Working with Aging Adults with Significant Vision and Hearing Loss
Growing old and declining to the point that you are entirely dependent on those caring for you is so difficult; and it's made all the more scary, if you are blind and nearly deaf. Here are some tips I've learned from working with John.
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“Hello, John, it’s Liisa here,” I say gently, but loudly, my mouth closest to John’s left ear. His eyes are open. I place my hand gently on his shoulder and say, “Is there anything I can help you with?”
John, like several of my oldest clients, is almost entirely blind, as well as hearing impaired. I see him visibly relax when I announce myself. He gathers his thoughts for a moment and then asks if I can bring him some cold water. I say, “of course.” Before handing it to him, I reach for his hand and close his hand round the bottle after removing the cap. “Here it is, John. I’m right here to take it when you are done.”
Growing old and declining to the point that you are entirely dependent on those caring for you is so difficult; and it’s made all the more scary, if you are blind and nearly deaf.
In John’s case, because he is also bed bound, he truly is reliant on those around him for everything—from helping reposition him to bathing him, from bringing food (and at times even feeding him) to helping him brush his teeth.
This is difficult to watch, whoever the patient is, but it makes it even more so for John because he spent his professional life tenderly caring for thousands of patients over the course of his 39 years as a physician.
I am writing this article for him and also, more importantly, for all family members and caregivers caring for others like him, with significant hearing and visual impairments due to aging.
But before going into tips that help, I must acknowledge that I know caregivers in Assisted Living and Skilled Nursing settings are often balancing many resident needs at once and some of these tips take time. Caregivers must do their best to wisely prioritize urgency and the many needs that arise simultaneously. I also know that sometimes, whether you’re staff, agency or a privately-paid caregiver or family member, many simply don’t know the ways to care for the visually and hearing impaired such that the person in their charge feels safe and secure and not anxious and afraid.
- When arriving to the room, it is important to announce who you are and what you are doing there. For example, “Hello, John. It’s Liisa. I’m here to help. Is there anything you need?” It will depend on the person you are helping, but in my experience, I’ve found it helpful to put a hand on his shoulder or hold his hand after announcing myself.
- If he is having a hard time hearing, check to see that his hearing aide is properly seated in each ear and that the batteries are working. (It’s good to always keep a fresh pack of the correct batteries nearby.) Ask if you are speaking too softly or too loudly.
- If he asks for anything (from soup, if it is meal time, to water, to his tooth brush or a tissue), I put it on his table in front of him, while telling him what I am doing and where I am placing the item. For example, “Jim, I have put eggs in front of you. The eggs are on a plate from 3:00 to 9:00.” (I verbally tell him in terms of a clock face). Long adult bibs, which can be bought on Amazon, are a great way to avoid unnecessary clothes changes due to spillage.
- Ask what he wants help with. “John, I can help put the eggs on the fork for you and you can feed yourself or I can help feed you. What would you like?” I try to anticipate what he may struggle with. For example, I take the cap off the water bottle. I put toothpaste on the brush. I put the toothbrush or flosser in his hand while telling him what I am doing. If he prefers to do it himself, then I let him.
- Speak slowly and repeat, if necessary.
- Put favorite items in the same place so they can be found.
- For activities in which someone feels especially vulnerable, like bathing or toileting, consider narrating exactly what is happening. For example, “I am undressing you for a sponge bath. I am raising the back of the bed so you can sit upright while I wash your back.” Keep a firm arm or hand on the client and reassure them that you’ve got them and that they need not worry. Be patient. Rushing can make them agitated.
- If something you’ve said doesn’t seem to register, repeat yourself or ask the question in a different way.
- If you see your client reaching for something unsuccessfully, ask what they want and hand it to them, to help avoid frustration, as well as a risk of falling.
- Remember that situations evolve and he may need help with something today that he didn’t last week.
- Use assistive technology to help a person stay independent as long as possible--whether magnifiers (like the Merlin and the Ruby), special lighting, technologies like books on tape for the blind (check out the “Talking Books” program), or tactile methods. For example, putting special tape for the blind on an “on” or “off” button. (See this previous post
The Alzheimers Association provides a virtual dementia tour in which you wear glasses that only allow you to see light and dark; headphones which play a continuous stream of loud static; spiky sandals which hurt your feet and mittens which make it hard to use your hands. After five minutes, I “got it.” When teaching medical residents at Duke University how to document and, through this, better understand the patient’s story, I witnessed similar results in my students.
With that story, I leave you with this reminder: Put yourself in your care recipient’s shoes over and over and over. While it might feel tiresome or frustrating at times, there is an opportunity for something more substantive to happen, too. Writer Annie Dillard once famously said, “How we do anything is how we do everything.” When we are compassionate, patient and connected with dear people like John, it bodes well for how we are in the relationships we have in our wider lives, too.
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