Excerpt from out-of-print book published by ASCLA on 101 Ideas for Serving the Impaired Elderly

An Excerpt from
101 Ideas for Serving the Impaired Elderly (An ASCLA publication that is out of print.)

Ideas and Models for Offering Programs

Libraries provide programming for the impaired elderly in a wide variety of ways in order to meet the broad range of needs of the individuals and the organization that serve them.

The ideal program is one that takes into account the self-expressed needs and interests of the individuals involved appropriate to their age and life experience. Consider these examples:

Homebound (yes, programs are possible!)

Book discussion groups which link homebound individuals to one another to discuss books and topics of interest. Library service providers get individual permission and exchange participant numbers.
Program packages which allow homebound persons, their family, neighbors and friends to share a group experience with ensuing discussion. Library staff furnish the audiovisual materials and equipment where needed for the patron, or for others to utilize at an appropriate time.
Library program participation, when the client's condition and available transportation (e.g. volunteer, handicap van service, etc.) allow for a trip to the library. Coordination of the trip with other agencies is likely to be needed.
Special interest visits from library volunteers who share a hobby, an interest, a career or a life experience with the homebound person. Related book materials should be sent at the time or shortly thereafter. An oral history project is an example of what can be developed for this shared experience.

Care Facilities (long term, intermediate and hospice)

Discussion groups may include specific book titles, poetry or topics of interest to provide for reminiscence, for reality orientation, needed information, or pure enjoyment. Books in large or regular print, multiple copy titles, audiovisuals materials, realia, discussion leadership training or facilitation may be provided by a library.
Audiovisual programs using films, slide or multi-sensory kits may be provided to facilities or used by staff for interactive programs with participants. In using audiovisual materials for group program special attention should be given to the quality of the sound (speakers away from projection equipment, limited overlapping of music and narrative voices) and clarity of the projected image (limited dissolved or diffused quality of images, crisp and sharp images are easier to see). Follow-up discussion is a must for active involvement of clients!
Talking Book/Radio Readers Listening Service groups allow three or four clients to share a listening experience as well as discussion with or without formalized leadership.
Booktalks stimulate an interest in reading or remaining in touch with what is current. They can be used as a separate program or as a part of another activity.
Library programs may involve library materials and personnel in a structured therapeutic program (i.e., activity, poetry, laugh, reminiscence, current events, death, and dying, validation, et al). If a program is thus identified by a facility, the library staff involved in presenting the program or selecting materials should be familiar with the objectives of the program, what the therapy entails, and any necessary documentation, reporting or credentialing involved.

Ideas and Models for Delivering Service

Locating Clients

The most essential steps in the delivery of service to the frail or impaired older person may be the initial steps taken in identifying potential clients for library service. To identify clients for homebound and nursing home service, library staff may want to explore a variety of resources such as:

Census tracts that give population densities may help in locating community organizations (i.e., churches) which would promote service availability or help in locating clients within a given area.
State or local agencies responsible for services to the elderly receive as well as make referrals for services.
Visiting nurses and meals on wheels organizations may assist in the initial identification of clients as well as in helping, through referral, with the continuity of service should a client be in need of long or short term residential care.
Disability groups, Libraries for the Blind and Physically Handicapped, and groups dealing with the aging children of aging parents may serve as sources for referrals as well as continued publicity.
Clients, family members, social workers, activity staff, nursing personnel, and direct service providers may be useful referral sources for themselves, their peers or family of the clients.

NOTE: When promoting and publicizing programs remember to include these groups in a special mailing. Standard publicity, newspapers, may not be enough. (See Marketing)

Delivering Service

Whether homebound, in a care facility, or impaired enough to warrant support in accessing regular library services, the client needs a range of choice in meeting his or her library and information needs. Ideally service delivery methods should be designed to give the broadest range of choice and accessibility possible.

Homebound

Personalized home visits by librarians or library volunteers can bring the range of choice and services the library offers into the home.
Piggy-backed delivery with other services, such as Meals-on-Wheels, allows for the regular delivery of materials. However, a personal link between library staff and clients is necessary for the selection of materials.
Van or bookmobile service, with portable shelving units or a lift, allows client accessibility to a variety of materials.
Books by Mail offers the client both a choice of materials as well as delivery to the home.
Technological access to the library is available where: home computers can be used to generate requests or to gather information; TDD's connect the client to the library as well as a broader range of community services, and where programs featuring library resources are available on cable television.

Care Facilities

Bed-to bed delivery can personalize service and facilitate access to information and resources. Delivery is best when provided by librarians and scheduled at a time when the client is able to participate fully in the process of selection.
The use of librarian surrogates, (i.e., trained facility staff or volunteers) to provide for individual client needs with the assistance of library staff in the selection of resources to meet individual needs - allows for the delivery of the service at a time when the client may be better able to enjoy both the interaction as well as the resources (i.e., talking book service in the evening when there is little ambient or background noise).
In-house library stations with rotating materials from the library should be staffed by the library, and might, with library supervision use trained volunteers or clients to actively meet the needs of residents, including those confined to their beds.
Vans or bookmobiles with portable shelving units or a lift, allow client accessibility to a variety of materials.

Don't Forget

Alternative transportation services may bring the impaired older adult into the library.
Between visits or service delivery clients should be encouraged to use the phone to call the library to meet their information needs.
Aids and appliances such as magnifiers and telecaption devices may be loaned as well.
Library accessibility for those who can come in ramps, automatic doors, doors wide enough for wheelchairs and walkers, accessible fountains and toilets, visible signage, tactile signage, and large print listings in large print, availability of aids and appliances and handicapped parking need to be considered if service is to be fully accessible.

Ideas and Models for Providing Resources

The resource needs of the impaired elderly are as varied as those of any adult user. However, there will be times depending on the degree of frailty or the nature of a disabling condition that it will be necessary to be more creative in assisting the patron to access the information required. The following list will address three types of resources and their practical considerations, formats available, and sources of information and/or evaluation.

Aids and Appliances

Aids can vary from the simple—one line magnifiers, ramps or TDDs—to the complex—Kurzwell Reading Machines or single-switched computers for the handicapped. Aids may be used in the library or made available for short or long term loan to individuals or nursing homes. Aids may be used to provide access to materials as well as programs. Promotion of aids is important and may include library displays, and use of newsletters, newspapers, letters to nursing homes or homebound clients.

Watch for: the availability of outlets, size and weight in relation to the physical strength of the patron, the need for batteries and the need for three prong adaptors.

Types: prism aids which allow reading from a prone position, book holder-stands, magazine holders, page turners, magnifiers of all kinds (for single lines or whole pages, raised, adjustable, illuminated), infrared systems, AM and FM radio systems which transmit sound to individual receiver headsets, audioloops or induction systems which amplify sound for those wearing hearing aids, telecaption decorders, telecommunication devices for the Deaf (TDDs), typewriters for the Dead (TTYs), audiocassette and record players available from the National Library Service for the Blind and Physically Handicapped, voice amplifiers, electronic voice generators, large print labelers, braille labelers, Braillewriters, and Kurzwell Reading Machines and cable television.

Selected Resources

Accent on Living Buyer's Guide. Cheever Publishing, Inc., P.O. Box 700, Bloomington, Illinois 61702.

Accent on Living Magazine. Quarterly. Box 700, Bloomington, Illinois 61702.

Aids for the 80's. C. Michael Mellor. American Federation for the Blind, 15 West 16th Street, New York, New York 10011.

Abledata. A product database. Catholic University, 4407 8th Street, NE, Washington, D.C. 20017.

Green Pages Rehab Sourcebook. 4th Edition. Sourcebook Publications, Inc., P.O. Box 1586, Winterpark, Florida 32790.

Large type Books in Print. R.R. Bowker Company, 205 East Forty Second Street,New York, New York 0017. (Includes a list of publishers)

National Library for the Blind and Physically Handicappedk, Library of Congress, Washington, D.C. 20542.

On Cassette. R.R. Bowker Company, 205 East Forty Second Street, New York, New York 10017.

Products For People With Vision Problems. American Foundation for the Blind. Customer Products Department, 15 W. 16th Street, New York, New York 10011.

Technology for Independent Living: A Source Book. Ed. Alexandra Enders. RESNA, Suite 700, 1101 Connecticut Avenue, NW, Washington, D.C. 20036.

Words on Tape: An International Guide to Recorded Books. Meckler Publishing. 11 Ferry Lane West, Westport, Connecticut 06880.

Books

Aside from aids and appliances to help impaired patrons access the regular collection, there are materials created to specifically accommodate certain impairments.

Types: braille, disk and cassette books are available for those who qualify with the National Library Service. Commercially produced cassettes are available for those who don't. Certain magazines and newspapers, as well as soft-cover and hard-cover books are available in large print.

Watch for: many frail elderly prefer soft-cover to hard-cover books because they are lighter. However, in any format be aware of the physical weight, the size and density of print, and the amount of white space between letters and lines.

Audiovisual

Audiovisual materials, whether for individual use or group programming, are particularly useful for and appreciated by the impaired elderly. Aside from video, 16mm films, slides, filmstrips, audiocassettes, records, and picture files, there are materials specifically created for the handicapped and the older adult.

Types: computer programs for the handicapped, captioned video and films for the hearing impaired, talking books and cassettes for the visually impaired and physically handicapped, and multi-sensory/multi-media program kits created for use with older adults. There are also records and tapes for adapted exercises for geriatric and disabled patrons and games such as braille and low-vision playing cards, Scrabble, Chinese Checkers and Dominos modified for tactile recognition, and special video game controls.

Watch for: when appropriate, quality of sound, overlapping sound and narration, proximity of sound source, background noise as well as the need for outlets, batteries and adaptors.

Ideas and Models for Promoting the Library

An effective promotion campaign informs older persons about how the library can serve them, and may help to dispel long held stereotypes about what the library has to offer.

A first step in initiating a promotional campaign is to understand the demographics of the community, in order to determine areas of concentration,and to assess all the available publicity outlets and resources available. (See Delivering Service)

Who Does the Library Need to Inform?

older adults themselves
family members and friends
specific service providers, or service agencies which directly serve (aging agencies, senior centers, nutrition sites, homes, adult day care facilities, housing developments, health and mental health facilities) and agencies that serve older adults and their families as part of their general population. (churches, adult education outlets,colleges, universities)
organizations, clubs, and professional groups which indirectly have contact with older adults, their families and other service providers,(i.e., geriatric practitioners and other medical personnel dealing with the elderly, fraternal associations, nursing care organizations,et al).

What Does the Library Have to Promote?

ANYTHING and EVERYTHING that could impact on the lives of the impaired older adult including those still living independently who may be difficult to locate.

When Should This Be Done?

Publicity should be done on a regular schedule in order to assure that information on services is not neglected and is up-to-date.

Where Should the Library DistributeThis Information?

Using as resources the clients identified, the agencies and individuals giving service, and routine library outlets the library should attempt to help spread the word about available resources and services to as broad a public as is possible.

How?

Routine publicity done collaboratively with other agencies or alone, include:

newsletters (including library and other agency publications)
newspaper articles (weekly, daily, special interest pages, regional editions)
monthly calendars of events - flyers for services (i.e., library, church, senior centers, et al)
speakers bureaus
bookmarks, pocket calendars - other give aways
public service announcements on radio, TV cable
radio readers listening service features
informational brochures for independent living (i.e., housing, health, aids and appliances, et. al)
displays or booths:
- in local or state agencies, offices, et al
- at independent living fairs
- at community health screening days
- at home shows or county fairs

NOTE: A library's publicity, both print and non-print, should utilize knowledge of current promotional practices for graphics and the media. In addition, when preparing items for the impaired older adult, remember to consider:

LARGE PRINT
GOOD LEADING (adequate white space between lines)
EASY ON THE EYE COLORS
NON-PRINT

Ideas and Models for Educating Staff

Working with the impaired elderly requires an understanding of and heightened sensitivity to the emotional, physical, psychological, social, and service delivery needs of each individual served. In order to work effectively staff - library as well as agency and institution, family, caregivers, volunteers, and clients themselves may need to have variety of training opportunities made available to assure better service provision.

Opportunities

Types of training opportunities include, but are not limited to: orientations, facility training sessions, meetings, brainstorming sessions, general and specific workshops, seminars, conferences, and individual structured learning experiences.

On site orientation to a facility (i.e., nursing homes, senior centers,et al) can enhance a library staff's understanding of its policies, procedures, and philosophy. Staff from the various agencies can also benefit from an orientation to the library: programs, activities, and services for the older adult population should be highlighted. Agency staff may be oriented both on site or in the library depending on what is appropriate.

Joint inservice training opportunities for library staff and agency personnel can provide a means for understanding common problems, exchanging information, gaining new knowledge, and learning new skills. Specific topics may include: disability simulations; lessons in using AV equipment; reviews of resources in gerontology; an overview of the organization and structure of nursing homes (including state certification); new directions in therapy for older adults; insurance options as well as diseases and disorders common in frail older adults, including suggestions about how to deal with them.

The events from which learning opportunities arise are many. For example, client use of a talking book machine may have its roots in a variety of training offerings. An orientation for staff, family, and/or client to the availability of the service will have addressed issues like: 1) what the service is, 2) what it requires of the staff/agency/family, and 3) what it requires of the user. Brainstorming might identify the ways in which client use can best be facilitated: i.e., physical proximity, changing of recordings (if needed), hours of use, dealing with background noise, et al. Instructing the client in the use of the machine requires (repetitive) demonstration,practice with feedback and coaching to support the client's efforts in having a successful experience with talking books.

Adults continuing education can occur informally through self-directed reading, discussions, and (even) staff meetings!

Resources

In seeking training and continuing education opportunities advantage can betaken of existing agency or organization training opportunities. State library associations, area agencies on aging, hospitals, community colleges,and community mental health associations routinely offer programs, workshops,seminars or conference programs which often apply to serving the impaired elderly. So too can workshops, seminars, conferences, or meetings organized at a local level provide those working with the impaired elderly an opportunity to broaden their network of contacts within the professional community concerned with older adults.

Human Resources

Older adults themselves can provide valuable insight into working with the impaired older adult population. Local, knowledgeable resource people in the fields of social work and/or gerontology are other potential resources for training and educating staff who provide service to the impaired elderly.

Resource people from community agencies, including hospitals, the Cooperative Extension Services, visiting nurse, Red Cross, and volunteer associations can help in meeting staff training needs.

Staff and clients already engaged in the delivery of services can contribute valuable knowledge and insights.

Materials and Equipment

Print or nonprint materials, equipment, and a variety of aids can be used for training-individuals and groups working with the impaired elderly. Items such as video, films, sign language materials, assistive devices, games, and realia can be incorporated into training and continuing education events. The availability of such resources should be publicized outside the library community and directed toward the needs of the agency staff, family members, caregivers, and volunteers working with the targeted population.