Imagine you are working in a state mental hospital with individuals diagnosed with severe and profound intellectual disability. Besides significant cognitive and adaptive skill limitations many of these individuals may also have multiple physical and sensory impairments. Those most impaired are likely totally dependent upon others for their care.

What are some important issues to consider when working with people with a high degree of impairment'? What kinds of things do you need to consider to be sure you are respecting the dignity of those for whom you care'?