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

RSA-7-OB for Maryland Division of Rehabilitation Services - H177B110020 report through September 30, 2011

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year574,648
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year202,583
Other federal grant carryover from previous year27,894
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2697,385
A2. Total other federal27,894
(a) Title VII-Chapter 1-Part B27,894
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other0
A3. State (excluding in-kind)63,850
A4. Third party0
A5. In-kind69,082
A6. Total Matching Funds132,932
A7. Total All Funds Expended858,211
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs11,726
C. Total expenditures and encumbrances for direct program services846,485

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 0.7500 4.0000 4.7500
2. FTE Contractors 2.1800 14.7100 16.8900
3. Total FTE 2.9300 18.7100 21.6400

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 11 6.0000
2. Employees with Blindness Age 55 and Older 4 2.5000
3. Employees who are Racial/Ethnic Minorities 11 3.7600
4. Employees who are Women 25 12.3800
5. Employees Age 55 and Older 5 2.4600

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 FY311
2. Number of individuals who began receiving services in the reported FY544
3. Total individuals served during the reported fiscal year (A1 + A2) 855

B. Age

1. 55-59100
2. 60-64114
3. 65-69105
4. 70-7491
5. 75-7991
6. 80-84134
7. 85-89116
8. 90-9485
9. 95-9916
10. 100 & over3
11. Total (must agree with A3)855

C. Gender

1. Female584
2. Male271
3. Total (must agree with A3)855

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race17
2. American Indian or Alaska Native3
3. Asian14
4. Black or African American295
5. Native Hawaiian or Other Pacific Islander1
6. White476
7. Two or more races12
8. Race and ethnicity unknown (only if consumer refuses to identify)37
9. Total (must agree with A3)855

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)408
2. Legally Blind (excluding totally blind)179
3. Severe Visual Impairment268
4. Total (must agree with A3)855

F. Major Cause of Visual Impairment

1. Macular Degeneration311
2. Diabetic Retinopathy129
3. Glaucoma167
4. Cataracts34
5. Other214
6. Total (must agree with A3)855

G. Other Age-Related Impairments

1. Hearing Impairment58
2. Diabetes109
3. Cardiovascular Disease and Strokes23
4. Cancer10
5. Bone, Muscle, Skin, Joint, and Movement Disorders44
6. Alzheimer's Disease/Cognitive Impairment11
7. Depression/Mood Disorder12
8. Other Major Geriatric Concerns90

H. Type of Residence

1. Private residence (house or apartment)758
2. Senior Living/Retirement Community49
3. Assisted Living Facility43
4. Nursing Home/Long-term Care facility5
5. Homeless0
6. Total (must agree with A3)855

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)255
2. Physician/medical provider92
3. State VR agency21
4. Government or Social Service Agency57
5. Veterans Administration6
6. Senior Center41
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization6
10. Independent Living center5
11. Family member or friend109
12. Self-referral207
13. Other56
14. Total (must agree with A3)855

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 23,520
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 102
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 310

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 564,362
1b. Total Cost from other funds 21,501
2. Provision of assistive technology devices and aids 413
3. Provision of assistive technology services 233

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 173,514
1b. Total Cost from other funds 21,502
2. Orientation and Mobility training 262
3. Communication skills 104
4. Daily living skills 192
5. Supportive services (reader services, transportation, personal 50
6. Advocacy training and support networks 106
7. Counseling (peer, individual and group) 91
8. Information, referral and community integration 1,159
. Other IL services 111

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 20,582
1b. Total Cost from other funds 21,504
2. Information and Referral 1,159
3. Community Awareness: Events/Activities 174 3,071

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) 934,830 846,485 -88,345
2. Number of Individuals Served 974 855 -119
3. Number of Minority Individuals Served 476 379 -97
4. Number of Community Awareness Activities 156 174 18
5. Number of Collaborating agencies and organizations 15 27 12
6. Number of Sub-grantees 3 2

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 233 100.00%
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) 87 37.34%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 143 61.37%
B1. Number of individuals who received orientation and mobility (O & M) services 262 100.00%
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) 49 18.70%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 213 81.30%
C1. Number of individuals who received communication skills training 104 100.00%
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) 97 93.27%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 7 6.73%
D1. Number of individuals who received daily living skills training 192 100.00%
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) 157 81.77%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 35 18.23%
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) 315 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) 18 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) 36 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 119 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) 9 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.

During FY11 the Maryland Division of Rehabilitation Services (DORS) worked collaboratively with two sub-contractors: Blind Industries and Services of Maryland (BISM) and Columbia Lighthouse for the Blind (CLB) to increase and enhance services to older blind individuals in Maryland. In addition, in-house staff continues to serve consumers being referred through various means. When necessary, consumers are cross-referred to a sub-contractor to ensure that appropriate services are provided in a timely manner.

Services provided by DORS and the sub-grantees included education, demonstration, and instruction in: Daily Living Skills for Independent Living, Braille/Communication, Orientation & Mobility, Adapted Computer Technology, Adjustment and Advocacy, Diabetic Management & Nutrition, Community Activities, Peer Interaction, Low Vision and Blindness Resources, plus adaptive aids, devices, and equipment. Statewide outreach efforts included speaking engagements, presentations, media exposure, conferences, and literature dissemination targeting senior consumers, senior centers, retirement communities, blindness-related agencies, and professionals in the field in an effort to reach seniors in all areas of the state including those in rural, remote, and underserved areas.

Blind Industries and Services of Maryland (BISM) implemented the Title VII-Chapter 2 program through a series of seven (7) training events for blind and low vision senior citizens. These events include six (6) workshops and one (1) residential retreat scheduled for June 7 through 10, 2011. Training events are presented at community sites and BISM training centers. Some examples of the workshops are:

--Dollars & Sense Workshop, Oak Crest Village Retirement Community of Seniors Served: 15 (Baltimore County) --Life Enhancement Workshop, Asbury-Solomons Retirement Community of Seniors Served: 18 (Calvert County) Through the workshops effort to reach underserved and unserved populations, BISM transports all staff and training supplies to every community workshop throughout the State. A unique outreach effort was the International Macular Degeneration webcast with the potential of many thousands of listeners received valuable information about BISM’s training programs for the older blind.

Furthermore, the Columbia Lighthouse for the Blind partnered with several local consumer groups (NFB, ACB, AFB, DORS, MWADB), the Arch Diocese of Washington, Local Disability organizations and affiliates, Department of Social Services, etc. to identify individuals who are blind, visually impaired or deaf-blind that qualify for and need the services provided through this funding.

CLB has incorporated an Independent Living skills retreat program that includes instruction on Braille, daily living skills, assistive technology, orientation and mobility, housekeeping and organizational skills. CLB’s support groups provided activities in knitting, exercise, Spanish and cooking just to name a few. These activities have been very well received by the consumers participating in these groups. Activities also include tours, recreational activities and subject matter speakers.

Lastly, Support Service Provider services are now being offered to MD deaf-blind residents to assist them with going shopping, reading emails, friendly visitors, and exercise activities. This is very important as visually impaired seniors begin to experience a dual sensory loss of vision and hearing.

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.

Networking and personal contact with professionals in the field of service delivery to the older blind population is an important aspect of DORS and Sub-grantee activities and their concentrated effort to expand the service reach to the unserved and underserved.

This year included outreach presentations to 115+ entities, with over 3000 attendees as well as meetings and communications with service providers of the elder blind population. Presentations were made at senior residential facilities, churches, transportation agencies, governmental agencies, state and national conventions of the blind, centers for independent living, local events, & to medical professionals. Some ways that ILOB events are publicized include webcasts, radio and TV, publicity campaigns, health and wellness fairs, magazine articles, community partner newsletters, conference presentations, program advertising, DVD distribution, and the DORS and BISM website updates.

During this period, BISM successfully provided a highly successful training for patrons of the Library for the blind and Physically Handicapped as the final event for this fiscal year.

August 17, 2011, a Healthy Lifestyles Diabetic Management Workshop was held at: The Library for the Blind and Physically Handicapped (LBPH) 415 Park Avenue Baltimore, MD (Baltimore City)

LBPH assisted in publicizing this diabetic management workshop to its Library patrons in the joint effort to reach underserved and unserved blind and low vision diabetic seniors in need of training.

BISM transported all staff and training supplies plus a nutritious, diabetic-friendly luncheon to the workshop site. Included with the many handouts given to workshop participants were copies of both BISM training DVD’s: “Tools and Techniques for Managing Diabetes Non-Visually” and “Life Enhancement through Non-Visual Skills.” These DVD’s are also available for viewing at www.bism.org.

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.

Participant satisfaction surveys are collected following each training event to obtain important feedback directly from the consumers who received the services. Following are results from a most recent training event:

Overall Rating:

96.8% Healthy Lifestyles Workshop (Diabetic Management) Library for the Blind and Physically Handicapped (LBPH) Baltimore, MD

The detailed Survey Satisfaction results are attached in the link below.

..\FY2011 Reports\ILOB SURVEY SATISFACTION RATING 2011.docx

Satisfaction surveys provide important feedback directly from the consumers who these programs are designed to impact. Overall, the satisfaction surveys were very positive across all programming. It is clear through survey results and in conversations held the seniors that participated in various workshops, services contributed significantly to improved medical care, independence and overall quality of life.

In addition to survey questions weighted with a 1 (low) to 5 (high) rating, participants also provided additional comments: -Liked personal instruction by staff and experience of blind instructors. -Prepared lunch non-visually by keeping my eyes closed and was surprised at how well I did. -This training took away my fear; I believe in preparing for the future. -Great that state helps BISM with the expense of this program. -We need the power from knowledge gained today as our vision diminishes. -Instructors engaging, informative, and supportive. - Braille was explained to me in a way that I can now pick it up. -Independence of the staff is eye opening and encouraging. -Learned a lot about dialing telephone; was afraid of small button phones; now I will do it myself. -I didn’t like the escalator, but it was a good thing for me to do. -There is nothing more you could have given me than you did. -I can go home now and do more for myself. -Was losing my confidence but I’ve gotten it back- not afraid of future vision loss. -I hope to live to be 120—healthy and independent!

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).

Again, satisfaction survey results continuously indicated that training program participants felt that the services they received helped improve their quality of life. Many reported that prior to training, they were unable to properly utilize a stove top, oven, other kitchen aids, talking glucose meter or measure insulin. Many also reported that following training they better understood nutritional labeling and portion control necessary to manage individual food plans. Many reported they most enjoyed learning about the talking glucose meter, insulin pens, insulin devices, nutritional tips, talking blood pressure monitor, methods for medication labeling, stress management, food exchanges, and assistive technology.

The Healthy Lifestyles workshop is specifically designed for blind and low vision diabetic senior citizens to receive the training necessary to better manage self-care and diabetes thus increasing independence and resulting in increased quality of life and personal wellness. Positive comments included:

“Recipe examples with carb counting were very helpful” “Small groups; nice location; very organized; knowledgeable group leaders” “All information presented was helpful in learning about diabetes” “Enjoyed hands-on demonstrations and learning about devices” “I learned to be healthy” “Can’t think of anything that wasn’t covered; well organized; covered all areas” “Being successfully sufficient is very important to me” “Enjoyed medication labeling section & daily consumption recommendations” “I want to come to more BISM trainings!” “I’m glad I came and will do more now!” “I was satisfied with everything.” “I like the SARA and bill folding.” “Instructors were great and did a great job. “Enjoyed all sessions, money identified, letter writing guide.” “I would like more discussion on “fear.” “Would like more training time; will look forward to more.” “Very nice workshop; lunch very nice; will think about retreat.” CLB reports that, one individual that received a low vision exam was able to return to recreational activities that they had previously abandoned. The handheld magnifier that was provided through this funding assisted the individual with the ability to read prescription labels, large numbered playing cards and allowed the individual the ability to return to the monthly Bid Whist Club.

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

Delivering low vision services which effectively impact senior’s safety, functioning, and independence in the community requires coordinated screening, evaluation, equipment purchase and training so that these resources are timely, relevant to the home/community context and accessible to the consumer. It continues to be a challenge to guide consumers through what at times appears to them as fragmented patchwork of services from various providers, often times inaccessible geographically, and with frustratingly inadequate training on how to integrate equipment or resources into the context of their home.

Other ongoing areas of concern are:

• Lack of advocacy for seniors having difficulty accessing services. • Seniors living alone who cannot safely accomplish daily tasks & needs. • Seniors in need of job skills who are forced to re-enter the workforce. • Reluctance of seniors to admit that vision is failing and who won’t seek help. • Medical issues and additional disabilities. Health issues, medical appointments, and secondary disabilities can prevent seniors from participating in training. Last minute cancellations may occur due to health issues and changing medical situations. • Rapidly growing projected number of senior blind in need of services. • Seniors who have not sought or been referred for services. • Family members or others who discourage seniors from seeking training. • Funding -- Training for blind senior consumers is costly in terms of staff time required as training is often presented in a one-to-one format of staff to senior. • Seniors have difficulty securing transportation for travel to training programs. It can be extremely costly to provide roundtrip transportation for these seniors. Often times, they live in rural or remote locations where public transportation is not an option, and hired transportation costs are prohibitive. Seniors who have not had the benefit of training are often fearful of traveling alone, with a stranger, to an unfamiliar destination. Seniors don’t often have family or friends available to assist them in commuting to training programs. It is costly to provide staff transportation for outreach presentations, training events, and visitation. • Professionals who are not trained in the unique service needs of the older blind population -- diabetes educators, senior center and senior housing staff, medical professionals, and teachers of the blind.

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 byTandra Hunter-Payne
TitleProgram Manager
Telephone410-554-9107
Date signed12/28/2011