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

RSA-7-OB for Services for the Blind, Vocational Rehabilitation Program - H177B120007 report through September 30, 2012

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year389,620
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year179,560
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2398,388
A2. Total other federal20,581
(a) Title VII-Chapter 1-Part B4,449
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other16,132
A3. State (excluding in-kind)595,296
A4. Third party0
A5. In-kind0
A6. Total Matching Funds595,296
A7. Total All Funds Expended1,014,265
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs348,148
C. Total expenditures and encumbrances for direct program services666,117

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 4.4000 8.2500 12.6500
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 4.4000 8.2500 12.6500

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 4 2.4000
2. Employees with Blindness Age 55 and Older 2 1.2000
3. Employees who are Racial/Ethnic Minorities 3 2.2000
4. Employees who are Women 13 8.8500
5. Employees Age 55 and Older 2 1.4500

C. Volunteers

1.00

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 FY30
2. Number of individuals who began receiving services in the reported FY751
3. Total individuals served during the reported fiscal year (A1 + A2) 781

B. Age

1. 55-5957
2. 60-6454
3. 65-6940
4. 70-7457
5. 75-7969
6. 80-84123
7. 85-89182
8. 90-94151
9. 95-9943
10. 100 & over5
11. Total (must agree with A3)781

C. Gender

1. Female550
2. Male231
3. Total (must agree with A3)781

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race36
2. American Indian or Alaska Native0
3. Asian5
4. Black or African American53
5. Native Hawaiian or Other Pacific Islander0
6. White657
7. Two or more races4
8. Race and ethnicity unknown (only if consumer refuses to identify)26
9. Total (must agree with A3)781

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)26
2. Legally Blind (excluding totally blind)732
3. Severe Visual Impairment23
4. Total (must agree with A3)781

F. Major Cause of Visual Impairment

1. Macular Degeneration506
2. Diabetic Retinopathy53
3. Glaucoma72
4. Cataracts2
5. Other148
6. Total (must agree with A3)781

G. Other Age-Related Impairments

1. Hearing Impairment256
2. Diabetes170
3. Cardiovascular Disease and Strokes441
4. Cancer46
5. Bone, Muscle, Skin, Joint, and Movement Disorders330
6. Alzheimer's Disease/Cognitive Impairment29
7. Depression/Mood Disorder30
8. Other Major Geriatric Concerns233

H. Type of Residence

1. Private residence (house or apartment)668
2. Senior Living/Retirement Community17
3. Assisted Living Facility58
4. Nursing Home/Long-term Care facility38
5. Homeless0
6. Total (must agree with A3)781

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)507
2. Physician/medical provider13
3. State VR agency10
4. Government or Social Service Agency9
5. Veterans Administration0
6. Senior Center9
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center5
11. Family member or friend62
12. Self-referral164
13. Other2
14. Total (must agree with A3)781

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 5,641
1b. Total Cost from other funds 2,134
2. Vision screening / vision examination / low vision evaluation 109
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 3

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 5,761
1b. Total Cost from other funds 96,861
2. Provision of assistive technology devices and aids 598
3. Provision of assistive technology services 43

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 113,273
1b. Total Cost from other funds 433,486
2. Orientation and Mobility training 277
3. Communication skills 383
4. Daily living skills 423
5. Supportive services (reader services, transportation, personal 7
6. Advocacy training and support networks 1
7. Counseling (peer, individual and group) 344
8. Information, referral and community integration 17
. Other IL services 286

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 0
1b. Total Cost from other funds 6,184
2. Information and Referral 0
3. Community Awareness: Events/Activities 69 724

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) 1,178,778 1,014,265 -164,513
2. Number of Individuals Served 847 781 -66
3. Number of Minority Individuals Served 97 100 3
4. Number of Community Awareness Activities 46 69 23
5. Number of Collaborating agencies and organizations 38 50 12
6. Number of Sub-grantees 0 0

Part VI: Program Outcomes/Performance Measures

Provide the following data for each of the performance measures below. This will assist RSA in reporting results and outcomes related to the program.

Number of persons Percent of persons
A1. Number of individuals receiving AT (assistive technology) services and training 43 100.00%
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) 35 81.40%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 1 2.33%
B1. Number of individuals who received orientation and mobility (O & M) services 277 100.00%
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) 188 67.87%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 14 5.05%
C1. Number of individuals who received communication skills training 383 100.00%
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) 282 73.63%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 17 4.44%
D1. Number of individuals who received daily living skills training 423 100.00%
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) 190 44.92%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 36 8.51%
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) 253 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) 15 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) 65 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 29 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) 25 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 Title VII-Chapter 2 program in CT is administered by the Bureau of Education and Services for the Blind (BESB), one of five agencies that was consolidated two years ago into a new independent state agency, the Department of Rehabilitation Services (DORS). DORS includes the general VR agency, Bureau of Rehabilitation Services. As BESB is a separate program within DORS, the agency remains DSU for both the VR and Chapter 2 program serving clients who are legally blind or severely visually impaired progressive. BESB’s Chapter 2 program is an in-house program housed within the Adult Services Division of BESB; the program is separate from the VR program in terms of staffing and funding. The Adult Services Division of the agency is funded with state and federal funding and serves clients who have signed independent plans or waivers. Clients who have completed IL Plans remain eligible for follow up services or can develop new plans on a lifelong basis.

Vision related rehabilitation and independent living services provided by the agency include but are not limited to social work services, advocacy, case management, rehabilitation teaching, orientation and mobility services, low vision services, assistive technology training and volunteer services. The agency does not contract for delivery of "core" vision rehabilitation services. The agency does contract with qualified eye doctors to provide low vision services and also uses vendors on contract for purchase of low vision, independent living aids, assistive technology and other adaptive equipment as well as related training.

BESB conducts outreach activities to promote awareness of BESB services to seniors through a variety of approaches including periodic mailings to all eye doctors to promote understanding of their statutory obligation to report patients who are legally blind to BESB.

BESB retains a confidential blind registry and as a result, conducts periodic mailing to all members targeted by age group, geographical community and other factors when relevant such as special events. The agency sends periodic mailings at the request of senior centers and other organizations to promote low vision support groups. BESB utilizes a web based volunteer match system to recruit volunteers to serve as senior companions to our older blind population, providing reading, shopping, transportation and companionship activities.

The agency participated in various community outreach activities this past year as in other years including senior health fairs, assisted living facilities, retirement communities and other events to promote awareness of our programs. Periodic mailings to clients are sent to make clients aware of events and new services that are available to them in their area such as low vision support groups, and technology fairs. Materials on the agency’s services are available in Spanish upon request.

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.

BESB continues to collaborate with organizations and agencies throughout the state in an effort to promote awareness of our services and to improve service delivery.

Of particular note this past year is the collaboration of BESB with the State Independent Living Council and AAA’s to develop a campaign to promote awareness of issues pertaining to dual vision and hearing loss with the elderly. This annual campaign based on the Helen Keller National Center theme of "Losing Sight and Sound Without Losing Your Identity (confidence)" was launched in June of 2012 and will continue into the next year. Posters of deaf-blind seniors were prominently displayed in the state Capitol during the months of June and July and an interview with two of the members was produced by the CT Radio Information System. Other planned activities include a caregiver conference co-sponsored by one of the AAA’s, as well as 4-5 senior center presentations on this issue.

BESB is also collaborating with the CT Tech Act program housed within BRS, the general VR agency, to assist our deaf-blind adult clients in applying for the National Deaf-Blind Equipment Distribution Program and assisting BRS with outreach, particularly to agencies that serve seniors. BESB will be sending flyers explaining the program to 200 clients identified as deaf-blind on its blind registry, as well as 800 seniors identified through the Chapter 2 program as hard of hearing in FFY 2013.

BESB also collaborated with the State Independent Living Council and the states five Centers for Independent Living (CILS) to promote and facilitate a project that facilitates access of adults who are blind as well as individuals with other disabilities to computer equipment, adaptive software such as Zoom Text, GUIDE, Scan and Read systems, etc. In FFY staff of CILS were provided training and an overview of all products installed on the CIL computers in order to facilitate support of clients. In FFY 2013 the SILC plans to purchase JAWS to be installed at CILS and training to be provided to CIL staff, to augment BESB Rehab Technology services.

In the past year BESB provided quarterly training of all new Transition Coordinators employed by the CILS, AAA’s and other agencies to transition adults from nursing homes and rehabilitation hospitals to community living through the Money Follows the Person Medicaid Waiver grant.

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.

BESB used to report all consumers whose cases remained open on the 7OB report. As some cases remained open because services rendered by vendors had not yet been billed and paid, this created a discrepancy between the date that the services were rendered and the date the case was closed. As a result the decision was made to only report cases for the 7OB report where one or more vision related rehabilitation services had been rendered during the preceding year and the case had been put into inactive (but not closed status) by case managers.

This change in reporting reduces the overall number of clients reported through the 7OB report, but substantially improves the accuracy of data obtained to complete the functional gains components of the report, particularly the confidence levels reported by clients obtained through a consumer survey. This change also results in the ability of the agency to provide more timely follow-up services to older adults through this process, including the provision of assistive technology devices and additonal training.

A total of 333 clients were successfully contacted who received assistive technology training, daily living skills training, communication skills training or orientation and/or orientation and mobility services. 76% reported improved confidence levels to function more independently as the result of BESB services; 24% reported no significant difference. 4% of the clients reporting no significant differences indicated that this was due to a change in life circumstances such as diminishing health or a move to a more restricted setting such as a nursing home. 2% reported a loss of functioning due to additional vision loss (within the last year) and will be reassessed.

Many clients requested additional assistive technology aides including items such as talking watches, additional tactile bump dots, low vision calendars etc. In addition, as the result of the survey, clients who requested additional services will be contacted by BESB case managers to determine if their case needs to be re-opened and re-assigned for additional training.

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).

BESB provides vision related rehabilitation services to older adults who are legally blind, primarily on an itinerant basis. The vast majority of older adults that BESB serves continue to live independently in their own homes or in retirement communities. The agency also serves older adults who reside in other settings such as rehabilitation hospitals, nursing homes, assisted living facilities and group homes. The mission of the agency is to maximize the independent level of functioning of older adults, regardless of residential setting. BESB also continues to collaborate with DSS and other agencies to transition older adults safely from nursing homes to the community. The following are case examples where BESB services have had a significant impact on the lives of older adults during the past fiscal year.

EH is a 59 year old female who lost most of her sight suddenly following surgery to remove a tumor from her pituitary gland. The hospital failed to refer her to BESB for services; however, staff from the skilled nursing home did contact BESB. BESB staff collaborated with nursing home staff and the client’s family to assist the client in regaining her independence so she could be safely discharged back to her apartment to live alone. The client received instruction in using a long cane as well as sunglasses and glare shields. The orientation and mobilty instructor also trained the client, the client’s family and agency staff in proper use of sighted guide technique. After the client was discharged to her apartment, her O & M instructor helped the client to create safe routes to travel to her mailbox, church and local grocery store and assisted her in filing an ADA paratransit application.

GM is a 78 year old female diagnosed with ARMD and hypertensive retinopahy. She resides in an urban community with her sister who has signs of dementa. The client received low vision rehabilitation services including training in using handheld magnifiers and a Closed Circuit Television Viewer. These devices enabled the client to read mail, pay bills, read recipes and manage her own as well as her sister’s medications. She also received communication aids and training including bold line paper, a 20/20 pen, signature guide large print address book to assist her in managing household and personal communication needs. Additionally the client received adaptive kitchen equipment to aid her in meal preparation for herself and her sister.

JS lost his ability to drive his car due to a progressive eye disease. However, he still wished to be able to visit his mother independently. She lived many miles away from his rural home, but public transportation was available for the trip. The client’s O & M instructor taught the client how to use a white cane and assisted him in learning bus routes, bus stops, transfer points, and specific street crossings, he needed to use to continue visiting his other on his own.

SB is a 70 year old woman with RP, who had been gradually losing her confidence to travel independently to her many social activities and medical appointments. She was progressively losing her peripheral vision and had fallen a few times in recent months and requested long cane training. SB subsequently received several hours of O & M instruction and is now able to confidently travel using ADA paratransit services to stores, medical appointments, and social activities. Initially reluctant to use the long cane, she now says that "she would never go anywhere without it!"

CL, a 62 year old man with legal blindness, was hospitalized, and eventually transferred to a rehabilitation hospital after being struck by a car. The accident resulted in orthopedic impairment and loss of his remaining vision. The client who had lived independently in his own apartment was at great risk of being evicted from public housing due to the length of time of his rehabilitation. BESB social work staff provided advocacy services to ensure that the client was eligible for transition services, advocated for the client to prevent eviction by the housing authority due to his absence of more than thirty days from his resident, and helped facilitated discharge planning meetings. he agency’s OM instructor worked with the client and the hospital’s PT staff to re-train the client to use a support cane as well as a long cane so that he could travel independently. After the client was discharged, OM staff continued to provide OM instruction and assist the client in applying for paratransit services. RT staff assessed the client for communication devices, and marked appliances to enable the client to use his microwave.

JF is a deaf-blind client who lcurrently lives independently in an apartment and receives independent living and companion services through the Acquired Brain Injury waiver. BESB staff including a social worker advocate and OM instructor participated in ABI waiver team meetings to ensure that the client’s vision related rehabilitation needs were being met. After the client used his cane inappropriately with a staff member, BESB’s OM instructor retrained staff to provide sighted guide technique and provided feedback to the team on how the client could continue to travel safely and under what circumstances the client could continue to use the cane decreasing risk to himself and staff. In addition, BESB paid for installation of an alertmaster system in the apartment of the client and training of the client and staff in using it for client safety as well as for low vision services including glasses to maximixe the client’s remaining vision.

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

To date, there have been no major problematic areas related to implementing the Title VII-Chapter 2 program in CT due to consolidation. However, declining state revenues as well as the prospect of diminishing federal revenues may be problematic for delivery of state FY 2013 services. The only state account for purchase of independent living aids for adult clients was reduced by $15,000 through the recission process. Further cuts may result during when the state budget is finalized in the coming months that could have more devastating consequences, particularly if federal funding is also cut.

However, to date the agency has been able to absorb reductions in revenue primarily because of the agency’s decision to cap the purchase of low vision devices particularly glasses, prescribed by low vision eye doctors. In addition, whereas clients were routinely referred to low vision eye doctors in the past by case managers, clients are now referred to Rehabilitation Teachers with training in low vision to provide magnifiers to clients, and to assess clients for referral to low vision eye doctors that can benefit.

In addition state funding for direct services positions in the Adult IL Division of the agency mostly remained intact although clerical and other administrative positions have been lost. However, the agency did lose one social worker case management position due to retirement that was not replaced, significantly increasing the caseload of the remaing four social workers. In addition, the agency was able to hire two new RT’s to fill existing vacancies. However, going forward into this next state fiscal year with projected budget shortfalls, the concern is that O & M and RT instructors who leave the agency due to retirement or other factors may not be replaced in a timely manner and this would substantially increase caseloads for the remaining staff.

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 byMarsha Brown
TitleOIB Program Manager
Telephone860-602-4046
Date signed02/06/2013