Booklet Adapting Accomodation

Introduction

We are all influenced by our environment: working, playing, socialising, resting and sleeping. Some places help us to concentrate, perform tasks better, relax, or enhance our feelings of wellbeing. Others can feel tense, depressing, distracting; they can also stop us from seeing things properly or provide us with misleading sensory clues.

There are ways to help people with sight problems and learning disabilities, by improving both the environment and the person's ability to use their senses to understand their environment. Adapting environments for people with visual impairments can have a dramatic effect on their ability to cope independently (or with support), without costing service providers large amounts of money.

This factsheet considers general design features for people’s homes, opposed to planning for individuals or large group settings such as day centres.

Sight problems

The term 'blind' is not a medical one. The sight of people who are registered blind/severely sight impaired may vary. A very small percentage of people with sight difficulties have no sight whatsoever. A minority have light and dark perception only, and some can only see colour. The majority of blind people have some useful vision, which they can use in their daily lives.

People with sight problems are different:

• Some people see the world as a blur - like a series of abstract pictures in muted colours
• People may have problems with their ‘visual field’ (all round vision). They may only see a small part of the whole or only see objects on one side or other, or the upper or lower fields of vision
• Others may have tunnel vision and have difficulty seeing what is on either side of them
• Many people have distorted colour perception

People who once had 'ordinary' sight often retain a 'visual memory'. It usually helps them make sense of the bewildering sounds, smells and tactile clues in the world around them and to make informed judgements. Building on previous knowledge, people may still need help to develop a visual picture in their mind from information gathered from a range of sources. However, memory may be selective or fade in time, sometimes providing distorted or unreliable images.

People with learning disabilities may develop additional ‘age-related’ sight deterioration. This is true for people born with a sight problem, as well as people who have lived ‘sighted lives’. 

General Design Principles

 
There are ways to assess an environment to see how appropriate it is:

• lighting

• use of colour and contrast - contrast is how much something stands out from the background

• surfaces and textures on both walls and floors
• physical aspects of a building
• noise and the use of sound
• inconsistent or misleading clues

Buildings contain permanent ‘landmarks’ - such as walls, or a front door, and ‘clues’ which may be temporary or appear and disappear - such as waste paper bins, the smell of food, or the sound of tea being prepared.

Lighting

There is no one way of lighting a room that is perfect for everyone. For most people with sight problems, more light is better and often the simple introduction of task lighting (for close activities such as reading) will meet the person’s needs.

However many people with visual impairments are sensitive to ‘glare’ which may literally ‘blind them’ and cause pain. People may experience glare when others with ‘ordinary vision’ do not find it particularly bright. Glare can come from windows and lighting, but it can also be caused by shiny surfaces - such as highly polished floors. It is vitally important that people can control the lighting around them, the amount of light, and how it is shone on to an object or activity.

In general, even (ambient) lighting is best for most situations, with lamp shades (these are ideally something like big paper balls that evenly scatter light, or long 'diffusers' on strip lights) to prevent glare. Dimmer switches are helpful to increase or decrease intensity with localised (task) lighting for areas where activities or close work take place. Overall lighting is usually best provided by a central ceiling light in small rooms, or a series of ceiling mounted lights in larger rooms, and may be increased by wall mounted lights. The colour and density of the lampshades have a huge impact on the amount of light that gets through and the way it is distributed.



Light-coloured ceilings and walls reflect the light back into the room. Dark coloured ceilings and walls absorb the light.

Great variations in lighting can make things very difficult for people with sight problems. Adapting to changes in the level of lighting (such as moving from light areas to dark areas) is a real problem for people with certain eye conditions. As we get older we all experience difficulties in coping with changes in lighting. This needs to be considered for safety reasons, as well as for people’s general functioning.

Individual spot lighting (task lighting) may provide as many problems as it solves if consideration is not given to

• position of the lamp (for example causing shadows)
• brightness (luminance)
• type of lamp (some produce lots of heat that can be really uncomfortable)
• manoeuvrability
• ease of use (can the service user switch it on and off independently?)

Use of colour and contrast

Colour and contrast, particularly when used well with good lighting, can make a big difference to a person's ability to understand the environment, find their way, make choices, and predict what is happening.

Poor colour-contrast, particularly with inappropriate lighting, can prevent individuals from functioning safely and independently. An example of this is frequently seen in toilets and bathrooms where the toilet, toilet seat, cistern, bath, washbasin, hand rails etc. are often all white. The bathroom is often also white, with white tiled walls, with a white ceiling and white door. These sorts of environments are made more difficult because people find it hard to use their hearing to make sense sound clues - because noises bounce off hard surfaces and walls. 

Examples of what can help in a variety of situations

• A coloured or plain wooden toilet seat will provide sufficient colour contrast to enable the toilet be identified
• In a dining-room or kitchen a coloured cushion on a wooden seat can help people to find their own chair 

• A coloured switch or plug can enable someone to put on a light, a CD or cassette player independently by allowing them to see where the power source is located

• Pale food on a dark plate can enable a person to see his or her food without support
• A coloured border on pale or differently coloured walls half way down the walls can give people clues about where they are; it is however important not to make an entire wall patterned as this can sometimes be more confusing
• A coloured door and door frame will make it easier to find the door if the colour contrasts against the surrounding walls

• A contrasting handrail on stairs will make it easier to find and hold on to

It does not take a great deal of money or imagination to make changes that will make a great difference to someone's ability to function safely and independently.

Go to the Dulux website and recieve a free DVD produced by Dulux and RNIB about colour and contrast.

Surfaces and textures

Surfaces and textures if carefully considered can provide useful tactile information to people with a visual impairment. However, poorly planned tactile information can confuse and disorientate people.

The following should be taken into consideration when implementing changes to any environment that will be used by people with a visual impairment.
 

• Are worktops and tiles shiny? (These will reflect light causing glare, making things difficult to see)

• Is the wallpaper border half way down the wall in an embossed paper, making tactile trailing easier? (‘Trailing’ is a technique used by many blind and partially sighted people.

The person reaches ahead, with elbow and arm about waist height or slightly higher. The person has only the back of the hand in contact with the wall. The fingers should be bent slightly inwards to avoid jarring on any objects)

• Is there a texture change to the flooring at the top of a flight of stairs, such as carpet to tactile blister (‘bumps’) or corded linoleum or even standard linoleum) to give people warning that they need to reach out for the handrail?
• Is there a mat that would give people a clue that they are near the front door? Is it secured? If not, it is more likely to be a safety hazard. (It may slip!)
• Is the environment all hard surfaces, making noise bounce around, preventing the person from making sense of what he or she hears?
• Is the place carpeted throughout? This may make things more difficult for many people as they may not know when they have moved from one room to another. Metal strips denoting different rooms may show people where they are. In addition linoleum at corridor intersections or fire exits will help to provide additional ‘markers’ to help people find their way. Other landmarks may need to be created to provide inexpensive but valuable clues to help visually impaired people move in the right direction to get where they want
• Carpets and curtains that absorb sounds help people hear speech and other sounds clearly. Soft furnishings also reduce echoes which may be confusing
• Changes in texture under the feet can provide excellent ‘orientation clues’. Blind people who use wheelchairs may also feel these changes in surface. Many blind people listen to the sound of other people’s footsteps, enabling them to tell when they are approaching 

Physical aspects of the building

• Handrails: do these give enough of the right sort of information? In many buildings the handrail gives people physical support and also provides important information, such as if they are near the top of the stairs. Where the handrails do not give advance information, it is important to create warnings, using floor changes, tactile markers applied to the handrail or colour contrast rail endings.

• Steps: should have colour contrasting nosings and tactile edgings where appropriate. ‘Corduroy’ or other tactile flag stones can be introduced to provide advance warning of danger on external steps. Tactile linoleum can be used inside buildings.

• Windows: do they have blinds? Do they reduce glare without blocking out valuable light? Are there curtains as well? Curtains that contrast with the walls can help people know where they are. Rooms can seem very different at different times of the day, due to changes in natural light and the change in direction of the sun. People may be comfortable sitting in one place at a particular time of day but may need to change their position at other times to avoid glare. Windows can also be dangerous if left open.

• Corridors: is there any natural light; is the electric lighting adequate and consistent? Glass doors can be extremely hazardous for people with sight problems. Good contrast on doors and doorframes is vital for people with visual impairments to find their way round.

Large print signs or raised pictorial logos with symbols or pictures will help people find appropriate rooms. For totally blind people it is important to provide a consistent approach to the environment, for example, round doorknobs for toilets, L-shaped handles for bathrooms etc. (Information on signage is available from RNIB Access Consultancy Services)

• Furniture that might have been moved without informing people with visual impairments may cause difficulties. They may have used it as a landmark. Low coffee tables and stools, that are not easy to spot, may also be dangerous.
• Other hazards: these could include doors and windows left ajar, rubbish bins or bags, boxes and briefcases, fire extinguishers - anything that may be tripped over. Hot radiators could be dangerous to touch - and people should be discouraged from feeling them as a clue to finding their way around. Leads to electrical equipment and extension leads on floors are easy to miss, even for fully sighted people. All these things need to be considered when working out ‘trail routes’ for individuals

Noise and the use of sound

Sounds can give very useful clues - they can tell us other people are in the room, even if we can't see them, they may tell us someone is walking towards us. They may tell us where we are - the noise of a washing machine might tell us we're in the kitchen, the ticking of a clock might tell us we are in the entrance hall, or wind chimes that we are near the back door. However, for many people with both sight problems and other disabilities, sounds may provide different information. Hearing aid users and other people with hearing problems will find lots of environmental noise confusing and may prevent them from picking up more useful noises.

Although sound may give useful pointers about where you are, some sounds are not permanent (e.g. a radio may be turned on and off and may even be moved) and so may give a clue to location but cannot be relied upon. Other sounds, especially if built-in features of the environment can give vital clues, for example a water feature that is always left on in a hall.

Inconsistent or misleading clues

Smells may provide some useful information in many situations. For example, when walking down the street, the smell of the bakers can give good clues as to where you are, if the bakery is open! There may be no smell at all if it is closed. Many smells are easily changed or short-lived.

Sounds (like a telephone ringing or a television on) may provide people with clues as to where they are. However sounds may be replicated in several different places and hence make the environment more confusing or difficult to negotiate. Environments without carpets and soft furnishings can be filled with background noise and echoes, creating a lot of different sounds that cannot be easily understood, making effective use of hearing difficult or impossible.

How to make things better

Pool your thoughts

Staff without any training in visual impairment can make some valuable judgements about things that might be helpful by pooling ideas and thoughts on individual service users:

• "Did you notice how Ron moves much more confidently in the morning in the sitting room than he does in the evening?"
• "Bola always seems to reach for the red cup."
• "Ayesha gets panicky if left in the large, smart bathroom by herself, but doesn't seem to mind in the old one that is due for refurbishment."

For every noted behaviour that individuals display, supporters should ask: why is this person doing this? What clues does it give me about what they can see, hear, feel, anticipate, and understand?

Try it out

Supporters can try things out. Walking round (with a guide) wearing sleep shades (blindfolds) or simulation spectacles may be helpful. Simulation spectacles roughly simulate different eye conditions and can give people a better understanding of what might present problems for people with visual impairments. These spectacles may also highlight potential solutions to environmental problems. (For example, "It would be really helpful to have a large colourful ball on the end of the light pull in the bathroom".)

‘Blindfolds’ (sleep shades) can be bought in chemists and some supermarkets. Both simulation spectacles and sleep shades may be available on loan from the local sensory impairment team at Social Services, Social Work department, or a local voluntary association for blind and partially sighted people. However, it is preferable to ask your local rehabilitation worker for visually impaired (ROVI) people to assess the environment for individuals.

A note of caution: Sleep shades and simulation spectacles can be useful in training and in testing out environmental features, checking safety and so on. However, they do not simulate what it is like to have sight problems, nor do they hint at what an individual's sight loss is like and the oppression many disabled people experience.

Look and think

Look at every room individually
Think what information the person with sight problems must have to find his or her way round that environment. Is there good use of colour, contrast, lighting and non-visual clues?

Look at the functions of the room
Does this person use this room often and what routes does it mean this person needs to learn to get to and from it?

Look at the overall sense of the building
Is there consistent use of colours (e.g. do all the toilets have the same coloured door)? Is there consistent use of contrast (e.g. doorframes - can all be distinguished from the walls that surround them), is the lighting adequate?

Look at what needs to be consistent
Furniture, handrails, tactile clues, lighting in 'journey' areas, such as corridors.

Look at what needs to be variable
Lighting in rooms should be controllable and changeable - through dimmers and additional ambient and task lighting.

Look at the outside
Is there danger in accessing the building; do you have to cross the car park? Is there lighting at night, are steps in the garden marked? Are there prickly shrubs round the gate or front door preventing people from locating and finding their way in safety?

Checklist for people with learning disabilities

Entrance Hall

• Can the door be seen by residents, or found safely by some other method - such as using touch? Avoid glass doors in buildings and, if they are already there, put something up (notices, ‘stained glass’ stickers etc) to make them more noticeable.
• Is the lighting adequate and consistent?
• Is there glare coming in from windows or doors?
• Is there a tactile strip or handrail along the wall for trailing?
• Is there a way that the individual can orientate themselves to find their way to other parts of the building? For example, "If you stand with your back to the notice-board and then begin trailing with your right hand you will find the door to the sitting room".

Corridors

• Is the lighting adequate and consistent?
• Is it easy to find which door you want on the corridor? Points of reference could be introduced to indicate what is down a particular corridor, for example, the hand rail to a bathroom may have a small face cloth attached to it indicating ‘Bathroom’.
• Is it free of obstacles?
• Is there good colour contrast?
• Is there a tactile strip or handrail that people can trail along?
• If people use wheelchairs, you may need to give verbal explanations as well as information about direction.

Areas where activities occur

• Check overall ambient lighting.
• Ensure additional task lighting if required.
• Check positioning of seating to ensure lighting from windows and ‘task lamps’ - is the light maximised, is it comfortable for the person doing the activity?

Kitchens

• Is there a talking microwave oven or can an ‘ordinary’ one be ‘marked up’ by a rehabilitation officer for visually impaired people?
• Is there lighting over the cooker? Are the buttons tactile? Can they be easily felt? Does the cooker have large numbers located at the front? (Information on labelling things for blind and partially sighted people is available from RNIB)
• Is there appropriate additional under-cupboard lighting for wall mounted cupboards? Is the lighting positioned to avoid causing glare?
• Is there good colour contrast - between wall and work surfaces, between cupboards and floors, between furniture and floors, between work surfaces and objects placed on the work surface. It is especially important that hot things, such as kettles, can be easily seen.
• Is there a central strip light? If so, is there a cover (diffuser) over it to remove glare and spread the light more evenly? If not, is the overall lighting adequate?
• Is there additional task lighting available? Lights attached to large clips are useful in kitchen areas for providing additional ‘spot lighting’.
• Are the surfaces shiny or matt? If they are shiny, it is often possible to make them matt (for example, by putting a tablecloth on the table), and quickly reducing some of the problems.
• Is there adequate space to put things down and to use them safely without knocking other things over? Things on slippery surfaces can be made safer by the use of non-slip or dycem mats; they can also make some things easier to find if they contrast.

Living/sitting room

• What size of room is this, and what are the acoustics like?
• Is there continual background noise, e.g. a television on?
• Is there furniture that has been moved? This may be confusing for many people, particularly where there is little colour contrast, where people have very poor vision, or where there is a lot of glare from lighting or windows.
• Is there low level furniture, like coffee tables? These are particularly easy for people with sight problems to trip over.
• Is there an easy way for people to orientate themselves or find their way round?
• Is the lighting comfortable and reasonably bright? Is it adjustable, is there additional task lighting, etc?
• Is there good colour contrast to mark out the doors, etc?
• Is the room cluttered - or is there space for people to move around safely?

Dining room

• Where does the person sit to eat their meals? People with cataracts, for example, need to have their backs to the window if it's a bright day.
• Can the person find their way there alone?

• Can they find their seat? (You could use, for example, a different coloured cushion on their chair, or a different place mat, etc).
• Is there reasonable overall lighting? Is there additional lighting for the table (e.g. pull-down lights)?
• Is there good colour contrast between the tablecloth and the china, cutlery, etc? (Avoid patterned or shiny tablecloths.)
• Are the plates, cutlery, place mats, etc. suitable, with clear colour contrast against the table or cloth? Can the person cope with the way the table is set? For example, does their plate slide around on the table or should it be placed on a slip-proof mat? Is the table set in such a way that the blade of the knife is easily seen?

Bedroom

• Can the person find their bedroom? How does it differ from others?
• Can this person find the door, the toilet?
• Can this person find their bed - is there colour contrast between the bed and the floor, and the bed and the walls?
• Is there a tactile surface, such as a dado rail, for this person to trail if they have insufficient sight to travel without following a tactile dado or other tactile information?
• Is there low level lighting (or plug-in night light) that will allow the person to get up in the night? Does this lead the person to the toilet door, and back to bed? Lack of lighting can mean a normally continent person becomes incontinent during the night.

Stairs

• Is the stairwell adequately lit, and is the lighting at the top and bottom of the stairs good?
• Are the handrails appropriate? Are the handrails easily seen and are they colour contrasted so they can be clearly seen? Do they give guidance on the stairs? Are the rails designed to give some anticipation time at the top and bottom? Anticipation time can be built in by having a longer horizontal run on the handrail at the top and bottom of the stairs, and by having an additional landmark. For example, carpeting changes to linoleum 1 metre before the top of the stairs, the person then reaches out for the handrail which is horizontal for 0.75 metre before sloping down as the stairs begin.
• Do they have extra tactile information if needed? If you have put this on yourself, e.g. tape to indicate top of stairs, this must not to be removable. It must withstand constant use. You need to label the top of stairs in the same way throughout the building.
• Is there additional tactile information - such as a surface change (for example, carpet to linoleum) on the flooring when people are approaching the top of the staircase to come down?
• Is there a highlighted and tactile edging to the steps?
• Make sure that any handrails on stairs are continuous and do not end before the top or bottom step. Rails that end before the top or bottom step give people wrong information, and so can be dangerous.

Outside

• Is the outside area ramped for people who use wheelchairs or cannot manage stairs?

• Are there already landmarks you can use for movement and ‘knowing where you are’ purposes, e.g. grass verges next to paving?
• Are there low fences or edging - these can be easily tripped over?
• Is there overhang from trees, shrubs, hedges, etc? This can not only scratch people, but can also reduce their confidence. Overhanging trees or bushes may effectively ‘push’ them away from a wall that they are using to guide them.

• Raised flower beds and scented flowers can be really helpful, but scents are not static all year round, and if raised flower beds are replicated in several places, they may lose their distinctiveness as orientation clues.

Providing additional information

People may need some additional markers created specially for them. They may need to know that they are ‘nearly there’ when walking down a long corridor. They may get lost - so it is important to build in some sort of reminder. This could be by using signs along the way, for example:

This is the way to the dining room ------>

This sign could also have Braille on it stating the same thing with a tactile arrow.

Alternatively the sign could use symbols or pictures: the person holds a picture of a plate - and a picture of a plate that matches could be half way along the corridor and on the door of a dining room.


There are many different ways to provide markers for people. It is worth considering what information an individual uses to ‘travel’ around a building.

Promoting independent movement

Some people with visual impairments and learning disabilities are reluctant to move about independently, even when an environment has been adapted to meet their needs. They may be afraid and not know ‘what is out there’. They may have been prevented from moving about by themselves in the past.

It is important to teach people to notice permanent ‘landmarks’ to help them identify exactly where they are. For example, people need to turn left to go towards the toilet when they touch the tape on the handrail.

Conclusion

Strategies to improve the environment can make a very positive impact on how someone can function in their environment, how they can keep independence skills and retain the motivation to learn new skills.

Sources of help:
National: Advice on building design and signage can be obtained from

RNIB Access Consultancy Services, 105 Judd Street, London, WC1H 9NE. Telephone: 020 7388 1266

Local Rehabilitation workers are usually employed by the local authority social services or social work departments, or voluntary societies for blind and partially sighted people. They should be able to advise on adapting the environment. Assessing and adapting a person’s environment is a crucial part of any assessment of a visually impaired person.

Equipment and games - RNIB has an extensive catalogue of products for daily living and leisure. Their website is www.rnib.org.uk