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

RSA-7-OB for Alaska Dept of Labor and Workforce Development - Division of Vocational Rehab - H177B120002 report through September 30, 2012

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year225,000
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year0
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2225,000
A2. Total other federal2,865
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other2,865
A3. State (excluding in-kind)80,397
A4. Third party40,310
A5. In-kind4,641
A6. Total Matching Funds125,348
A7. Total All Funds Expended353,213
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs50,049
C. Total expenditures and encumbrances for direct program services303,164

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 0.1000 0.0000 0.1000
2. FTE Contractors 0.4040 3.8910 4.2950
3. Total FTE 0.5040 3.8910 4.3950

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 20 3.0930
2. Employees with Blindness Age 55 and Older 3 0.2215
3. Employees who are Racial/Ethnic Minorities 7 0.2630
4. Employees who are Women 26 4.1780
5. Employees Age 55 and Older 11 1.7410

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 FY158
2. Number of individuals who began receiving services in the reported FY211
3. Total individuals served during the reported fiscal year (A1 + A2) 369

B. Age

1. 55-5935
2. 60-6449
3. 65-6954
4. 70-7442
5. 75-7943
6. 80-8460
7. 85-8947
8. 90-9430
9. 95-997
10. 100 & over2
11. Total (must agree with A3)369

C. Gender

1. Female231
2. Male138
3. Total (must agree with A3)369

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race4
2. American Indian or Alaska Native98
3. Asian8
4. Black or African American14
5. Native Hawaiian or Other Pacific Islander5
6. White234
7. Two or more races0
8. Race and ethnicity unknown (only if consumer refuses to identify)6
9. Total (must agree with A3)369

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)17
2. Legally Blind (excluding totally blind)80
3. Severe Visual Impairment272
4. Total (must agree with A3)369

F. Major Cause of Visual Impairment

1. Macular Degeneration133
2. Diabetic Retinopathy44
3. Glaucoma37
4. Cataracts40
5. Other115
6. Total (must agree with A3)369

G. Other Age-Related Impairments

1. Hearing Impairment107
2. Diabetes64
3. Cardiovascular Disease and Strokes128
4. Cancer19
5. Bone, Muscle, Skin, Joint, and Movement Disorders150
6. Alzheimer's Disease/Cognitive Impairment18
7. Depression/Mood Disorder30
8. Other Major Geriatric Concerns117

H. Type of Residence

1. Private residence (house or apartment)306
2. Senior Living/Retirement Community20
3. Assisted Living Facility16
4. Nursing Home/Long-term Care facility25
5. Homeless2
6. Total (must agree with A3)369

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)94
2. Physician/medical provider41
3. State VR agency21
4. Government or Social Service Agency12
5. Veterans Administration1
6. Senior Center20
7. Assisted Living Facility3
8. Nursing Home/Long-term Care facility19
9. Faith-based organization0
10. Independent Living center29
11. Family member or friend54
12. Self-referral53
13. Other22
14. Total (must agree with A3)369

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 26,252
1b. Total Cost from other funds 19,100
2. Vision screening / vision examination / low vision evaluation 202
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 38,443
1b. Total Cost from other funds 12,869
2. Provision of assistive technology devices and aids 273
3. Provision of assistive technology services 300

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 110,183
1b. Total Cost from other funds 36,286
2. Orientation and Mobility training 32
3. Communication skills 229
4. Daily living skills 315
5. Supportive services (reader services, transportation, personal 119
6. Advocacy training and support networks 74
7. Counseling (peer, individual and group) 102
8. Information, referral and community integration 190
. Other IL services 49

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 44,672
1b. Total Cost from other funds 27,885
2. Information and Referral 106
3. Community Awareness: Events/Activities 190 3,020

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) 273,762 303,164 29,402
2. Number of Individuals Served 330 369 39
3. Number of Minority Individuals Served 107 131 24
4. Number of Community Awareness Activities 161 190 29
5. Number of Collaborating agencies and organizations 79 86 7
6. Number of Sub-grantees 4 4

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 300 100.00%
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) 123 41.00%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 76 25.33%
B1. Number of individuals who received orientation and mobility (O & M) services 32 100.00%
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) 20 62.50%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 1 3.13%
C1. Number of individuals who received communication skills training 229 100.00%
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) 99 43.23%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 68 29.69%
D1. Number of individuals who received daily living skills training 315 100.00%
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) 132 41.90%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 51 16.19%
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) 129 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) 9 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) 4 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) 3 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 Alaska Division of Vocational Rehabilitation continues to administer Independent Living Services for Older Individuals who are Blind through four contracts with non-profit agencies. Contracting to agencies located throughout the state assists us in providing services for those who live in both rural, remote and urban areas. Services are provided in a variety of venues including individuals’ homes, senior centers, nursing homes, in-house at contractors’ agencies and out in communities. Of the four agencies we contract with, three are Centers for Independent Living, (CILs). Many of the Older Blind participants also receive other IL services that the CILs provide. The other contractor, the Alaska Center for the Blind and Visually Impaired, provides services specifically to individuals who are blind and visually impaired. Many Older Blind participants receive specialized services through this agency.

The four contractors are:

• The Alaska Center for the Blind and Visually Impaired, (South Central Alaska) • Access Alaska, (CIL), Fairbanks, (Interior and Northern Alaska) • Independent Living Center, Homer (Kenai Peninsula) • Southeast Alaska Independent Living, (Southeast Alaska)

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.

In such a large, expansive state it is important for all contractors to collaborate and work closely with other agencies and individuals such as Optometrists, Nursing Homes, Division of Vocational Rehabilitation, Senior Centers, Lions Clubs, Talking Book Libraries, Public Health Agencies, Tribal Vocational Rehabilitation Programs, and a multitude of other service providers.

Contractors continue to utilize technology to reach and identify eligible individuals in rural areas. One contractor has purchased webcams to better communicate with their staff and consumers in their satellite offices. One contractor became a member of a group of Senior Agency Providers who decided to conduct outreach to seniors who reside in Senior/Disabled Housing Complexes. They met in three complexes and shared much information with the seniors who reside there. The seniors in attendance appreciated this format as the provider had come to them with information, rather than the seniors having to seek out appropriate services and providers. Another contractor partnered with Tlingit and Haida tribes of Southeast Alaska, and worked with their Elders and Caregiver Services program. As a result, they identified many older individuals challenged with low vision issues and provided them with information/education on low vision aides, assistive technology that has enhanced the quality of their lives and increased their independence.

Presentations are made and brochures are distributed at a variety of health fairs and senior centers throughout the state.

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.

Each individual served through the Older Blind program is given an opportunity to express their satisfaction/dissatisfaction with the services they receive. This is conducted in a variety of ways including written surveys and 3rd party interviews. Contactors have stated that the best way to get feedback from this population is directly, through conversations with each individual. This approach allows for more detailed, personal responses. Written surveys are distributed, but the response rate is lower (23%) than getting feedback through personal interviews (90% +). Overall the feedback has been positive and respondents report being satisfied with the services. They report the program provides valuable resources and opportunities to actually try out a variety of devices and low vision aides. Our contractors in Alaska not only assess satisfaction, they listen to and make changes based upon the feedback received. Through the satisfaction assessment process it was discovered that a number of individuals wanted to learn more about nutrition and safety in the kitchen. A Nutritionist from Cooperative Extension was contacted and together with an older blind individual who was an experienced cook, they held workshops on nutrition and over the course of several months, taught a number of hands-on cooking classes. Participants enjoyed learning the finer details of cooking with a visual impairment, such as how to measure ingredients, how to cut safely with a knife and how to tell when meat was cooked.

Here is a sample of responses from older blind participants: “This program opened up my vanishing world through support and magnification devices.” “They treated me so good, I felt like Elvis Presley.” “The audio books are a real joy, and the magnifier has let me return to the bead and artwork I truly love. I feel productive again, much more fulfilled.” “I learned so much during this clinic and am excited about using the new equipment!” “Thanks for coming to my home. I now know a lot more about how to live with vision loss and still be 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).

A gentleman in his early 60’s with a rapidly deteriorating eye condition was provided with a functional low vision assessment. Following the assessment he indicated he wanted to be able to walk safely in the religious community of which he is a leader, and was provided O & M instruction. He was feeling confident until he learned recently that his vision was expected to diminish greatly in a very short period of time. As a result, he was given additional O & M instruction and instruction in activities of daily living. He reported that although he is not yet able to accept his current and projected vision loss, he is feeling more capable of living independently and safely because of the services he received.

Paulette is a fifty-six year old woman who has suffered severe domestic abuse that lead to a TBI, vision loss and depression. She also experiences other physical difficulties due to a previous work injury. Through the Older Blind program Paulette received a low vision assessment, low vision aides and assistance in purchasing glasses. She also received other wrap around services offered through the CIL, including assistance in getting Social Security, Adult Public Assistance, Senior Benefits and received specialized Medicare counseling from certified CIL staff. Paulette stated she was very interested in working again and was referred to the Division of Vocational Rehabilitation for assistance. She is currently receiving services from several organizations to gain the tools and learn the skills needed to live safely and independently.

An elder and his adult daughter came and participated for the first time in a peer support low vision group. The elder explained that one of his greatest passions in life is reading and he is no longer able to read books which interest him. He also added that the state library does not offer these books in the BARD system for audio playback. Through research the contractor found a Kindle application for his computer that downloads books for him to read in large print. The contractor also arranged for a volunteer who meets with him weekly to assist in locating and downloading books online which interest him.

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

One of the largest obstacles to individuals with low vision is the lack of funding to obtain eye treatment, glasses and assistive technology they need to live independently. Many people who seek OB services cannot afford eye care or eye glasses. Consequently, many continue to live with blurry vision or even worse, with a treatable eye condition which they can’t afford to treat and results in complete loss of vision. Several contractors report how difficult it is to show people assistive technology that would greatly improve their lives, but have no way to assist them in purchasing it.

Travel within Alaska continues to be expensive and occasionally impossible. The majority of the state is predominantly rural with many communities not connected with a road system. Travel during the winter months, October through March, is often not possible due to inclement weather. Many of our contractors schedule travel and outreach activities in the spring and summer, and although individuals residing in these rural areas receive services, they are sporadic.

There are very few O & M specialists in Alaska, and virtually none in remote areas. The high cost of travel combined with contracted expenses, results in very limited availability of O & M and other specialized services.

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 byVelja Elstad
TitleIL OIB Program Coordinator
Telephone907 465-6932
Date signed12/18/2012