Diary of a vision rehabilitation officer

Posted: 
7 November 2016

Being a vision rehabilitation officer is a varied job, you have to think on your feet, make instant decisions and respond to the different needs of very different people. 

In this diary, a vision rehabilitation officer, shares a snippet of a day in their life for one week. It’s often funny and moving, and illustrates just why vision rehabilitation support is so important. The stories are based on real clients and real visits. All names have been changed, and identifying features removed, the vision rehabilitation officer remains anonymous.
 
The diary demonstrates why local authorities must take the opportunity when setting budgets to ensure that there are the right resources in place whether funding, staff or systems so that everyone with a visual impairment in need of support, can receive it.
 
RNIB is calling on all local authorities to ‘See, Plan and Provide’.
 

“I’m proud to be a rehab officer. It’s not an easy job; there are lots of ups and downs. Lots of frustrations and triumphs, laughter and tears but I feel humble to have been able to work with so many different people who in their own way have taught me just as much as I have taught them. It is a privilege that people let me into their lives at times when they are struggling, and trust me to work with them to learn new skills and get back some old ones to enable them to go on and lead more independent lives. I hope this little diary helps to make more sense of how we do what we do.” 

Monday
Tuesday
Wednesday
Thursday
Friday

Monday

Alarm goes off 6.45am – I don’t need to get up yet, but I love that comfy don’t want to get out of bed feeling - so I plan in at least three hits of the snooze button. 
 
Once up, it’s time for breakfast with the morning news, then shower, dress, makeup, and hair. Pretty normal stuff. 
 
08.30 – time to start work. 
 

Here we go! I turn the computer on, trawl through emails and deal with anything that’s urgent. Then it’s time to plan the day; who I’m seeing, where I’m going, and how to get there. I read clients notes and plan the sessions. Next, I check that I have all the equipment I might need. The boot of my car is full of bumpons, canes, and various talking gadgets - which tend to go off - usually on the motorway. 

First, it’s a 40 minute drive to see Doris, who is 92 - going on 18. She refuses to take part in the communal activities at her sheltered housing complex, because it’s “full of moaning old people”. 
 
I’ve been visiting Doris for two months, we've looked at pouring, using a liquid level indicator – (which is now apparently used mainly for wine), I have marked her cooker, washing machine and microwave, with bumpons, we've practiced peeling and chopping and we've organised her cupboards. 
 
She's now able to use her kitchen, but she confides that she sometimes spills her wine when pouring her fourth glass… I'm reassured, and consider this as perfectly normal. 
 
When I arrive Doris offers to make me a drink, I accept even though I'll be bursting for the loo later, but it means I can check on her pouring skills. Pouring goes well, nice cup of tea. 
 
Doris would like to read and has decided to try a USB player to access talking books. This is our plan for today. Doris is nervous when we start, she doesn’t know what a USB stick is, or how it works. We start at the beginning and go over what it looks and feels like. We explore the machine, where the plug goes, where the battery compartment is, on and off, pause and start, fast forward and rewind, volume control, etc. We practice starting the machine and inserting the USB stick - we repeat this until she has the hang of it. The process is harder than it sounds, when you can’t see, have arthritis, struggle to concentrate, and can’t remember too much in one go. 
 

We fill in the application for talking books and - yes Doris is happy to receive the books with the 'naughty bits' in them! If I get to 92, I hope I’m like Doris. Good session and Doris is excited to be able to read again.

Driving back home I need the loo as I knew I would. I get home; check emails, and grab lunch before heading off for the afternoon session. 
 
This time it’s a 30 minute drive in the opposite direction. As much as we like to plan to visit clients that live near to each other, it rarely works out that way! 
 
Traffic is bad, but it gives me time to think about this afternoon’s client. Jane is 19 and fairly new to me. If I’m honest getting information from her is like pulling teeth. Jane has serious confidence issues and has admitted to feeling nervous around people. There’s a lot of work to do to build her confidence. She can orientate herself, and keep safe, but is too nervous to ask for help, and won’t go out alone. We have agreed to work on this, and to brush up on her mobility skills.
 
I arrive in time, but have to park five minutes away and run to meet her. Well - ok walk fast, I don’t really do running. 
 
We drive to a large shopping area that she's familiar with, but she's never been into the shops on her own. We chose one that she would use. We walk the route to the doorway, then into the shop, up to the counter, and back out again. We practice a few times, I ask if she can go in and ask the assistant for something. She says no. That wasn’t the plan.
 
Plan B, diversion time - we sit on a bench and talk about her interests. This seems to do the trick, and she relaxes. It’s the most she’s said all afternoon. I suggest we try again, and she agrees.
 

She manages well and I feel a bit like a proud parent. I can tell that she's happy too, but she’s far too cool to admit it! The talk did it. I drop Jane back and head home. The Jane breakthrough puts me in a good mood, so I turn up the radio for a bit of a sing along. 

I get home and have a well deserved cuppa, and realise it’s the first drink I have had since lunch - four hours ago. I have a big glass of water too. Right - now time to relive the day and record it on our IT system. Before I know it, it’s five, and I still have to write my notes for the day. I write up Doris’. It’s amazing how two hours gets condensed into a paragraph. 

Tuesday

I repeat my morning routine. Firstly I do my notes for Jane. I'm about to have a second cuppa and remember that I’m doing a long mobility session. There is nothing worse than needing the loo halfway through a mobility session. It’s supposed to rain, so I have waterproofs at the ready.
 
I'm seeing Clive today. When we first met, he hadn’t been outside on his own for a year after a fall knocked his confidence. We identified that he needed support to learn how to use a white cane. We started work in a local park and have spent a few weeks working on basic techniques. 
 
The first route he's learning is from his home to the shops. Clive’s technique is good, but progress has been slow. We've broken the route into small sections, and today we're working on the third part.
 
We begin by talking through the first two sections of the route, which he mentally walks in his head before we start. He's nervous but determined. He will walk the first two sections of the route on his own, I will follow him, but I won't interrupt him, unless there is danger. I keep everything crossed that this will go well, so that he has confidence for the next section of the route. Clive sets off and the first section goes like clockwork. We turn the corner to start the second section and ahead there is an old sofa - slap bang in the middle of the pavement. Great! Clive won’t see it, however, the cane will find it - but it might throw him completely. I move a little closer to him, just in case. Whack – the cane makes contact, Clive stops still in his tracks. I'm willing him to use the cane to find a way around. He stands still. We have practiced unforeseen obstacles, and I know he needs bit more time.

"The cane moves, Clive moves, he finds the gap between the sofa and the kerb, and walks through. I remember to breathe... Clive stops turns around, smiles and gives me a thumbs up. Result."

We move onto the next section, which includes a side road crossing and a sweeping corner. It starts to rain. Unfortunately, as the sun was shining and there was blue sky when we left I'd decided that I didn’t need my waterproof, and left it in the car!
 
The sweeping corner is no problem as we have done lots of verge following in the park, but we spend time practicing the side road. Before we know it, we've been out for an hour and a half, so we head back for a well-deserved cuppa and a chat about what we've done today. We discuss the next stage of the route. Good session. It’s then a 30 minute drive home in soggy clothes. I get home, change clothes, check emails, eat some lunch then out again for an initial assessment. 
 
I admit initial assessments still make me nervous. I am going to a stranger’s house, I have no idea what I'm going to encounter or what reaction I will receive. I pull up outside, and the house appears neglected. The garden looks like it was maintained in the past, but is now overgrown. 
 
Here it goes. I knock at the door, and there is no answer. I knock again and wait. A frail older lady answers the door with her Zimmer frame. She invites me in, and I'm shocked, the house is in a mess. There are flies landing on empty tins of food on the floor. A straggly cat comes in and sits on her lap. Where do I start? This is going to be a tough afternoon. I can see she’s really struggling.
 
She looks so sad, and then starts to cry. She's embarrassed by her home and herself, she lived with her daughter up to a year ago when she died of cancer. She has no other family. She started to lose her sight around the same time, this coupled with grief and other difficulties have led to where she is now. She explains that she was too proud to ask for help and didn’t know where to ask anyway. She has severe arthritis and hasn’t been able to get up the stairs in three months.

"During this time, she had been sleeping on the sofa and washing in the kitchen sink. She had fallen through the net."

The vision rehabilitation assessment goes out the window, that can wait for another day. I listen to her speak about her daughter. We then talk about whether she will agree to me sorting out some help for her. It's a long exhausting afternoon, but she eventually agrees to let me refer her to social services for an emergency assessment, to occupational therapy for some physical aids and to other services to check her benefits and for some help with her grief. I leave Mable’s house, sit in my car and cry. 
 
I drive home completely drained; I make all the referrals and phone calls needed for Mable. I write up my notes while it's still fresh in my mind, though I know that this isn't going to be an afternoon I forget in a long time.

Wednesday

Office day today so I leave the house at 06.50. It’s an unpredictable journey that can take anything between 45 minutes and two and a half hours!! I spend most of the journey thinking about Mable. I get to the office for 08.00 and meet with my colleague. I tell her about yesterday, and she tells me about a sad phone call she had with a client's daughter who had called to tell her that her mother had passed away. I catch up with everyone else in the office; it’s good to see everyone as I’m not in the office much. Team meeting this morning and I manage to stay focused all the way through… well almost. I keep thinking about Mable. I grab some lunch and pick up some equipment, and I’m off for my next visit.
 
John has a chaotic lifestyle and occasionally uses substances. He is trying hard to turn things around. We had the conversation when we began to work together, that if he has been drinking, that I won’t be able to work with him for that session, and that if this happens regularly we will have to reconsider the support I can offer. He promised that it would never happen, but every time I visit I’m never quite sure. 
 
He has been attending AA meetings and he has a care package of support workers in place. He's been making good progress so hopefully we'll be able to do our planned mobility session. 
 
I arrive at John’s and as soon as he opens the door I know he’s been drinking. He looks tired and is definitely worse for wear. I ask him outright, and thankfully he admits he has been drinking. He had forgotten I was due to visit today. He apologises over and over again, and says it will never happen again.
 

I feel sad about John and really hope he can get a handle on things, otherwise I might have to stop working with him which will add to his problems. It’s a tough one; I know he has the right support, so that is reassuring but you can’t help worrying. 

I get home and write up the notes. I have a gap next week, so contact a new client to book them, but they aren’t available then, so I book them in for two weeks’ time. I try another client, whose case I hope to close soon, as their aims have almost been met. 
 
Her husband tells me she has had to go into hospital after having a stroke. I spend half an hour chatting to him; he's frightened about the future.
 

I make sure he has all the support numbers he might need, and I promise to find out some information about the Stroke Association for him. We may now need to completely start all over again when she gets home.

I try another new lady who informs me she's absolutely fine and doesn’t need any help at all. She may just not be quite ready yet, so I check with colleagues and they confirm that she has been sent information about what we do, and all the contact numbers she will need. I will leave it for her to contact us if she needs support in the future. I check my emails and realise that I quite a few need my attention, so that will fill my gap!! Good job I didn’t book anything in!!!

Thursday

George this morning, he was in the Navy and his front room looks like a naval museum. I've never seen him without a tie on, and I make sure I'm smartly dressed when I see him. 
 
George is also a bit of a flirt so I sharpen my wit. I've referred George to Blind Veterans and they have provided him with a state of the art CCTV, which has just been delivered. We practice using it and George manages some reading which he was finding difficult with his magnifier, due to his arthritis. We go on to talk about and try some eccentric viewing techniques - this tries to get someone using the section of their vision that's less affected by their eye condition. I referred George to Blind Veterans after his initial assessment, and he's off to Brighton for a week with them, I think he's going to absolutely love it. 

"OK onto Vera, an 80 year old, living on her own, with an excitable dog that insists on jumping all over me every time I visit. I don’t mind animals, but I’m not keen about being slobbered on. However, this is not something I would let on as making a fuss of a client’s pet/child/garden/anything is part and parcel of gaining their trust. So I am resigned to the fact that I will go home smelling of wet dog."

 
Vera has always been fiercely independent and has found it hard to come to terms with not being able to do some of the things she used to. We've been working on kitchen skills and things are improving. One thing that she mentioned when I first met her was baking. She loved to bake cakes for family visits and was frustrated that she couldn’t do it anymore. We've worked on building her confidence to use her cooker. Today we’re going to use talking kitchen scales, and try some simple cakes. I had asked Vera to prepare as much as possible before I get there, and true to form everything we need is organised and ready - always a good sign. 
 
We start by trying the talking scales and she is immediately hooked. Before we knew it, Vera was weighing out flour, sugar and butter in a whirl, I actually did very little apart from make encouraging noises. We had already done the preparation work to lead up to this, Vera had the knowledge and the skill, and she now has the equipment and the confidence to do what she had been doing all her life. It was lovely to watch and the cakes were lovely- yes I tasted one just to check the quality – obviously! Relieved today was a better day. I arrived home turned on the computer and had a sudden shock when I opened my emails, lots to reply to.

Friday

Busy day today. I'm spurred on by the fact that it’s Friday and I’m off out tonight for a pizza and a drink with friends (ok maybe two drinks….). There’s just eight hours till the weekend and that Friday night feeling.
 
I’m seeing Diane this morning. I have been working with her for nearly a year. That might seem like a long time, but when I first met her she had lost her sight almost overnight. Her diabetes was out of control and had resulted in a massive bleed which had damaged her sight extensively.  She was a legal secretary and had been signed off sick.
 

She had gone from working full time, being a busy grandmother and wife, to being at home all day on her own worrying about what her future would hold.

She was the centre of the family, the strong one who held everyone else up and now she felt a shadow of herself. We had to learn the basics from scratch, and to overcome the practical and emotional aspects of her situation. I referred her for counselling support, benefit advice and employment services, even though she initially laughed at me when I had discussed maybe one day going back to work. 
 
We began with work around the home. She learnt to make drinks, prepare meals, use her hob and cooker, manage the laundry, the cleaning, ironing and all the tips and ideas for maintaining her personal care, everything from matching her clothes to putting on her makeup.
 

Gradually she started to regain some independence and confidence; it was then time to move onto her mobility. Diane had not been outside the house on her own since her sight loss.

She even felt unsafe with her family. So that’s where we began. We had a session one evening when her children and husband were home and went through guiding techniques. 
 
We then went onto the long cane. I’ll never forget the first time we went outside, it took 10 minutes to get to the end of the garden path. I thought my circulation was in serious danger - she held on so tight! We went from pounding up and down the garden path, to pounding the pavement to learning cane techniques and building up simple routes. We then moved onto bus routes, and around this time we discussed returning to work. This time she didn’t laugh. She had been thinking about it herself. 
 
Access to work was organised and plans are now in place for her return to work in a month’s time. Today we are practicing routes around her office, including toilets, kitchen, lifts and stairs. It goes brilliantly.
 

Her hard work, determination and training have brought her to this point and the increase in confidence and independence has been amazing. She admits she never thought it would have been possible, but she has proved it is.

Not much time for lunch today, grab a quick sandwich to eat in the car and off to the next client. 
 
Stan was a vicar. He has been an avid reader all his life. He uses talking books but misses the feeling of holding a book and getting lost in the words in his head. The thing he misses the most is his bible. We have just begun to learn Braille. Stan is so motivated and determined, and he will need to be. Braille is like learning another language completely. Having learnt it I can totally relate to the utter frustration of finding out that there are so many rules and regulations, let alone symbols and shapes. It’s all so alien to feel a combination of dots and turn them into words in your head. When you start off you sound like a five year old again. This can seem laborious and embarrassing. This is where Stan is at the moment, and he is not enjoying this stage one bit.
 
He's keen to be able to read as quickly as he's done before but I have to try to reassure him it all takes time, and the end result is worth the effort. When I left last time I wasn't sure if he would do the homework I set him, as he was a bit disgruntled and fed up, but I'm relieved to find that he has.
 

He reads a short paragraph and is so much better than last week. I think we might be making progress. I introduce the next set of symbols and rules and Stan gives me a huge sigh but at least this week it's followed by a smile. 

My pizza is calling me…ok my glass of wine is calling me… one more visit. 
 
It’s an initial assessment this afternoon with a 23 year old young mum, Janice. She has a small son and has a degenerative eye condition. She's been struggling recently and when I arrive I meet her and her son who is a typical two year old, and has the energy I can only dream off. We have a general chat but I sense she's really worried and nervous. I'm keen to tell her more about my role in case she thinks I'm there to check up on how she cares for her son. I sense her relax a little bit and we begin to talk about how she manages around the house. She has some central vision so can still manage most tasks well so I just give her a few tips she hadn’t thought of.
 

However, it's her mobility that is the main problem. She has had two serious falls recently and is now scared to go out at all.

This is causing her concern as she lives in a flat and doesn't feel she can provide all the stimulation her growing son needs. She's scared to take him out. We discuss possible sources of extra support that might be available while we train. I then focus on how we can begin to look at her mobility. 
 
Techniques and training will need to be adapted to incorporate the needs of the use of a buggy and a walking toddler. We will have to address not just her safety, but that of her son, and she is relieved to think that it is a possibility that we can explore together. We will start with her independent mobility and then add in the extra adaptations as needed.
 

She seems excited and anxious all at the same time and to be honest so am I!! It’s going to be challenging for me too, but I have a good feeling that it could work out well.

Finally, it's the end of the day and the end of the week. I think I definitely deserve that glass of wine…or two…

Have you enjoyed reading the diary?

Want to find out more about the role vision rehabilitation provides for people with sight loss? Discovered the importance of vision rehabilitation support and want to make sure it's available in your area? Find out more about our See, Plan and Provide campaign and ensure your council does just that.

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