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

RSA-7-OB for Iowa Department for the Blind - H177B110015 report through September 30, 2011

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year338,508
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year119,233
Other federal grant carryover from previous year268,334
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2229,782
A2. Total other federal268,334
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other268,334
A3. State (excluding in-kind)95,657
A4. Third party0
A5. In-kind0
A6. Total Matching Funds95,657
A7. Total All Funds Expended593,773
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs65,708
C. Total expenditures and encumbrances for direct program services528,065

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 0.8200 3.5200 4.3400
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 0.8200 3.5200 4.3400

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 2 0.6900
2. Employees with Blindness Age 55 and Older 1 0.3500
3. Employees who are Racial/Ethnic Minorities 0 0.0000
4. Employees who are Women 10 3.6100
5. Employees Age 55 and Older 2 0.6900

C. Volunteers

0.00

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 FY444
2. Number of individuals who began receiving services in the reported FY592
3. Total individuals served during the reported fiscal year (A1 + A2) 1,036

B. Age

1. 55-5930
2. 60-6445
3. 65-6946
4. 70-7469
5. 75-79127
6. 80-84200
7. 85-89259
8. 90-94179
9. 95-9965
10. 100 & over16
11. Total (must agree with A3)1,036

C. Gender

1. Female789
2. Male247
3. Total (must agree with A3)1,036

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race6
2. American Indian or Alaska Native2
3. Asian1
4. Black or African American13
5. Native Hawaiian or Other Pacific Islander0
6. White1,000
7. Two or more races0
8. Race and ethnicity unknown (only if consumer refuses to identify)14
9. Total (must agree with A3)1,036

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)69
2. Legally Blind (excluding totally blind)621
3. Severe Visual Impairment346
4. Total (must agree with A3)1,036

F. Major Cause of Visual Impairment

1. Macular Degeneration701
2. Diabetic Retinopathy72
3. Glaucoma60
4. Cataracts18
5. Other185
6. Total (must agree with A3)1,036

G. Other Age-Related Impairments

1. Hearing Impairment436
2. Diabetes91
3. Cardiovascular Disease and Strokes361
4. Cancer46
5. Bone, Muscle, Skin, Joint, and Movement Disorders188
6. Alzheimer's Disease/Cognitive Impairment61
7. Depression/Mood Disorder22
8. Other Major Geriatric Concerns64

H. Type of Residence

1. Private residence (house or apartment)697
2. Senior Living/Retirement Community130
3. Assisted Living Facility122
4. Nursing Home/Long-term Care facility87
5. Homeless0
6. Total (must agree with A3)1,036

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)69
2. Physician/medical provider35
3. State VR agency1
4. Government or Social Service Agency38
5. Veterans Administration6
6. Senior Center43
7. Assisted Living Facility4
8. Nursing Home/Long-term Care facility7
9. Faith-based organization10
10. Independent Living center0
11. Family member or friend241
12. Self-referral300
13. Other282
14. Total (must agree with A3)1,036

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 2,350
1b. Total Cost from other funds 290
2. Vision screening / vision examination / low vision evaluation 272
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 0

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 227,939
1b. Total Cost from other funds 28,172
2. Provision of assistive technology devices and aids 430
3. Provision of assistive technology services 540

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 234,989
1b. Total Cost from other funds 29,044
2. Orientation and Mobility training 134
3. Communication skills 500
4. Daily living skills 712
5. Supportive services (reader services, transportation, personal 55
6. Advocacy training and support networks 52
7. Counseling (peer, individual and group) 522
8. Information, referral and community integration 163
. Other IL services 741

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 4,700
1b. Total Cost from other funds 581
2. Information and Referral 0
3. Community Awareness: Events/Activities 119 3,000

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) 478,653 528,065 49,412
2. Number of Individuals Served 942 1,036 94
3. Number of Minority Individuals Served 27 22 -5
4. Number of Community Awareness Activities 113 119 6
5. Number of Collaborating agencies and organizations 5 5 0
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 540 100.00%
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) 412 76.30%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 105 19.44%
B1. Number of individuals who received orientation and mobility (O & M) services 134 100.00%
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) 77 57.46%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 44 32.84%
C1. Number of individuals who received communication skills training 500 100.00%
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) 391 78.20%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 88 17.60%
D1. Number of individuals who received daily living skills training 712 100.00%
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) 560 78.65%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 132 18.54%
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) 450 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) 23 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) 130 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 62 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) 15 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.

In-house Program: The Iowa Department for the Blind (IDB) operates an in-house Chapter 2 program and does not sub-grant or contract to provide services. The IDB is a state agency and provides a comprehensive range of services and programs for those Iowans who are blind or visually impaired. The IDB houses the Regional Library for the Blind and Physically Handicapped, it operates an Adult Orientation and Adjustment Center, a small aids and devices store, a Randolph-Sheppard program, and, in accordance with the Rehabilitation Act, it operates a Vocational Rehabilitation (VR) program and an Independent Living (IL) program. All programs are closely integrated in order to provide a seamless system of services to blind and visually impaired Iowans. The Chapter 2 program is an important component of this service system. The IDB has ten rehabilitation teachers. These teachers divide their time between serving clients receiving vocational rehabilitation services and those receiving independent living services. The teachers maintain time logs to ensure accurate cost allocation.

Chapter 2 services are provided on an outreach basis, with the teachers traveling the state to meet individuals in their homes and communities. Iowa is seeing some growth in the provision of low vision services. Several low vision centers have opened across the state. There is also an increase in the number of vendors of low vision aids and increased involvement of occupational therapists in the provision of vision therapy. With low vision services more readily available, the IDB places much emphasis on providing training in adaptive, non-visual techniques. This training is provided in conjunction with guidance and counseling in order to promote a positive adjustment to vision loss. Teachers also help individuals access other community resources and services as appropriate. The teachers are all experienced (the most junior has two years of field experience and the most senior has over thirty years) and are very familiar with the range of services and supports available to clients.

Outreach to underserved: Iowa has many rural counties. The IDB has experienced a low rate of referral from these areas and has identified the rural population as underserved. This past year, the counties in southwest Iowa were targeted for concerted outreach efforts. This is a very rural area of the state, with several counties reporting a total population of less than 6,000. Demographic data further reveals that a significant number of these individuals are aged 65 or older, living on limited, fixed incomes. The Department receives very few referrals from this area of the state, though a high concentration of older individuals would suggest it is likely that a number of people experience vision loss given the prevalence of age-related macular degeneration. In an effort to increase referrals, the IDB hosted open-houses in four different communities in this corner of the state. Information was provided on the range of services available through the older blind program, as well as through the Regional Library for the Blind and Physically Handicapped (housed at the IDB). Several vendors were also in attendance to exhibit a variety of low vision aids. A month later, we returned to the same communities to provide instruction on the use of digital services through the library. These events were promoted through press releases, radio interviews, and speaking engagements, as well as through mailings and through the IDB’s website. Attendance was lower than anticipated, but it is hoped that the seeds planted will generate referrals in the future.

The IDB has a very dynamic website, which features information on the Chapter 2 program. Each month a new tip on adaptive techniques for common, every day activities is added. Over 700 service providers and consumers are notified of this new technique via email with a link to the website. Additionally, the website includes short videos providing basic instruction on simple adaptive techniques. Individuals visiting the web are able to make referrals for services directly from the website (www.IDBonline.org). While the majority of our referrals come through other means, there continues to be an increase in referrals from the web.

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.

Collaborative Relationships and Activities The IDB’s Chapter 2 program enjoys several ongoing collaborative relationships. The Chapter 2 program staff works closely with Iowa’s two newspaper reading services, Newsline (an over-the-phone, automated newspaper reading service) and IRIS (a radio reading program), by exchanging referrals, delivering radios, and providing instruction on accessing and using the Newsline system.

During this past year, the Chapter 2 program partnered with members of the aging network to host a resource fair for individuals with vision loss at a popular senior center in an eastern Iowa community (Iowa City). The event was very well attended and has resulted in invitations to return to conduct similar events in the future.

The IDB has enjoyed a collaborative relationship with the Department on Aging (DOA) in the past. Due to internal changes at the Department on Aging, including staffing, this relationship was not as strong during the last reporting period (FFY10) as it was once. However, efforts to renew this relationship have paid off with the result that there is again a representative of the DOA on the Independent Living Advisory Committee. Additionally, the Chapter 2 program manager has been asked to serve on the Aging and Disability Resource Council (ADRC).

As referenced above, a key partner in the development of IL services for Iowa’s blind and visually impaired population is the Independent Living Advisory Committee of the Iowa Department for the Blind. The Committee has statewide as well as minority representation and consists of 13 members: 12 individuals who are blind, and a representative from the Department on Aging. Committee members actively work to increase public awareness in their home communities by arranging and conducting speaking engagements, promoting White Cane Safety Day, and simply participating in various activities and organizations. Because members are so active and visible in their communities, they often serve as a point of referral and help many individuals access independent living services. Members also serve as peer advisors, participate in self-help groups, and assist with various program functions (i.e., Senior Orientation). The Committee has proven to be a vital asset in the planning and delivery of services.

The Chapter 2 program manager serves as an ex-officio member of the Iowa Statewide Independent Living Council. This affords an important link to Iowa’s IL community. This past year, the program manager was heavily involved in the development of the SPIL, which helps to ensure that the delivery of IL services is coordinated and unduplicated across the state. No new service delivery methods were developed that required incorporation in the SPIL.

Community Awareness and other Activities In addition to the activities described above, Chapter 2 staff conducted 113 speaking engagements (including in-service training to other providers), participated in 10 exhibits, and generated at least 4 articles in local papers throughout Iowa. Continuing with last year’s growth, referral numbers increased once again by nearly 100 (referrals were 830 in 2009, 942 in 2010, and 1036 in 2011).

Finally, it should also be noted that the Chapter 2 program continues to work very closely with the Regional Library for the Blind and Physically Handicapped (housed at the IDB) to assist with the transition from cassette to digital media. Staff followed up with older individuals who needed one-on-one assistance as they learned the new player and/or learned to download books. It is noteworthy that starting this past July, more digital books than cassette books were being circulated on a monthly basis.

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.

The IDB asks individuals served to complete a “feedback form” when they attend a group training. Last year, the IDB conducted 20 group trainings, which were attended by 124 individuals. Responses were overwhelmingly positive. All indicated that they had learned a new skill and had a more positive attitude about blindness. When asked what they thought was the most important thing they gained from the training, comments included: “I got information you can’t get anywhere else.” “There’s still life after vision loss.” “It’s a lot easier for me to do my stuff around the house.” “It helps you get control of your life back.”

Finally, the number of independent living objectives set, met, not met, and in progress is used as an evaluation tool. Between 85% and 90% of the objectives set are successfully met. There is a higher success rate for daily living objectives than for mobility objectives. Anecdotal data suggests this is because of other factors unrelated to vision loss that interfere with a person’s mobility.

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).

As a direct result of services provided, many individuals feel they have regained their lives. When individuals are first referred for services, they are very fearful of what the future may hold. Many have found that, because of vision loss, it has become a struggle to perform activities they once enjoyed, and many of the tasks essential to independent living now feel overwhelming. For instance, many people either limit or give up on the use of the phone, others cut back on cooking and begin to rely on family or local services to meet their nutritional needs, still others will not go anywhere by themselves, and others have abandoned hobbies (i.e., gardening, sewing, playing cards). As their vision continues to decline, this downward spiral of dependency gains momentum, and many fear they are at grave risk of losing their independence and personal autonomy. Fortunately, most individuals find they can turn this situation around by learning some basic adaptive techniques and using some simple aids.

Gert Gert was originally referred to the Chapter 2 program in 2001. At that time she was 73 and newly diagnosed with macular degeneration. Her vision loss was not very significant and she was mainly interested in information on available resources. Over the years her vision decreased. In 2007, she was declared legally blind and this sparked a new referral from a concerned friend. Initially, Shirley was not receptive to services beyond the provision of low vision aids. She declined any need for assistance with home management, stating that her family was very supportive and helped her with everything from laundry, to meals, to getting to her basic appointments (doctor, hair, and church). However, the teacher was able to persuade Gert to attend a group training in her local community, if only to meet other individuals who were also experiencing vision problems. To Gert’s surprise, she discovered that she could learn many simple techniques to aid in her daily living. At the same time, her vision loss reached a point where even her CCTV was of limited benefit. She decided to attend several more trainings and to accept home training as well. She set goals to independently prepare meals, to feel safe when traveling outside of her home, and to more easily and independently meet her communication needs (e.g., use the phone, write lists, maintain a calendar, etc.). Gert received training over a period of years as she kept discovering that she was capable of doing more than she had expected, and her goals continued to evolve. Both the teacher and Gert reached a point where they agreed Gert had met all of her independent living goals. She was using a combination of Braille and an adaptive aid (Pen Friend) to identify her canned goods, manage her medications, and maintain her phone directory. She consistently used a white cane and felt much more confident and far less restricted in traveling outside of her home, and she was again preparing her own meals. However, Gert was experiencing increased difficulty related to communication with others. Over the years she had experienced a progressive hearing loss. Originally an assistive listening device, provided with Chapter 2 funds, was of benefit. However, her hearing loss had reached a point that this was of little value. The teacher worked with a local audiologist and was able to arrange for the provision of a donated hearing aid, which significantly improved Gert’s hearing. Gert now feels secure in her independence and in her ability to maintain communication with her family and friends. Looking back, she can’t believe she was ever reluctant to accept services.

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

While not a problem, it should be pointed out that there is a possibility we are seeing a shift in our demographics. Specifically, the number of individuals referred who are aged ninety or older continues to increase, and this is accompanied by a decrease in the number of individuals who are living in their own homes, much like what we saw last year. If this does become a trend it will mean some changes in our outreach and service provision. Also of note is a slight increase in the number of non-English speaking referrals. This poses a challenge in terms of finding affordable, competent interpreters.

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 byRebecca W. Criswell
TitleProgram Manager
Telephone515-281-1299
Date signed12/27/2011