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CHAPTER 3 IDENTIFYING COMMUNITY CARE NEEDS

Key Findings

There appear to be commonalities among adults with hearing, visual and dual sensory loss with regards to core community care needs. The most apparent of these, as identified in the literature, can be summarised as rehabilitation, mobility, communication, access to benefits and services and accessibility issues.

Rehabilitation in this context refers more directly to the skills required for independent living including domestic skills, personal care and life skills (for example, cooking, cleaning and shopping). This includes a need for specialist equipment to facilitate daily life activities.

A core issue facing sensory impaired adults, especially visually and dual sensory impaired persons is mobility, including the need for training in safe access and movement outside the home (for example, road safety, use of canes, walking sticks and other mobility devices) and safe navigation within the home.

Visual, hearing and dual sensory impaired adults share challenges in the area of Communication⁴, specifically help with reading and writing and access to appropriate human aids to communication. This may also include training in communication media including Braille or moon, deafblind manual (and other tactile communication methods) for those who acquire dual sensory impairment, and access to information in appropriate formats for all groups.

The literature suggests that there is a common challenge experienced in accessing benefits and services. In particular, accessing mainstream health and specialist services and learning about the availability of benefits, statutory concessions and other services appears to be problematic due to lack of adequate information about what is available and support in applying for benefits.

Finally, accessibility and social isolation appears to affect each of the three sensory impairment communities. In particular, there appear to be barriers to accessing education, employment and other social arenas including leisure pursuits (for example, social clubs and organised activities). This combines to create feelings of social isolation and, in some cases, poverty of social and financial positions.

Whilst this chapter highlights some of the most common community care needs identified from the literature, it is also clear that needs are diverse and variable with both the level and nature of need being affected by life stages and changes in the severity of sensory loss. This diversity makes it difficult to provide a definitive or comprehensive itinerary of needs.

Introduction

3.1 The 2004 Community Care Services for People with a Sensory Impairment: Action Plan states that community care services are often an important lifeline for people with a sensory impairment. Through a range of supports, these services offer a quality of life that might not otherwise be possible.

3.2 Community care encompasses a range of services and support provided across service sectors aimed at improving the quality of life of those who are often most vulnerable in the community. For sensory impaired adults, the nature of need will share many similarities to other groups in society who receive help in achieving independent lifestyles and social integration. These needs will, however, inevitably be compounded by a need for specialist support resulting from their impairment and this means that that special provision needs to be in place to ensure that the community care needs of all adults are met.

3.3 Whilst recognising that sensory impaired adults will share some needs that are unique to their community, it is also important to recognise the diversity of need that exists within the visual, hearing and dual sensory impaired communities. Importantly, the nature and level of need will change at different life stages and the chapter attempts to highlight this, mindful of the scope of the current work to focus on adults. This diversity makes it difficult to provide a definitive or comprehensive itinerary of needs. However, existing research evidence, and the work undertaken as part of this review, offers an insight into the common needs identified among this particular population.

3.4 This chapter attempts to summarise the most commonly identified community care needs of sensory impaired adults and their carers drawing on key research literature that exists in the field.

3.5 Mental health needs are presented separately in the following chapter but relate only to needs associated with sensory impairment and not mental health needs that may occur ordinarily and dissociated from sensory impairment. This is not within the scope of this research and it is recognised that much more information is available in mental health literature in a generic sense.

Community Care and Hearing Impairment

3.6 For the most part, literature in the area of community care needs for the hearing impaired, focuses on two distinct groups, these being young people and older deaf people.

3.7 The needs of young people making a transition from school to adult life are well documented in mainstream educational literature. For young people with a sensory impairment, this period can often be one of the greatest points of change in their life.

3.8 A report by RNID and the National Deaf Children's Society ( NDCS) (2002) states that Deaf young adults are more likely to leave education earlier and enter employment earlier than their hearing counterparts. However, more deaf young adults in their early 20s are out of work or have difficulty getting work or staying in employment compared to hearing peers (ibid).

3.9 Young deaf adults therefore need access to support services to address these issues. For example, advice about support available when in further or higher education (eg Disabled Student Allowance) may be invaluable (ibid).

3.10 The literature suggests that social work intervention is crucial in developing a transition plan and informing young deaf people of places where they can obtain advice about their education and employment choices (ibid).

3.11 Social work services can assess the ability of deaf young people to manage daily living, including knowledge about and managing equipment designed for deaf people, communication support, and inaccessible environments (ibid). They can also monitor the withdrawal of support, with support workers providing access to potential mentors, role models and other sources of support (ibid).

3.12 At the other end of the age spectrum, older deaf adults also face difficulties when leaving the world of work and becoming less socially active.

3.13 As the Department of Health (2005) report explains, Deaf people, like everyone else, may need residential care when they get older and become frail. However, most older Deaf people will go into residential and nursing care, where staff do not differentiate between this group and people who have become deaf in later life, even though the two groups have very different communication needs (ibid). There are 24 nursing home places for Deaf people across the UK - as the report notes, this is unlikely to be sufficient (ibid).

3.14 Older Deaf people may find themselves to be particularly socially isolated, especially if they become frail and less mobile in old age (Department of Health, 2002). As many more of their contemporaries develop hearing impairment as a consequence of ageing, there is a greater risk that their unique needs may not be recognised by social care and health services (ibid).

3.15 For those outwith these two age groups, the Sensing Progress report ( SWSI, 1998) highlights the main needs of Deaf and hard of hearing people as being:

• communication;
• information; and
• equipment.

3.16 The main communication need of this community is Sign Language Interpreters and other communicators (lip readers and lip speakers) to act as a liaison between hearing and hearing impaired adults. The recently published Investigation of Access to Public Services in Scotland using British Sign Language (Scottish Executive, 2005) stresses the strongly held view among the Deaf community that BSL usage when accessing public services is a right and not a service.

3.17 Mirroring the need for alternative language use among service providers is a need for information regarding community care and mental health per se to be made available to the Deaf and hard of hearing community. In particular, adults in these communities require access to information regarding the existence of services (Denmark, 1994) and information about benefits and statutory concession ( RNID and NDCS, 2002).

3.18 Availability of communication technology to hearing impaired adults is also a widely cited need. The Sensing Progress report also highlights other equipment required by these communities including:

• communication support (loop systems, adapted telecoms devises); and
• devises for maintaining safety in the home (flashing lights and personal listening aids)

3.19 In general, research suggests low levels of community care uptake among hearing impaired adults. According to Scottish Executive (2005) research into BSL users in Scotland, just 10% use social services 'often' and 50% never use social services.

3.20 The Scottish Best Practice Standards for Deaf, Deafened, Hard of Hearing and Deafblind people (2001), developed by a multi-agency Task Force, are designed to ensure that Community Social Work Services are founded in good practice. They state that deaf people have the right to:

• be well-informed;
• access all social services;
• the same rights and opportunities as hearing people, free from discrimination;
• be safe, healthy and protected from abuse, bullying or neglect;
• independence and to make choices about things that affect their lives;
• have their privacy and dignity respected in the home and in the community; and
• a standard of living and quality of life equal to that enjoyed by hearing people.

3.21 However, the adoption of these principles as standards for commissioning and contracting is at best patchy (Scottish Executive, 2004), and gaps in service provision have been identified in the current research.

3.22 According to the Scottish Council on Deafness (undated), there is a 'major crisis' in recruitment, training and retention of specialist social workers with deaf people. Although deaf awareness should be instilled in both frontline staff and among management ( RNID and NDCS, 2002), not all staff will require the same depth of knowledge or skills. Staff who undertake assessments and provide support to deaf people will need appropriate levels of specialist training (ibid).

3.23 Suggestions for training needed by social services staff include communication, BSL, use of interpreters (including interpreting ethics, organising room settings etc), equipment, deaf awareness (eg how to attract the attention of a deaf person, how to use a text-phone, adapting communication techniques etc), deaf community and culture, and the effects of discrimination against deaf people ( RNID and NDCS, 2002).

3.24 A Department of Health (1997) study found that only 18% of social workers interacting with deaf people were qualified in BSL to the minimum standard. This is of particular concern given that, due to the acute shortage of trained BSL interpreters, social workers are often called on to interpret in health care and other service settings (Harris and Bamford, 2001). Ubido et al (2002) also note the existence of disagreements between health services and social services about who should fund interpreters for deaf people.

3.25 Technology that could aid communication between deaf people and community care services is not always used. For example, Chisholm et al (1998) found that almost one in three social service departments did not have telephone equipment or software that would enable deaf people to contact them.

3.26 Alternatively, individuals who become deaf in later life may be unaware of the technological advances that could benefit them (Ubido et al, 2002).

Hearing Impairment and Social Isolation

3.27 The link between hearing impairment and social isolation is well documented in the literature. RNID research in 2000 found that 66% of deaf and hard of hearing people feel isolated because their deafness excludes them from everyday activities. Research by FMR (an independent research organisation), also in 2002, suggests that deaf people experience social exclusion, discrimination, and barriers to access in relation to communication with hearing people.

3.28 The Department of Health's (2002) report 'A Sign of the Times', suggests that social exclusion among deaf adults is, in part, due to their difficulties in accessing further, higher and professional education, resulting in problems in gaining employment. Although the education levels of deaf people are improving, they are still lower than that of the hearing community (Dye et al, 2000).

3.29 As can be expected, this is reflected in high unemployment rates among deaf adults (McClelland et al, 2001), particularly within the professional and management sphere (Dye et al, 2000) and among deaf women in particular (Department of Health, 2002). High unemployment rates among the deaf population may be of concern, given the positive relationship between employment and psychological well-being (Department of Health, 2002).

3.30 It has been suggested that this high risk of social exclusion among deaf people may affect both their mental health and their access to appropriate mental health services (Department of Health, 2002). Klein and Kitson (2000) point out that the difficulties deaf people face accessing professional education does not just affect their own mental health, but has a two-fold effect: deaf people are also less likely to gain access to jobs in social and health care, where they are vitally important in providing services to other deaf people.

3.31 Research has also found that positive self-esteem (an important factor in maintaining mental health) can be much harder to develop when socially excluded. Consequently, high numbers of Deaf people suffer from psychological distress (Department of Health, 2002).

3.32 Research by McClelland et al (2001) also supports the notion of a link between social exclusion and mental health difficulties among deaf adults: their research investigated residential facilities for deaf people with mental health problems and found that such facilities tended to be in deprived areas. The authors argue that this suggests that there is a relative concentration of deaf people with significant mental health problems in areas of relative social deprivation, because the facilities were set up in response to local demand.

3.33 More recent research by Tambs (2004) suggests that hearing loss is related to anxiety, depression, self-esteem and well-being, especially among younger deaf adults, aged under 65.

Community Care and Visual Impairment

3.34 The Association of Directors of Social Services ( ADSS) National Standards of Social Care for Visually Impaired Adults ( ADSS, 2002) provides a summary of the core needs of blind and visually impaired adults. These can be broadly summarised as:

• rehabilitation and mobility;
• equipment; and
• information and advice.

3.35 For the most part, needs relate to daily functioning and maintenance of healthy lifestyles with basic needs being: assistance with personal care and hygiene (including understanding of medication labels); domestic management (cooking, cleaning, payment of utility bills); and participating in social activities.

3.36 In carrying out these tasks, blind and visually impaired adults will be required to develop a number of skills, through experience, working with carers and, where available, through assistance from trained rehabilitation workers. Rehabilitation support is an essential part of community care for visually impaired adults since nearly half of those over 16 who are registered blind or partially sighted live alone (Du Feu and Fergusson, 2003).

3.37 The ADSS National Standards outline the various arenas in which rehabilitation workers can assist visually impaired adults to achieve independent living through life skills training. These include:

• orientation and mobility skills training (mobility indoors and outdoors, use of public transport and high technology aids);
• independent living skills training (general household skills, clothes care, grooming and personal hygiene, kitchen skills, shopping and handling money, looking after dependents, personal safety);
• communication skills training (reading print using low vision aids, handwriting and signing, use of Braille, keyboard and word processing skills, use of specialised audio and telecommunications equipment); and
• low vision enhancement training/low vision therapy (training in the use of optical and non-optical low vision aids, advice on the best use of natural and artificial light in the home and work environment, advice on distance, size, colour contrast and glare reduction, and special requirements and techniques needed for people who have multiple disabilities).

3.38 In addition to practical everyday support, the ADSS (2002) guidelines note that people with a visual impairment may require a range of equipment to help them in their daily lives. The Sensing Progress report also highlights the importance of appropriate environmental aids and equipment to the quality of people's lives, not least because it assists in moving them towards independent living.

3.39 Equipment for visually impaired adults includes:

• aids to mobility (including all types of cane);
• oral/aural and written communication (digital voice recorder, big-button telephone, allowance book signature guide, writing frame, signature guide and Braille equipment);
• viewing and communications technology (computer equipment and software);
• personal health and well-being equipment (medicine dispenser, talking body thermometer, autodrop eye-drop dispenser, talking blood pressure monitor, talking clocks and watches and money holders);
• domestic adaptations (talking appliances, tactile products and microwave, self-threading needles, tactile tape measure, liquid level indicator, talking kitchen scales, safety can opener); and
• building and lighting adaptations.

3.40 In addition to these daily needs, visually impaired adults may require information regarding their rights, responsibilities and the availability of support. This includes, for example, information about rights (including the Disability Discrimination Act, 1995), about health and services and treatments, procedures for assessment, certification and registration, social and practical support services provided by the statutory, voluntary and private sectors and employment and education opportunities.

3.41 In order for blind and visually impaired service users to make informed decisions about the services they receive, they need to have access to up-to-date and timely information, in the format of their choice, on the range of mainstream and specialist services that are available locally ( ADSS, 2002).

3.42 The ADSS guidance also highlights the shared responsibility across service sectors in ensuring that these needs are met. This includes information availability at such services as resource centers and community equipment stores, reception areas in social services departments, libraries and community centres, council housing offices, Citizens' Advice Bureaux, Schools and colleges, health specialists (opticians, GP surgeries, ophthalmic units, low vision services, diabetic clinics and audiologist clinics), post offices, village shops, church halls and lunch clubs, Government offices (eg Benefits Agencies, Job Centres), local voluntary societies for visually impaired people, disabled people, older people and minority ethnic communities, telephone help-lines, Internet sites and local newspapers, magazines, radio and television.

3.43 Despite this guidance, research suggests that information about the support and services that could help visually impaired people is often dispersed across a number of agencies and is difficult to access (Vale, 2004).

3.44 In an RNIB survey (Vale, 2004), only 46% of the Scottish visually impaired respondents were aware of the social services rehabilitation service; 32% were aware of mobility training and 59% were aware of a local society for blind and partially sighted people (ibid). Clearly, the provision of information is vital in improving awareness of what services are available.

3.45 The RNIB (2003a) See Change report also states that it is important that private and confidential information is available in accessible formats so that people with sight problems can become more involved in the arrangements for their own health and social care. This report also stresses that this will allow them to make more choices and to take more control over their lives (ibid).

Visual Impairment and Social Isolation

3.46 The RNIB (2003) report Out of Sight stresses that visually impaired people are often socially and economically excluded. They may feel particularly vulnerable because of worries about poor mobility, and practical issues such as being unable to read their own mail (ibid). Poverty is a serious issue for many people with visual impairments. Vale's (2004) research for the RNIB surveyed blind and partially sighted adults in England, Scotland and Wales, and found that three quarters were living in or on the margins of poverty.

3.47 Vale (2004) argues that blind and partially sighted people are among the most disadvantaged people in the UK. They tend to have less disposable income than their sighted peers, and are usually dependent on benefits such as Disability Living Allowance and Attendance Allowance. When surveyed as part of the research, only 15% of Scottish respondents said they were 'living comfortably'.

3.48 As noted in the ADSS (2002) 'National Standards of Social Care', over 90% of visually impaired older people live on less than half the average national income, which is a widely accepted definition of poverty.

3.49 As Vale's report points out, low incomes are linked to ill-health and lower life expectancy. There are also links between poverty and mental health problems (ibid).

3.50 De Feu and Fergusson (2003) point out that, historically, blind people had little access to education, were often cared for in institutions and trained only for manual work. They argue that low expectations and under employment continue to be problems for blind people today.

3.51 According to the ADSS (2002) social care guidelines, 75% of all visually impaired adults are unemployed, yet few receive any employment related training or help.

3.52 Despite low employment rates among the visually impaired, the RNIB survey (Vale, 2004) found that 51% of respondents were unsure of their entitlement to benefits, while one in 10 said they did not claim benefits to which they knew they were entitled because the process was too complicated.

3.53 Social isolation is another problem for blind and visually impaired people. Vale's (2004) survey found that only one in three respondents had daily contact with someone from the outside world; three out of five were living alone. Many people with a visual impairment may, therefore, feel isolated and unable to engage in community life because they do not receive appropriate social care ( ADSS, 2002).

3.54 Community care service provision for visually impaired people is currently acknowledged in the literature to be poor. The RNIB report 'Out of Sight' (2003) argues that gaps in service provision are allowing many blind and partially sighted people in Scotland to " slip into ill-health and premature dependency" because of an absence of appropriate support.

3.55 The literature suggests that there are gaps in services in terms of access to information, the amount of time people have to wait for an assessment, the equipment that is provided, and, again, in levels of awareness among service providers.

3.56 In one RNIB survey (Vale, 2004), only 53% of respondents said that they had ever had a visit at home from any professional or voluntary body as a result of their sight loss to assess their needs. Only 48% had someone to help with household chores. Nearly two thirds (63%) said they needed help to get out and about, but less than half (47%) had anyone to help them do this (ibid).

3.57 According to the RNIB (2003), those visually impaired people who are registered with social work services often wait many months before receiving services such as long cane mobility training, and this survey found that more than half receive no mobility training at all.

3.58 Other research by the RNIB (2004) revealed that the majority of blind and partially sighted people surveyed had not received vital pieces of equipment that could have helped them to live independently. For example, only 41% had been offered a white cane and only 37% had been offered liquid level indicators, which help to avoid scalding when pouring a hot drink. Those who had been offered such items found them useful (Vale, 2004a). Vale notes, however, that equipment like this is inexpensive and effective, and yet it is not being offered routinely (Vale, 2004).

3.59 The RNIB report that they continue to receive requests from councils for charitable donations, although community equipment should be provided for free. It has sometimes been suggested that, if the request is declined, the equipment will not be provided, despite assessments confirming need (Vale, 2004a).

3.60 Vale (2004a) suggests that there are many reasons for these gaps in service provision. For example, under-reporting of partial sight has led to registration figures which underestimate the extent of the problem. This has resulted in care service planners viewing sight loss as a low incidence disability (ibid).

3.61 A recent RNIB report, 'Out of Sight' ( RNIB, 2003) points out that sight loss is a significant issue for commissioners of community care, particularly as around 90% of blind and partially sighted people in Scotland are aged 60 or over. With an ageing population, the number of people with sight problems is set to increase ( RNIB, 2003). Du Feu and Fergusson (2003) also note that older people are less likely to ask for help (such as mobility services and Braille training, vision aids or talking books) than younger people.

Measuring Demand

3.62 The RNIB (2003) report 'Out of Sight' emphasises the importance of social work services quickly assessing the needs of blind and partially sighted people, and addressing their independent living needs. However, it suggests that this does not always happen - for example, the 1998 Scottish Office 'Sensing Progress' report states that only an estimated 23% of blind and partially sighted people in Scotland are registered with social work services ( RNIB, 2003).

3.63 Vale (2004a) supports this argument, although he notes that estimates of the rate of certification and registration among people who would be eligible is somewhere between 25% and 40%. Whichever figure is accurate, it seems that the majority of those with sight difficulties are not even known to social work services.

3.64 Consultation undertaken by the Scottish Executive in 2004 suggests that one reason for these low levels of registration is that there is a certain amount of stigma attached to being seen as different. Alternatively, older people may accept visual impairment as an inevitable consequence of the ageing process and be unaware of the support they are entitled to (ibid).

Community Care and Dual Sensory Loss

3.65 The single biggest need identified from the literature on dual sensory impairment is the need for guide/communicators to facilitate social interaction and equality of opportunity in accessing services.

3.66 Guide/communicators provide a combination of mobility and communication support for adults with dual sensory loss. They act as both 'eyes and ears' in facilitating access to services and in carrying out daily tasks. Guide/communicators are trained in various methods of communication including BSL, SSE, Deafblind Manual, lip reading, hands-on signing, visual frame signing, clear speech, keyboard interpreting, note-taking, Braille, moon and Makaton, and often provide the only means of communication available for deafblind adults with hearing and sighted people.

3.67 Guidance under Section 7 (2001) of the Local Authorities Act (1970) in England and Wales also recognises the needs of deafblind adults as a unique impairment population. The guidance requests that local authorities:

• identify, make contact with and keep a record of deafblind people in their catchment area (including those who have multiple disabilities including dual sensory impairment);
• ensure that when an assessment is required or requested, it is carried out by a specifically trained person/team, equipped to assess the needs of a deafblind person - in particular to assess the need for one-to-one human contact, assist technology and rehabilitation;
• ensure services provided to deafblind people are appropriate, recognising that they may not necessarily be able to benefit from mainstream services or those aimed primarily at blind people or deaf people who are able to rely on their other senses;
• ensure that they are able to access specifically trained one-to-one support workers for those people they assess as requiring one;
• provide information about services in formats and methods that are accessible to deafblind people; and
• ensure that one member of senior management includes, within his/her responsibilities, overall responsibility for deafblind services.

3.68 The Department of Health (2001) also notes that are several key factors to maintaining independence for people with dual sensory impairment, which are:

• autonomy and the ability to make choices and take control of your life;
• health and safety;
• managing the daily routines of personal and domestic life; and
• involvement in education, work, family, social and community activities.

Specific services for deafblind people

3.69 Although services exist for deaf and blind people, the needs of deafblind people are very different and people with dual sensory impairment may not be able to benefit from mainstream services (Department of Health, 2001). Guidance for local authorities therefore stresses the importance of providing services that are specifically designed for deafblind people (ibid).

3.70 Sense and Deafblind UK (2001) also note that many people will not be totally deaf and totally blind, but will have some remaining use of one or both senses. They may also have additional physical and/or learning disabilities (ibid). Services will therefore have to be flexible enough to meet the very specific needs of these individuals within the deafblind community.

3.71 The Department of Health (2001) guidance also points out that deafblindness poses particular challenges in ensuring that information is accessible. Under the Disability Discrimination Act (1995), information must be provided in a way that is accessible to those with a sensory impairment: service providers should ensure that the information is also accessible to deafblind people.

3.72 This may include using various sizes of Large Print, Braille, Moon, audio or video (subtitled or signed) but also computer disk or e-mail (to be accessed by specialist technology), text-phones and Type-Talk (Department of Health, 2001).

3.73 The only method of communication available to some deafblind people is tactile communication (eg hands-on sign, deafblind manual); in these circumstances the Department of Health guidance states that a suitably skilled communicator should be used to deliver the information. In medical settings, the Scottish Office Department of Health NHSMEL (1998) 4, makes clear the responsibility of service providers to ensure availability of guide communicators for deafblind people attending hospitals or GP surgeries.

3.74 Lack of access to such communicators does not reflect a lack of trained staff. As the Scottish Executive (2004) report notes, Deafblind Scotland trained more than 200 people in Communication and Guiding Skills with deafblind people between 1998 and 2003, only 25 of whom were working within the deafblind field when the report was published in 2004. The main reason for this was that only a few deafblind people are funded to receive a specialist service in any given area (ibid).

3.75 Respondents to the Scottish Executive's (2004) consultation on community care needs for people with a sensory impairment also reported that there are major variations across Scotland in what types of service are funded, and the number of hours of each service that are made available. While residents in one area can receive up to 25 hours of weekly guide communicator time, other authorities do not offer anything beyond normal community care services (ibid).

3.76 The report also notes that although a guide/communicator service was first offered in Scotland in the mid-1990s, much of the country continues to be without a service. From April 2002 to March 2003 Deafblind Scotland provided 24,000 hours of guide/communicator service to just under 80 people.

3.77 In summary, the Department of Health (2001) guidance states that local authorities should:

• identify and keep a record of deafblind people in the area;
• ensure that assessment is carried out by specifically trained staff equipped to assess the needs of deafblind people;
• ensure that services provided to deafblind people are appropriate and that they are able to access specialist one-to-one support workers;
• provide information about services in accessible formats and methods; and
• ensure that one member of senior management has overall responsibility for deafblind services.

3.78 Overall, research focussing specifically on the needs of deafblind adults is limited and much of the work that does exist has been carried out by charitable organisations and voluntary agencies. This may suggest a requirement for more focussed work with this population to identify similarities and differences in needs from their single impaired counterparts.

Features of Good Practice

3.79 The literature highlights the following key areas of good practice:

• clients have a right to be well informed and have equality of access to all information as services;
• services should be free from discrimination and privacy and dignity need to be preserved;
• clients should have independence to make choices about things that affect them directly;
• routinely, visual and hearing aids, aids to communication and appropriate communications technology should be provided;
• up to date information should be provided in accessible formats; and
• support should be provided as soon as impairments are disclosed or identified by the care providing community.

Summary

3.80 In sum, the literature shows that the community care needs of sensory impaired adults are as complex of those of the non-impaired population but are compounded by issues of accessibility and poor understanding of need in the population. The array of needs suggests that widespread awareness of the nature and challenges of deafness, blindness and deafblindness is required to achieve equality of access to services .

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