Hearing Loss Care for Nurses in California: Technology and Gene Therapy

Hearing loss is common across care settings, and nurses play a key role in improving communication and patient outcomes. New advances in hearing technology and emerging gene therapy are expanding care options.

Modern hearing aids come with very sophisticated programming and options that allow even those with severe hearing loss can hear in most environments. However, many not persist in getting that programming optimized. Helping those in your life, to be optimistic and continue to ask audiologist for changes is important.

In addition, when in certain environments, especially if the person is moving about while talking, extra accessories like a “partner mic” or Meta Glasses or Iphone live listen gives the patient ability to hear better, since all the noise is eliminated and focus is on speech. Stand alone no tech knowledge needed, assistive listening devices are available like the Williams Sound: Pocket Talker can make communication clear and easier. The key is to be open to whatever technology is available, helping patient feel comfortable with its use.

New research emphathizes that early access to care remains critical. A recent study compared children who received cochlear implants, early gene therapy, or no medical intervention. Children who received implants or gene therapy showed similar early developmental outcomes, while those without medical intervention showed more variability—even with appropriate educational support. This treatment progress is exciting, especially as they are predicting that this treatment will have FDA approval soon. Even for those late deafened, or progressive genetic causes, seem to get better results if cochlear implants are done sooner.

What this means for nurses in California:

• Identify signs of hearing difficulty (withdrawal, missed responses, speaking over others)

• Support early referrals to audiology and hearing specialists

• Stay aware of evolving technologies and treatment options

As options expand, patient-centered communication and early support remain essential to quality care.

Use adaptive communication strategies:

• Face the patient

• Incorporate visual aids or written communication wherever possible

• Reduce background noise

• Rephrase with different words to allow for recognition

• Ask open ended questions to assess understanding

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses provide engaging and practical skills in supporting their clients with vision and/or hearing loss.

Approvals & Accreditations:

• OHA - Oregon Health Authority - Cultural Competence CE

• NASW-OR National Association of Social Workers - Oregon Cultural Competence CE

• CRCC - Commission on Rehabilitation Counselors Certification - Ethics CE

• Approved by the California Nursing Board, Provider CEP#18080 for 6 contact hours of geriatric-related continuing education for Nurse Practitioners

Who these courses are helpful for: 

Nurses, Psychologist, LCSW, LFMT, PT, OT, SLP, ND, NP, PA, MD, DDS, LPC, Chiropractor, License Professional Counselor, Marriage and Family Therapist, Dentist, Dental Technologist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Lactation Consultant, Long Term Care Administrator, Massage Therapist, Medical Imager, Midwife, Naturopathic Doctor, Occupational Therapist, Optometrist, Pharmacist, Polysomnographic Technologist/Respiratory Therapist, Social Workers, Caregivers and Families.

• For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and others working with individuals navigating sensory loss and disability. Her courses are designed to be interactive and helpful, and will help you gain skills valuable to your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey. 

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life

Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

The Colleague Down the Hall: Working with Blind and Low Vision Colleagues

We spend a lot of time talking about patients with vision loss. Less often do we talk about the person working with us.

Legally blind and low vision professionals are in our clinics, our hospitals, and on our teams. And most of the awkwardness that shows up around them comes from the same place: coworkers who want to do the right thing and are afraid of doing the wrong one. So they hesitate. They over-help, or they avoid entirely, and the new colleague spends their first month feeling like a problem being managed rather than a clinician being onboarded.

The National Research and Training Center on Blindness and Low Vision at Mississippi State University and it opens with the only rule you really need. When in doubt, just ask.

They Are Already on Your Team

There is a persistent assumption in healthcare that vision loss and clinical work do not mix. The data say otherwise. A national survey of roughly 6,000 physicians estimated that about 3 percent report having a disability. That figure is almost certainly an undercount, because disclosure carries risk and many clinicians decline to report. Blind and low vision professionals practice as physicians, nurses, pharmacists, therapists, social workers, counselors, and researchers. They read imaging with magnification software, chart with screen readers, and manage caseloads with the same competence as anyone else, using different tools.

What the Resource Sheet Covers

Vision loss looks different for every person. Most people with vision loss are not totally blind. Some read print, recognize faces, and travel independently. Others struggle with detail, unfamiliar spaces, or particular lighting. Assumptions about what a colleague can and cannot see are usually wrong in one direction or the other, so let them tell you.

Digital accessibility is the top complaint. More than 95 percent of blind and low vision workers report that inaccessible digital content is their biggest workplace challenge. The fixes are things most of us can do in a minute: use real heading styles instead of bold text, add alt text to images, avoid sending screenshots or scanned PDFs in place of actual text, and choose readable fonts with decent contrast. Word, PowerPoint, Excel, Outlook, Acrobat, and Canva all include an accessibility checker. Running it before you hit send costs almost nothing.

Small conversational habits carry a lot of weight. Introduce yourself by name each time rather than assuming your voice will be recognized. Use your colleague's name so they know you are speaking to them. In meetings, say who is in the room and name people as they speak. Mention when you are leaving. Describe what they cannot see, including who just walked in. Give directions in specifics, not in "over there." And relax about vocabulary, because words like see, look, and watch are perfectly normal.

Send meeting materials in advance. Easy to overlook, and it makes an enormous difference. It gives a colleague time to review content in the format that works for them, rather than sitting through a discussion of a handout they cannot read.

Do not rearrange the environment without telling them. Moved furniture, a blocked hallway, a restroom out of order, painting or construction. These are navigation problems, and a two-second heads-up prevents them.

Resources

• NRTC on Blindness and Low Vision

• Resource Sheet

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses provide engaging and practical skills in supporting their clients with vision/hearing loss.

Approvals - Accreditations:

OHA - Oregon Health Authority - Cultural Competence CE
CEP #18180 CA Board of Registered Nursing, Continuing Education Provider
NASW-OR Nat. Assoc. of Social Workers - Oregon Cultural Competence CE
CRCC - Commission on Rehabilitation Counselors Certification - Ethics CE

Who these courses are helpful for:

Nurses, Psychologist, LCSW, LFMT, PT, OT, SLP, ND, NP, PA, MD, DDS, LPC, Chiropractor, License Professional Counselor, Marriage and Family Therapist, Dentist, Dental Technologist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Lactation Consultant, Long Term Care Administrator, Massage Therapist, Medical Imager, Midwife, Naturopathic Doctor, Occupational Therapist, Optometrist, Pharmacist, Polysomnographic Technologist/Respiratory Therapist, Social Workers, Caregivers and Families.

• For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence< Health Equity & Ethics accredited continuing education courses for better healthcare and sign up today at Adaptability for Life

Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

When Hearing Loss Looks Like Something Else: What Healthcare Providers May Be Missing

Recognizing unaddressed hearing loss in the clinical encounter.

Hearing loss doesn't always announce itself with, "I'm having trouble hearing." Yet significant numbers of your patients may be struggling to understand.

In a busy healthcare setting, it may show up in much quieter ways: a patient who asks for something to be repeated, talks before a question is finished, watches your face closely, relies on a family member, or seems to miss the point of a conversation.

These behaviors can have many explanations. But they can also be signs that the patient is working harder than we realize to hear and understand what is being said. And in today's fast-paced clinical environment, that matters.

Because when a patient doesn't fully hear the conversation, they may not fully experience the conversation either. They can miss information, lose their place, hesitate to participate, or leave feeling that they weren't really heard or understood. Over time, that can affect the relationship with the healthcare provider—and even whether the patient feels it is worth coming back.

A Common and Under-Documented Condition

Hearing loss is one of the most prevalent chronic conditions in older adults and one of the least likely to appear in a problem list. A 2023 analysis of Medicare beneficiaries in the National Health and Aging Trends Study found that 65 percent of adults aged 71 and older had measurable hearing loss, rising to 96 percent by age 90. Among those with hearing loss, fewer than one in three used hearing aids. The interval between onset and treatment is long. The figure most often cited in the literature is approximately nine years.

What Might Make You Wonder About Hearing?

No single behavior indicates hearing loss. Look instead for patterns.

A patient may:

• Complain about mumbling or rate of speech.

• Ask you to face them, or move hand away from mouth.

• Watch your face closely while you speakGive responses that don't quite fit the question.

• Talk a lot or over others or begin responding before the question is finished

• Rely on a spouse, child, or caregiver to repeat parts the conversation

• Seem frustrated or short tempered during conversations.

• Seem to not follow instructions completely.

Presentations That Are Commonly Misattributed

1. Apparent nonadherence. The patient agreed to the plan because the fragments they caught sounded reasonable. They are not resisting the plan. They are working from an incomplete version of it.

2. Apparent cognitive impairment. Effortful listening consumes working memory. A patient allocating substantial cognitive resources to decoding speech has less available for encoding and recall, and may present as slow, tangential, or forgetful.

3. Apparent disengagement or rudeness. A patient who does not respond to their name in a waiting room has not heard it. Names are short, competing voices are many, and waiting rooms are acoustically poor.

4. Apparent irritability with staff. Repeated communication failure across settings is fatiguing and often humiliating. Frustration presenting at your front desk may have accumulated well before the patient arrived.

5. Reliance on an accompanying family member. Deferring to a companion is an effective workaround that costs the patient privacy, autonomy, and accurate history-taking. It is worth noticing rather than accepting.

6. Attrition. Patients rarely disengage by citing hearing. They describe the practice as unpleasant, or simply do not rebook.

Hearing Sound Is Not the Same as Understanding Speech

A patient may be able to hear your voice and still miss much of what you are saying.

This becomes especially apparent when there is background noise, when several people are speaking, or when the conversation moves quickly. Many people compensate without consciously realizing it. They use context, facial expressions, familiar phrases, and what they expect to hear to fill in the gaps.

Often, it works. Until it doesn't.

In a healthcare encounter, a missed word can matter. A medication name, a dosage, a follow-up instruction, or a qualification such as "unless" or "only if" can change the meaning of an entire conversation.

A Simple Way to Check During the Visit

You don't necessarily need a formal hearing test to recognize that hearing may be affecting the encounter. You can start with the conversation already happening. Choose something meaningful from the visit—a piece of information from the chart, a medication instruction, or a brief explanation you've just given.

Then ask the patient to tell you more about it.

Rather than asking:

"Did you hear me?"

try:

"Tell me what you understood from that."

This gives you much more information. If the response is on topic and reflects the important information, communication is probably working reasonably well at that moment. If the response is consistently off topic, misses key information, or seems to reflect a different version of what you said, pause.

Instead of asking simply, "Do you have hearing loss?", ask:

"Are there situations you avoid because it's difficult to understand what people are saying?"

Restaurants. Family gatherings. Meetings. Social events. Places with several people talking at once.

Patients may not think of themselves as having hearing loss. But they may readily recognize that they have stopped going places where conversation has become difficult. That distinction is clinically useful. The problem may not be an inability to hear sound.

It may be an increasing inability to understand speech in the situations that matter to the patient.

Don't assume the patient wasn't paying attention.

Change the communication conditions first.

Move closer rather than increasing volume; raising volume only makes vowels louder, not consonants and reads as anger or impatience.

Ask if they have a better ear. Lower your voice and talk a little bit slower. Not exaggerating. Face the patient. Make sure they can see you, Increase lighting. Reduce background noise if possible. Then try again. Numbers like 50 & 60 are particularly hard, so could be a test. If the patient's understanding improves, you've learned something important.

The Part We May Miss: Connection

The consequences of hearing loss aren't limited to missed words. Conversation is how we establish trust. Patients want to feel that their concerns were heard. They want to understand what is happening and feel that they have participated in decisions about their care.

When hearing becomes difficult, that sense of connection can gradually erode. A patient may smile and nod because it is easier than asking for another repetition. They may let a spouse answer because it keeps the visit moving. They may stop asking questions because they aren't sure they heard the answer. They may leave an appointment with less understanding than either the patient or provider realizes.

Screening can be brief.

For an objective measure, the Hearing Number app from the Johns Hopkins Bloomberg School of Public Health is free, available for iOS and Android in English and Spanish, takes about five minutes with headphones in a quiet space, collects no personal data, and returns a decibel threshold for each ear that can be tracked over time. It is a wellness metric rather than a diagnostic audiogram, but it is sufficient to open a referral conversation.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses provide engaging and practical skills in supporting their clients with vision/hearing loss.

Approvals - Accreditations:

OHA - Oregon Health Authority - Cultural Competence CE
CEP #18180 CA Board of Registered Nursing, Continuing Education Provider
NASW-OR Nat. Assoc. of Social Workers - Oregon Cultural Competence CE
CRCC - Commission on Rehabilitation Counselors Certification - Ethics CE

Who these courses are helpful for:

Nurses, Psychologist, LCSW, LFMT, PT, OT, SLP, ND, NP, PA, MD, DDS, LPC, Chiropractor, License Professional Counselor, Marriage and Family Therapist, Dentist, Dental Technologist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Lactation Consultant, Long Term Care Administrator, Massage Therapist, Medical Imager, Midwife, Naturopathic Doctor, Occupational Therapist, Optometrist, Pharmacist, Polysomnographic Technologist/Respiratory Therapist, Social Workers, Caregivers and Families.

• For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life

Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

Making Medication Instructions Accessible: Communication Tips for Pharmacists Serving Patients with Hearing and Vision Loss

As pharmacists, we know that ensuring patients understand how to take their medication is just as important as dispensing it. But when patients live with hearing and/or vision loss, communication becomes more complex. Labels may be unreadable. Verbal counseling may be missed. And the risks—from non-adherence to adverse events—rise significantly.

Why Accessibility Matters in Pharmacy

Hearing and vision loss increase with age and socioeconomic factors. Many older adults live with dual sensory loss (DSL), where both hearing and sight are diminished. Studies show that patients with DSL often experience higher levels of frustration, fear, and anger when communication breaks down—making it harder for them to follow their care plan and trust their providers.

For pharmacists, this means that cultural competence and accessibility aren’t “extras”—they are critical components of safe, ethical, and compassionate care.

Practical Tips You Can Use in the Pharmacy

Here are strategies that can help bridge the gap:

Labeling Medications Safely

• Tactile cues: One rubber band, bump dot, or sticker can signal once-daily dosing; two can indicate twice daily. This also helps patients track which bottles are “active.”

• Large print and color coding: Increase readability with high-contrast, larger fonts.

• Technology:

  • Audio & RFID tags allow patients to hear instructions.

  • Apps like Be My Eyes AI can read labels aloud, though pharmacists should caution patients that AI may make errors.

  • ScriptTalk (talking prescription labels) is now available in many states and helps ensure accurate, independent medication use.

👉 For more details, see the American Foundation for the Blind’s Guidelines for Prescription Labeling.

Communication Best Practices

• Lower your pitch instead of raising your voice. Yelling actually distorts soft consonants like p, s, t, th, making speech less clear.

• Check for understanding. Don’t just ask “Do you understand?”—invite patients to repeat back instructions in their own words.

• Orient and guide. If patients are unfamiliar with your pharmacy layout, provide verbal cues to help them navigate safely.

• Involve caregivers when appropriate. Reinforce instructions with family members or aides, especially if multiple medications are involved.

Legal & Regulatory Context

Most states—including Oregon—require pharmacies to provide accessible prescriptions upon request. Staying compliant not only avoids legal risk but strengthens patient trust and ensures equity in care delivery.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses provide engaging and practical skills in supporting their clients with vision/hearing loss.

Approvals - Accreditations:

OHA - Oregon Health Authority - Cultural Competence CE
CEP #18180 CA Board of Registered Nursing, Continuing Education Provider
NASW-OR Nat. Assoc. of Social Workers - Oregon Cultural Competence CE
CRCC - Commission on Rehabilitation Counselors Certification - Ethics CE

Who these courses are helpful for:

Nurses, Psychologist, LCSW, LFMT, PT, OT, SLP, ND, NP, PA, MD, DDS, LPC, Chiropractor, License Professional Counselor, Marriage and Family Therapist, Dentist, Dental Technologist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Lactation Consultant, Long Term Care Administrator, Massage Therapist, Medical Imager, Midwife, Naturopathic Doctor, Occupational Therapist, Optometrist, Pharmacist, Polysomnographic Technologist/Respiratory Therapist, Social Workers, Caregivers and Families.

• For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life

Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

Supporting Patients Living with Deafblindness s — A Guide for Healthcare Professionals

Imagine walking into a clinic where you cannot rely on your eyes to read a provider's expression or your ears to catch your name being called. For patients living with deafblindness — the combined loss of vision and hearing — this is daily life, and it makes the healthcare setting one of the most disorienting places they can enter. Yet with understanding and a few thoughtful adjustments, that same setting can become one where these patients feel respected, safe, and fully in charge of their own care.

Deafblindness Is a Spectrum, Not an Absence

The phrase "deaf and blind" can call to mind total silence and total darkness, but that image fits very few people. Most patients living with deafblindness have some usable vision, some usable hearing, or both. What defines the condition is that the two losses combine — each one limiting the strategies a person might otherwise use to compensate for the other.

Deafblindness has many causes. Some patients are born with it, through conditions such as Usher syndrome (which pairs hearing loss with progressive vision loss) or CHARGE syndrome. Many others acquire it later in life, and this group is growing: as the population ages, combined age-related hearing loss and vision loss — from macular degeneration, glaucoma, cataracts, or diabetic retinopathy — is increasingly common and frequently under-recognized in older adults. A patient whose hearing aids and glasses no longer keep pace with both losses may be experiencing dual sensory impairment without anyone having named it.

Practical Steps for Healthcare Professionals

1. Speak to the patient, not the SSP or interpreter. Direct your questions, explanations, and eye contact to the patient. Phrases like "Does she understand?" addressed to a companion strip away dignity and autonomy. The patient is your patient.

2. Understand what an SSP is — and isn't. An SSP facilitates communication and access, but is not necessarily a qualified medical interpreter. For complex medical discussions, diagnoses, or informed consent, arrange a qualified interpreter (including a tactile or deafblind interpreter when needed) so nothing critical is lost.

3. Ask about communication preferences first. Before anything else, find out how the patient communicates best and follow their lead. Confirm understanding rather than assuming it.

4. Announce yourself and narrate your actions. Identify yourself each time you enter, and let the patient know when you are leaving so they are not left addressing an empty room. Explain what you are about to do before you touch them for any exam or procedure.

5. Allow extra time. Tactile communication, environmental description, and guiding all take longer than a standard visit. Building in time is not a courtesy — it is the difference between adequate and safe care.

6. Make the environment work for the senses that remain. Improve lighting, reduce glare, minimize background noise for patients with residual hearing, and use high-contrast, clutter-free spaces. Keep the patient's belongings and mobility aids where they left them.

7. Provide information in accessible formats. Offer consent forms, education, and instructions in braille, large print, audio, or screen-reader-compatible electronic formats — and read documents aloud or through the patient's preferred method when needed.

Protect autonomy in every decision. Mirror the SSP philosophy: give the patient complete information and let them decide. Never route consent or medical choices through a family member or SSP without confirming that this is genuinely what the patient wants.

Who Are Support Service Providers?

Support Service Providers are trained professionals who act as a bridge between patients living with deafblindness and the world around them. They facilitate communication, relay visual and environmental information, and provide human guide support for navigation. In everyday life, SSPs assist with tasks such as grocery shopping, using public transportation, making phone calls, and attending appointments and social events — helping patients live independently and with confidence.

One principle sits at the heart of the SSP philosophy, and it matters enormously in healthcare: respect for the patient's leadership and choices. A skilled SSP conveys information but does not make decisions, offer recommendations, or steer outcomes. The goal is to keep the patient in the driver's seat — informed, autonomous, and in control. Modern SSPs maintain a supportive but professional distance precisely to protect that objectivity.

The Bottom Line

Living with dual sensory loss presents real challenges, but with informed, compassionate care — and, where appropriate, the support of an SSP — patients living with deafblindness lead full, self-directed lives. As healthcare professionals, our role is not to speak or decide for these patients, but to remove barriers and hand them the information and access they need to lead their own care.

Understanding the deafblind experience, recognizing the vital role of Support Service Providers, and honoring each patient's autonomy are how we build a more inclusive and accessible healthcare system — one respectful interaction at a time. For patients and families seeking ongoing support, most states offer deafblind services and SSP programs that can be a valuable next step beyond the clinic.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses provide engaging and practical skills in supporting their clients with vision/hearing loss.

Approvals - Accreditations:

OHA - Oregon Health Authority - Cultural Competence CE
CEP #18180 CA Board of Registered Nursing, Continuing Education Provider
NASW-OR Nat. Assoc. of Social Workers - Oregon Cultural Competence CE
CRCC - Commission on Rehabilitation Counselors Certification - Ethics CE

Who these courses are helpful for:

Nurses, Psychologist, LCSW, LFMT, PT, OT, SLP, ND, NP, PA, MD, DDS, LPC, Chiropractor, License Professional Counselor, Marriage and Family Therapist, Dentist, Dental Technologist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Lactation Consultant, Long Term Care Administrator, Massage Therapist, Medical Imager, Midwife, Naturopathic Doctor, Occupational Therapist, Optometrist, Pharmacist, Polysomnographic Technologist/Respiratory Therapist, Social Workers, Caregivers and Families.

• For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life

Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

What psychologists, counselors, and physical therapists can learn from new research on using touch to teach orientation and mobility for people who are deaf blind.

When a person with combined hearing and vision loss is tasked with learning to navigate in the real world of traffic and public transportation, many fears and risks can be expressed. As a healthcare provider, helping people evaluate the reality of fears and risks, it can be difficult to know what to say. For years there was no validation thats safe independent travel could be achieved. Or how to convey the needed information in the midst of constantly changing environments.

This summer, Portland State University and the Helen Keller National Center shared research on touch-based orientation and mobility (O&M) for travelers who are DeafBlind, as part of DeafBlind Awareness Week and its theme, Connected by Touch. I was honored to join the panel as a person who is deafblind: legally blind and hard of hearing to connect the findings to everyday life.

The research is framed around teaching strategies that provide cues other than speech, issues with technology and bluetooth use, and provided proof that deafblindness need not prevent independent safe travel. But underneath it is a lesson that reaches well past the crosswalk: how to communicate in noisy environments quickly and safely. Regardless of the level of hearing or blindness. Yet, it doesn’t mean that every deafblind person can travel anywhere, without careful attention to skills, and each environment.

When psychologists, counselors, and physical therapists interact with patients/clients who have some usable hearing and vision, need to understand that hearing and vision not always reliable hearing and vision. They may also be able to help process fears around being touched, or not being safe. Or perhaps use the information to empower clients if a system is saying that safe, independent travel is not possible. For it certaintly is, as long as the mobility specilist is aware of using touch, smell, temperature and many other cues, besides just hearing. In addition, several strategies using technology to communiate with the hearing/ sighted public are possible. Such as receiving texts, and reading it with a braille display. The world is much much accessible these days. But often times, the teachers or other professionals may not be up to date on the possibilities or techniques.

Why It Matters

Noise doesn't just make speech quieter; it makes it ambiguous. "No" and "go" can sound identical. "First Street" and "Fir Street" can send a traveler down the wrong route. In a clinic or gym, a misheard instruction during a transfer or a balance exercise isn't a small thing.

For a person with combined vision and hearing loss, how well they hear can change dramatically from one moment to the next, depending on background noise, fatigue, and how their hearing aids are set. A client who followed you easily last week may struggle today. That isn't inattention—it's the condition.

And there's a cost most instruments never measure: mental energy. When a person is worried they might miss something important, they brace, they slow down, and they lose focus. Reliable access to information does the opposite. When I know information will reach me in a form I can actually use, I stop spending energy straining not to miss it—and have more left for the decision, the exercise, or the conversation in front of me.

One principle sits above every strategy below: touch is only helpful when it's expected and welcome.

Always ask before you touch, and never make contact—or approach from behind—without warning. Announce yourself, say what you're about to do, and let the person tell you where and how firmly they prefer to be touched. Preferences vary from person to person and even day to day. A startle in a clinic, a gym, or at a curb isn't just uncomfortable—it can be unsafe. Consent here isn't a formality; it's the foundation everything else rests on.

Practical Strategies You Can Use Right Away

• Get closer, not louder. Moving nearer and lowering your pitch does more than raising your volume—it preserves the soft consonants (s, t, p, c) that carry meaning and cuts through background noise.

• Agree on a few touch signals, and keep them consistent. For example: two slow taps = ready / go; a firm squeeze or several quick taps = stop / wait; a touch to the right shoulder = move or turn right. The exact signal matters far less than both of you understanding it the same way, every time.

• Confirm the words that matter. For anything safety-critical, have the person repeat it back, spell it into their hand (if you both know the manual alphabet), or write it on their palm. Sound-alike words are where quiet errors hide.

• Build the picture by touch. A tactile map, a route traced on someone's back or arm, or a layout drawn on the palm can convey spatial information that spoken words in noise simply can't.

• Treat fluctuating hearing as expected, not as effort. If a client seems to "tune out," check the environment and their fatigue before you read it as disengagement.

• Be cautious with streaming tech in the community. Remote microphones and direct-to-hearing-aid streaming can sharpen a voice beautifully, but they often reduce the environmental sound—traffic, footsteps, room cues—a person relies on for safety and orientation. Great for a quiet conversation; risky at a busy intersection.

The Takeaway

For many travelers who are blind and hard of hearing, independence comes from combining touch, residual hearing, residual vision, environmental awareness, and good judgment. Touch is often the tool that organizes the information, reduces the ambiguity, and supports a confident decision. The same is true in your office or gym—so long as it always begins with permission and never a surprise.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses provide engaging and practical skills in supporting their clients with vision/hearing loss.

Approvals - Accreditations:

OHA - Oregon Health Authority - Cultural Competence CE
CEP #18180 CA Board of Registered Nursing, Continuing Education Provider
NASW-OR Nat. Assoc. of Social Workers - Oregon Cultural Competence CE
CRCC - Commission on Rehabilitation Counselors Certification - Ethics CE

Who these courses are helpful for:

Nurses, Psychologist, LCSW, LFMT, PT, OT, SLP, ND, NP, PA, MD, DDS, LPC, Chiropractor, License Professional Counselor, Marriage and Family Therapist, Dentist, Dental Technologist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Lactation Consultant, Long Term Care Administrator, Massage Therapist, Medical Imager, Midwife, Naturopathic Doctor, Occupational Therapist, Optometrist, Pharmacist, Polysomnographic Technologist/Respiratory Therapist, Social Workers, Caregivers and Families.

• For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life

Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

The 20/25 Paradox for MDs and PAs: When the Eye Chart Says "Fine" and the Patient Isn't

As physicians and PAs, we trust our instruments. The Snellen chart is fast, standardized, and tells us something real about a patient's central acuity. But for some patients, that single number quietly tells the wrong story—and the patient is left to argue against their own chart for years.

Consider a patient who reads 20/25 yet sees the world through roughly ten degrees of visual field: clear in the center, gone at the edges. On paper, that patient looks fully sighted. In life, they may be legally blind. Both can be true at the same time—and our intake forms rarely leave room for that.

This is the experience Mark G. Hubers describes in his essay The 20/25 Paradox.

Why It Matters

Legal blindness has two paths, not one. A patient qualifies if best-corrected acuity is 20/200 or worse, or if the visual field is 20 degrees or less. Conditions like retinitis pigmentosa take the periphery first and often spare the center until late—so a patient can have excellent acuity and a severely constricted field. Be aware that restricted fields create safety hazards, especially when early in the journey. Such as falls off loading docks, accidents while crossing the street, difficulty driving through tunnels, or changing lanes. RP and other peripheral loss conditions include the loss of being able to see in dim or bright light, so may express difficulty in movie theaters, or bars. This is often the first sign of RP.

The trouble is that acuity is almost always what gets tested first, recorded, and carried onto every form: insurance, disability, accommodations, license renewals. When the field number never makes it onto the page, a patient who is legally blind can spend a year fighting for a single piece of documentation—sometimes inside a specialist's own office.

A patient who reads the chart can still be unable to see the room it hangs on. Our job is to make sure the record reflects that. Even if you don’t have visual field testing equipment, you can use simple, low cost screening to determine who needs a referral. A ruler or even a paper on the wall, with a tape on the floor, with marks that are spaced in inch increments, with a center focus dot, can alert you to potential deficits. You can learn more about hot to do these screenings in the course. Understanding the Diversity of Legal Blindness, It’s Impacts & Solutions

What We Can Do—Starting at the Next Visit

Small, concrete changes close most of this gap:

• Record both numbers. Put visual field next to acuity in your note and on any form the patient takes with them. "Best-corrected acuity: ___. Visual field (degrees): ___." One extra line captures the patients acuity alone misses.

• Know both legal-blindness criteria—and make sure your staff do too. If front-office and technician colleagues only recognize 20/200, a field-based patient gets stuck. A ten-minute team huddle prevents a year of back-and-forth.

• Don't let strong test stimuli reassure you prematurely. Bright, large perimetry targets can be detected even as real-world peripheral vision (dim, small, moving objects) is already failing. Pair the printout with what the patient reports living through.

• Listen when a patient says the equipment seems off. Many of these patients are careful observers of their own vision. If a result doesn't match the clinical picture or the patient's lived experience, it's worth a re-test rather than a reassurance.

• Give patients their own data—every visit, without being asked. Per-eye acuity, uncorrected vision, field measurements, scans. Patients who manage a progressive condition make better decisions when they can see their own trend line.

• Sign the legal-blindness form when the field qualifies. For an eligible patient, this is often a thirty-second confirmation. Spare them the multiple-visit campaign to get there.

A Word on Language and Effort

It helps to retire labels that describe a symptom and pretend to explain the person. "Lazy eye" tells a patient their eye is at fault when the cornea may be damaged; "legally blind with 20/25" sounds like a contradiction only because the form has one box instead of two.

It's also worth remembering what these numbers don't capture: the cognitive work a patient does to stay functional. Brains performing real-time sensor fusion and filling in a constricted field spend real energy doing it—patients often describe being drained by mid-afternoon. There's no billing code for that, but acknowledging it changes how we talk with the patient in front of us.

The Takeaway

The eye chart is a good test. It simply isn't the whole test—and for patients with field loss, it can be the one that hides the diagnosis in plain sight. Recording the field, training the team, and handing patients their own data costs us a few minutes. Not doing it can cost a patient years.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses provide engaging and practical skills in supporting their clients with vision/hearing loss.

Approvals - Accreditations:

OHA - Oregon Health Authority - Cultural Competence CE
CEP #18180 CA Board of Registered Nursing, Continuing Education Provider
NASW-OR Nat. Assoc. of Social Workers - Oregon Cultural Competence CE
CRCC - Commission on Rehabilitation Counselors Certification - Ethics CE

Who these courses are helpful for:

Nurses, Psychologist, LCSW, LFMT, PT, OT, SLP, ND, NP, PA, MD, DDS, LPC, Chiropractor, License Professional Counselor, Marriage and Family Therapist, Dentist, Dental Technologist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Lactation Consultant, Long Term Care Administrator, Massage Therapist, Medical Imager, Midwife, Naturopathic Doctor, Occupational Therapist, Optometrist, Pharmacist, Polysomnographic Technologist/Respiratory Therapist, Social Workers, Caregivers and Families.

• For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life

Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

Understanding Blindness Bias and Its Cost — Insights for California Nurses and Oregon Medical Professionals

When a patient living with vision loss asks themselves, "Am I blind enough to use a cane or have a guide dog?" the question rarely starts with them. More often it has been planted by someone else — a comment from a mental health professional, a friend, a colleague, or a stranger who questioned whether they were "really blind" because they could read their watch, glance at a phone, or find a button to push. That single moment of doubt can echo for years, and as nurses and medical professionals, we are in a unique position to either deepen it or help heal it.

Blindness Is a Spectrum, Not a Switch

The most persistent myth about blindness is that it means total darkness. In reality, the large majority of people who are legally blind retain some usable vision. And in fact some can read normal size print.Very few have no light perception at all.

Legal blindness in the United States is generally defined as visual acuity of 20/200 or worse in the better eye with best correction, or a visual field of 20 degrees or less. Neither of those definitions describes a person who sees nothing. A patient can be legally blind and still:

• Read a watch or phone held a few inches away

• See faces in bright light but not in dim hallways

• Notice movement out of the corner of their eye while missing what is directly in front of them

• Have crisp central vision but almost no peripheral awareness — or the reverse

Vision also fluctuates. A patient with macular degeneration might use peripheral vision to move around a room while being unable to read a name badge or recognize a face. Glare, fatigue, contrast, and lighting can change what a person sees from one hour to the next.

What Blindness Bias Looks Like

Blindness bias is the assumption that a person must prove their disability before they are believed or supported. It often sounds harmless, even friendly, but it carries a sharp edge:

• "You don't look blind."

• "But you can see me, right?"

• "Do you really need the cane if you can use your phone?"

• "Are you sure it's that bad?"

These comments come from every direction — including, painfully, from trusted clinicians. A skeptical aside from a healthcare professional carries extra weight precisely because patients expect us to know better. When a provider implies that a patient is exaggerating, that doubt can override years of the patient's own lived experience.

The Cost of "Blind Enough"

Delayed help and lost independence. Patients who do not feel "blind enough" often postpone the very tools that would keep them safe and independent — a white cane, orientation and mobility (O&M) training, low-vision rehabilitation, or a guide dog.

Physical safety. Without mobility aids and training, the risks climb: falls, collisions, injuries, and disorientation in unfamiliar environments like a hospital ward.Repeated episodes will contribute to reduced willingness to go to new places - promote isolation and lost opportunities. A white cane is not only a tool for the person using it; it is also a signal to everyone around them. Provides a clear message that the person may not see them.

Mental and emotional health. Internalized doubt breeds shame, anxiety, and isolation. Patients may hide their vision loss to avoid judgment, grieve in silence, or withdraw from activities they once loved. The emotional weight of constantly proving oneself is exhausting and rarely acknowledged.

Worse clinical outcomes. A patient who has learned that disclosing vision loss invites skepticism may simply stop disclosing it. That silence leads directly to communication breakdowns, medication errors, missed accommodations, and care plans built on incomplete information. Bias does not just hurt feelings — it degrades the quality and safety of care.

A few intentional habits can dismantle blindness bias at the bedside:

1. Learn the spectrum. Internalize that partial, fluctuating, or context-dependent vision is still vision loss — and still blindness for many patients.

2. Believe your patients. Skip the "but you can see that" observations. Take a patient's description of their vision at face value, and ask what helps them rather than testing whether they qualify.

3. Use patient-first language, and follow each patient's lead. "A patient living with vision loss" centers the person. Some patients prefer "blind" as an identity term — mirroring their preferred language is part of respectful care.

4. Normalize the tools. Treat canes, guide dogs, magnifiers, screen readers, and O&M training as ordinary, smart adaptations — never as something to be justified.

5. Account for fluctuation. Recognize that lighting, glare, fatigue, and contrast change what a patient can see, and adjust the environment and your communication accordingly.

6. Refer generously. Connect patients with low-vision specialists, orientation and mobility instructors, and vision-loss support services rather than waiting until vision is "bad enough."

7. Document without doubt. Record vision status and accommodations accurately and neutrally, so the next clinician inherits facts and a care plan — not skepticism.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses focus on helping doctors, acupuncturists, physicians assistants, psychologist, nurses, dentists, chiropractors, therapists, and other healthcare professionals and families better serve individuals with vision or hearing loss, blindness, deafness and combinations of sensor loss through culturally competent, practical, and engaging continuing education. These are approved by Oregon Health Authority (OHA) and the Commission on Rehabilitation Counselor Certification.

For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life


Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

Communicative Care for Patients Living with Blindness: A Guide for California Nurses

Caring for Patients Living with Blindness: A Guide for California Nurses

California nurses care for diverse patient populations across hospitals, clinics, and long-term care settings. One frequently overlooked factor that significantly impacts safety and outcomes is vision loss — including total blindness and low vision. Using person-first language (e.g., "a patient living with blindness" or "a patient with low vision") supports respectful, patient-centered care. Keep in mind that many people in the blindness community prefer identity-first language ("a blind patient"), so the best practice is to follow each patient's own preferred terms.

Why Vision Loss Matters in Nursing Care

Patients living with blindness or low vision often face barriers that directly affect:

• Communication and informed consent

• Medication understanding and adherence

• Fall risk and patient safety, especially in unfamiliar surroundings

• Emotional well-being, anxiety, and sense of independence

• Misinterpretation of behavior as confusion or non-compliance

When vision needs are not recognized, patients may be incorrectly perceived as cognitively impaired or uncooperative. It is also important to remember that blindness is not hearing loss — speaking louder or directing questions to a companion is both unnecessary and undermining.

Common Gaps in Care

In many healthcare settings, challenges include:

• Inconsistent screening for vision loss at intake

• Limited staff training in sighted guide technique and adapted communication

• Patient education and consent forms provided only in standard print, which are inaccessible

• Rearranged belongings, cluttered pathways, and half-open doors or cabinets that create hazards

• Assumptions that blindness implies hearing or cognitive impairment

These gaps can lead to preventable errors, falls, and reduced quality of care.

Practical Steps for Nurses

1. Screen Early

Include basic vision questions during admission to identify needs early. Ask what the patient can see, what aids they use, and what helps them most — many patients have some residual vision rather than total blindness.

2. Introduce Yourself and Narrate Care

Identify yourself by name and role whenever you enter the room, and let the patient know when you are leaving so they are not speaking to an empty room. Describe your actions before and as you perform them — for example, "I'm going to place the blood pressure cuff on your left arm now."

3. Orient the Patient to the Environment

Walk the patient through their immediate surroundings: the location of the call button, bed controls, water, phone, and bathroom. Use clock-face descriptions for meals and items ("chicken at 6 o'clock, vegetables at 3 o'clock"). Keep belongings in consistent places and avoid moving items without telling the patient.

4. Use Proper Sighted Guide Technique

Offer your arm rather than grabbing the patient's. Let them hold just above your elbow and walk a half step behind you, and describe terrain changes such as steps, doorways, and turns as you go. Learn more sighted guide technique/watch?v=AuGb4yge-ys

5. Provide Information in Accessible Formats

Offer education materials and consent forms in large print, braille, audio, or screen-reader-compatible electronic formats. Read documents aloud when needed, and confirm understanding using teach-back. The patient has the right to accessible information — do not default to having a family member sign or decide on their behalf.

6. Support Medication Safety

Vision loss affects the ability to read labels, distinguish pills, and follow written instructions. Verify the patient can identify and manage medications, and connect them with tools such as rubber bands, bump dots, large-print tags doen with bold marker, placement strategies, braille labels, pill organizers, or talking devices for home use. Most pharmacies can provide this at no charge.

7. Reduce Fall Risk and Improve the Environment

Keep pathways clear, push in chairs, close cabinet and door openings, place the bed in a low position, and keep the call light within reach. For patients with low vision, maintain good lighting, reduce glare, and use high-contrast signage when possible.

8. Accommodate Service Animals and Assistive Devices

A patient may have a guide dog or use a white cane, magnifier, or smartphone accessibility features. Do not pet or distract a working service animal, and support the patient with logistics such as a relief area for the dog when needed.

9. Address Emotional Well-Being

New or worsening vision loss can bring grief, fear, and a loss of independence, and hospitalization removes patients from the adapted environments they rely on at home. Acknowledge these feelings, offer reassurance, and involve patients in decisions about their own care.

The Bottom Line

Recognizing and accommodating vision loss is a core part of safe, respectful nursing care. Small, consistent practices — introducing yourself, narrating your actions, orienting patients to their space, and providing accessible information — reduce errors, prevent falls, and help patients living with blindness feel seen, safe, and in control of their care. Documenting each patient's vision status and preferred communication format in the care plan ensures these accommodations carry across every shift.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses focus on helping doctors, acupuncturists, physicians assistants, psychologist, nurses, dentists, chiropractors, therapists, and other healthcare professionals and families better serve individuals with vision or hearing loss, blindness, deafness and combinations of sensor loss through culturally competent, practical, and engaging continuing education. These are approved by Oregon Health Authority (OHA) and the Commission on Rehabilitation Counselor Certification.

For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life


Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

When Neck Pain, Headaches, and Falls May Be Signs of Vision Loss

When Neck Pain, Headaches, and Falls May Be Signs of Vision Loss

As healthcare professionals, we are trained to look for the obvious causes of neck pain, headaches, poor posture, and recurrent falls. But what if the underlying issue is not musculoskeletal at all?

A growing body of research suggests that visual impairment can contribute significantly to neck and shoulder strain. In the 2019 study, “Visual System Disorders and Musculoskeletal Neck Complaints: A Systematic Review and Meta-analysis,” researchers found significant associations between visual dysfunction and neck musculoskeletal complaints. Individuals with vision loss often adopt altered head positions and increase visual effort to compensate for reduced visual information, leading to chronic strain and discomfort.

This topic is deeply personal to me.

By age 35, I had sustained three fractures in two years. During physical therapy, I was repeatedly corrected for my posture and asked why I leaned forward when walking. The answer was simple: my peripheral visual field was rapidly disappearing.

No one suggested a visual field evaluation. Instead, I was told I was too young to have serious eye problems.

In reality, I was already legally blind, with less than 20 degrees of visual field remaining in both eyes.

For individuals with conditions such as retinitis pigmentosa or Usher syndrome, a common pattern emerges: narrowing visual fields, increased scanning and head turning, leaning forward to maximize residual vision, chronic neck and shoulder tension, headaches, and a higher risk of falls and injuries.

Many people also delay using a long white cane because they do not feel “blind enough” or fear being identified as blind. As a result, they rely heavily on their remaining vision, often increasing physical strain and injury risk.

When patients present with unexplained falls, persistent neck pain, headaches, unusual posture, or mobility challenges, consider whether vision loss may be contributing to the problem. A simple visual field assessment could reveal an important piece of the clinical picture.

Awareness can prevent years of unnecessary pain, injuries, and missed opportunities for intervention.

Update: Oregon Medical Board (OMB) is now accepting OHA( Oregon Health Authority) approved cultural competence courses for credits for their license holders, including LaT, MD, PA, NP, DO, DMD, and many others.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses focus on helping doctors, acupuncturists, physicians assistants, psychologist, nurses, dentists, chiropractors, therapists, and other healthcare professionals and families better serve individuals with vision or hearing loss, blindness, deafness and combinations of sensor loss through culturally competent, practical, and engaging continuing education. These are approved by Oregon Health Authority (OHA) and the Commission on Rehabilitation Counselor Certification.

For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life


Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com

Improving Communication and Care for Residents with Hearing & Vision Loss: A Guide for Long Term Care Administrators

Improving Communication and Care for Residents with Hearing & Vision Loss: A Guide for Long Term Care Administrators

As a Long Term Care (LTC) Administrator, you’re responsible for creating an environment where residents not only receive safe care, but also feel understood, respected, and empowered. One often-overlooked factor that deeply affects resident well-being is sensory loss — specifically hearing and vision impairments — which are common in older adults and can profoundly influence communication, cognition, behavior, and quality of life within LTC settings.

Why Sensory Loss Should Be a Priority in Long Term Care

Research shows that in long-term care facilities, hearing and vision loss are highly prevalent and frequently under-recognized.

Sensory loss doesn’t just affect a resident’s ability to hear or see — it influences:

• Communication effectiveness

• Cognitive function and decline

• Behavior and emotional well-being

• Participation in activities and social interaction

• Risk of isolation and frustration

For LTC administrators, this means that failing to account for sensory loss can lead to higher care burdens, misinterpretation of behavior, and reduced resident satisfaction.

Real Evidence on Communication & Cognitive Impact

A recent BMC Geriatrics survey found that hearing and vision loss don’t just affect sensory experiences — they correlate with increased risk of cognitive decline among long-term care residents. In this study, residents with sensory impairments were more likely to experience declines in cognitive function unless appropriate aids (like glasses) were regularly used.

What this means for you as an administrator: sensory care isn’t a cosmetic add-on — it’s core to preserving cognition, engagement, and overall quality of life in your residents.

Barriers You Should Know — and Address

Despite widespread awareness of sensory needs, long-term care staff often lack training, confidence, and tools to support residents effectively. A global survey published in the Geriatric Psychiatry showed that while staff recognize sensory loss as a need, few are confident in identifying hearing/vision issues or supporting the use of assistive devices like hearing aids and magnifiers.

Additional research demonstrates (articles are linked below):

• Sensory impairments are under-screened and under-treated in LTC settings.

• Routine screening can be done with free apps such as the Hearing Numbers, developed by John Hopkins University Medical School, and a simple 10’ vision chart which is easily found online. Research shows that tools are often not used or not adapted for sensory impairments.

• Residents with poor sensory function often miss out on social activities and meaningful engagement, increasing isolation.

These gaps present both challenges and opportunities for leadership to champion best practices, staff training, and environmental design that support residents’ communication needs.

What Long-Term Care Leaders Can Do Now

Here are practical, research-aligned steps to improve sensory-aware care in your facility:

1. Implement Routine Sensory Screening

Partner with nurses and allied professionals to ensure hearing and vision screening is standard practice, not ad hoc. Research shows that formal screening leads to better recognition of needs and referral for appropriate support.

2. Train Staff on Communication Practices

Educating your team on effective communication with residents with sensory loss improves care quality and reduces frustration for both staff and residents. You can find more about our practical class below: Ensuring Effective Communication with Clients Who are Hard of Hearing

For example these items are covered:

• Face residents directly when speaking

• Use high-contrast visuals and large font for written materials

• Reduce background noise during communications

3. Ensure Assistive Devices Are Used and Maintained

Hearing aids, magnifiers, and visual aids can improve activity engagement and even help protect cognitive function. However, the lack of routine checking and device management is a major barrier identified worldwide. A simply first step is to make sure a supply of hearing aid batteries or training staff on how to recharge hearing aids.

4. Adapt Your Environment

Simple changes — good lighting, contrast cues, reduced noise, and signage — support residents with sensory deficits. A calm, well-designed environment has been shown to reduce stress and improve daily functioning in residents with sensory loss.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses focus on helping psychologist, nurses, dentists, doctors, chiropractors, therapists, and other healthcare professionals and families better serve individuals with vision or hearing loss, blindness, deafness and combinations of sensor loss through culturally competent, practical, and engaging continuing education. These are approved by Oregon Health Authority (OHA) and the Commission on Rehabilitation Counselor Certification.

For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

• Strategies to prevent social isolation and despair

• Tools to support clients experiencing progressive loss

• Skills to improve communication and connection

• Easy, low- or no-cost accessibility techniques

• Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life


Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com