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My mom is 92 years old, mentally healthy with ‘lite’ dementia. She is 90% deaf. We always used white boards to communicate with her. Now her macular degeneration is in full force and she is losing her sight. She broke her hip 3 years ago so she is in a wheel chair but able to get to the bathroom by herself and has PT where they walk her with a gait belt and her walker, to keep her as mobile as possible for bathroom independence. She lives in a really good nursing home and I am retired, so I spend lots of time with her.

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Maybe teach her the habit of trailing along the wall, her hand going along the railing most people use to hold onto as they walk. This way she will learn to recognize and "feel" where she is while in the wheelchair. Practice doing the exact same sequence each time she goes to a place, for example, bathroom, dining, tv room, she will begin to recognize the route. You can also tap on her shoulder each time she goes past a door. For example, if there are 4 doors to the dining area, each time she passes the door tap her shoulder.
Sometimes it's actually easier to not get as confused about visual input if it is diffusely lit than half lit or too bright making a glare. Play around with it. Mind that she is not mobile alone when you have the room dark. Usually, late afternoon western light coming in from a window brings the most glare. Try to stay away from shiny reflective surfaces.
Tv shows that have slower tracking for the eyes are easier to watch and take in information. Sometimes the visual stimulation can be on overdrive because she is having to work hard to take in all her surroundings.
Keep decor simple and contrasting. It is easier to concentrate and focus what is in front when there is less going on in the room. Although she is mostly deaf, the combination of tv and someone talking can be confusing visually and auditorily to process.
There are many items that use vibration instead of light or sound.
See if these help for various needs:
bump dots with bold colors
vibrating watch
xl silicone mat in vibrant color you can cut into shape to fit tray on bed or wheelchair so she can distinguish items on her tray versus the floor of bed linens next to it.
Velcro solid-colored small plastic containers all the same color to a contrasting silicone mat to store different things. This way they do not slide off the tray and easier to see. Make sure to keep a large space of colored mat between containers to separate them with large color contrast.
Have a button made with large bright with contrasting colors smiley face of puff paint for aides to wear so she recognizes safe people and can run her fingers across. Because it is difficult to see people's faces the touch of the smiley face will make her feel at ease.
Family members can wear light organic cologne or perfume. Run of the mill perfumes are often too strong for people who use the sense of smell to distinguish the surroundings. Each person can have a dedicated scent and she will recognize you and perhaps remember you better, especially if you start using it before she gets far along in her dementia.
These things give her a sense of familiarity now that her 2 main senses are beginning to fail.
Make a small snuggle lap blanket from fabrics from home of things familiar to her . Think of colors, textures, smells of fabric items from her past to comfort her. As she progresses, she can use it for comfort to rub when she is out in open places, to help ground her.
Use your fingers to draw picture of nouns on her hand or thigh . For example, a heart, a smile.
Write her very short messages in bold puff paint and bring it along on contrasting corrugated stiff board so she can trace the question or letter you want to convey.
EAT WATER COLD HOT
Mold her hand to the shape of sign language "eat" and place her hands like that to her mouth to let her know dinner or food is ready to eat. Suddenly placing a fork or spoon to her mouth can be startling.
Often verbal communication is used to try to convey a feeling or uncomfortable ness. When the surroundings are easier to interpret, then there is less confusion and communication needed to correct something that is bothering her. This way she can enjoy and relax more focusing on you and what you want to communicate to her.
Sometimes people think that if they speak as LOUD as possible the person who is hearing impaired will hear it better. Something I have noticed is when one speaks low ( deeper tone voice) and slow I have better success.
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BarbaraR: Per her retinologist, my late mother had the worst ever case of wet Macular Degeneration that he had ever seen. However, she overcame her disability by the following various methods: She had a magnifying machine (large) from the COB (Commissioner of the Blind) that enabled her to write checks, address cards and read newprint, she also was given from the COB a device with prongs that went into a teacup and had an audio alert if she poured hot water too high in the cup, she had a large screen television, she had large print mags and blank checks, I made her address labels and writing paper that were in bold print, which is best for an individual with wet Macular Degeneration and even more assists. My mother was also quite hearing impaired.
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There are low vision assists available. My Papa was in the same situation, he was prescribed monucular glasses. It helped vision in one eye. It came with attachments that screwed on - one was for reading, one was for computer work and one was for watching TV.

It took a bit to get use to (he was 93), but he was able to see much better. My advice would be to check it out sooner rather than later. It will be easier to adapt with some vision left.
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With macular degeneration, she will lose her central vision but retain vision on the periphery (edges of her visual fields). It might be a good idea to start spelling into her hand like Helen Keller did with her teacher Annie Sullivan.
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Let's not forget that Helen Keller was around 7 years old when she met Anne Sullivan. Thus, could quickly learn spell lettering with her hands.

The original post's mother is 92 years old, thus spell lettering would be difficult as her sense of feel would be lessen.
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Why don't you read up on Hellen Keller and the communication process that her teacher taught her to spell letters with her hands instead of visual cues. It's a fascinating process taught to her by Anne Sullivan.
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When the time on earth is coming to an end, all the lights begin to be turned off, one by one. Your mother was fortunate to maintain the light of her brain lighted, but the others are being shut down. With hearing and sight gone, communication will become a humongous problem. The only senses left will be smell, touch and taste. Communicating with those senses is the only alternative. I'm sorry I can't give you any suggestions.
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Someone in another post had suggested looking for tactile experiences. Could you make a unique kind of taggie blanket so each tag represents a specific meaning? Maybe have one with plastic foods? Maybe use puffy paint or embroider words?

Can you smuggle a cat or dog in for a visit?
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I'm not sure if she's a candidate for hearing amplifiers or not:

https://aginginplace.org/hearing-aids/best-hearing-amplifiers

You don't need to be tested or have them prescribed, they're more like earbuds, bigger, easier to adapt to, mostly under $175, so not a huge financial risk if she doesn't use them.
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I understand that there is good support for vision problems from the government. I would check with your state's department of health. You need someone with specific experience
in this area. As a 78 year old person with both of these problems beginning, I am very curious about what you learn. You just reminded me that now is the time to start myself. Good luck!
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https://www.scie.org.uk/dementia/living-with-dementia/sensory-loss/deafblind.asp

This gives some helpful basic advice. It’s not easy. Sending good wishes.
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BarbaraR, yes, my own Mom also had lost most of her hearing, and also had macular degeneration, and was also in her 90's with mild dementia.

Communication wasn't easy. I had to yell trying different words for a subject matter. Once she knew what was the subject she could talk about it, even thought most of the time it wasn't what we were trying to ask her. Mom tried every hearing aid on the planet. Dad said an old fashioned ear horn would work just as well. We never tried that.

As for my Mom's vision. She could see a bit out of the corner of her eyes, since macular degeneration tends to cloud the front of vision. Mom found using a flashlight helped somewhat so she could try to read. I found it interesting how tiny Mom would write compared to her normal penmanship. My Dad did the same thing.

One important thing, don't move anything out of place. My Mom had a good memory of where everything was in the house. Whenever I would get groceries, Mom would quickly put the items away before Dad got his hands on the stuff.
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Find out if she is a candidate for a cochlear implant!
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You might consider Braille, but I'm not sure how to communicate given that your mom is almost deaf.  However, remember Helen Keller.   These days, there are also computer assists but I don't have any idea how they work.

I would contact some nonprofit deaf and blind organizations; they might be the best source of information.

Your mother sounds like a strong person.   Good luck; I hope you find some assistance.
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