How to Meet the Growing Challenge of Older Americans with Vision Loss

As the U.S. population gets older, the prevalence of visual impairment continues to increase. The nation faces a growing number of older adults for whom visual impairment presents daily challenges to their ability to live independently.

Almost 20 million Americans—8% of the U.S. population—have visual impairments. Visual impairments, including blindness, are one of the leading causes of loss of independence among people ages 65 and older. According to the National Council on Aging, there were 55.7 million adults ages 65 and older living in the United States in 2020, and they represent one of the fastest-growing groups in the nation, expected to reach 80.8 million in 2040.

Yet there is a woeful lack of funding and specialized services available for older adults experiencing vision loss, and the preponderance of existing programs and services are mostly focused on employment, not on the broader needs of this group trying to navigate the community and seek social engagement and independent living outside of employment-related settings.

Many state agencies are aware of the serious gaps in education and training related to vision loss for service providers and agencies across the aging network. These include a lack of information about access points for available supports and services for older Americans experiencing vision loss.

AARP’s 2021 Home and Community Preferences survey found that more than three-quarters (77%) of adults ages 50 and older want to remain in their homes as they age. However, for those with vision loss there are often major obstacles that make this extremely difficult.

Federal, state, and local governments, and the U.S. Administration on Community Living, in particular, could do much more to ensure that older Americans who experience vision loss are able to age in place and with dignity.

Two key focus areas need spotlighting: public awareness and education outreach, and upskill training of Area Agency on Aging staff.

Public Awareness and Education Outreach

The Department on Aging, through the state departments of health and human services, provides a wide range of services for older Americans, including all types of services, such as healthcare, home care, personal care, and long-term care to ensure their well-being, dignity and independent-living choices. Programs also are in place to support family caregivers. Experienced state agency staff and paid contractors help eligible older Americans access services that:

• Create opportunities to live independently in their own homes.
• Provide information about state and federal benefits and legal rights.
• Give family caregivers tools to do their job.
• Provide access to meals at home or in group settings.
• Identify assisted living facility care, daytime programs, or nursing home services for which they may qualify.
• Advocate for people who live in assisted living facilities or nursing homes.
• Guide people to the right long-term care services.

Lamentably, many of these programs and services, such as those provided by local area agencies on aging (AAA), in-home care and the Aging and Disability Resource Centers (ADRC), are not well known, especially among older Americans who may be experiencing vision loss or their families. This represents a major challenge in providing services to this population—if individuals don’t know where to go or what resources are available in their community.

What is needed is a broad-based, multipronged awareness campaigns aimed at:

• older adults with visual impairment and their families;
• healthcare providers across the continuum, both in-home and facility-based;
• aging network partners (AAAs, ADRCs and their community partners); and
• broader community stakeholders, such as first responders and faith-based communities.

Likewise state agencies supported by the federal Department on Aging should conduct public awareness and education outreach campaigns designed to provide information relating to the programs and resources available to older adults who are blind or visually impaired. The campaigns must be:

• tailored to targeted populations, including:
  • older adults with or at risk of blindness or visual impairment and their families and caregivers;
  • healthcare providers, including home- and community-based services providers, healthcare facilities, and emergency medical services providers;
  • community and faith-based organizations;
  • the public; and
• disseminated through methods appropriate for each targeted population. Often, designated websites or information portals are minimally effective because they are not easily accessible or commonly used by persons with vision loss or their family members.

Upskill Disability Sensitivity and Awareness Training

There are clear gaps in education and training related to vision loss for service providers and agencies across the aging network. These include a lack of knowledge and training about appropriate interaction and understanding of individuals experiencing vision loss.

There is a need for training and education across service provider and professional association networks within existing structures. A tiered approach would work best—scalable from base knowledge to task-specific, such as orientation and mobility, independent living skills and up-to-date, inclusive language.

The goal should be to help reduce the tendency toward paternalism when helping older Americans with vision loss. One possible approach could be an online training curriculum focused on basic awareness and sensitivity of vision loss targeted to home healthcare providers, nursing home and assisted living staff and ombudsmen with the AAAs and ADRCs. Such training should include describing the fear, vulnerability, sense of loss of control and loss of confidence, need to learn new ways to live life, and family dynamics as life changes with loss of vision.

Any policies or initiatives instituted by the Department on Aging or the Administration for Community Living should align with these two focus areas outlined above: Public Awareness and Education Outreach and Upskilling Training of area agency staff. The end goal should result in more older Americans who experience vision loss being able to remain in their own homes, if they so choose, and live their later years with dignity and independence.

The above multipronged approach to these complex issues will ultimately require a concerted effort to collaborate and cooperate from many entities and departments. The Alliance on Aging and Vision Loss works tirelessly, in conjunction with the Aging and Vision Loss National Coalition, to bring about a comprehensive policy shift that will lead to the changes outlined in this article.

A broad range of vision rehabilitation services and support also are available. To locate vision rehabilitation services in your state visit https://timetobebold.org/state-directory/. The Connect Center provides information at connectcenter@aph.org and a referral hotline at 800-232-5463.

For more information on The Reality of Aging and Vision Loss in America, Vision Rehabilitation Can Complete the Continuum of Care, Vision Rehabilitation—Help and Hope, Vision Rehabilitation Helps Older Adults Thrive, Shining a Light on Inclusion: Empowering People with Vision Impairment, Vision Rehabilitation Professionals Make the Difference, and The Connection Between Health and Vision Impairment, read the first seven articles in this series by VisionServe Alliance.

Larry Johnson is a member of the Board of Directors of the Alliance on Aging and Vision Loss, author of seven books and an advocate and champion for persons with disabilities, serving in leadership roles at the local, state and national level. He spent 21 years as a Human Resources manager with AT&T/Southwestern Bell Telephone, 23 years as a radio and television broadcaster, and 42 years as an international motivational speaker, trainer and workshop presenter.