Annual Report - Independent Living Services For Older Individuals Who Are Blind

RSA-7-OB for Services for the Blind, Vocational Rehabilitation Program - H177B110007 report through September 30, 2011

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year384,670
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year195,797
Other federal grant carryover from previous year39,969
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2389,586
A2. Total other federal39,969
(a) Title VII-Chapter 1-Part B14,935
(b) SSA reimbursement2,289
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other22,745
A3. State (excluding in-kind)749,223
A4. Third party0
A5. In-kind0
A6. Total Matching Funds749,223
A7. Total All Funds Expended1,178,778
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs389,535
C. Total expenditures and encumbrances for direct program services789,243

Part II: Staffing

FTE (full time equivalent) is based upon a 40-hour workweek or 2080 hours per year.

A. Full-time Equivalent (FTE)

Program Staff a) Administrative and Support b) Direct Service c) Total
1. FTE State Agency 5.6500 8.5000 14.1500
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 5.6500 8.5000 14.1500

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 5 3.0000
2. Employees with Blindness Age 55 and Older 2 1.2500
3. Employees who are Racial/Ethnic Minorities 4 2.2500
4. Employees who are Women 7 4.0000
5. Employees Age 55 and Older 1 0.9400

C. Volunteers

1.00

Part III: Data on Individuals Served

Provide data in each of the categories below related to the number of individuals for whom one or more services were provided during the reported fiscal year.

A. Individuals Served

1. Number of individuals who began receiving services in the previous FY and continued to receive services in the reported FY212
2. Number of individuals who began receiving services in the reported FY635
3. Total individuals served during the reported fiscal year (A1 + A2) 847

B. Age

1. 55-5940
2. 60-6430
3. 65-6948
4. 70-7470
5. 75-7997
6. 80-84140
7. 85-89210
8. 90-94151
9. 95-9953
10. 100 & over8
11. Total (must agree with A3)847

C. Gender

1. Female570
2. Male277
3. Total (must agree with A3)847

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race35
2. American Indian or Alaska Native0
3. Asian2
4. Black or African American59
5. Native Hawaiian or Other Pacific Islander0
6. White750
7. Two or more races1
8. Race and ethnicity unknown (only if consumer refuses to identify)0
9. Total (must agree with A3)847

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)36
2. Legally Blind (excluding totally blind)792
3. Severe Visual Impairment19
4. Total (must agree with A3)847

F. Major Cause of Visual Impairment

1. Macular Degeneration587
2. Diabetic Retinopathy61
3. Glaucoma74
4. Cataracts2
5. Other123
6. Total (must agree with A3)847

G. Other Age-Related Impairments

1. Hearing Impairment247
2. Diabetes184
3. Cardiovascular Disease and Strokes493
4. Cancer44
5. Bone, Muscle, Skin, Joint, and Movement Disorders390
6. Alzheimer's Disease/Cognitive Impairment35
7. Depression/Mood Disorder44
8. Other Major Geriatric Concerns305

H. Type of Residence

1. Private residence (house or apartment)734
2. Senior Living/Retirement Community11
3. Assisted Living Facility59
4. Nursing Home/Long-term Care facility43
5. Homeless0
6. Total (must agree with A3)847

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)535
2. Physician/medical provider20
3. State VR agency15
4. Government or Social Service Agency16
5. Veterans Administration0
6. Senior Center2
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center0
11. Family member or friend82
12. Self-referral177
13. Other0
14. Total (must agree with A3)847

Part IV: Types of Services Provided and Resources Allocated

Provide data related to the number of older individuals who are blind receiving each type of service and resources committed to each type of service.

A. Clinical/functional vision assessments and services

Cost Persons Served
1a. Total Cost from VII-2 funds 22,711
1b. Total Cost from other funds 264
2. Vision screening / vision examination / low vision evaluation 78
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 3

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 33,645
1b. Total Cost from other funds 81,659
2. Provision of assistive technology devices and aids 681
3. Provision of assistive technology services 29

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 125,674
1b. Total Cost from other funds 498,564
2. Orientation and Mobility training 295
3. Communication skills 369
4. Daily living skills 486
5. Supportive services (reader services, transportation, personal 13
6. Advocacy training and support networks 9
7. Counseling (peer, individual and group) 295
8. Information, referral and community integration 361
. Other IL services 343

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 0
1b. Total Cost from other funds 0
2. Information and Referral 0
3. Community Awareness: Events/Activities 46 800

Part V: Comparison of Prior Year Activities to Current Reported Year

A. Activity

a) Prior Year b) Reported FY c) Change ( + / - )
1. Program Cost (all sources) 1,584,370 1,178,778 -405,592
2. Number of Individuals Served 1,293 847 -446
3. Number of Minority Individuals Served 156 97 -59
4. Number of Community Awareness Activities 33 46 13
5. Number of Collaborating agencies and organizations 37 38 1
6. Number of Sub-grantees 0 0

Part VI: Program Outcomes/Performance Measures

Provide the following data for each of the performance measures below. This will assist RSA in reporting results and outcomes related to the program.

Number of persons Percent of persons
A1. Number of individuals receiving AT (assistive technology) services and training 29 100.00%
A2. Number of individuals receiving AT (assistive technology) services and training who maintained or improved functional abilities that were previously lost or diminished as a result of vision loss. (closed/inactive cases only) 1 3.45%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 28 96.55%
B1. Number of individuals who received orientation and mobility (O & M) services 295 100.00%
B2. Of those receiving orientation and mobility (O & M) services, the number of individuals who experienced functional gains or maintained their ability to travel safely and independently in their residence and/or community environment as a result of services. (closed/inactive cases only) 69 23.39%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 201 68.14%
C1. Number of individuals who received communication skills training 369 100.00%
C2. Of those receiving communication skills training, the number of individuals who gained or maintained their functional abilities as a result of services they received. (Closed/inactive cases only) 82 22.22%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 249 67.48%
D1. Number of individuals who received daily living skills training 486 100.00%
D2. Number of individuals that experienced functional gains or successfully restored or maintained their functional ability to engage in their customary daily life activities as a result of services or training in personal management and daily living skills. (closed/inactive cases only) 93 19.14%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 373 76.75%
E1. Number of individuals served who reported feeling that they are in greater control and are more confident in their ability to maintain their current living situation as a result of services they received. (closed/inactive cases only) 107 n/a
E2. Number of individuals served who reported feeling that they have less control and confidence in their ability to maintain their current living situation as a result of services they received. (closed/inactive cases only) 3 n/a
E3. Number of individuals served who reported no change in their feelings of control and confidence in their ability to maintain their current living situation as a result of services they received. (closed/inactive cases only) 20 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 3 n/a
E5. Number of individuals served who died before achieving functional gain or experiencing changes in lifestyle as a result of services they received. (closed/inactive cases only) 239 n/a

Part VII: Narrative

A. Briefly describe the agency's method of implementation for the Title VII-Chapter 2 program (i.e. in-house, through sub-grantees/contractors, or a combination) incorporating outreach efforts to reach underserved and/or unserved populations. Please list all sub-grantees/contractors.

Connecticut’s Chapter 2 program is administered by the Board of Education and Services for the Blind (BESB) recently consolidated with four other agencies into a new agency, the Bureau of Rehabilitative Services. BESB remains a separate program within the new BRS agency, and remains DSU for both the VR and Chapter 2 program for individuals who are legally blind.

The agency is primarily an in-house program in terms of administration of the V-II program and delivery of vision related rehabilitation services and independent living services including social work services, rehabilitation teaching, orientation and mobility training, advocacy, and low vision services. The agency uses vendors that are on state contract to provide adaptive equipment and training, and low vision services provided by qualified eye doctors.

BESB conducts outreach activities to promote awareness of BESB services to seniors through a variety of venues including periodic mailings to eye doctors to promote understanding of their legal obligation to report all patients who are legally blind to BESB. The agency also publishes a calendar that is sent to consumers and other individuals in accessible formats.

The agency also utilizes a web based volunteer match system to recruit volunteers to work as senior companions to our older blind population, providing reading, shopping and transportation, and companionship activities.

The agency participated in various community outreach activities including senior health fairs, assisted living facilities and retirement communities, and other community events to promote awareness of BESB services to seniors.

B. Briefly describe any activities designed to expand or improve services including collaborative activities or community awareness; and efforts to incorporate new methods and approaches developed by the program into the State Plan for Independent Living (SPIL) under Section 704.

BESB continues to collaborate with organizations and agencies throughout the state in an effort to improve services to older blind adults. Of particular note is the continued collaboration between BESB, the Department of Social Services, Area Agencies on Aging, the State Independent Living Council, and the Centers for Independent Living on various initiatives.

BESB continues to train new Transition Coordinators on a quarterly basis. Transition Coordinators are case managers responsible for transitioning adults from nursing homes to community based living through the Money Follows the Person waiver initiative administered by CMS/DSS. BESB’s independent living staff including social workers, orientation and mobility instructors, rehabilitation teachers, and advocate(s) from BESB have actively collaborated with DSS and private providers to transition blind individuals to the community.

This past year BESB also assisted in the training of 12 new Aging and Disability Resource Counselors on blindness related issues, BESB and other community based services. The primary purpose of the ADRC initiative administered by DSS’s Aging Division is to provide information on long term care options to consumes and the general public as a means of deterring older adults from nursing homes. Participants in the ARDC training received an overview of eligibilty for BESB and other community based services, and demonstration of sighted guide instruction, long cane travel, independent living aids and equipment including CCTV’s, and a resource manual.

BESB also collaborated this past year with CT’s State Independent Living Council and CT’s Centers for Independent Living on various activities including a computer training initiative to facilitate the access of blind individuals and other individuals with disabilities to computer equipment and training. The CILs were funded with Part B funding by the SILC/BRS for purchase of computers loaded with adaptive computer software (i.e. Zoom Text, GUIDE, etc.) and other adaptive equipment.

In FFY 2012 BESB Rehabilitation Technologists and private vendors will collaborate to provide develop and implement computer technology training to CIL staff so that consumers can access computers at CILs. BESB will also collaborate with the CILs to provide community outreach activities to promote awareness of the project on a statewide basis. This collaboration builds on a prior pilot computer training initiative by BESB in collaboration with CILS and private vendors to train older adults who are blind to use GUIDE, a simple software designed for individuals who are visually impaired or have acquired brain injury to access the web and email.

In addition, BESB co-sponsored a Tech Fair at the Baldwin Senior Center with the Disability Resource Center of Fairfield County and NEAT Marketplace to demonstrate adaptive equipment and technology to seniors with vision loss including digital tape recorders, computer technology, closed circuit television viewers, scanning and reading systems, etc. These projects will help to reduce the "digital divide" that exists between the general population and seniors, particularly seniors with disabilities including blindness.

BESB’s orientation and mobility instructors also also provided training to Fidelco, a local guide dog organization, and severl trainings to CT transit bus drivers. These trainings were designed to ensure that individuals who are blind are treated with dignity and respect, as well as ensure that blind individuals including older adults are able to access the system safely.

Community awareness outreach activities by BESB were also targeted to senior venues including senor health fairs, retirement communities, and assisted living facilities. BESB O & M and RT staff also provided training to nursing homes to ensure that staff of nursing homes to ensure that clients can travel safely in the facility, are treated with dignity and respect, provide adaptive equipment and improved access to meals, social and recreation activities, etc.

Finally the agency has participated in several trainings and events for private providers acknowledging the fact that our clients often have other disabilities in addition to legal blindness. This past year BESB collaborated with the Communication Advocacy Network to train 20 new SSP’s on deaf-blindness issues and services. In addition BESB staff trained staff that work with clients who have psychiatric disabilities in a residential setting.

C. Briefly summarize results from any of the most recent evaluations or satisfaction surveys conducted for your program and attach a copy of applicable reports.

BESB continues to rely upon the agency’s annual consumer satisfaction survey as the primary means of gathering performance measures for the 7OB report.

The agency’s database (System 7 - Libera) has not yet been modified to gather performance measures, including pre and post test measures that could be answered by staff including case managers, and instructors. The results of the survey can be found in the performance measures section of the 7OB report.

The consumer satisfaction survey data was gathered primarily by agency volunteers. There are problems with this method, but most of the problems are not related to staffing or training issues. This past year a total of 345 consumers whose cases had been closed or completed on the data base (i.e. all goals achieved) were contacted by volunteers via telephone. Of this pool, 155 completed the survey but 190 did not participate for a variety of reasons including phone not in service, not willing to participate, not able to participate because of severe medical conditions or chronic disability, not able to reach after numerous phone calls, etc. We anticipate that the database system will be altered this year so we are able to gether more accurate information on performance measures internally, and use the survey as an additional tool in completing the performance section of the 7OB report.

D. Briefly describe the impact of the Title VII-Chapter 2 program, citing examples from individual cases (without identifying information) in which services contributed significantly to increasing independence and quality of life for the individual(s).

Eight narratives are included that are typical of the IL Services that the agency provides to older blind adults. All clients exercise choice of the array of independent living services that they receive and also choose whether or not to sign an IL Plan or an IL Waiver.

Client JW was referred by an agency social worker for orientation and mobility services, and rehabilitation teaching. The client was instructed in sighted guide training and was given a support cane for identification purposes and support and sunglasses to reduce glare. MAX TV glasses were dispensed by an agency RT so the client could see the television better and a lamp so that he could read his mail better with the use of magnifiers.

Client AW was referred by an agency social worker for OM instruction, Low Vision services provided by BESB staff, and rehabilitation teaching. The client was given a long travel cane and training to use it as well as sunglasses. The client requested assistance to be able independently manage her own finances. Client was given check writing guide and a handheld magnifier, but still struggled so she was given a closed circuit televison viewer so that she could read her bills and write checks. The client was also assigned a volunteer from our volunteer department for assistance with shopping, transportation, reading and companionship.

Client CT diagnosed with RP had received O & M instruction for several years as her vision loss progressed. After receiving cane training, she was able to acquire a guide dog and remained independent in the community. This past year the client’s visual fields deteriorated to the point where she could could no longer rely on her sight for oreintation. She received 15-20 hours of orientation training this past year to assist her in the development of mental mapping skills as a compensatory technique. Now she is able to ride the bus independently and to walk long routes to keep her to optimize her guide dog’s skills. Without this additional training, she would not have been able to maintain her level of independence.

MS, 69 year old man dx with diabetes, lives with his wife who works full time. The client was in need of communication skills training. Hand magnifiers were proven to not be effective. The RT idispensed a Pen Friend, a voice labeling system, to the client. he is now able to record and retrieve information and used the device to organize his CD collection.

Client RO, an 85 year old woman who lives her adult son wanted to remain independent in her own home. She received a 4x handheld magnifier and training to use it. The RT also tactually marked her wall oven and microwave. Lighting and contrast were discussed including the use of layering in order to create color transt on tables, counters, and other work surfaces in her home. Client was also given communication aides and communication skills training including boldline paper, 20/20 pens, writing guides, large print calendar and a large print LED alarm clock. She was provided with a set of easy-thread sewing needles and shown techniques for proper threading including use of bar soap to stabilize needle while threading it. Client demonstrated competence in being able to perform this task which she will use for basic clothing repair.

LF, 74, lives with wife. The RT provided the client with a 4x handheld pocket magnifier and a portable video magnifier to assist with reading mail, prescription bottles, and duties associated with his officer position at his local Lion’s Club chapter. RT also conducted a lighting evaluation in the home and provided him with strageies for improving both general and task lighting, and glare reduction from windows. The client was dispensed a daylight desk lamp to assist him with writing tasks. He was also dispensed communication aids such as writing guides, large print address book and calendar and relevant instruction. Additional services included marking of household appliances, provision of large print playing cards, large print and alarm clock. The client was also given adaptive kitchen equipment and training to use it.

Client MP, is a 67 year old man, who has been blind for 20 years. He and his wife who is also blind travel extensively in their neighborhood and surrounding towns with their guide dogs. The client was very discouraged that a No Turn on Red sign that he had worked so hard to obtain at a busy commercial intersection in his neighborhood had been removed due to state legislation. The client’s guide dog became very apprehensive traveling in this area after the light changed. Through the provision of five O & M lessons, the client and the O & M instructor were able to develop different ways to reach the same same destination and to reduce the anxiey of both the client and the dog so that the client could remain active in all of his previous activities.

The distraught spouse of a recently blind client called one of the agency social workers to say that his wife who had been active prior to her vision loss was basically sitting her her chair crying for most of the day. The agency social worker visited the couple in their home and discussed the array of rehabilitation and independent living services that the agency provides. After receiving rehabilitation services from an agency RT, the client no longer relies on her spouse to perform many of her activities of daily living. She uses a Closed Circuit Television Viewer to handle her mail, read recipes, etc. She received orientation and mobility instruction and she now uses a white cane to travel safely in the community and can access public transportation to go places without her spouse. She feels like she has regained her independence and is now very active again.

E. Finally, note any problematic areas or concerns related to implementing the Title VII-Chapter 2 program in your state.

During this past year Connecticut continued to have difficulty with its economy. State revenues remained down, including a reduction in state supplemental funding, and almost all state funded vacant positions remain unfilled in the agency, including the Independent Living services divison of the agency. Currently we have one unfilled social work position and one rehabilitation teaching position that are open (although the RT position was recently posted). The combination of reduced positions and medical issues has resulted in increased caseloads for existing staff in almost all cases.

The agency relied heavily during the past three years on ARRA IL OB funding for purchase of low vision services from eye doctors. The decrease in this funding as well as other issues resulted in a decision by the agency to CAP low vision services provided by eye doctors. New policies and procedures adopted by the agency now require Rehabilitaton Teachers trained in low vision to provide low vision assessments, and dispense low vision devices such as MAX TV glasses and handheld magnifiers. The new policy requires RT’s to determine whether or not a client should be sent to an eye doctor for further low vision services, typically prescriptive glasses. As a result, of this policy change, RT’s within the agency now have increased responsibilities for providing low vision training and dispensing of aids to clients. Without additional resources, this could result in a delay in providing services.

The 7OB report for FFY 2011 shows a reduction in the number of new Chapter 2 clients. The primary reason is related to an overall lower referral rate. In FFY 2010 the agency served a total of 1,293 older adults; 884 were new referrals. In FFY 2011 the agency served a total of 847 adults; 635 were new referrals. As the primary source of referrals to BESB are eye doctors that are mandated to report legally blind patients to BESB, BESB will need to address this issue in the upcoming year. Specifically, BESB will need to send an updated mailing to all ophthalmologists and optometrists in CT notifying them of their statutory reporting requirements in addition to updating them on the services that BESB is currently providing, including but not limited to low vison services delivered by itinerant staff and through the agency’s centralized model developed in collaboration with eye doctors and other organizations. A community outreach plan will also be created to target increased referrals.

In addition, new reporting forms and monitoring procedures will be in place by February of 2012 to improve accuracy of data entry issues as well as modification of the agency’s database to internally capture performance measures separate from the agency’s consumer satisfaction survey.

Part VIII: Signature

As the authorized signatory, I will sign, date and retain in the state agency's files a copy of this 7-OB Report and the separate Certification of Lobbying form ED-80-0013 (available in MS Word and PDF formats.

Signed byMarsha Brown, MSW
TitleOlder Blind Grant Program Manager
Telephone860-602-4046
Date signed01/12/2012