Rehabilitation of the Elderly Blind in germany

The German Federation of Blind and Visually Impaired People (DBSV) and its 20 legally independent regional organisations carry out extensive work for the benefit of blind and partially sighted citizens. Approximately 3,000 volunteers are committed to the delivery of self-help programmes, many of them being elderly blind or partially sighted themselves. They work side by side with fully employed staff who make an important contribution towards the organisation of activities. The regional associations of the blind maintain home instruction services for the elderly, recreational homes with rehabilitation services, advisory centres counselling on aids and equipment for the blind, workshops for the blind, as well as sheltered workshops with homes for multi-handicapped blind and visually impaired people.

In Germany, there are about 155,000 blind and approximately 500,000 partially sighted people. In the majority of cases the onset of blindness and visual impairment occurs at an advanced age, most frequently as a result of disease or "age-related tear and wear". 72 % of all blind people are over sixty. In addition, 52 % have some additional disability or chronic disease. Special care needs to be given each year to some 23,700 newly blind people, of whom 70 % are over 60 years old.

Especially with regards to this group, the deterioration of sight frequently develops very rapidly once a certain stage of visual impairment has been reached. Those concerned often hardly have time to adjust inwardly to the entirely new situation they are facing. The same is true, incidentally, for friends and relatives. So in addition to one's feelings of insecurity and clumsiness, there is lack of self-confidence which entails considerable problems for all involved. Many questions are being asked, and very often it is not easy to give the right answer.

How do I cope with my new situation ? What will I be able to do without the help of other people ? What will I have to give up once and for all ? How do I adjust myself as a relative, friend or helper to a situation which is totally unfamiliar to me ? How do I behave towards the people affected : do I need to be specially considerate, or should I act as if life went on as before ?

Of course it is not possible to give a general answer to these and similar questions. Reactions can only be seen as individually different.

Within this difficult context of direct help and support provision, basic rehabilitation programmes play a very important part. As the term already suggests, basic rehabilitation aims at preparing and practising, at it were, the elementary, i.e. first fundamental steps towards achieving the greatest possible level of independence.

Consequently, the self-help movement of the blind is concerned first and foremost with using peer experience and the expertise of mobility and rehabilitation instructors, as well as social workers, to help clients to cope with their disability and to achieve maximum mobility and independence.

How difficult this task is becomes immediately obvious if we consider the fact that nearly 70 % of all information is received through the eyes.

The large group of those who are partially sighted face problems of a different kind. Often the individual is not aware of his/her increasing visual impairment, or the problem is simply repressed. Coping with the impact of disability requires a different approach as devices for the blind cannot be applied directly, or sometimes not at all, to the needs of partially sighted people.

Local branches offer a wide range of services adapted to individual rehabilitation needs, such as :

- Giving sensitive support to enable clients to cope with his/her new situation ; it is only under this condition that clients will be able to respond actively ;

- Providing advice on social benefits ;

- Assisting clients in achieving the greatest level of social integration ;

- Teaching braille in order to enable clients to at least read their own braille notes or tactile references ;

- Counselling clients regarding the availability of devices for the blind ;

- Aids for partially sighted people and instruction on how to use them ;

- Assisting clients in mastering daily living skills, particularly as to the following :

• Organisation of the home
• Washing clothes
• Preparation of meals
• Using household appliances
• Handling money
• Training in writing one's signature
• Maintaining things in a special order
• Making useful tactile markings
• Planning and implementing good orientation and mobility training to enable clients to get about in their home and in public places
• Exchanging experiences with peers, as well as relatives and close friends
• Participating in cultural and sports events
• Assisting clients in making contacts with audio libraries for the blind
• Holiday and recreation programmes
• Provide a range of information materials in the form of brochures, periodicals and guides.

Hence the delivery of basic rehabilitation programmes for recently blind elderly people is very important, not only because it is the largest group of blind and partially sighted people. Additionally, it is the group of people who have the biggest difficulties in coping with their situation - this is particularly true for the late-blind.

The German Federation of Blind and Visually Impaired People has set up a special working group in order to be better able to assess the technical and practical problems frequently involved, and to find solutions together. The group primarily deals with the position of elderly late-blind people, looking at the social, psychological, legal and practical issues which arise in the field of basic rehabilitation. The most important achievement of this working group is the publication of four general reports on seminars dealing with this issue, and of a brochure with the beautiful title "Dein Weg geht weiter" (Your road continues). The brochure contains a number of reports by peer counsellors and professionals working in this field who write about their personal experiences in meeting the many challenges, and who give information about the wide range of devices for the blind that many clients should know about. For many people whose vision loss is only very recent, the brochure has become an important companion on their way towards independence.

It should also be emphasized that, unlike the educational and vocational rehabilitation of newly-blind people, basic rehabilitation programmes for elderly blind citizens do not receive adequate funding. Apart from very limited income support schemes, there is practically no alternative funding for the teaching of daily living skills. This creates a situation which, regardless of the scarce public financial resources, cannot be accepted.

Alfred Preusse, Member of the Commission on Activities of Elderly Blind and Visually Impaired People