Visual Impairment Rehabilitation -

Issues for Service Provision

Simon LabbettRehabilitation Workers’ Professional Network

SCOVI - September 2015

Vision loss – a life-changing experiencehow many of these get disclosed in

initial phone assessments?How will I read my

bank statements? – I think my daughter’s on

the take

I can’t see to change my stoma – there are

some things I can’t ask my son to do

I want to know when to get off the bus – I ended up in a trading estate

last month

I’m afraid to answer the door, I can’t see

who’s there

I need to able to see the computer

screen to do online shopping

I want to cross the road to my friends house but the cars

are just a fog to me

I hate having to ask my friend to read my son’s

report

I bought the wrong sanitary towels this

week.

I just want to be able to cook tea for

my kids like I should do

What is Rehabilitation Work? - the underpinning values in English

law 2013 ADASS position statement  

“Visual impairment rehabilitation in the context of personalisation” •Rehabilitation for visually impaired people is a specific form of reablement. There are some intrinsic characteristics which define rehabilitation as being distinct from other forms of reablement. •Evidence from service users is that visual impairment rehabilitation is a long-term process borne out of a long-term condition. It encompasses mobility and other independence skills, emotional support and the development of new communication skills and cannot necessarily reach a successful conclusion within a six-week timeframe. Due to the degenerative nature of most eye disease people frequently need to re-engage with preventative services. •Rehabilitation programmes should be time limited but not time prescribed. It is not expected that a rehabilitation programme will have no end point, but due to the nature of sight loss and personal circumstances of each individual, this may not be possible to achieve within a six week period the outcomes that will truly minimise dependency.

Evidence base and good practice guidance• University of York – Social Policy Research Unit “Vision Rehabilitation Services: Increasing the evidence base” 2014

• Welsh Local Government Association “Visual Impairment Benchmarking Study” 2006

• Association Of Directors of Adult Social Services (ADASS) “Position Statement on Visual Impairment Rehabilitation” 2013

Findings from York University

http://www.york.ac.uk/inst/spru/research/pdf/virehabRF.pdf

• People with sight loss are positive about the impact of vision rehabilitation services on their safety, confidence and independence. Some would like earlier access to services and more readily available information

• The existing evidence base for community-based vision rehabilitation is under-developed. However, there are strong indications of the potential for these services, in particular group-based interventions, to have a positive impact on people’s daily life and emotional well-being

• A survey of rehabilitation services found they vary widely in the type of provider, type of support offered, structure and skills of teams delivering interventions, caseloads and waiting times. Services provided by voluntary organisations appear to experience more pressure on budgets and staffing ratios than local authority services

• A quarter of services inappropriately required people to have a Fair Access to Care Services (FACS) assessment to determine their eligibility to receive the service. Two thirds have a waiting list. The average waiting time is 10 weeks. Service managers and staff are concerned about shortages of staff and inadequate opportunities for staff training and continued professional development

• Services are more likely to address people’s need for mobility, independent living skills, aids, adaptations and equipment than their need for emotional support

• Just over half of services say they measure outcomes and less than half of these use standardised measurement tools

Themes of Good Rehabilitation Practice(a distillation of previous good practice

guidelines)• Entitled to an assessment• Offered an initial assessment within two weeks of CVI/BP1 and rehab services

within 12 weeks of initial contact • Eligibility criteria should not be applied to preventative services• Specialist assessment offered by someone with appropriate knowledge and skills• Offered range of services that address emotional and functional need• Services and range of equipment provided free of charge• Individual and carer agree the contents and outcomes of assessment and rehab

package• Information in a timely and accessible manner• Ability to re-access a service as need arises• All staff providing vision support undertake training and regular CPD

Measuring the need – current and future numbers

Total numbers and annual numbers Totals, by way of example, for Falkirk•BP1 registrations (892)•Background diabetic retinopathy (2,757)•Glaucoma + Ocular hypertension (1,529 + 2,263)•Late stage AMD (1,238)•Cataract (1,365)•Stroke (664)•Learning disability (40% of all people with LD have visual and/or hearing impairment – be clear about role of vision and hearing on learning)

RNIB Sightloss Datatool http://www.rnib.org.uk/knowledge-and-research-hub-key-information-and-statistics/sight-loss-data-tool

Visual Impairment and Falls

Scuffam Formula (adapted) quoted in “Falls - costs, numbers and links with visual impairment, Boyce. RNIB, 2011”•3.8 per cent of falls resulting in hospital admissions could be attributed to visual impairment costing 10 per cent of the total cost of treating accidental falls. (Falkirk: number of falls attributable to vision 251; number of falls with hospital admission attributable to vision 41)

•Be clear: how will home-based vision assessment & rehabilitation help?

Visual Impairment Outcome Measures

• Research is in its infancy: York University 2014; Cardiff University 2015

• No single template will meet all reporting needs• What are you measuring? • Whose perspective are you measuring it from?• Who is asking for the outcomes and why?

Measuring personal gains – goal related

 Outcome Coding

AIAE Achieved Independently and Above Expectations

AI Achieved Independently

AS Achieved With Support

B Baseline

BB Below Baseline

Goal/Outcomes Baseline Score Date Identified

Action Date To Review

Date Goal Completed

Outcome Code

Measuring financial savings – care plan and travel training costs

Client Need Time per week

Unit cost Weekly cost Annual Cost

Rehab Input £25 per

hour

Rehab Cost intervention   Year One Savingper hour

1 - JNLives alone. Needs to get to shops to

buy food and go to bank1 h/w £13.75 £13.75 £715.00 5 125 mobility to shops   £590.00

2 - PCMoves into new house alone. Need to cook and to get bus into town to shop

and socialise

4x 0.5h/w + 1x1hr p/w

£13.75 £41.00 2132 30 750bus mobility and

cooking skills  £2,057.00

3 - RMNeed to go shopping and need to be

able to cook meal after wife died 1x 1hr p/w

5x 0.5 hr p/w13.75 £48.10 2501 6 150

confidence in supermarket and

cooking  £2,351.00

4 - GU Make lunchtime snack and drink 5x0.5 hr p/w 13.75 34.38 1788 3 75drink and snack

makingreduced

calls£1,713.00

5 - MDMake lunchtime snack and climb stairs

to toilet2 x 0.5hr p/d 13.75 68.75 3575 5 125

stair mobility and meal heating

reduced calls

£3,450.00

6- AC Take medication safely 1 x 0.25hr/d £10 12.5 650 1 25 Lighting & ILSstop nurse

call£625.00

7- SYIndependent travel to become active

volunteer    126.11 6557 13 325

bus travel to Bradford

pre SDQ £6,232.00

8 - PO Prepare tea for mother who was ill 5x0.5 hr p/w 13.75 34.38 138 3 75 meal makingreablement

stopped£63.00

9 - JOWife works f/t, need for lunchtime

snack and monitor medication5x0.5 hr p/w + 1x 0.5 hr/d

13.75 + 10. 34.38 + 35 715 + 1820 3 75cooking skills + magnifier and

lighting

stop nurse call

£2,460.00

10 - MS Need to adminsister own insulin 2x 0.5 hr/d £10 £70 3640 2 50magnifiers and

lightingstop nurse

call£3,590.00

Outcomes -“how will I carry on with my life?”

How will I read my bank statements? – I

think my daughter’s on the take

I can’t see to change my stoma – there are

some things I can’t ask my son to do

I want to know when to get off the bus – I ended up in

a trading estate last month

I’m afraid to answer the door, I

can’t see who’s there

I need to able to see the computer

screen to do online shopping

What skills and knowledge does the worker need in order to solve these problems?

I want to cross the road to my

friend’s house but the cars are just a

fog to me

I hate having to ask my friend to read my son’s

report

I bought the wrong sanitary towels this

week.

I just want to be able to cook tea for

my kids like I should do

That’s the need; What skills are needed?

ADASS Statement 2013 Securing qualified Rehabilitation Officers

 The increasing number of older people with sensory needs mean that rehabilitation is likely to be a service in high demand. It is well established that there is a strong correlation between visual impairment and falls amongst older people. Additionally, visual impairment is often present alongside other conditions such as hearing loss, learning disability or dementia. Local authorities should consider securing specialist qualified rehabilitation and assessment provision (whether in-house, or contracted through a third party), to ensure that the needs of people with sight loss are correctly identified and their independence maximised. Certain aspects of independence training with blind and partially sighted people require careful risk management and should only be undertaken by a fully qualified Rehabilitation Officer.

Critical issues• Screening of referrals – referrals not getting to rehab. services. Why?• How well is the size of the need known – how good is the data?• Need to be much clearer of the role of rehabilitation in relation to other

health issues eg falls prevention; depression, diabetes management; stroke • Need to promote cost savings in health and care budgets, for example,

learning disability, older peoples teams and travel training, falls prevention, mental health

• Poor understanding of how rehabilitation helps meet personal goals and improves wellbeing

• Need to stress the link between sightloss/deafblindness and safeguarding issues

• Poor understanding of what specialist skills are required to undertake job • Critical shortage of specialist workers

Simon LabbettRehabilitation Workers Professional Network

www.rwpn.org.uksimon.labbett8@btinternet.com