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

RSA-7-OB for California Department of Rehabilitation - H177B120005 report through September 30, 2012

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year3,397,041
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 23,329,906
A2. Total other federal28,683
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other28,683
A3. State (excluding in-kind)14,954
A4. Third party0
A5. In-kind355,035
A6. Total Matching Funds369,989
A7. Total All Funds Expended3,728,578
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs1,338,823
C. Total expenditures and encumbrances for direct program services2,389,755

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 1.0000 0.0000 1.0000
2. FTE Contractors 18.5300 50.9200 69.4500
3. Total FTE 19.5300 50.9200 70.4500

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 39 20.4500
2. Employees with Blindness Age 55 and Older 26 10.4800
3. Employees who are Racial/Ethnic Minorities 67 33.3000
4. Employees who are Women 147 75.6700
5. Employees Age 55 and Older 56 27.9500

C. Volunteers

23.00

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 FY2,997
2. Number of individuals who began receiving services in the reported FY4,271
3. Total individuals served during the reported fiscal year (A1 + A2) 7,268

B. Age

1. 55-59688
2. 60-64780
3. 65-69674
4. 70-74664
5. 75-79836
6. 80-841,111
7. 85-891,311
8. 90-94913
9. 95-99257
10. 100 & over34
11. Total (must agree with A3)7,268

C. Gender

1. Female4,951
2. Male2,317
3. Total (must agree with A3)7,268

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race865
2. American Indian or Alaska Native43
3. Asian586
4. Black or African American568
5. Native Hawaiian or Other Pacific Islander57
6. White4,909
7. Two or more races59
8. Race and ethnicity unknown (only if consumer refuses to identify)181
9. Total (must agree with A3)7,268

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)404
2. Legally Blind (excluding totally blind)3,354
3. Severe Visual Impairment3,510
4. Total (must agree with A3)7,268

F. Major Cause of Visual Impairment

1. Macular Degeneration3,257
2. Diabetic Retinopathy592
3. Glaucoma944
4. Cataracts296
5. Other2,179
6. Total (must agree with A3)7,268

G. Other Age-Related Impairments

1. Hearing Impairment1,428
2. Diabetes1,363
3. Cardiovascular Disease and Strokes1,730
4. Cancer289
5. Bone, Muscle, Skin, Joint, and Movement Disorders1,303
6. Alzheimer's Disease/Cognitive Impairment341
7. Depression/Mood Disorder253
8. Other Major Geriatric Concerns1,628

H. Type of Residence

1. Private residence (house or apartment)5,352
2. Senior Living/Retirement Community1,582
3. Assisted Living Facility224
4. Nursing Home/Long-term Care facility97
5. Homeless13
6. Total (must agree with A3)7,268

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)1,711
2. Physician/medical provider373
3. State VR agency335
4. Government or Social Service Agency464
5. Veterans Administration80
6. Senior Center1,275
7. Assisted Living Facility55
8. Nursing Home/Long-term Care facility298
9. Faith-based organization132
10. Independent Living center58
11. Family member or friend954
12. Self-referral1,022
13. Other511
14. Total (must agree with A3)7,268

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 283,989
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 1,827
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 456

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 420,630
1b. Total Cost from other funds 0
2. Provision of assistive technology devices and aids 2,047
3. Provision of assistive technology services 1,395

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 1,413,672
1b. Total Cost from other funds 0
2. Orientation and Mobility training 1,098
3. Communication skills 1,022
4. Daily living skills 2,103
5. Supportive services (reader services, transportation, personal 2,449
6. Advocacy training and support networks 904
7. Counseling (peer, individual and group) 2,249
8. Information, referral and community integration 2,429
. Other IL services 1,523

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 271,464
1b. Total Cost from other funds 0
2. Information and Referral 1,540
3. Community Awareness: Events/Activities 610 23,431

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) 6,637,140 3,728,578 -2,908,562
2. Number of Individuals Served 5,874 7,268 1,394
3. Number of Minority Individuals Served 1,918 2,359 441
4. Number of Community Awareness Activities 681 610 -71
5. Number of Collaborating agencies and organizations 0 0 0
6. Number of Sub-grantees 17 17

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 1,395 100.00%
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) 984 70.54%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 570 40.86%
B1. Number of individuals who received orientation and mobility (O & M) services 1,098 100.00%
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) 538 49.00%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 352 32.06%
C1. Number of individuals who received communication skills training 1,022 100.00%
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) 684 66.93%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 311 30.43%
D1. Number of individuals who received daily living skills training 2,103 100.00%
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) 1,439 68.43%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 676 32.14%
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) 4,562 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) 59 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) 261 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 222 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) 48 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 Department of Rehabilitation (DOR) provides comprehensive independent living services (ILS) to individuals age 55 years and older throughout California. The Department, through its 17 sub-grantees, provides the majority of its services in the consumer’s everyday surroundings, whether it be home or community-based settings.

The program is implemented through sub-grant agreements with private, nonprofit community-based organizations that have expertise in providing effective services to individuals who are blind or visually impaired. The grant is advertised statewide and opened to application by non-profit eligible agencies providing core ILS in-home and in community settings. For purposes of providing Title VII, Chapter 2 services throughout the state, DOR divided the state into 14 separate geographical areas with a goal to award at least one grant in each of the 14 designated geographic areas.

In 2010 the sub-grantee applications were assessed, scored and three-year funding recommendations were made based upon the following components: • demonstrated ability to effectively provide ILS in a specified geographic area; • proven expertise in providing core in-home ILS to older individuals who are blind or visually impaired; • effective service provision to enhance consumers’ participation and integration in their communities; • establishment of innovative tools to identify, target and reach underserved, unserved and ethnically diverse population groups; • provision of culturally sensitive and linguistically appropriate ILS services; • development of a comprehensive plan of operation for delivery of services including referral processes; and • service delivery collaboration with local DOR offices of Blind Field Services (BFS) for DOR consumers and non-DOR consumers.

Outreach Efforts to Unserved and Underserved Populations Title VII, Chapter 2 sub-grantees are required to meet State Plan for Independent Living (SPIL) outreach challenges by utilizing methodologies that help ensure that eligible consumers are aware of services and to focus upon unserved and underserved population groups.

The outreach challenges of the 17 sub-grantees to identify local needs of sub-population groups within their geographic area have been met with innovative and effective strategies that included: • hiring culturally sensitive and knowledgeable Outreach Workers; • encouraging inclusiveness of consumer involvement in impacted, underserved and unserved communities by coordinating peer-to-peer volunteer services and utilizing senior support groups to promote and advertise services; • providing translation services for non-English speaking populations; • incorporating gender and ethnic appropriate ILS promotional information via various media: specialty publications, ethnic-specific print, television, radio and public service announcements; • partnering with senior advocacy organizations to disseminate information on the availability of ILS services; • conducting ILS training information to eye care medical specialists and physicians serving targeted population groups in underserved and unserved communities to increase referrals for services; • conducting presentations at adult day health centers and health/social service organizations located in unserved and underserved communities; • ensuring that allied organizations promote services and are oriented to the ILS referral process; • providing ILS services information to organizations, agencies and businesses serving target populations; • utilizing ‘senior mentors’ to orient and demonstrate non-visual skills to members of targeted population sub-groups living in residential facilities, attending health and disability fairs and participating in culturally-based social activities and support groups; • recruiting volunteers, who are representative of various cultures and languages of diverse populations, to identify and respond to service barriers (i.e., transportation, geography, cultural sensitivity, translation services, etc.); • identifying underserved and unserved communities with high demand for ILS services and finite resources to help fill in service gaps; and • distributing ILS information at faith-based organizations and establishments located in underserved and unserved diverse communities.

One of our sub-grantees, Blindness Support Services, Incorporated (BSSI), continues to be one of the top agencies in California serving underserved populations. Consumers are referred by family, friends, medical professionals, and non-profit/government organizations. Their second approach for recruiting consumers comes from attending fairs throughout Riverside and San Bernardino Counties and speaking with people who can benefit from their programs. During the 2011-12 Federal Fiscal Year (FFY) BSSI attended four fairs which targeted seniors or individuals with disabilities throughout Riverside County. Further, BSSI worked with other service providers within their area who referred potential consumers, family members, and friends. Finally, BSSI scheduled presentations at senior centers, senior homes, and assisted living facilities.

One activity at BSSI is their peer support meeting scheduled once a month. Several Spanish speaking consumers participated in these meetings. BSSI is also trying to develop low vision games that are popular in the Latin culture, such as "Bingo." BSSI is also developing some good ideas for their annual "Blind Awareness Day." They want a strong presence of beneficial resources that will attract seniors from Riverside and San Bernardino counties.

For the 2011-12 FFY, 49.3% of all consumers served by BSSI were from various ethnic groups.

Another agency, LightHouse for the Blind, provides services in four areas of Northern California. The LightHouse North Coast Agency collaborates with the Area 1 Agency on Aging and the Humboldt Senior Resource Center to ensure they have an understanding of LightHouse programs and training resources for seniors in the community. Outreach includes senior residences and senior centers in Eureka, Arcata and McKinleyville. During the year, Area 1 Agency on Aging has provided the LightHouse increased community connection and support, including a consumer article in the local paper. Additional outreach/collaboration includes: • LatinoNet annual health fair, "Festejando Nuestra Salud," targeting the Spanish-speaking population, in conjunction with a volunteer interpreter at Redwood Acres in Eureka; • the United Indian Health Services for outreach and services to Repchem, the diabetes management group, in remote Weitchpec, which led to direct vision rehabilitation services to three, Title VII eligible seniors; • the Northern California Indian Development Council for outreach to the Native American community during a Native American health conference in Blue Lake; and • the Area 1 Agency on Aging for increasing collaboration and services to the senior community "Aging in Place" in both Humboldt County and Del Norte County.

The above efforts by LightHouse for the Blind are reflected in their serving 849 individuals in the 2012 FFY which was a 3.9% increase from the 2011 reporting year. Of this total, 31.2% were of various ethnic groups.

Another sub-grantee, The Center for the Partially Sighted (CPS), provided comprehensive low vision rehabilitation services with the goals of enhancing any remaining sight, providing emotional support, and training in independent living strategies. The Center offers optometric care, the latest in computer and assistive technology, individual and group counseling sessions, independent living skills training, orientation and mobility (O&M) instruction, a low vision store, as well as a variety of other services. Optometric evaluations are conducted on-site. Counseling is offered face-to-face or by telephone. Instruction in O&M and rehabilitation services are provided in consumers’ homes. The Center conducts outreach to low-income clinics, ophthalmology and optometric offices, and maintains a website.

The Center for the Partially Sighted served 833 older individuals who are blind or visually impaired for the 2012 FFY, 44.3% of that total were from various ethnic groups.

Of all consumers served during the 2011-12 FFY, sub-grantees averaged serving 32.5% non-white consumers. This was a decrease of 0.1% from the prior reporting year. The primary reason for the consistent services to underserved/unserved populations is sub-grantees’ employment of 67 staff members who are representative of California’s diverse population groups. Below is a breakdown of the diversity of the consumers served by sub-grantee agency including agency location and counties served:

FFY 2011-12 Sub-grantees

Agency Non-white percentage Location Counties Served Blind and Visually Impaired Center of Monterey County 17.8% Monterey Monterey Blindness Support Services, Inc. 49.3% Riverside Riverside, San Bernardino The Center for the Partially Sighted 44.3% Culver City Los Angeles, Santa Barbara, Ventura Community Access Center 34.4% Riverside Riverside Dayle McIntosh Center for the Disabled 32.8% Garden Grove Orange Earle Baum Center of the Blind 1.9% Santa Rosa Sonoma, Napa, Lake, Mendocino El Dorado Center for the Visually Impaired 2.8% El Dorado El Dorado Independent Living Services of Northern California 7.4% Chico Butte, Shasta, Tehama, Plumas LightHouse for the Blind 31.2% San Francisco Marin, San Francisco, Solano, Humboldt, Del Norte Lions Blind Center of Diablo Valley 57.4% Pittsburg Contra Costa Lions Center for the Blind, Oakland 48.8% Oakland Contra Costa, Alameda San Diego Center for the Blind 29.4% San Diego San Diego Santa Clara Valley Blind Center 35.8% San Jose Santa Clara, San Mateo Society for the Blind 26.3% Sacramento Sacramento, Butte Valley Center for the Blind 40.3% Fresno San Joaquin, Fresno, Kern, Merced, Madera, Tulare, Kings, Mariposa Vista Center for the Blind and Visually Impaired 24% Palo Alto Santa Clara, San Benito, Santa Cruz, Monterey VTC Enterprises 14.8% Santa Maria Santa Barbara, San Luis Obispo

B. Briefly describe any activities designed to expand or improve services including collaborative activities or community awareness; and efforts to incorporate new methods and approaches developed by the program into the State Plan for Independent Living (SPIL) under Section 704.

Collaborative Activities: Through the SPIL under Section 704, the Santa Clara Valley Blind Center (SCVBC) understands the critical need to collaborate with other agencies to reach underserved populations who are homebound, in nursing facilities, or are non-English speakers. In May, SCVBC collaborated with Vista Center for the Blind and Visually Impaired to host their Annual Low Vision Expo which had an attendance of over 200 individuals from Gilroy to Stockton to Palo Alto. During the expo, SCVBC met with several vendors, including Vision Anew, who sold used desktop video magnifiers at low cost and offered repair services. Vision Anew, based in Half Moon Bay, offered to assist SCVBC’s program with repairs at no cost. Over the past six months, SCVBC had Vision Anew assist with repairing three devices which are now in the homes of consumers who are homebound and dependent on the assistive equipment to read their mail. SCVBC also met Advanced Diabetes Supply who helps blind and visually impaired diabetics obtain talking glucometers at no cost through their health providers. The talking glucometer also comes in several languages and, with Advanced Diabetes Supply, SCVBC was able to obtain talking glucometers for Spanish speaking consumers.

Another agency, Lions Center for the Blind Oakland (LCBO), recently implemented group “Living with Vision Loss” classes which take place at the Center in Oakland or in community settings. For example, a class was recently conducted at the retirement community of Rossmoor. This six-week class provided consumers new to vision loss with information, resources, and skills training. Teaching consumers in a group setting offers consumers support and hands on experience. This class will help many individuals new to vision loss adjust to vision loss and maintain their independence and quality of life. In addition, those consumers needing more personalized one-on-one ILS training have now been educated on the services and training available to them through the Title VII Chapter 2 program at the LCBO.

The goal of California’s Title VII Chapter 2 program is to prolong the independence of older individuals who are severely visually impaired. The sub-grantees participated in the following collaborative and community-oriented activities: • developed and implement initiatives that strengthen existing relationships with public and private health agencies; • expanded partnerships with multi-cultural, ethnic and senior organizations to help close the gap to access to services among the state’s diverse population sub-groups; • participated in social marketing campaigns with other agencies serving seniors and the diverse senior communities; • referred appropriate related services such as mental health services and public assistance programs; and • established network of care systems with various providers, medical providers, agencies, associations and organizations that emphasize ILS to improve access and ensure cost-effective use of resources.

The DOR continues to provide technical assistance and consultation to sub-grantees on strategic planning of delivery of comprehensive ILS.

Community Awareness: In addition, sub-grantees participated in the following community awareness activities: • health forums sponsored by cities’ parks and recreation departments; • public awareness campaigns; • annual health/social services events and seminars sponsored by organizations that target seniors (i.e., Arthritis Foundation, Diabetes Association, American Stroke Foundation, etc.); • presentations at adult education schools; • coordinating public events with various foundations and organizations that specifically serve the visually impaired; • demonstrations in English as a Second Language classes; and, • distribution of culturally and ethnically sensitive agency information at various events conducted by or provided to individuals of ethnicities who are unserved or underserved.

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.

Currently, sub-grantees report quarterly on the outcomes of their Older Individuals Who Are Blind (OIB) programs. The evaluation of the reporting requirements for OIB is an in-house program evaluation activity. Careful documentation of service provision and consumer outcomes help measure sub-grantees’ effectiveness and identify technical assistance needs. Moreover, the evaluations increase accountability, strengthen quality assurance and identify where program policy revisions are needed. The evaluation process includes all components of the data collection requirements established by RSA.

Below are a few examples of sub-grantees’ narrative reports on their evaluations.

VTC Enterprises Since October 2011, individuals receiving OIB independent living services from VTC Enterprises, located in Santa Maria, and met 79.9% of their personal objectives; this represents 386 tasks that can now be performed independently. Since October 2011, 62 out of 69 people who responded to their satisfaction survey for the Low Vision Program were satisfied with services; 63 felt it improved their quality of life; 61 are still using the equipment that they received; and 55 are using the training. When asked for comments, one individual responded, "My mother passed away last August. We were very grateful for the assistance from VTC!!! It made her last days easier to cope with her very limited vision."

Society for the Blind The benefits to blind and low vision seniors attending Society for the Blind’s day and residential retreat programs are substantial, with more than 90% of participants expressing overall satisfaction with their retreat experience. Similarly, more than 90% of participating consumers demonstrate measurable improvements in their ability to live productively and independently.

Santa Clara Valley Blind Center The SCVBC regularly conducts 30-day and 90-day consumer evaluations. The 30-day evaluations are given to new consumers and serve as a satisfaction survey. The 90-day evaluations help identify improvement in adjustment to vision loss, improved socialization, increased activity level, increased knowledge of community resources, and increase in sense of independence.

Based on the 30-day evaluations: • 31 Title VII individuals began services in 3rd and 4th Quarter; • 19 consumers were evaluated; • 19 were pleased with the responsiveness and attention of the agency to their needs; • 16 were currently enrolled in activities or courses at the agency at time of evaluation; • 3 who were not enrolled in activities or courses at the time of the evaluation were undergoing physical therapy and recovering from illnesses; • 19 believed that the course materials were clear and effective for them.

As a result, 100% were pleased with the services and found them effective, and 84% are still active in programs at SCVBC.

Based on the 90-day evaluations: • 68 consumers were evaluated; • 68 thought the service was good; • 68 thought the course instructions were clear and effective; • 65 felt more confident in their activities; • 3 felt the same confidence in their activities. The 3 that felt the same cited that their lifestyle has changed due to other reasons than their vision loss.

As a result, 96% felt more confident since receiving services at SCVBC.

San Diego Center for the Blind The San Diego Center for the Blind (SDCB) routinely administers the AVL (Adjustment to Vision Loss) scale designed by the LightHouse for the Blind in New York as a pre-test in addition to the Burns Depression and Anxiety scales. Results from the pre- and post-tests have confirmed our research that approximately three months after entering program/services, consumers will experience an increase in depression, which rebounds to a significant decrease after the initial three months. SDCB’s Ph.D. Psychologist theorizes that upon entering the program, consumers are faced with the reality of their loss which results in a rise in depression and anxiety before gaining skills and coping techniques which leads to general improvement thereafter.

Consumer Satisfaction surveys are administered by student interns to a random 50% of the consumers receiving services under Title 7 Chapter 2 at random times, some during programming, some after services. Results from this survey show a satisfaction rate of 85 to 95%.

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).

Below are a few examples of sub-grantees’ narrative reports on their consumers.

Carolyn Carolyn is 78 years old and came to the SDCB as a result of vision loss from macular degeneration. She decided to participate in the full vision rehabilitation program offered by the Center which included: ILS, Cooking, Sensory Awareness, Group Counseling/Peer support, and Resource Information for the Blind.

Carolyn took advantage of all the resources that were available. She practiced what she learned in class that week when she went home, and was ready for new information when she returned the following week. She really applied her skills, became an excellent role model/life coach for new students that arrived at the Center, inspiring them to be the best that they can be and to get the most out of their program. Carolyn has become very involved with SDCB’s quarterly Family Seminar and has included her daughter as well. As a result, the daughter has been more active in her mother’s vision rehabilitation, which has benefitted the both of them. Carolyn was particularly pleased with the services from the low vision department with assistive technology and training in devices. It is a pleasure to see Carolyn’s attitude change from, "What do I do now?" to, "How can I make my life better?"

Mrs. G Mrs. G was in crisis when we first opened her case; she and her family finally decided that she could no longer care for her husband and take care of her own needs as a person with a visual impairment. Her three children were taking turns traveling from a distance to care for their mother. After determining her goals, we: increased the lighting in her home and introduced magnifiers that would allow her to pay bills on her own; provided appropriate filters for both in and outdoors to increase visibility and comfort; provided a cane and instruction for safe mobility in her community; enlarged her file labels so she could locate important papers; marked her appliances so she could cook safely; and taught her how to use a Talking Books digital player to continue her favorite hobby . . . reading! A large portion of service provision involved referral and information; those included the local low-vision support group, ADA Paratransit services, equipment catalog companies, and a senior placement service for her husband. Her children expressed comfort that they could now leave her alone for extended periods.

Ms. T Ms. T was fortunate to have a family member who is an architect/builder. He designed and built an accessible apartment for his mother. However, the lighting that he chose was based upon guidelines for a typically-sighted individual. The VTC Enterprises’ ILS provider devoted an entire session to education about lighting for both Ms. T and her family. Afterwards, the son stated that he was impressed at the increase in his knowledge; he now understood why his mother constantly stated that there wasn’t enough lighting in the house — a comment which he had been taking as a slight to his skills as a designer. At subsequent sessions, it was noted that he incorporated new lighting ideas into her apartment. They also were pleased that his mother could operate the microwave oven by using one marked button and the large print directions that they made after learning the print size that she could read. With suggestions, they manufactured a container on her wheelchair to hold her cordless phone and new talking keychain watch — items that she was constantly misplacing.

Hispanic male, 84 year old The Dayle McIntosh Center’s (DMC’s) Aging with Vision Loss (AVL) Program provided services to an 84 year old, Hispanic male consumer residing in the city of Anaheim. The consumer is experiencing vision loss due to diabetes and a stroke. The consumer was referred to the AVL program by DMC’s Assistive Technology Coordinator who is working with the consumer to identify a local community resource that will assist him with grab bars in his home. This consumer is a great example of a consumer at DMC receiving multiple services. The consumer is experiencing multiple disabilities which made the adaptive diabetic equipment training priority challenging. The consumer has limited mobility in his hands due to Parkinson’s and a stroke. This made his ability to grasp, hold, and press extremely difficult. His wife is supportive, yet may be too eager for him to be able to accomplish self-testing of his blood sugar all on his own. The ILS Counselor demonstrated the testing process using a talking glucometer. Using his own lancet device she had him try testing with a high level of support from her to help him prick his finger with the lancet, to inserting the test strip, to sliding the strip back and forth on his finger to find the blood. He has the desire to practice the technique; however, may not be able to accomplish the physical task due to the limited hand mobility. The ILS Counselor requested that he practice only the lancet portion of the process for now, and have his wife continue with the remainder of the testing process. Besides the adaptive diabetic equipment training, the consumer also benefited from a Spanish talking clock, learned about having a low vision assessment at the Braille Institute and wants to receive a free audio Bible from Aurora Ministries. Ultimately, the consumer increased his awareness of services available for older adults with a visual impairment, was connected to additional services and received a basic, low tech device in the form of a talking clock which makes a huge impact in his ability to tell time.

Dan A consumer from The Center for the Partially Sighted (CPS) is Dan, a vigorous 81 year old man who is partially sighted due to histoplasmosis. Aside from hypertension, he enjoys excellent health and had great plans for his retirement years. One of his most important priorities was to continue to manage his properties, which involved substantial computer work and bookkeeping. However, he was completely stymied by his low vision, which interfered with his livelihood and his quality of life. He presented to the CPS doctors with two primary goals — reading the computer screen and reading small print. He was concerned and saddened that these very important tasks seemed beyond him.

The CPS low vision optometrist evaluated his vision in light of his stated goals. A simple illuminated hand magnifier helped Dan read small print and he immediately brightened at the prospect of being able to read again. Dan has traveled back to the Center on more than one occasion to purchase additional magnifiers. He uses them for work and a variety of other activities, including reading for a hobby. He says he wants to make sure he always has a magnifier handy. The optometrist also introduced Dan to a head-borne magnifier to use with his computer. Happily, with this low vision device, he has access to the print on his computer screen. Finally, the optometrist refracted Dan to see if she could improve on his general vision. She wanted him to be able to travel about the community as safely as possible and avoid the risk of falls. Dan remarked that he had no idea that glasses could make such a difference — he hadn’t seen as well in quite some time. Dan remains partially sighted, but equipped to handle his work responsibilities and enjoy his retirement.

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

The Center for the Partially Sighted The association of vision loss with the development of other health care issues is not widely recognized. Falls, medication mismanagement, poor diet, reduced exercise and isolation/depression resulting from impaired vision can be alleviated by comprehensive low vision services, but access is limited. In California, the elimination of optical devices from Medicaid coverage and the reduction in payment levels creates an added burden for Medicare/Medicaid beneficiaries. Medicare coverage also does not include rehabilitation services by rehabilitation specialists, O&M specialists or low vision therapists, nor do they include optical and electronic devices under covered durable medical equipment. As a result, older adults with limited resources have only OIB funding to rely on. The need will only continue to outpace the availability with the aging of the population and the increase in diabetes related vision loss, especially in areas with large populations of Latinos and African Americans and others with limited access to healthcare.

LightHouse for the Blind The challenges continue this 4th quarter as we find in our area there are an increased number of referrals from skilled nursing facilities, and vision loss is only one of many issues of the individual - and clearly not the primary issue. Based on last quarter’s findings, we have provided more outreach to social workers at the skilled nursing facilities, providing more education as to appropriate referrals and information about low vision and blindness. This quarter we have also had staff attrition due to staff leaving and staff becoming very ill — filling the positions is difficult due to few professionals in the field who live in the bay area, as well as ensuring that existing staff can assist with coverage.

Lions Center for the Blind, Oakland Our primary challenge remains financial. The limited resources we receive from the Title VII Chapter 2 grant does not cover the full cost to serve all of the visually impaired residents that are in need of services in our community. We are currently working on developing more funding sources so that we can continue to serve the growing number of consumers.

Society for the Blind One challenge Society for the Blind faces in serving Sacramento, Chico and Mount Diablo is the large geographic area these regions encompass. There are many blind and low vision seniors within these areas who are either unserved or underserved as a result of residing far from available services. Society for the Blind works to address the needs of these individuals by extending outreach efforts to far flung communities and attempting to organize training events that serve groups of seniors large enough to justify the time and resources necessary to serve communities many hours driving distance from Sacramento.

Linguistic and cultural differences also present challenges to serving blind and low vision seniors from ethnic minority groups. Outreach efforts to these seniors require engaging the services of translators to facilitate communications between service providers and potential consumers. Also, time and effort must be given to establishing relationships that engender trust in service providers and willingness among blind and low vision seniors from ethnic minority groups to step outside the familiarity of their communities to receive beneficial services. Overcoming cultural beliefs that discourage full participation of blind and low vision seniors in many activities is one of the greater challenges faced in providing services to these individuals.

Vista Center for the Blind and Visually Impaired Transportation continues to be a growing challenge. The para-transit companies are making cuts as to who can receive their services and where they will take them. Our agency serves four different counties and the para-transit organizations are county-based. Although most of our services are itinerant, there are services that are center based (Low Vision Clinic, Support groups, Computer training) that would benefit the consumers but they are limited by their transportation opportunities. The cost of gas is becoming a major cost when it comes to serving people in the community.

VTC Enterprises-Santa Maria Title VII funds alone are not sufficient to provide services to all who need it in all three counties, so we must continue to look for alternative funding for both support staff and direct services. Since our providers are spread across a 185-mile strip of three counties, we need to find funding that would reimburse educational and collaborative meetings with all of our subcontractors. As the Baby Boomer generation enters the senior population, their increased use of technology will require ingenuity in obtaining expensive adaptive technology to meet their needs. In addition, as new technology emerges, we need to locate funding that will enable us to update our demonstration kits.

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 byJoe Xavier
TitleDeputy Director, Specialized Services Division
Telephone916 558-5822
Date signed12/21/2012