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

RSA-7-OB for Massachusetts Commission for the Blind - H177B110021 report through September 30, 2011

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year710,566
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year458,154
Other federal grant carryover from previous year223,261
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2649,947
A2. Total other federal444,795
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other444,795
A3. State (excluding in-kind)137,633
A4. Third party0
A5. In-kind0
A6. Total Matching Funds137,633
A7. Total All Funds Expended1,232,375
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs112,222
C. Total expenditures and encumbrances for direct program services1,120,153

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 1.6000 3.1000 4.7000
2. FTE Contractors 0.0000 0.5000 0.5000
3. Total FTE 1.6000 3.6000 5.2000

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 0 0.0000
2. Employees with Blindness Age 55 and Older 0 0.0000
3. Employees who are Racial/Ethnic Minorities 1 1.0000
4. Employees who are Women 5 4.2000
5. Employees Age 55 and Older 4 3.5000

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 FY1,011
2. Number of individuals who began receiving services in the reported FY331
3. Total individuals served during the reported fiscal year (A1 + A2) 1,342

B. Age

1. 55-5927
2. 60-6452
3. 65-6962
4. 70-74112
5. 75-79165
6. 80-84293
7. 85-89353
8. 90-94206
9. 95-9966
10. 100 & over6
11. Total (must agree with A3)1,342

C. Gender

1. Female981
2. Male361
3. Total (must agree with A3)1,342

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race15
2. American Indian or Alaska Native3
3. Asian4
4. Black or African American43
5. Native Hawaiian or Other Pacific Islander0
6. White1,232
7. Two or more races13
8. Race and ethnicity unknown (only if consumer refuses to identify)32
9. Total (must agree with A3)1,342

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)38
2. Legally Blind (excluding totally blind)1,304
3. Severe Visual Impairment0
4. Total (must agree with A3)1,342

F. Major Cause of Visual Impairment

1. Macular Degeneration909
2. Diabetic Retinopathy82
3. Glaucoma105
4. Cataracts16
5. Other230
6. Total (must agree with A3)1,342

G. Other Age-Related Impairments

1. Hearing Impairment506
2. Diabetes243
3. Cardiovascular Disease and Strokes737
4. Cancer59
5. Bone, Muscle, Skin, Joint, and Movement Disorders634
6. Alzheimer's Disease/Cognitive Impairment122
7. Depression/Mood Disorder58
8. Other Major Geriatric Concerns221

H. Type of Residence

1. Private residence (house or apartment)1,215
2. Senior Living/Retirement Community39
3. Assisted Living Facility77
4. Nursing Home/Long-term Care facility11
5. Homeless0
6. Total (must agree with A3)1,342

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)20
2. Physician/medical provider6
3. State VR agency1,126
4. Government or Social Service Agency7
5. Veterans Administration0
6. Senior Center50
7. Assisted Living Facility9
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center1
11. Family member or friend8
12. Self-referral108
13. Other7
14. Total (must agree with A3)1,342

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 173,551
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 721
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 331

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 388,113
1b. Total Cost from other funds 0
2. Provision of assistive technology devices and aids 664
3. Provision of assistive technology services 92

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 471,887
1b. Total Cost from other funds 0
2. Orientation and Mobility training 43
3. Communication skills 280
4. Daily living skills 506
5. Supportive services (reader services, transportation, personal 46
6. Advocacy training and support networks 78
7. Counseling (peer, individual and group) 1,208
8. Information, referral and community integration 1,208
. Other IL services 77

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 86,602
1b. Total Cost from other funds 0
2. Information and Referral 39
3. Community Awareness: Events/Activities 163 3,746

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) 1,190,774 1,232,375 41,601
2. Number of Individuals Served 1,219 1,342 123
3. Number of Minority Individuals Served 51 78 27
4. Number of Community Awareness Activities 170 163 -7
5. Number of Collaborating agencies and organizations 129 128 -1
6. Number of Sub-grantees 7 6

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 92 100.00%
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) 43 46.74%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 49 53.26%
B1. Number of individuals who received orientation and mobility (O & M) services 43 100.00%
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) 39 90.70%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 3 6.98%
C1. Number of individuals who received communication skills training 280 100.00%
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) 112 40.00%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 168 60.00%
D1. Number of individuals who received daily living skills training 506 100.00%
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) 329 65.02%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 177 34.98%
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) 91 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) 5 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) 14 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 21 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) 16 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 Massachusetts Commission for the Blind’s (MCB) Title VII, Chapter 2 Program (the BRIDGE Program) utilizes a program design that includes both an In-House and Sub-Grantee component. The In-House program employs a Program Director and three Case Workers who provide direct IL services to blind elders. The direct IL services include: case management, low vision services, low vision devices, assistive technology devices and services including the provision of magnifiers, cooking items, clocks and watches, communication devices, adaptive software, hearing aids, and assistive listening devices, as well as independent living and adjustment training and services. The ARRA funding allowed us to hire an administrative assistant for the BRIDGE program. She has made an outstanding contribution to our program specifically with budget and program management activities.

The Sub-Grantee component includes contracting with a Public Education Consultant to conduct outreach that targets under-represented populations as well as raising community awareness about benefits and services available to blind elders in Massachusetts. Outreach activities included presentations to low vision support groups, Senior Centers, Health Fairs and Professional Conferences. During FY 11, the BRIDGE Program Public Education Consultant conducted 131 public education events with a combined audience of 3,746 individuals. Outreach to under-represented individuals included training at Central Boston Elder Services for case managers and nurses of whom 70 were African-American or Asian. The United Elders Expo 2011 included a workshop for 160 minority individuals with over 600 mostly minority individuals visting the MCB booth. The Public Education Consultant also targeted services to Deaf-Blind elders and provided several in-service training sessions for staff of the Deaf and Hard of Hearing Independent Living Service Program, sponsored by D.E.A.F. Inc in Attleboro - this training included 17 staff plus two CART reporters and two interpreters. The Public Education Consultant also targeted rural areas of Massachusetts in FY 11 with 40% of her presentations occurring in the more rural Regions of MCB.

During FY 11, MCB’s BRIDGE Program contracted with the following vendors: The Carroll Center for the Blind in Newton for Essentials Skills Training, Senior Low Vision Evaluations, and Diabetic Self-Management training; Sight Loss Services of Cape Cod and the Islands in W. Dennis to operate ten low vision support groups on Cape Cod; The Massachusetts Association for the Blind in Brookline to operate thirty-four low vision support groups throughout the Commonwealth; The New England Eye Institute of Boston to operate a Mobile Eye Clinic, "New England On-Sight," to provide state of the art eye care and low vision services especially in the rural areas of the state; the RRTC at Mississippi State University for program evaluation and to conduct training in the area of Consumer Self-Advocacy for agency staff; and finally with Andrea Schein who is beginning her eleventh year as our Public Education Consultant.

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 Massachusetts SPIL states that, "The priority of the public education component is the provision of information that will enhance capacity for independent living to consumers and service providers, with particular emphasis on outreach to under-represented populations."

The following is a brief summary of the ARRA funded activities that occurred during FY 11 that allowed the BRIDGE Program to expand and enhance its IL programming as well as faciltate collaborative and community-awareness activities with our public and private partners:

New England Eye Institute was awarded ARRA funds to operate a Mobile Eye Clinic. The Mobile Eye Van began operation in October 2010 and provided state-wide eye care services including vision screenings, eye exams and low vision evaluations to over 100 legally blind elders. The Mobile Eye Van had particular success in Western and Central Massachusetts where eye care services are more limited and blind elders are geograhically isolated from Springfield and Worcester where most eye care providers/services are located.

MAB Community Services was awarded ARRA funds to conduct "What’s Up Doc," a workshop focusing on facilitating communication between consumers and their physicians, to members of the thirty-four state-wide Peer Support groups. Additionally, thirty-four ChatterVox amplification systems were purchased and distributed to Support Group Corrdinators to enhance two-way communication at Peer Support meetings.

Sight Loss Services of Cape Cod & the Islands used ARRA funding to establish an Independent Reading Resource Center at its West Dennis headquarters. Additionally, funds were used to pay for room rental for a health fair that was held in Barnstable and a painting class for six vision impaired seniors including one legally blind elder that was held in Harwich. This innovative and fun class was covered in a terrific new story by the Cape Cod Times.

The Carroll Center was awarded ARRA funds to expand its center-based programming to communities throughout Massachusetts. Thirty-three consumers living in Region I benefited from the community-based Senior Low Vision Assessments, while twenty-eight elder blind consumers participated in community-based Diabetes Management Training. Community-based Essential Skills Programs were conducted in Chelmsford, Woburn, Danvers, Winthrop, Bedford, Lowell and Quincy involving forty-nine blind elders.

The RRTC at MSU used ARRA funding to conduct a two day training on the topic of Consumer Self-Advocacy. Presenters Alberta Orr and BJ LeJeune received excellent evaluations by staff that attended this training.

ARRA funds were used to purchase one hundred and twenty-three closed circuit reading machines (CCTVs) for older blind consumers. An MCB consumer summed up the general feelings of the recipients in an email exclaiming, "I can’t stop reading."

ARRA funds were used to purchase hearing aid systems for twenty-five OIB consumers who had no other funding available to them. Hearing loss in combination with vision loss presents enormous barriers to independent functioning for our consumers.

ARRA funds were awarded to the OIB Consultant for Vision and Aging to increase outreach to minority communities and individuals. Additionally, the Consultant conducted a series of workshops for Coordinators of non-contract Low Vision support groups located throughout the state. Massachusetts is fortunate to have over eighty support groups statewide that assist individuals coping with the issues of vision loss. MCB supports forty-four of these groups through OIB funds and was able to provide technical assistance to many of the remaining groups through our Consultant who has developed a curriculum around the issue of "Running a Successful Support Group."

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 BRIDGE Program contracts with the RRTC at Mississippi State University to conduct program evaluation and measure consumer satisfaction. The final report for FY 2011 was recently completed and a copy will be mailed to Elizabeth Akinola. A Program Participant Survey was conducted to determine the degree to which consumers are satisfied with the independent living services they receive or are receiving from the BRIDGE program. In addition, the survey gathers outcome data from consumers related to the level of independence they gained from their program. Included in the survey are four questions related to participant satisfaction with the manner in which services are provided, nine questions related to the types of services provided, five questions related to perceived outcomes of the program and a question asking if consumers needed additional assistance with hearing loss, transportation, computer application, or some other service. In addition, the survey includes multiple demographic, health, secondary disability, and vision related questions. This unique survey was designed to allow the administrative team to gather outcome data to supplement reporting to RSA plus some additional data that would be useful in program analysis and planning.

The results of the overall Program Participant Survey were extremely favorable. Demographic characteristics of the respondents to the survey indicated an average age of 84.4 years ranging from 64 to 97. Sixty-six percent were female, 81% lived in their own home or apartment, 59% reported a hearing loss. All were legally blind and 10 indicated they had no usable vision. Seventy-nine percent reported macular degeneration as the cause of their vision loss, 6% reported glaucoma, 4% cataracts, 1% diabetic retinopathy, and 10% reported another condition causing their vision loss.

Section I of the survey revealed that consumer satisfaction with the manner in which services were provided was favorable among 100% of those who responded to the survey. Section II of the survey revealed that consumer satisfaction with specific services provided was favorable overall at a rate of 96.4%. During this reporting year most areas were above the 90% rating that has long been a bench-mark for the Title VII-Chapter 2 Programs. The highest rating of above 95% were given to Instruction Received, Counseling and Guidance (97%), Low Vision Aids and Devices (96%), Information Regarding Vision Loss (98%), Orientation and Mobility (100%), Involvement in Peer Support Groups (97%), and Training in Diabetes Management (100%).

Section III of the survey queried participants regarding their perceived outcomes of services. The percentage of persons who agreed that they had either gained or maintained their ability to travel independently was 88%. Eighty percent indicated that they had either gained or maintained their ability to engage in personal management activities. The highest percentage rate of 95% was among persons who indicated that because of the Assistive Technology received from the BRIDGE program, they were able to regain or improve their ability to engage in customary life activities. Ninety-eight percent indicated that they were in either the same or better control of their lives because of the services they received. The number of persons indicating that they had either gained or maintained their ability to engage in life activities was 82%. The overall rating of 88.6% is slightly below the target score of 90% but appears to relate somewhat to the lack of understanding of participants that these questions were directly related to the program of services they received, rather than life circumstances such as decreased health or change in living situation. Nineteen percent of respondents indicated they had experienced major life changes beyond vision loss. There is a significant level of satisfaction for the BRIDGE program and this is especially significant due to the mean age and level of visual impairment of the consumers served by the program.

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).

Consumer is an 82 year old widowed female who lives alone in a condominium complex in a large city north of Boston. Consumer has an extensive social network and maintains regular contact with family and friends. She is legally blind as a result of wet AMD with resultant acuity of CF OD and 20/200 OS. In addition to her visual condition, consumer has angina, arthritis, esophageal problems and a hearing loss. A recent diagnosis of pulmonary fibrosis severly reduces her physical stamina and her ability to walk long distances. Consumer applied for BRIDGE services in October 2010 as she was struggling with various ADL tasks. To help consumer increase her functional capacity for independent living, the following BRIDGE services were provided:

Senior Vision Assessment at Carroll Center for the Blind. As a result of this evaluation, consumer was provided with a Big Eye magnifying lamp and a Topaz flat panel video magnifier. She uses her new video magnifier for reading mail, pill bottles, financial material, and looking at photographs - especially her grandchildren. She uses the Big Eye Magnifying lamp to complete Soduku and Cryptoquote puzzles.

Optelec 7X LED pocket magnifier. She uses this hand-held magnifier for spot reading and shopping.

20/20 pens, LV writing paper, LP calendar, and LP address book. With these aids, she is able to complete personal record keeping tasks independently.

Orange round bump dots. She has placed these tactile aids on the controls of household appliances.

Comfort Duett assistive listening device. This assisitive listening device makes it easier for her to hear television and participate in conversations.

Eschenbach 2.1X MAX-TV glasses. These glasses enable her to see the images on her television more clearly.

The provision of BRIDGE services has enabled consumer to experience functional gains in important areas: record keeping, meal preparation, hearing, and leisure time activities. Consumer currently completes her own meals, laundry and peronal record keeping. At application, this consumer was unable to complete certain ADL tasks without great difficulty. She appeared extremely anxious about her ability to live independently in the community. Now, with her new independent living aids, she is able to complete critical ADL tasks with much greater ease. As a result of BRIDGE services, she appears to be much more confident about her future as an elder with vision loss.

Consumer is a 77 year old woman who lives with her husband in a single family home in a rural town in southeastern Massachusetts. She was registered as legally blind in 2002 due to glaucoma and diabetic retinopathy. Prior to becoming legally blind, consumer was able to maintain her home, and complete medical and personal tasks. Since becoming legally blind, her husband has taken over many of these tasks and consumer has become very dependent on him for her most basic needs. She was referred to BRIDGE for assitance in regaining some of the independent functioning she had lost.

The following services were provided to assist consumer in reaching her goal of independent living:

7X Optelc hand held magnfier to assist her with reading the mail, food labels, sales circulars, and bill paying.

Talking watch to assist her with time management.

Talking thermometer and blood pressure meter to assist her with monitoring these important health indicators.

Large print bingo cards so she could resume her favorite recreational activity.

Through BRIDGE services, consumer has gained enough independent techniques to complete most ADLs including cooking, record keeping, medical monitoring, and recreational activities. Her husband feels relieved and he has been able to resume his activities outside of their home. Consumer is extremely grateful for BRIDGE services and the independence she has regained and she is happy that she no longer has to rely on her husband for daily assistance.

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

The lateness of the Grant Award and Continuing Resolution Award letters continues to be problematic often resulting in service delays for Chapter 2 consumers.

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 byCheryl Standley
TitleTitle VII, Chapter 2, Program Director
Telephone617.626.7488
Date signed12/29/2011