Vision and Hearing Loss in California Assisted Living

Yes. Poor sight and poor hearing do not appear on California's lists of restricted or prohibited health conditions for assisted living communities and board and care homes, licensed in California as residential care facilities for the elderly (RCFEs).

The difference between homes is in how well they do it. A person who cannot hear the caregiver's question can be taken for something else. The National Institute on Aging (NIA) notes that older people who do not hear well are sometimes mistakenly thought to be confused, unresponsive or uncooperative. So this is a subject to raise on the tour, not after move-in.

Title 22 has no chapter on sensory loss. The duties are spread across several sections:

• Assessment: before admission, the home assesses the person's physical condition, including vision, hearing and speech (section 87459).
• Devices: when residents need prosthetic devices, vision aids or hearing aids, staff must be familiar with their use and assist residents with them as needed (section 87465).
• Appointments: the home must arrange, or help arrange, medical and dental care and help with transportation, which may be limited to the nearest available provider that meets the need (section 87465).
• Safety: the administrator is responsible for making special provisions for the safety and guidance of residents with visual or auditory deficiencies (section 87405).
• The building: stairways, inclines, ramps and open porches must be closed to residents with poor balance or eyesight unless they have sturdy hand railings and are well lighted, and night lights are required in hallways and passages to shared bathrooms (section 87307).
• Belongings: the home's theft and loss program includes a personal property inventory at admission and a method of marking items, including engraving dentures and tagging other prosthetic devices (section 87218).

The Resident's Bill of Rights, Health and Safety Code section 1569.269, adds a right to reasonable accommodation of individual needs and preferences in all aspects of life in the home, except when the health or safety of the person or other residents would be endangered. Asking staff to face your mother when they speak, or to seat her away from the kitchen noise, is the kind of request that right covers.

The NIA lists the eye conditions that can lead to vision loss in older adults: age-related macular degeneration, which harms sharp central vision, diabetic retinopathy, cataracts and glaucoma. It defines low vision as eyesight that cannot be fixed with glasses, contact lenses, medication or surgery. A person with low vision may have trouble reading or recognizing faces, or may find that lights do not seem as bright.

The institute's practical tips for low vision translate well to a care home: brighter lighting, colored tape on the edge of stairs, light switches that contrast with the wall, clocks with large numbers and large-print labels. It also recommends regular eye exams, and says people over 60 should have a dilated eye exam every year or two. Ask the eye doctor what schedule fits your parent, and ask the home who takes residents to those visits.

Two care questions follow from poor sight. One is falls: the NIA says even small changes in sight and hearing are linked to an increased risk for falls, a subject covered in our guide to fall risk. The other is medication. A resident who can no longer read a label may need the home to store and hand out medicines, which our guide to medication management explains.

About one-third of older adults have hearing loss, according to the NIA. People who cannot hear well may become depressed or withdraw from others, which can lead to isolation and loneliness, and the institute reports that older adults with hearing loss have a greater risk of developing dementia than those with normal hearing.

Hearing aids only help when they are worn, charged and clean. In a care home that depends on staff: someone has to put them in each morning, store them at night and notice when a battery is dead. This is why the staff familiarity rule in section 87465 matters. Ask the doctor or audiologist to show you the routine so you can pass it on.

The NIA's tips for talking with a person who has hearing loss are worth watching for in staff: face the person, keep eye contact, speak clearly and a little louder without shouting, cut background noise, and repeat with different words if needed.

California's definition of a nonambulatory person, in Health and Safety Code section 13131, includes anyone who is unable, or likely to be unable, to physically and mentally respond to a sensory signal approved by the State Fire Marshal or to an oral instruction relating to fire danger. A resident who would not hear or understand an alarm can fall into that group, and a home needs the matching fire clearance and an approved room. Our guide to wheelchairs and transfers explains that clearance.

The NIA describes alert systems for people with hearing loss that work with doorbells, smoke detectors and alarm clocks and send visual signals or vibrations. The RCFE regulations we read do not require them in a resident's room, so ask each home what it has and whether a family may add one.

Visit at a mealtime if you can, when noise and lighting are at their most demanding. Use these points with our assisted living tour checklist:

• Lighting: are hallways, bathrooms and the dining room bright and even, without glare?
• Contrast: can you tell the plate from the table, the toilet seat from the floor, the step from the landing?
• Noise: is a television on in the dining room? Can two people hold a conversation?
• Staff: do caregivers face residents, speak clearly and wait for an answer?
• Hearing aids and glasses: who puts them on in the morning, where are they kept at night, who charges or changes batteries, and how are they labeled?
• Appointments: who drives residents to the eye doctor and the audiologist, and is there a charge?
• Activities: what is offered for a resident who cannot see print or hear a group?
• Emergencies: how would staff alert my father at night if he does not hear the alarm?

Hamssa Benrekia is a senior living placement specialist in Torrance who has worked in senior care for more than a decade. She talks with families about a parent's care needs, including sight and hearing, suggests licensed homes in the South Bay and Harbor area that may fit, from large assisted living communities to small board and care homes, and goes on the tours with you. To talk it through, contact Hamssa. The California Assisted Living Placement Guide covers the rest of the decision.