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

RSA-7-OB for Kentucky Office for the Blind - H177B110017 report through September 30, 2011

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year459,989
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year401,071
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2421,641
A2. Total other federal562,937
(a) Title VII-Chapter 1-Part B30,901
(b) SSA reimbursement136,771
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other395,265
A3. State (excluding in-kind)57,856
A4. Third party0
A5. In-kind0
A6. Total Matching Funds57,856
A7. Total All Funds Expended1,042,434
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs0
C. Total expenditures and encumbrances for direct program services1,042,434

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 0.3750 7.4350 7.8100
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 0.3750 7.4350 7.8100

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 3 2.2500
2. Employees with Blindness Age 55 and Older 0 0.0000
3. Employees who are Racial/Ethnic Minorities 1 0.7500
4. Employees who are Women 10 6.3100
5. Employees Age 55 and Older 2 1.5000

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 FY164
2. Number of individuals who began receiving services in the reported FY603
3. Total individuals served during the reported fiscal year (A1 + A2) 767

B. Age

1. 55-5967
2. 60-6471
3. 65-6971
4. 70-7458
5. 75-79102
6. 80-84132
7. 85-89155
8. 90-9480
9. 95-9928
10. 100 & over3
11. Total (must agree with A3)767

C. Gender

1. Female538
2. Male229
3. Total (must agree with A3)767

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race0
2. American Indian or Alaska Native0
3. Asian1
4. Black or African American55
5. Native Hawaiian or Other Pacific Islander0
6. White708
7. Two or more races3
8. Race and ethnicity unknown (only if consumer refuses to identify)0
9. Total (must agree with A3)767

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)55
2. Legally Blind (excluding totally blind)475
3. Severe Visual Impairment237
4. Total (must agree with A3)767

F. Major Cause of Visual Impairment

1. Macular Degeneration462
2. Diabetic Retinopathy78
3. Glaucoma72
4. Cataracts9
5. Other146
6. Total (must agree with A3)767

G. Other Age-Related Impairments

1. Hearing Impairment86
2. Diabetes142
3. Cardiovascular Disease and Strokes172
4. Cancer17
5. Bone, Muscle, Skin, Joint, and Movement Disorders122
6. Alzheimer's Disease/Cognitive Impairment18
7. Depression/Mood Disorder4
8. Other Major Geriatric Concerns115

H. Type of Residence

1. Private residence (house or apartment)676
2. Senior Living/Retirement Community54
3. Assisted Living Facility18
4. Nursing Home/Long-term Care facility19
5. Homeless0
6. Total (must agree with A3)767

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)159
2. Physician/medical provider53
3. State VR agency55
4. Government or Social Service Agency40
5. Veterans Administration2
6. Senior Center25
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization8
10. Independent Living center1
11. Family member or friend187
12. Self-referral207
13. Other30
14. Total (must agree with A3)767

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 38,236
1b. Total Cost from other funds 15,617
2. Vision screening / vision examination / low vision evaluation 556
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 537,808
1b. Total Cost from other funds 219,668
2. Provision of assistive technology devices and aids 591
3. Provision of assistive technology services 419

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 149,092
1b. Total Cost from other funds 60,897
2. Orientation and Mobility training 144
3. Communication skills 605
4. Daily living skills 606
5. Supportive services (reader services, transportation, personal 49
6. Advocacy training and support networks 41
7. Counseling (peer, individual and group) 490
8. Information, referral and community integration 367
. Other IL services 65

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 14,992
1b. Total Cost from other funds 6,123
2. Information and Referral 367
3. Community Awareness: Events/Activities 218 7,117

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) 779,782 1,042,434 262,652
2. Number of Individuals Served 777 767 -10
3. Number of Minority Individuals Served 45 58 13
4. Number of Community Awareness Activities 301 218 -83
5. Number of Collaborating agencies and organizations 9 9 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 419 100.00%
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) 325 77.57%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 94 22.43%
B1. Number of individuals who received orientation and mobility (O & M) services 144 100.00%
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) 117 81.25%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 27 18.75%
C1. Number of individuals who received communication skills training 605 100.00%
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) 482 79.67%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 123 20.33%
D1. Number of individuals who received daily living skills training 606 100.00%
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) 493 81.35%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 113 18.65%
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) 575 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) 0 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) 47 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 15 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) 13 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.

The Kentucky Office for the Blind provides Older Individuals Who Are Blind (OIB) services through an in-house program. Direct services are provided by OIB counselors who are employees of the Office for the Blind. Services are made available to all 120 Kentucky counties. OIB counselors are assigned geographic regions consisting of several counties and travel thousands of miles annually meeting with consumers and promoting services through marketing and outreach efforts. Most consumers prefer to receive training in their homes, but upon request, counselors meet with consumers in other community locations such as libraries, senior centers, one stop career centers, health departments and churches. At the close of fiscal year 2011, OIB counselors were housed in the Office for the Blind locations in the following Kentucky cities: Paducah, Owensboro, Bowling Green, Elizabethtown, Louisville, Somerset, Lexington, Florence, and Prestonsburg. The OIB counselor located in Florence serves the Northern Kentucky region. Initially, this position was funded using ARRA monies, but in August 2011, a full time permanent employee was hired. The OIB program administrator is located in Bowling Green, KY and carries a part time caseload in addition to performing administrative duties.

In addition to providing direct services, outreach remains one of the primary responsibilities of counselors. Each counselor must develop and maintain referral sources within the assigned work area. To insure counselors understand the importance of this task, it is incorperated into performance evaluation standards. To meet the minimum evaluation standard, each counselor must have three quarterly marketing/public relations/outreach activities. During FY2011, counselors participated in over two hundred activities in outreach to all areas of the state. Contacts have been made with many professionals who are likely to have contact with older persons such as eye care professionals, ministers, aging services case managers, health care providers, diabetes educators, social service agency directors, etc. Besides the one on one contacts, counselors have given group presentations to civic groups, church groups, consumer groups and peer support groups. Two Kentucky areas that have been traditionally underserved are Central and Northern Kentucky. Both of these areas now have permanent full time counselors and concentrated efforts have been made to spread the word concerning availability of services. The counselor in Central Kentucky has made hundreds of face to face contacts with community members letting them know about services and how to access them. Due to the rural nature of the geographic region, the counselor concentrated on meeting with bankers, utility company workers, post office staffs, ministers, etc as these are the people most likely to know of persons in their communities experiencing vision loss. As a result, the number of people served in that area in 2011 increased over 2010. In Northern Kentucky, the temporary employee made many contacts which the permanent counselor is now attempting to follow-up on to establish a presence in the area. We anticipate receiving many new referrals in this area during FY2012.

In all regions, counselors continue to engage in activities that will increase awareness of services and technology for persons with low-vision. Several opportunities have involved exhibits/demonstrations giving individuals experience using adaptive devices. Such expos/exhibits are usually well attended with people attending from surrounding communities/counties and result in increased awareness of services, training opportunities, available technology and how to access resources. Often immediate referrals are made to the OIB program for persons interested or needing services.

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.

The OIB Counselors attempt to maximize reources by working with other professionals within the Office for the Blind as well as other service providers. The OIB program administrator and OFB DeafBlind Services Coordinator worked collaboratively to host a Confident Living Training for persons age 55 and over experiencing both vision and hearing loss. OIB Counselors nominated the eight individuals from across the state who particiipated in the three day training program. Counselors attended and served as consumer service assistants during the training sessions. During the three days, there was a great deal of information sharing between consumers and between counselors and consumers.

During the second year of having ARRA funds available, OIB counselors continued the work closely with Assistive Technology Specialists to enable more individuals to receive CCTVs. Under normal circumstances, this type of equipment is too costly to be funded with regular OIB funds and most consumers cannot affort to purchase with private funds. During the two year cycle of available ARRA monies, OIB counselors identified persons needing such devices and made referrals to Assistive Technology Specialists who completed assessments and made recommendations for specific devices best suited for individual consumers. During the period between October 1, 2010 and September 30, 2011, approximately 90 persons benefited by receiving equipment purchased by OIB counselors using ARRA funds.

During FY2011, OIB counselors continued the pilot project of conducting small group trainings at various locations throughout the state. Most of the groups consisted of 5-6 people and generally lasted approimately two hours. The purpose of the sessions was to provide basic ADL instruction, provide information about resources, and give opportunities for peer support. Many of these groups were held in areas where consumers do not have access to organized peer support activities, and according to satisfaction surveys conducted following the sessions, one of the most liked parts was the chance to be with others sharing a common experience of vision loss.

A new tool for counselors’ use is a booklet of quick tips that can be provided to consumers, family members or other interested persons. The simple tips are intended to either introduce basic adaptive methods and/or reinforce instruction provided by the counselors. The tips are organized into the following categories: lighting, safety, managing medications, personal grooming, telephone dialing, household chores, money and checking, kitchen and cooking, and resources.

Since the OIB counselors serve large areas, it is imperative for them to work in cooperation with other service providers. By participating in interagency groups, diabetes education groups, deafblind service teams, etc. counselors are more informed of local resources and better prepared to meet the diverse needs of consumers.

The OIB program administrator represents the Office for the Blind on the Kentucky Statewide Independent Living Council. The SILC promotes independent living to all persons and OIB supports the goals set forth in the SPIL. The OIB program administrator has a good working relationship with the Directors of the Centers for Independent Living and encourages staff to work in cooperation with the CIL located in their area. Knowledge of resources is freely shared between the OIB program and the CILs.

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 Office for the Blind completes a telephone satisfaction survey with OIB consumers chosen at random upon the case being closed. The calls are made by an Office for the Blind employee who is not directly connected to the provision of OIB services. In 2011, 113 consumers were surveyed representing 14.7% of the total number served during the fiscal year. Nine questions were asked with two being open ended. When asked if the services received "met my needs", 97% answered either "agree" or "strongly agree". In response to being asked if they feel better able to do activities around his/her house independently or need less help from others, 96% said "agree" or "strongly agree". In addition, 96% stated "agree or "strongly agree" to "I feel more confident in my ability to perform activities I had given up due to my vision loss". When asked to rate their satisfaction with services received, 69% responded "very satisfied" and 26% said "satisfied" for a total of 95%. Each person was given an opportunity to tell what they had liked best about the program and responses included: "Liked everything, it helped me a great deal", "Just everything", "It helped a lot, made life a lot easer". Several people stated how much they appreciated being given adaptive devices such as magnifiers, special telephones, etc. To conclude the survey, individuals were asked for any suggestions for improving the program. Some of the responses were: "more budget money needed", "need more counselors", "continue to update materials". Many people said they liked the program and had no suggestions for improving it.

As mentioned in the previous section, satisfaction surveys were completed with attendees of the small group training sessions conducted during FY2011. Three open ended questions were asked: (1) What did you like best about the training session?, (2) What would you change? and (3) If another such session was held, would you either be willing to attend again or recommend it to someone else?

One of the most common responses to question one (1) was that the best part was the opportunity to learn about adaptive devices and to know what is available. Many people answered they had not known about the devices or how to get them before attending the meeting. In response to question two (2), there were no suggestions of how to improve the sessions, but all said they just appreciated the opportunity. Everyone responded to question three (3) with an overwhelming "yes" they would attend again or recommend it to another person. Perhaps one lady summed it up best after one of the sessions when she stated "I see hope".

The OIB program administrator encourages and expects all counselors to practice pinciples of good customer service. Consumers are givien contact information for the program administrator, and if any situations do arise with particular consumers, the program administrator does a direct follow-up to help facilitate a satisfactory outcome.

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).

Mrs. B lives in small Kentucky city. When she was first interviewed, her husband was present and the counselor was told they did most daily tasks together. In addition to her vision loss, she has a secondary disability which has resulted in her using a wheelchair for mobility. Initially, her desire for services and ADL training centered around tasks that would enable her to better assist her husband. However, during the time she was participating in services, her husband became ill and died. She notified the OIB Counselor that her needs had now changed and she would need to gain skills necessary for doing more tasks independently. She identified her biggest area of concern was being able to pay bills and do other personal bookkeeping. Although she had already been provided various magnification devices, the counselor referred her to the AT Specialist in her area for an evaluation on the use of CCTVs. This evaluation indicated she would be able to do perform most reading tasks with such a device, and using ARRA funds, the counselor purchased the unit recommended by the AT Specialist. In addition, she was made aware of how to better use features of her computer and introduced to enlargement software. Several months have now passed, and Mrs. B continues to care for herself, her home, and her personal bookkeeping. She contacted the OIB Program Administrator and said the services received have "saved my life". As a compliment to the OIB program, she has referred other people from her area for services.

Mr. S is 77 years old and lives alone in an apartment. Soon after an initial OIB assessment, Mr. S had to relocate to another apartment in a different part of his town. Mr. S presented with dual sensory loss as he is very hard of hearing as well as visually impaired. Mr. S needed instruction in various daily tasks such as learning to tactually operate his new appliances. He was introduced to using a Pocket Talker hearing device which made converation easier for him, but he stated an interest in trying to obtain hearing aids. Since his private funds are limited, the counselor referred him to the OFB DeafBlind Services and that Coordinator helped him complete an application process to receive low-cost hearing aids. Transportation was made available to him to keep appointments with the nearest hearing aid provider participating in the program. Several 150 mile round trips were necessary to obtain the hearing aids, to complete fittings, etc. Mr. S asked the counselor if there was any way he could have a CCTV as he believed such a machine would make many of his daily tasks much easier. Following an AT evaluation, the counselor was able to utilize ARRA funds to purchase the recommended unit. Currently, Mr. S is living in his own apartment with some support from the Aging Services who provides general house cleaning services. By coordinating a variety of services, a comprehensive package of independent living assistance has made it possible for Mr. S to continue living in his own apartment.

Mrs. P, 83 years old, lives in her own home, and is fortunate to have a good network of local family support. However, Mrs. P was very sad about not being able to read and her daughter contacted the OIB program to learn if there was anything that might help Mrs. P regain this ability. The OIB counselor met Mrs P in her home and completed an assessment and plan appropriate services. The counselor learned Mrs. P is still able to perform most daily tasks but that reading was very difficult and something she missed very much. Initially, an evaluation was done to determine if magnification would be helpful. Mrs P became tearful when she could see to read her mail, etc with certain magnifiers. These items were provided, but the counselor knew this would not totally satisfy her desire to read the newspaper and books. The counselor informed Mrs. P of options such as Newsline and Talking Book Library, and assisted Mrs. P in completing the necessary applications. Instruction was also given in the use of raised labeling on appliances eliminating the need to "read" the controls and using writing guides to keep on a straight line when writing letters, etc. Based on Mrs. P’s success using standard magnifiers, the counselor arranged a demonstration of CCTV units at the OFB office. When Mrs. P demonstrated a good use of this type of equipment, the counselor requested ARRA funds for this purchase. Mrs. P is living independently making good use of all the technology and training she has been provided. She told the counselor that she never expected so much when her daughter made the first call and that she is very thankful for services.

Mrs. B, Mr. S, and Mrs P are only examples of how valuable OIB services are to individuals. Many people state they did not know where to turn or how to start adjusting to their vision loss, but that these services offered just the guidance they needed. During satisfaction survey contacts, many consumers relate how important it was for them to receive individual attention from someone with specialized knowledge about living with blindness.

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

The Office for the Blind has attempted to expand the OIB program in the Northern Kentucky area. This area is one of the more highly populated areas of the state and mostly has been served by counselors traveling from other areas to meet with consumers. The first attempts to place a counselor in the area utiliized a FFTL position. Each of the two counselors hired as FFTL employees stayed six months. Due to difficulty finding qualified persons interested in accepting the FFTL job, the position stayed empty several months after the counselors resigned for other jobs. Although the OIB program administrator traveled to the area as much as possible to meet with consumers, ground was lost in establishing referral sources and developing a caseload. In August 2011, a full time position was established and a full time counselor was hired. The counselor is now working to establish a presence in the 17 county region and referrals are being received on a more regular basis.

During the period of vacancy in the Northern Kentucky area, another counselor located in Western Kentucky resigned. Due to the state personel process, it was approximately three months before a new counselor was hired. Again, the program administrator traveled to the area to meet with consumers and perform caseload duties.

For a period of about six months, the program administrator was carrying 2.5 caseloads in diverse areas of the state which meant a great deal of travel each week. When the new counselors began, the program administrator continued to travel to the areas providing training to the new employees.

With counselors spread out all across the state and not at the same location as the program manager, it can be difficult to provide appropriate on-going training and support as needed to new and veteran staff. Attempts are made to keep in close contact with counselors via telephone and electronic means.

Due to the economic times, it is becoming increasingly difficult to provide a high quality of service to a growing number of people. Resources at all levels, local, state, and federal, are limited and must be used in the most efficient manner. The Office for the Blind is working to find and adopt practices that will help offset the higher cost of providing OIB services.

The OIB program as well as the entire Office for the Blind continues to make every effort to improve all phases of tracking and documenting services and related costs. This is an on-going process and can be slow due to procedures a state agency must pass through to implement changes or alter systems. However, the Office for the Blind makes every effort to maintain and report accurate records

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 byGay Pannell
TitleRehabilitation Administrator
Telephone270-746-7479
Date signed12/28/2011