From Wales Council for the Blind
For the Care Standards Inspectorate for Wales
National Minimum Standards for Care Homes for Older People – Supplementary Guidance - visual impairment
Supplementary Guidance
This supplementary guidance to the National Minimum Standards for Older People provides additional advice to inspectors when interpreting the relevant standards for visually impaired people. It is not the intention for this guidance to replace or amend any particular standard.
The guidance has been developed jointly between the Wales Council for the Blind and the Care Standards Inspectorate for Wales.
Background
The current figure for those registered blind and partially sighted in Wales is nearly 20,000. Statistics drawn from the Welsh Health Survey of 1998 indicate a much higher figure for those with uncorrectable sight difficulties - over 80,000 in the general population. Of those 90 % are on or over retirement age. The implication is that every care home is likely to have a service user or service users with significant sight problems.
Furthermore the development of sight problems increases rapidly with age. One in four people over 75 is likely to be registerable. This is why attention to eyecare is a continuous duty for registered persons and staff in care homes.
Attending to eye conditions and providing appropriate support can improve service users' independence and lessen confusion. It is therefore to everyone's advantage to understand how to implement the supplementary guidance.
For convenience, the supplementary guidance has been attached to the relevant paragraphs in the National Minimum Standards with reference to the relevant Regulations.
However, to avoid unnecessary repetition, there are some introductory points which will help explain the specific circumstances in visual impairment
(A) Registration
This has a special meaning in the field of visual impairment. It is a legal and medical procedure which signifies that the person concerned has been certified by an ophthalmologist as having sight below a medically defined level and has been registered by Social Services as eligible for support services. Current developments indicate that access to Social Services will in the future cease to be associated with registration.
Registration acts as a passport to some services and benefits but there are others for which registration is not necessary.
(B) Rehabilitation
This too has specific meaning for visual impairment with its own accredited training and Higher Education Diploma. It refers to the teaching of the skills and techniques to service users which have been developed to compensate for the loss of sight in gaining and re-gaining independence. It includes an assessment of the individual's ability to respond to training, navigation and mobility training, daily living skills, low vision and communication.
(C) Specialist assessments
Assessments of vision should be carried out by an optometrist.
Diagnoses of sight conditions should be provided by ophthalmologists.
Assessments of the disability can be carried out by qualified Rehabilitation Workers.
Other support may be available from specialist social workers employed by the local authority's Social Services Department.
(D) Information
Wherever reference is made to records or information being made available to service users, the home should be able to provide this in suitable formats - large, print, audio-tape, braille or moon - or to utilise the methods described in para 7.2.
(E) Contacts outside the home
There is a plethora of organisations, statutory, voluntary and private, both local and national, that provide specialist services for v.i. people and for service providers, which should be identified and recorded by homes for use as appropriate. Examples of these are:
• local societies with a social programme
• local societies who provide practical advice and help
• talking newspapers and audio-books services
• large print and braille books
• radios for the blind
• aids and equipment
• rehabilitation training
(F) Awareness training
This is distinct from disability equality training which focuses on changing attitudes towards disability and directing thinking towards the social model and away from the medical model.
It is also different from disability awareness training which deals more with general disability issues. Visual impairment awareness training is recommended to understand the background and the factors specific to visual impairment. It should prepare participants to think about the nature of visual impairment and how the practical problems caused by the impairment can be overcome.
The National Minimum Standards for Care Homes for Older People
Visual Impairment
SECTION I Choice of home
Standard 1 Information
1.1 'statement of purpose'
The home should develop a coherent approach to handling the difficulties arising from sight loss either with a current stated policy on accommodating service users with visual impairments or by including references to visual impairment in all policies where relevant.
Service users' guide
1.2 'suitable ... format'
See above para (D) Information.
1.3 'special needs ... catered for'
This should state how the home intends to provide for the needs of service users who are or who become visually impaired.
1.4 'relevant ... format'
See above para (D) Information.
Regulations 4 (1) (c), 5 and 6 and Schedule 1.
Standard 2 Needs assessment
2.1 'full assessment'
A full assessment should include evidence of a recent sight test and, where appropriate, of diagnosis.
2.3 ' needs assessment …sight, hearing + communication ..'
See above para (B) Rehabilitation and para (C) Assessments.
Regulations 14 and 15
Standard 3. Capacity to meet needs
3.1 'the home's capacity to meet the assessed needs, including specialist needs'
All information to service users should include reference to visual impairment and the specialist service provided and should be available in alternative formats.
3.2 'clinical guidance'
The records of all service users should include the date of the last eye-test and the optometrist's report.
The record of a v.i. service user or one who has become v.i. should also include
• registration status
• date of registration
• date of the last appointment with ophthalmologist
• copy of the report (the BD8 where applicable)
• eye condition
• visual acuity and field
• date and details of any treatment
• date of last appointment with the Low Vision specialist
• recommended low vision aids, lighting requirements
• preferred medium
The latter category could be termed 'communication needs' to cover hearing impairment, deafblindness. learning disabilities, non-literacy, dyslexia.
3.4 'Staff ... have the skills and experience to deliver the services and care which the home offers'
See above para (F) Awareness Training and Standard 23 Staff Training.
Regulation 12 (4) (b)
Regulation 14 (1) (d)
Regulation 16 (1)
Standard 4. Trial visits
4.4 'inform the service user'
See above para (D) Information.
Standard 5. Contract
5.1 'provided with a statement of terms and conditions'
See above para (D) Information.
5.3 'signed by the service user'
Signature guide cards are available.
Regulation 5
SECTION II Planning for individual needs and preferences
Standard 6. Service user plan
6.1 'a comprehensive assessment'
See above para (B) Rehabilitation and (C) Specialist assessments.
6.3 ' clinical guidelines'
See above para 3.2
6.5 'a style accessible to the service user'
See above para (D) Information.
Regulation 12 (1) (b)
Regulation 14 (1) (b) and (1)(d)
Regulation 15
Standard 7. Record keeping
7.1 'for the protection of service users'
See above para 3.2.
7.2 'access to their records'
This could be achieved by:
• transcribing the text as explained in(D) Information
• reading the text aloud to the service user
• a C.C.T.V. for service users who can read large print.
• character magnification computer software
• staff trained to read and interpret as part of training.
Regulation 17 (LAWYERS TO CONFIRM)
SECTION III Quality of life
Standard 8 Autonomy and choice
8.1 'maximise service user's capacity'
This can be achieved by
• maximising the sight by proper medical treatment
• carrying out a rehabilitation assessment
• arranging for rehab. training where appropriate
• ensuring that communication needs are met
Regulation 12 (3)
Regulation 13 (1) (b)
Regulation 16 (2) (m)
Regulation 16 (2) (n)
8.2 'handle their own financial affairs'
8.3 'assisted in contacting external agents'
See para 7.2
Regulation 16 (2) (l)
8.5 'Access to personal records'
See para 7.2.
Regulation 14 (1) (b)
Regulation 15 (2) (b) and (e)
Regulation 17
Standard 9. Social contact and opportunities
9.3 'opportunity to exercise choice in relation to ... leisure and social activities and cultural interests ... religious observance'
This can be achieved by including in the home's programme of activities in which v.i. people can participate for example, music activities, reminiscence based on speech, sound and smell, or activities which can be adapted e.g. bingo with large print cards, tactile dominoes.
It should also include activities specifically designed for v.i. people e.g talking books, sensory stimulus equipment.
The home should research and record up-to-date details of resources, services and organisations which can assist with activities for v.i. people.
9.4 'outside the home'
9.5 'Up-to-date information'
The record mentioned above should contain details of local and national v .i. organisations who organise activities in which service users could participate.
See above para (D) Information.
Regulation 16 (2) (m) and (n) and (3)
Standard 10. Community contact
See paras 9.4 and 9.5
10.5 'Relatives, friends and representatives of service users'
This should include advice and encouragement on communicating in an appropriate way e.g. in face to face encounters, by phone, in large print., tape etc. If the service user begins to lose their sight after being admitted, information about this and about the most appropriate means of communication should be given to relatives etc.
10.6 'Involvement in the home by local community groups'
The local society for the Blind could be approached about visiting the home or including the service user in any visiting scheme.
Regulation 16 (2) (m) and (n)
Standard 11. Rights
11.1 'legal and civic rights'
As for all disabled service users these include rights under the Disability Discrimination Act. For those with responsibility for care homes, the legislation on the right of access to goods, services and information would have particular relevance. But if the registered person has any doubts, it would be advisable to seek advice e.g. Welfare Rights, C.A.B., solicitor.
11.2 'advocacy'
The home should ensure that any external advocacy service made available to the v.i. service user understands the disability and is capable of accommodating the communication needs. This is particularly important with advice on benefits entitlements and benefits application procedures.
Standard 12. Confidentiality
See Standard 14 Privacy and Dignity
SECTION IV Quality of care and treatment
Standard 13. Intermediate care
13.2 'Rehabilitation'
See above para (B) Rehabilitation.
It should be borne in mind that the person assessed as needing intermediate care may also have a visual impairment.
Standard 14. Personal care - privacy and dignity
14.2 'consultation'
Particular efforts should be made to ensure the privacy and confidentiality of v.i. people in consultation on health, legal and financial matters. As they will often need to have documents read aloud or described to them, the home should be able to provide a quiet and private space.
Alternately, some service users preference would be for documents in large print or on tape or in braille and then the transcription process should guarantee confidentiality.
Regulation 12 (4) (a)
14.3 'access to a telephone'
A large-button telephone should be available for v.i. service users.
Regulation 16 (2) (b)
Standard 15 Health Care
15.1 'access to health care services'
• This should involve regular eye tests.
• Referrals to G.P.s by optometrists should be facilitated as quickly as possible.
• Appointments with ophthalmologists should be facilitated without fail.
• Any treatment prescribed by the ophthalmologist should be facilatated.
• Any aids prescribed by the Low Vision Service should be obtained and their use monitored and recommendations on lighting should be carried out.
• Staff should be alerted to notice signs of secondary sensory loss as this will necessitate a new approach to communication.
• There are certain physical conditions which often accompany sight loss e.g. back pain and the registered person should be alert to these possibilities.
15.8 Opportunities are given for appropriate exercise and physical activity'
See above para 9.3
15.11 'access to ...'
This list should be understood to include 'optometric and ophthalmological services'
15.12 'access to ... sight tests and appropriate aid, according to need'
See above para (B) Rehabilitation and para (C) Assessments.
With aids such as low vision equipment etc., staff can be shown how to assist with these.
Regulation 12 (1) (a) and (b)
Regulation 13 (1) (b)
Regulation 17 (1)(a) Schedule 3
Standard 16. Meals and mealtimes
16.7 see (D) Information
16.9 'independent eating'
V.I. service users can receive training as part of rehabilitation in independent eating and staff can be shown how to assist with this.
For example the use of crockery in a contrast colour to the surface of the table or tray will make it easier for someone who is visually impaired to handle their meal.
See below Standard 23 Staff Training
Regulation 16 (2) (g) and (h)
Standard 17. Medication
17.1 'Service users are able to take responsibility for their own medication'
This may be possible as a result of rehabilitation training if the service user is otherwise capable of managing medication.
Regulation 13 (2)
Standard 18 Safe working practices
Compliance with requirements for making premises accessible for visually impaired people will contribute to the safety of service users.
See below Section VIII The Physical Environment
Staff training should include simple mobility and sighted guiding to help preclude the kind of accidents which can result from visual impairment.
See below Standard 23 Staff Training
Staff must observe the rule that objects must not be left in the way of service users who may be visually impaired.
Regulation 13 (4) (a), (b) and (c)
SECTION V Staffing
Standard 21. Qualifications
There are currently no qualifications for v.i. awareness training but it does underpin some N.V.Q.s.
Standard 23 Staff training
'Staff are trained and competent for the job they do.'