille reading and writing. Independent living programs at rehabilitation agencies may offer Braille instruction if it is requested. Braille instruction books are also available from the NFB Independence Market. Many members of the NFB are happy to provide some instruction in Braille for new readers.
Larger Braille cells can be produced for people who really do have impaired touch in their fingers. This is called Jumbo Braille. Some blind persons also keep notes on a cassette tape recorder.
How can I learn to use a computer?
Your local chapter or state affiliate of the NFB should be able to put you in touch with someone who can help determine what hardware and software would be necessary to do the things you wish to do. Your rehabilitation agency may have staff who can provide similar information. If you purchase a program to enlarge the print on the screen, you may need some special instruction to learn to use it. If you purchase speech or Braille output, you may need to arrange for training from another visually impaired person or a special instructor. You will need to use the entire keyboard to operate a speech output program, and the commands are numerous. However, many, many blind and visually impaired individuals are proficient computer users.
Color is Important
As you lose vision, you may lose much of your ability to discern colors. Still, you know which colors are attractive together, so you will wish to keep track of the colors of your clothing and other items. Be sure you know what the colors of new purchases are.
When sorting clothing, pay attention to identifying characteristics such as buttons, collars, pleats. This author likes to knit. When I am purchasing yarn, I ask that each color be placed in a separate bag. If I cannot identify different colors by the feel of the skeins, I may tie the top of one bag or tear off one label. But I want to be able to keep these colors straight when there is no one around who can see it. I am planning to make a baby blanket of rainbow colors. I will use rubber bands, safety pins, stitch holders and whatever it takes to keep track of the seven colors plus white. I do not like to rip out my work, and I certainly am not willing to have the colors in the wrong order. Therefore, I must be creative.
Can I continue to sew and do handwork?
In our Independence Market we have self-threading needles and a needle threader for sale. These items are also available in local fabric stores. To use the self-threading needle, hold the thread taut between your hands and pull it into the end of the needle which is divided. You will feel a small ‘pop’ when the thread goes in. Many individuals use self-threading needles for mending, sewing on buttons, and hemming.
Some blind and visually impaired individuals prefer to use the needle threader with a regular needle. You may find that large-eye needles are easier to use. Place the wire loop of the needle threader through the eye of the needle; then drop the thread through the wire loop and pull it through the needle. This draws the thread through the eye of the needle so you can tie it and proceed to sew.
Many blind individuals continue to sew, both by hand and with the sewing machine. It is possible to guide the fabric on the sewing machine by touching a seam guide or the presser foot. It is also possible to cut around the edge of a tissue paper pattern.
Many women and some men like to knit, crochet, do latch hook, and other handicrafts. Most of these can be done by touch very well. We recommend that you talk to other blind and visually impaired individuals if you have questions or interest in any of these hobbies. The president of the National Federation of the Blind in your state is listed on your state resource list and should be able to refer you to people whose interests correspond to yours.
Labeling Foods and Medications
Cupboards and freezers may be organized in a certain order. Labels may be made with black markers or Braille and attached with rubber bands. Braille labels for cans may be purchased also.
If you take several medications and need to mark bottles to tell them apart, you may use black markers or tactile markers. You may wish to put tape on the lid of one bottle and on the bottom of another. You could put a rubber band around a third bottle. Different locations may also be a way to know which bottle is which. Many seniors use containers divided into seven compartments (one for each day of the week) to pre-sort their medications. If necessary you may have one divided container for mornings and a second for evenings. Develop your own system, and stick to it.
When you go to a restaurant, relax and enjoy yourself. If you need to have your server read a menu or part of it, he or she should be glad to do so. Do not hesitate to ask if the restaurant has large print or Braille menus. Some do. If they do not, this will bring to the attention of the restaurant personnel that special menus would be used if available. You may also wish to ask your server to tell you when he or she places something in front of you. If drinks are placed in the middle of the table, you may not always be aware when this occurs. We tip servers for service, but we cannot expect them to know our needs if we do not say something.
Generally, you will not need to have your food served in a special way. If you wish to have the lettuce cut up in your salad, ask that this be done in the kitchen before it is served. Use your fork and knife to find the food on your plate. You can practice at home cutting meat and picking up vegetables with your fork without bright light. Most people with low vision find dimly lighted restaurants difficult if they do not practice eating in dim light anywhere else.
If you wish to go through the salad bar line, ask if someone has time to help you identify what is there.
How do I know it is clean?
It is easy to feel dust on knick-knacks and furniture. You can generally tell by touch when counters, sinks, tubs, etc. are clean. It may be desirable to have someone else check for stains occasionally. Many people with low vision like to vacuum the floor with bare feet to help check for dust. Systematic parallel strokes will help you know when you have covered the entire floor. You say you have cobwebs along the ceiling from time to time? Using a white cane and a cloth is a good way to knock them down.
A touch-tone telephone is very easy to use by touch. You can also purchase large button phones. But you may find it less stressful not to have to look at all. Put three fingers across the top three buttons to push one, two, and three. Move them down a row when you wish to push four, five or six. Move down another row to push seven, eight, and nine. You may move down another row for zero or use your thumb. Those buttons are easy to feel. Be sure the phone is not at an angle when you are dialing, and a little practice will be all you need.
Where can I live?
A blind or visually impaired person can live comfortably and safely almost anywhere he or she chooses. Certainly, the same choices about living quarters should be available to the blind and visually impaired as are available to sighted individuals. Landlords are required by law not to discriminate against tenants because of vision loss.
In recent years thousands of older citizens have found it desirable to move into senior citizens’ villages, apartment buildings, mobile home parks, or clusters of houses reserved for retired people. Some of these include group dining rooms and recreation facilities, while others have very few special services.
Undoubtedly, some people with low vision will find arrangements such as these desirable. Some will not. Blind and visually impaired people have the opportunity to live in these senior citizen villages along with everyone else. Assuming there are no health problems that make nursing home care necessary, elderly individuals with low vision should be able to learn alternative skills to care for themselves and live in whatever type of housing situation they prefer.
How to get around without driving?
Sooner or later loss of vision makes it necessary to stop driving. No one wants to be unsafe as a driver, but driving is a convenience that may be hard to give up. Nevertheless, there are many other ways to go places, and it may actually save money not to maintain a car.
Most cities of 100,000 people or more have city buses and some smaller cities do also. The quality and quantity of bus service varies considerably from one city to the next. A person with poor vision or no vision can learn to use these buses if motivated and if he or she does not have other serious physical disabilities. A blind person waiting at a bus stop may not be able to read the sign on the front of the bus. Then, when the door opens, one simply steps up to it and asks the driver the number or name of the bus. Drivers are required to announce stops. It may be helpful to tell the driver ahead of time which stop you want to help insure that he or she does not forget to announce it.
There is an information number in most cities that can provide information about where each route goes and on what schedule. This information is also printed and can be mailed to interested persons, but it may be more convenient to call the general bus information number.
Bus service is called fixed route service. Most cities also provide dial-a-ride service. This is intended for persons who live on the bus routes and cannot use the fixed route service. Many seniors can qualify. One must become certified for this service and then order it ahead of time. Either the bus company or the mayor’s office can tell you how to get in touch with this service. Many smaller towns and cities have only this dial-a-ride service.
Taxis are used by many blind and visually impaired people. They are more expensive than buses or dial-a-ride services, but may not cost as much as maintaining a car, especially if you do not need to use one too frequently. Paying for a taxi once or twice a week is certainly a bargain compared to owning and operating a car. In addition, taxicabs generally operate 24 hours a day seven days a week. This is not true of city buses or dial-a-ride systems. Some towns and cities provide a subsidy for disabled people and seniors to use with taxis. This may be called scrips or something else. You may learn about this subsidy by calling the mayor’s office or services for the aging.
Many blind people who can afford to do so own cars and get friends, family members or employees to drive them when needed. The insurance company will require you to name a primary driver, but this does not prevent other people from driving your car. Some blind people find that this system is more reliable than depending on other people’s cars which sometimes are not available or may not always be in good repair. Of course, much depends on personal resources and preferences.
Many people with low vision ride bicycles, especially in good weather. It is important to be honest with yourself about when this is safe and when it is not. This depends on vision and traffic, but it is a personal decision and is not regulated in most places by rules or laws.
Of course many people with low vision walk more than they did before losing sight. The white cane can provide a great deal of information both to the person using it and to those he or she meets. Anyone who is legally blind is entitled to carry a white cane. For more information about how to use the cane, see the section, “Who needs a white cane?”
There are some special van services for seniors associated with senior activities and with some senior residences. These may be an important factor when choosing a place to live.
These vans may provide transportation to doctors’ offices, shopping, recreational activities, and other places a group of people wish to go.
Many people with low vision also find it important to choose an apartment or house located near a city bus route if bus travel is going to be used. Most individuals who do not drive find it best to use several different kinds of transportation. Some live where they still have access to Greyhound buses or trains. These are also good transportation alternatives for those who do not drive. Airports and airlines provide escorts if needed when going from gate to gate or from check-in to flight. These services should be offered, not required. It is up to the blind person or the person with low vision to decide which services are helpful to him or her, but it is very helpful that the airlines offer special consideration.
Those who live in rural areas may have fewer choices available when planning transportation. It may be necessary to rely on friends and neighbors for help in getting places that are too far from home to walk. Most people who find themselves in this situation learn to find things to do for those who help them. One woman goes grocery shopping with a neighbor and then treats the neighbor to lunch. Many hire high school or college students for some help. Many people with low vision are fortunate to have family members who are able to assist with transportation to doctors’ appointments or shopping, but it is best not to be totally dependent on friends and family.
Coins are easily sorted by touch. Dimes and quarters have rough edges, while nickels and pennies have smooth edges. Quarters are the largest; nickels somewhat smaller; and dimes and pennies are the smallest.
Paper money can be folded or sorted in separate compartments of the wallet. There is no wrong or right way to sort money. Each person should decide what to do and follow the same plan consistently. This writer folds ones and fives in fourths and keeps them in different compartments. Tens are folded lengthwise first and end to end second. Twenties are folded end to end first and then side to side. Anything larger than twenty is kept in a remote section. This is only an example of one approach, but each person will make variations.
You will find a check-writing guide in the Low Vision Resource Kit. You may also use it as a signature guide. Your handwriting will continue to be as legible as previously. You merely need a guide so that you write in the correct places. You may wish to keep your check register on a computer or a separate notebook. Some individuals with low vision use black markers for check registers. Some record this information on tape.
Many people, both blind and sighted, like to shop with friends. If you do, your friend will be glad to tell you prices and read other information about the products you are considering. If you prefer to shop on your own, sales clerks will, as they have time, read the same information. Of course, sales clerks also want to sell the products so you can’t depend solely on them to decide what you need or like.
You may also need to ask directions to go from one department or store to another. Strangers are often uncomfortable giving a blind or visually impaired person directions. This is because they use visual landmarks to know where they are. You may need to suggest other pieces of information. For instance, “You mean I should turn left at the first aisle after the carpet ends?” Or “So the escalator is this way (motion with your hand), and I should go past it and turn right?” Thus, you are confirming directions that may not have been quite clear. The person you are talking with can affirm that you are correct or not. As with so many other things, you develop skill in this area with experience.
Can I get financial or medical assistance other than Social Security and Medicare?
If you are sixty-five or older, you will not receive any additional money from Social Security just because you are blind. If you are under age sixty-five, it is very important for the Social Security worker to know that you are legally blind. If you are eligible for Social Security Disability Insurance, you may continue to receive disability benefits (which may be higher) until you are age 65, at which time your payments will convert to Social Security Retirement based on the fact that you have attained age sixty-five.
Medic are pays hospital and doctor expenses under certain rules and limitations, but if your income is very low and/or you have some large medical bills, you may be eligible for some other medical assistance through your state or local programs.
Depending on your financial circumstances, it may be possible to qualify for medical assistance through your State Department of Social Services. Most states also have what is called a “spend down program.” If you are found eligible for this, you will pay a set amount of medical expenses for a six-month period of time, and the Department of Social Services will pay anything above this amount. Please check with your State Department of Social Services for further details. In a few states, rehabilitation agencies for the blind can provide financial assistance for medical treatments to prevent blindness. This may include treatment of Diabetic Retinopathy and wet Macular Degeneration.
There are university hospitals in most states which are teaching hospitals for medical students. They are often able to provide medical services at a reduced rate. Other hospitals which have been constructed with federal funds are sometimes required, at least for a number of years, to provide some assistance to low-income individuals. Please check with hospitals in your area for this type of program.
If you are a Medicare recipient, there are some doctors who will accept for payment the amount that Medicare will pay. Many hospitals have doctor referral services and can tell you which doctors will accept Medicare patients.
If you are sixty-five or older, a U.S. citizen or legal resident, and you do not have access to an ophthalmologist that you have seen in the past, you may be eligible for the National Eye Care Project. If you think you may be eligible, call (800) 222-EYES (3937). Callers who meet the eligibility requirements are mailed the name of a participating ophthalmologist near their home. Participating doctors provide medical eye exams and treatment for conditions or diseases if necessary. Qualified callers will receive treatment at no out-of-pocket expense for the doctor’s services. Eyeglasses, prescriptions, hospital services, and other medical services are not covered under the program. Doctors accept insurance assignment as payment in full.
It is the responsibility of the agency on aging in your state to act as a referral agency for older citizens. There is also a state rehabilitation agency for the blind in your state which should be able to give you information. There may be other state or local services for which you may be eligible.