AMERICAN LAKE BLIND REHABILITATION CENTER STUDENT HANDBOOK

Transcription

1 AMERICAN LAKE BLIND REHABILITATION CENTER STUDENT HANDBOOK Last updated June 13, 2012 Blind Rehabilitation Center (A-112-BRC) VA Puget Sound Health Care System American Lake Division 9600 Veterans Drive, Tacoma, WA Voice: ; Fax:

2 Welcome to the American Lake Blind Rehabilitation Center American Lake Blind Rehabilitation Center is located in Tacoma Washington and is one of 13 comprehensive blind rehabilitation centers in the VA system. The center currently has a capacity of 11 private patient rooms and serves between 100 and 130 Veterans annually. We are accredited by the Commission for Accreditation of Rehabilitation Facilities (CARF). Our mission is to enhance the quality of life of Veterans and Active Duty Military Personnel who have experienced vision loss. We provide instruction to restore, improve or maintain your optimal level of functioning. This handbook will provide you with information that you may find useful in preparing for your stay. Contact Information Our primary telephone number is After hours, you may reach us through the nurse s station at Direct lines and addresses of program administrators are listed below.

3 Tim Sniffen, Director Mike Aleckson, Assistant Director Page Howard, Social Worker Mike Pistacchio, Administrative Officer Blind Rehabilitation Continuum of Care We are one part of an extended team that provides rehabilitation services to visually impaired Veterans and Active Duty Service Members in the northwest. The Veterans Administration has a continuum of care that strives to provide services as close to home and in as timely a manner as possible. You can read about the Blind Rehabilitation Continuum of Care on our website at

4 Visual Impairment Services Team (VIST) Coordinators Your local VIST Coordinator is your initial point of contact and your case manager. He or she can connect you with services available at your local facility and refer you for blind rehabilitation services available at other facilities. Besides referral for blind rehabilitation services, your VIST Coordinator can offer counseling services regarding benefits and vocational training opportunities. Most VIST Coordinators sponsor support groups where you can meet other visually impaired Veterans and family members. They can help connect you with recreational events in your community and national programs for visually impaired Veterans. In the Northwest we have the following VIST Coordinators: Station Coordinator Phone Anchorage, AK Martha Farris (907) Boise, ID Valerie Duffy (208) Fort Harrison, MT Tracy Tillinger Portland, OR Jodi Roth (503) Roseburg, OR Jean Best Ext Seattle, WA Kim Richardson (206) Spokane, WA Suzanne Bennatt (509) Tacoma, WA Walt Werkhoven (253) Walla Walla, WA Spencer Peterson ext White City, OR Marilee (Sam) Friedrich-Sanders Ext 3300 Blind Rehabilitation Outpatient Specialists (BROS) BROS are master level blind rehabilitation specialists with teaching credentials in more than one discipline. They serve Veterans and Active Duty Service Members in their local communities whether by office visits or

5 by making visits to their clients homes, schools or workplaces. The VIST Coordinator may refer you to the BROS in your area to meet your immediate needs, to help you prepare for a referral to a low vision clinic or our blind center, or to meet all of your needs due to limitations you may have in attending a program such as ours. In the Northwest we have BROS in: Seattle Spokane Tacoma Portland Bill Wilson Kelly Golden Don Felthouse Paul Thomas Low Vision Clinics The VA has low vision clinics in Seattle, Spokane, and Portland to provide services to Veterans living in the Northwest. You may be referred to one of them by your primary care provider, an eye care professional, or by your VIST Coordinator when standard optometry services are not sufficient to meet your needs. Low vision clinics provide clinical examinations, a full spectrum of adaptive devices, and specialized training in low vision. They may meet all of your current needs. If not, they may refer you on to the Comprehensive Blind Rehabilitation Center at American Lake through your VIST Coordinator. Who should come to American Lake Blind Rehabilitation Center? Most of the people who come to our Blind Center are not totally blind. Despite what most folks might imagine, we rarely teach Braille. Most of our clients use magnification, whether optical or electronic, to read again. Those who cannot read visually may use an electronic reading machine or a scanner attached to a computer to read again. So don t think you don t belong here because you can still see. You do belong here or at another blind rehabilitation facility if visual problems prevent you from living a full life whether those problems have left you with a partial or a full loss of vision. In order for a Veteran to be eligible for admission to our program, he or she must be eligible for VA health care and meet one of the following criteria: 1. Legal Blindness. Best corrected central visual acuity in the betterseeing eye less than or equal to 20/200, or visual field dimension in

6 the better-seeing eye less than or equal to 20 degrees at the widest diameter, even if central visual acuity is better than 20/ Functional Loss. Comprehensive treatment at a Blind Rehabilitation Center is needed for appropriate restoration of the individual's safety or functional independence or for establishment of their personal or social adjustment to vision loss. If the visual impairment alone or in combination with excess disability factors presents needs which cannot be appropriately addressed by local components of the VHA continuum of care, admission to a BRC is authorized. Admission Process You apply for training through your VIST Coordinator, who makes the referral and makes sure we have access to basic information such as recent physical examination, lab work, chest x-ray, eye report and social history. If you receive your medical care outside the VA, you will need to give your VIST Coordinator copies of this information to pass along to us with your application. Our admissions committee meets every week and reviews applications for training. If there is not enough information to allow us to know what it takes to keep you medically stable or how you might benefit, we will ask your VIST Coordinator for more information. If you would like, you are free to visit us and take a tour of the facility to learn more about us. Just contact us at to set up a visit. If your application is approved, you will hear from us directly and you will be placed on our waiting list for admission. In 2011 our average waiting time grew to 56 days from the time we receive an application to the date we first offer admission. It is back down to 21 days during the first half of 2012, but this shows how it can vary. We are working on ways to bring the wait down including expanding blind rehabilitation services around the northwest so that some folks who are waiting can receive services at home. Even so, most Veterans are surprised to hear from us so quickly and some ask for more time to prepare before admission. Our social worker, Page Howard, will call you to coordinate your admission and answer any questions about what to bring. You should also hear from one of our nurses in the days leading up to admission. They will make sure we know about your medications and are prepared to handle any medical

7 or nursing needs you may have. Finally, one or more of your teachers may call you to get a better idea of your goals. What to bring Bring your current medications in the bottles they came in. You can bring a pill box if you use one, but don t fill it. We are required to throw out any medications that are not in their original bottles. Orders for medications that are available through our pharmacy will be written during your intake physical. One of the purposes of the nurse s pre-admission phone call is to learn of any medications you are taking that are not on our list of available medications so that they can alert you what to do. Bring a week s worth of comfortable clothes and comfortable walking shoes or sneakers. You will probably be outdoors during some parts of your training and on recreational outings and should bring an appropriate jacket or coat depending on the season. We have towels, bedding and pajamas. You may bring your own pajamas if you prefer. The only money you should bring is for incidentals at the canteen or out in the community. We have an Automatic Teller Machine (ATM) on campus and there are many in the local community. Bring any portable aids you are using to overcome problems due to vision loss if at all possible: low vision aids, canes, recording devices or portable reading devices, and so on. We will use them in class and may upgrade them or exchange them with devices that work better for you. Definitely bring any prescription eyeglasses you are using at home. Check with us about any desktop computing equipment you are using. If it is possible for you to bring it, it may be beneficial to do so. Bring your keyboard, accessibility software, notebook computer or other portable computing device if it has been issued by the VA. Sometimes we need you to bring or ship your current desktop computer for training and possible updates if it was issued by the VA. We will let you know if you need to do this. If you are having difficulty reading your mail, especially bills and statements, please bring samples so that we work together to find solutions.

8 Priority of Care Active duty military personnel have first priority for admission. Serviceconnected Veterans rated 50 percent or greater for any combination of disabilities, and those who are service-connected for their visual impairment, have priority status provided they have not received prior training at a VA Blind Rehabilitation Center. We also consider urgent need factors such as safety issues, medical issues, lack of a caregiver, vocational needs (e.g., attending school, employed), and lack of previous rehabilitation services. Occasionally we give priority to visually impaired Veterans who have been admitted for specialty care in another part of our hospital system if they cannot return home safely without blind rehabilitation training. In lieu of these priority circumstances, we normally offer an admission date based on the date an approved application was received. If an admission is needed in order to maintain bed census, we may give priority to Veterans who are willing to be admitted on short notice. The Rehabilitation Process Your training here is a partnership between you and the professional staff. Your individual goals are extremely important. Each person will get out of the program what he or she puts into it. If you are motivated to do your best, you will gain a great deal. Your rehabilitation program will consist of evaluation and training in various skill areas. Instruction will be adapted to your needs, goals and abilities. You are expected to take an active part, along with our treatment team, in the planning of your individualized training program and planning for your discharge. Length of Stay There is no set course of training; each Veteran s program is based upon his or her individual needs and desires. Hence there is no set length of stay, and don t let anyone tell you that you ll be here a set number of weeks. Your needs and your preferences determine how long you will be here. That said, the average length of stay across all Veterans has run about a month, but we ve had people with limited needs graduate in as little as one or two weeks and those with comprehensive needs choose to stay as long as eight or nine weeks.

9 Types of Admissions The Blind Center offers several types of programs. Our regular program consists of training in Orientation & Mobility, Low Vision (if applicable), Living Skills, Manual Skills, and Recreation Skills. We ll tell you more about these subjects below. Our CAT program focuses on Computer Access Training. If you have been admitted to a Blind Center before or are already knowledgeable about computers, you may be admitted for our Dual program, which combines our regular program with our CAT program. If you are brand new to computers you should come to our regular program first. We will cover keyboarding skills and introduction to computers during your initial stay and invite you back for computer training when you are ready to attend or even invite you to stay on and work on computers as you complete other subjects. We also admit previous graduates to work on a single class or goal, if that s all they need. Let s talk about the subjects we cover. Orientation and Mobility Orientation and Mobility (O&M) instruction teaches principles of safe, independent travel. Training programs are designed around the Veteran s individual needs and potential for independent travel. Vets with severe motor impairments or limited range of travel may practice getting around safely indoors. On the other end of the spectrum, Vets may practice taking several buses to get to an event downtown. Lessons may include sighted guide, self- protective indoor techniques, and long cane travel in various environments including residential, business and downtown areas. If public transportation is a viable option for you back home, we will include the appropriate training in your program. Veterans are encouraged to use any remaining vision and optical travel aids such as telescopes. Electronic global positioning systems (GPS) may also be incorporated where beneficial. We do not provide guide dog training here but we do work closely with several guide dog schools and can refer you for services. We also work with Veterans with guide dogs to develop further mobility skills after they attend a guide dog school.

10 Manual Skills The Manual Skills program is dedicated to developing the remaining senses of the blind or partially sighted Veteran. The Veteran is evaluated in order to assess tactile perception, bimanual coordination, and manual dexterity. He or she may then be assigned guided activities which will improve tactile ability in these areas. The following crafts are commonly used as training tools but others may be substituted: Leather Crafts Home Mechanics Copper Tooling Woodworking Living Skills Living Skills covers a wide variety of common everyday skills which are generally broken down into three component parts. The first is personal management things like personal hygiene, managing money, telling time, telephone dialing, clothing care, and housekeeping. Communication skills can also be covered such as Braille, typing, handwriting aids, talking book and reading machines, cassette recorders, and talking calculators. Finally, cooking skills are evaluated and adaptive safety techniques are taught in this class. The objective is to improve the Veteran s ability to manage day-to-day activities safely and as independently as possible.

11 Low Vision and Optometry The Low Vision program is devoted to educating Veterans about their eye conditions and teaching them how to maximize their remaining vision. Low Vision Specialists work closely with the staff optometrist to evaluate and then train Veterans to use their vision in conjunction with low vision devices or aids. Training in this area helps Veterans achieve vision related tasks including, but not limited to, reading, watching TV or seeing signal lights. Technology Training Many Veterans focus on technology training so much that it requires more explanation up front than any other training area. If you aren t interested in technology good for you! We ll give you priority admission and chocolates on your pillow. If you are interested in technology or if you become interested once you are here, read on. And on. American Lake Blind Rehabilitation Center provides training on the latest software and equipment to meet the needs of low vision and blind technology users whether desktop computers or mobile computing devices such as notebooks, tablet computers or smart phones. Technology training is offered when there is a demonstrated need and a reasonable expectation of a successful outcome. Adaptations include screen magnification, screen reading (speech output), screen simplification, and voice recognition (speech input). While we practice daily tasks such as reading and sending , browsing the Internet to keep up on the news and explore areas of interest, writing letters and other documents, scanning and reading the mail, and keeping a computer in good running order, our purpose is to get visually impaired Veterans capable of using accessibility options to use technology, not turn them into computer experts or train them to use specialty software needed at a job site. We provide training and issue technology equipment based upon a Veteran s needs for adaptive technology and ability to use it, not his or her desires for a particular brand or model of device. This is so important to note that we are putting it in bold print below: We may issue a computer or mobile device when a Veteran requires adaptive solutions to use it and demonstrates both the need and ability to use it independently in daily life.

12 We provide Internet connections and telephone services at our center for your use during training, but these items are your responsibility to provide, to configure, and to maintain once you return home. If you have issues with Internet connectivity back home, call your Internet provider for support. Memory Problems - yours, not the computer s The biggest problem most of our Veterans face when trying to master technology is not vision loss; it s normal learning difficulties associated with aging. Unfortunately, people need to carry out a series of steps to do anything useful on a computer outside of pulling the plug. And the bad thing about having to carry out a series of steps is having to remember them all in the correct order -- once your instructor is out of the room and the instruction book is closed and it s just you and the computer. If you think that s bad, try remembering it all when you re back home and it s been weeks since you last met with your instructor. If you have trouble remembering a series of steps to complete a task, we will do everything we can to help. But eventually you will have to remember those steps if you re going to use a computer at home successfully. Step-by-step written instructions can only take you so far. At some point you re going to have to be able to problem solve when something pops up or doesn t work the way you thought it should. Some Veterans struggle to master a computer and become frustrated when they run into difficulties caused by memory loss rather than vision loss. They might have been happier watching the news on TV than searching for it on a computer and calling friends and loved ones on the phone rather than using , but now they ve invested themselves in this stupid machine and they don t want to fail. We often see Veterans struggle so hard to learn to use a computer that all other aspects of their rehabilitation program fade away and all they think about is that computer. And dynamite. In such cases the computer becomes a hindrance to increased independence, not an aid. It can also become a health issue as tension and frustration mount. We ask you to focus on your overall independence while you are here and not confuse successful rehabilitation or even your own sense of self-worth -- with mastering a particular piece of technology. While computers and gizmos can be great fun, they are not the focus of your rehabilitation program you are. ipads, iphones, and iwantones

13 The VA has recently started to teach touch screen mobile devices such as Apple s ipad and iphone. These devices can represent a breakthrough in accessibility and ease of use, and we will consider them when we look at your technology needs. There are some prerequisites for their use, however. If you are going to rely on the device to speak to you to read the screen, you must be able to hear and understand its synthesized voice. If you are going to use your remaining vision to read using the device, you have to be able to live with its limited screen size and deal with all the scrolling you might have to do. Finally, you must have the finger dexterity to handle one, two and three finger gestures needed to control the device. Three other conditions have been met before we can issue any equipment: 1. The equipment must help you overcome specific challenges to your independence due to vision loss. 2. Assessment of your needs must demonstrate that the equipment represents the best tool for the job. 3. There is documentation that you have been successfully trained by qualified staff to use and care for the equipment in pursuit of your goals. Technical Support The training we provide and the equipment we issue is meant to get you started or return you to using technology for basic communication needs. We cannot provide advanced application training or a lifetime repair, helpdesk, and upgrade service. Once you are up and running with the appropriate accessibility options, we ask that you step up and meet your day-to-day support needs through your warranty provider or through your local community, the same as any other person would do. Our whole mission is to support your independence, after all. If your accessibility needs change, we can readmit you to look at new options, but all offers of admission are contingent on rehabilitation goals, not desires for new equipment. Internet services and home networks are always the Veteran s responsibility from the get go. Call your Internet Service Provider (ISP) for resolution of any difficulties with them. We cannot and will not assume responsibility for your Internet service or your router or home network. This

14 includes problems connecting to networked or wireless printers, even if we gave you the printer. We can repair or replace defective printers, but not defective connections. Warranty vendors will be contracted to provide two years of support for technology we issue to you. You should call them rather than the VA when you have an issue. We will place their contact information prominently on the equipment. Keep in mind that there is often a maximum of 5 support incidents within that 2 year support contract, so use those incidents wisely and identify a family member, friend, neighbor or computer repair specialist to help with small, day-to-day issues. Your VIST Coordinator can arrange for additional service tickets with your warranty vendor beyond those five incidents in two years when necessary but neither your VIST Coordinator nor your BROS is a support tech. They need to spend their time serving the rehabilitation needs of visually impaired Veterans, not fixing computers. If you rack up an extraordinary amount of support tickets over the years, we will have to reassess your ability to handle technology equipment independently if you return to us with new technology goals. Recreation Recreation activities are offered for your enjoyment throughout your program as part of your leisure skills classes. Other recreational activities are offered throughout the work week, in the evenings and occasionally on weekends. All recreational activities outside of normal class hours are voluntary. We ask that you participate in leisure skills class at least one hour a day while school is in session to help you practice the low vision and other skills you are re-acquiring in a fun way and to help you relax and refocus. If you are taking computer instruction, we insist. American Lake Blind Center sits on a beautiful, 368-acre lakeside campus offering nature walks, golfing, fishing, gym and other recreational facilities on site and available to our students. We also offer trips into the

15 community for bowling, major league baseball, Blinded Veterans Association luncheons, concerts, and other events. We have partnered with the volunteers over at the American Lake Golf Course to offer our Veterans one-on-one golf lessons, many opportunities to play, and an outpatient golf club to carry on with golf once they graduate. So whether you re new to golfing or have many years experience, we have something to offer you. Leisure skills are part of every plan of care and adaptive table games, video games, walks, exercise classes, and other activities are offered on an individual and group basis to meet your preferences and needs. Adjustment to Sight Loss Counseling is available for each Veteran who enters the program. This can be especially important with a recent loss of vision, or severe medical problems. Counseling is provided by our consulting psychologist or staff social worker. There is a weekly group session which allows each person to share his or her concerns regarding blindness. Family Training Program Family training may be part of your program if you and your treatment team deem it appropriate. We will answer questions about your vision loss and familiarize family members or friends with your newly reacquired skills and abilities so that they feel more comfortable when you try to do use these things on your own back home. You may also want us to clarify any areas where you will still need help and how that help can best be given. We will try arrange family training on days when your family or friends are already planning to be here whether to pick you up to go out on weekend pass, to attend your graduation ceremony, or to drive you home at the end of training. We regret that we no longer have on-going funds to support family training costs such as travel, lodging and meals. We can ask for funding on a case-by-case basis, but we cannot guarantee that a family

16 training program that requires an overnight stay will be part of your program. Blind Rehabilitation Outpatient Specialists (BROS) may be called upon to provide family training in your home area for the convenience of the family or in order to show the family the skills learned in the setting they will be used. We have four BROS in the northwest in Seattle, Tacoma, Portland and Spokane. All four occasionally go outside their normal areas to visit Veterans at sites that do not have their own BROS. If you have had previous blind rehabilitation experience, your family is probably already aware of what to expect. Family training may not be indicated. Nursing and Health Care R.N. or L.P.N. nursing coverage is provided twenty four hours per day. Many Veterans who enter our program have concomitant medical problems which greatly inhibit their ability to live independently. Our nursing staff provide training which can allow a Veteran to administer his or her own medications and other health maintenance activities. In addition, education regarding medical problems such as diabetes, chronic lung disease, coronary artery disease, etc., is provided on a one to one basis. A primary nurse is assigned to each student. Your primary nurse and the Nurse Manager will coordinate all aspects of any medical needs you many require while in the program. Your primary nurse will also reinforce your self-care skills and promote sufficient wellness and health maintenance. Team Coordinator All students are assigned Coordinators upon admission. The Coordinator is a blind rehabilitation instructor who will meet with you daily to make sure your needs, expectations, and training goals are being met. Your Coordinator will try to call you several days before you come to get to know you. He or she will provide you with your weekly schedule and a list of your instructors. You should inform your Coordinator if your program needs to be changed or if you will need to go on pass.

17 The First Couple of Days You are not expected to arrive in time for your first regularly scheduled class on the day of admission. While you may get to one or two classes that first day, much of your day will be spent in initial program orientation and assessment. You will have a nursing assessment and within 24 hours a physical exam, which will include lab work, when you enter the program. The dietitian, optometrist, chaplain, and team coordinator will also see you during your first few days here. We will also sit down with you informally after lunch on your second day so that you can meet the entire team and we can get to know one another. Classes are on a scheduled basis very much like school. Until you are able to locate your classrooms your instructors will meet you in your room at the beginning of each class. Weekday Schedule Wake-up is between 6:30 and 7:00 a.m. You are responsible for making your bed and keeping your room neat and secure Breakfast is served between 7:00 and 7:30 a.m. Lunch is served at noon. Dinner is served at 5:30 p.m. Morning class times are on the hour and last 50 minutes. They begin at 8 am and run through lunch at noon. All students get an hour and a half off at midday and classes resume at 1:30 pm and run up to 3:30 pm. Classes may be doubled for those who need longer stretches in a particular subject or halved if 50 minutes is too long a stretch. Assessment By the time you arrive, you and we both should have some idea of what you want to study. Your VIST Coordinator can help you identify goals. If you have a BROS or a low vision clinic in your area, they may help you address some of your initial goals and perhaps identify more goals you want to work on while here. We will have access to all that information and will use it in helping you develop your treatment plan. Your instructors will spend the first several classes going over the goals you ve listed and

18 checking your current level of independence. They will also make you aware of other skills you may want to address. Our Veterans come to us from many backgrounds and bring work and life experiences that enrich us and their classmates while they are here. We have had physicians, engineers, educators, craftsmen, businessmen, career soldiers, active duty service members, executives, mechanics, authors, musicians, and many Veterans from other professions. So it can come as a shock when we assess your current needs and ask you to perform simple everyday tasks such as return to a particular location in the building, write a short note, measure the length of something and so on. We are not discounting your life experiences or insulting your intelligence; we are trying to understand your current visual, manual, and mobility functioning given your vision loss and current health status. Bear with us. If we just ask how things are going rather than ask to witness it, sometimes people are more aware of how they used to do something than how they are doing now. Treatment and Discharge Planning Our team of instructors will sit down with you once a week beginning on your second day here and together we will formulate a treatment plan based upon the goals and needs you come to tackle and those you discover through the assessment process. One of your instructors will be appointed to coordinate your care and make sure things happen as planned. We will estimate a discharge date as soon as we have a full picture of the scope of your needs and our ability to address them. You and the team will jointly decide if family training is indicated or not. We will help you plan for your transition back to the community and make referrals to your local VA and other agencies as appropriate. You may have a representative join you for a team meeting if you wish a family member, friend, counselor whomever you feel appropriate. After your weekly meeting with the team your Coordinator will provide you with a updated copy of your plan, showing your progress, prosthetic aids issued or ordered, and added or deleted goals. If you require an audio version of your updated treatment plan, he or she will be happy to tape it for you. Patient Satisfaction and Outcomes American Lake Blind Rehabilitation Center staff are dedicated to providing you quality services. At graduation ceremonies, at annual reunions, during

19 follow-up office visits, and on patient satisfaction surveys our Veterans let us know that they were truly amazed by the warm, personal attention they received from every member of the staff. For two years from 2008 through 2010 we called our graduates a month after graduation to ask them to grade their satisfaction with 10 key elements of their care using standard letter grades. Month after month, year after year we maintained a 3.9 GPA. 97% of our graduates say they have met their goals. 95% report positive changes in their quality of life as a result of their training at American Lake Blind Rehabilitation Center. In Fiscal Year 2010 which ended September 30, 2010, we asked each of our students to identify their goals for training from a list of 125 separate possible skills in our curriculum. Most of our students chose between 20 and 35 items to work on. Here are the top 25 most requested skills in descending order: Read at length using optical aids Read at length using electronic aids Learn to use my remaining vision better Gain an overview of adaptive computers Watch TV using low vision aids Read labels and price tags Use low vision aids for handiwork Read signs using low vision aids Browse the Internet Write notes, fill in forms & sign name Use Scan and listen to documents Use a tape measure Routine computer maintenance Simple computer troubleshooting Manage personal information on computer Eating out Write and edit documents Leathercrafts Maintain and manage files & resources Cross streets & get around downtown Access pictures, movies or music Make phone calls

20 Woodworking Measure ingredients We asked our students to rate their independence before admission and again a month following discharge. They were to measure their independence performing these goals on a 5 point scale: 1 I cannot perform this task 2 I need lots of assistance 3 I need some assistance 4 I am independent in everyday circumstances 5 I am independent in all circumstances Their average self score across all goals before training was 2.6 somewhere between needing lots of assistance and needing some assistance. A month following discharge, their average score was 4.0, indicating they were independent on the vast majority of their goals. Pass Policy The main purpose of our program is to help Veterans maximize their level of personal independence. To that end we encourage our students to use their independence skills and to participate in community and family activities. Staff will help you assess your potential travel risks and show you methods to minimize risks. You need to let your team coordinator, instructors, and nurse on duty know if you plan to go out on pass during the evening or on the weekend. We need to be aware of where you are and how to get a hold of you because we want to do all we can to ensure your safety while away from our care. Your instructors will want to know your plans because we may loan you prosthetic equipment or ask that you practice certain skills based upon what you are going to do say go to a ball game or a movie or go out to eat with the guys. Weekend passes should be requested by the prior Wednesday if at all possible. If you have any difficulty returning as scheduled, you should contact the nurse s station at

21 Library &Talking Books Talking book players and talking books are available for check out at the Library. Your instructors will assist you with this process. Your living skills instructor can also teach you how to use the tape player. As talking books are completed, you are encouraged to return them to the library. The day before your discharge you will be asked to return all books and the player to the library. Accommodations The blind center is housed in Building 5. There are eleven single bedrooms for our students. One bedroom has a private bath and shower to accommodate female patients. Several others share a bathroom with the adjoining bedroom. There is a communal bathroom and shower in the patient wing as well as a dayroom, nursing station, and laundry room. There are no TVs in the bedrooms. We want our students to get out of their rooms in the evening and interact with their fellow students. Getting to know other visually impaired Veterans and learning that you are not alone is often the most valuable part of the program. Mail Mail should be sent to: Your Name Your Room Number American Lake Blind Rehabilitation Center (A-112 BRC) VA Puget Sound Health Care System Tacoma, WA Telephones Your room telephone allows you to make and receive phone calls. Your telephone is hearing aid compatible, which allows you to control the volume. We are not authorized to offer long distance calling, however, you may purchase calling cards at the retail store. In cases of emergency, staff will help you place a call using office telephones. Classes run between 8:00 a.m. and 4:00 p.m., please arrange for incoming calls after 4:00 p.m.

22 Emergency Calls Emergency calls are received at the nurse s station 24 hours a day at The Administrative Officer can answer emergency calls Monday-Friday 8:00 a.m. to 4:00 p.m. at Visiting Hours Visitors are discouraged from being at the blind center during class time unless invited to participate in family training. Special arrangements may be made through your team coordinator, if necessary. Weekday visiting hours are 4:30 p.m. until 8:00 p.m. Weekend and holiday visiting hours are 9:00 a.m. to 8:00 p.m. Dress Code We suggest casual and comfortable attire. Well-fitting walking shoes or sneakers are recommended. Sandals other than for use walking to the showers are discouraged for safety reasons. We do expect you to be neat and clean while you are in the program, and we prefer you honor the rest of your Scout oath too. Laundry Facilities A washer and dryer are available at the blind center. There is no charge for these machines. Your living skills instructor will provide instruction in the use of the machines. Laundry soap is provided. You should bring enough clothes to last you a week between washings. Meals Meals are served cafeteria style at the dining hall, and they re good, according to 96% of our graduates between 2008 and Past performance should not be taken as a guarantee of future results. Our dietitian will work with you to identify any special dietary needs you may have. Should you be unable to go to the dining hall, a meal tray can be brought to you at the blind center. At times inclement weather or construction may hinder safe passage to the dining hall and all Veterans will be served meals in our day room. Meals served in the day room are

23 less good. You don t get to pick and the trays were carted over through inclement weather, so the temperature s not always just so. Hand Washing In order to prevent the spread of infection, we require that each student wash his or her hands carefully before and after meals, after using the restrooms and between classes. In the event of a water utility failure, waterless hand cleanser dispensers are located throughout the blind center. Staff members are required to wash their hands between every patient contact. Don t be embarrassed to ask your instructors and nurses to wash their hands when entering your room. We take hand washing very seriously and ask you to let the Nurse Manager or the Program Director know if you notice anything amiss. Security We recommend that you secure valuable personal items or money at all times. Each room has a locking cabinet that can be used to store your valuables. It is critical, though, that you understand that your personal belongings are your responsibility. Please keep them safe. Money All your meals and your room are taken care of, so any money you choose to bring is only for things you may want at the canteen store, such as personal incidentals, or for outings in the community. We recommend that you carry no more than $20.00 with you. There is a 24 hour cash machine on the medical center campus and several in town in the areas where we practice orientation & mobility skills. You may also choose to open an account with the Agent Cashier but we recommend using the on-station ATM for your convenience because it is always available. Your team coordinator or your Orientation & Mobility instructor can assist you with this. Smoking This Medical Center is a smoke free facility. [Tobacco] smoking is allowed only in the smoking shelter located across the drive from the blind center, or 50 feet away from entrances to the building. If requested, we will orient you to the location of the smoking shelter. Smoking is not permitted indoors and may result in discharge from the program.

24 Fire Safety & Emergency Drills In case of fire, smoke alarm or other emergencies, staff will instruct and assist students with exiting the building and meeting in a designated spot. Drills may be held during your stay with us and emergency evacuation is part of every student s orientation. Prohibited Items The following items are not permitted in the building or on VA grounds: alcohol, illegal drugs, firearms, or other weapons. Pocket knives are considered weapons and will be confiscated and held by nurses until discharge. Any violations will be grounds for discharge. Dog Guides Please tell us if you plan to bring a certified service animal so that we are prepared to accommodate you both in a suitably-sized room. A pet is not a service animal even if you buy him a vest that says so. If you have not undergone appropriate training by an accredited school and received the animal through that program, we cannot allow you to shelter the animal in our hospital building to protect the rights and safety of other patients. The grounds behind Building 5 can be used as a service animal relief area. It will be the responsibility of the user to clean up after the service animal. Code of Conduct All students and staff of the American Lake Blind Rehabilitation Center are expected to conduct themselves to socially acceptable standards. We must treat each other with dignity and respect at all times. Aggressiveness or inappropriate behavior for any reason will not be tolerated and may result in immediate discharge (see Patient Rights and Responsibilities below). Religious Support A chaplain is available for visits. Your Team coordinator or nursing staff can assist you in arranging a visit. We will make every reasonable effort to contact the specific clergy of your choice. Some specific services offered include: Support and encouragement during your rehabilitation program

25 Confidential pastoral discussion of personal or family issues Worship services in the chapel Assistance in observing specific holidays and rituals Pastoral and spiritual counseling A chaplain will meet with you when you first come into the program. The chapel is located on campus. Non-Denominational Protestant services are held at 10 a.m. on Sundays. Catholic mass is held at 8:30 a.m. on Sundays and at 4:30 on Mondays, Thursdays and Fridays. Patients may make arrangements to attend other services in the community. Retail Store/Canteen The Retail Store and Canteen are located in Building 132. The store carries a variety of items including personal care, cards, snacks, soft drinks, clothing, batteries, electronics and seasonal items. Hours of operation are 9:00 a.m. to 4:00 p.m., Monday through Friday. The canteen serves breakfast and lunch. Hours of operation are 7:00 a.m. to 3:30 p.m., Monday through Friday. Your orientation and mobility Instructor will familiarize you to this area. An ATM is located near the Canteen. A barbershop is located in the Canteen and is open 8:00 a.m. to 3:00 p.m.

26 Driving Directions From I-5 take the Gravelly Lake Drive exit which is Exit 124. Going Northbound I-5, make a left turn onto Gravelly Lake Drive and go over the freeway. Going Southbound I-5, make a right turn onto Gravelly Lake Drive. Proceed on Gravelly Lake Drive for about one mile. Make a left turn onto Veterans Drive at the stoplight. This will take you into the VA. When you enter the VA grounds you will drive past our golf course and pass a speed bump and the Police Station on your right; then turn left onto Custis Way (the lake will be on your left). Go to the end of Custis Way, which terminates in a cul-de-sac. Blind Rehab is in Building 5 on the left (lake side). Short term parking is available in front of the building. You will need to stop inside and get a signed parking permit in order to use the parking space. Again, the Blind Rehab s phone number is (253)