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

RSA-7-OB for Iowa Department for the Blind - H177B120015 report through September 30, 2012

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year338,612
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year217,780
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2479,957
A2. Total other federal0
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other0
A3. State (excluding in-kind)89,391
A4. Third party0
A5. In-kind0
A6. Total Matching Funds89,391
A7. Total All Funds Expended569,348
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs132,330
C. Total expenditures and encumbrances for direct program services437,018

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 0.9400 4.2000 5.1400
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 0.9400 4.2000 5.1400

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 2 0.6900
2. Employees with Blindness Age 55 and Older 1 0.3500
3. Employees who are Racial/Ethnic Minorities 0 0.0000
4. Employees who are Women 10 3.4900
5. Employees Age 55 and Older 2 0.6900

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 FY387
2. Number of individuals who began receiving services in the reported FY607
3. Total individuals served during the reported fiscal year (A1 + A2) 994

B. Age

1. 55-5932
2. 60-6453
3. 65-6949
4. 70-7459
5. 75-79119
6. 80-84187
7. 85-89243
8. 90-94174
9. 95-9955
10. 100 & over23
11. Total (must agree with A3)994

C. Gender

1. Female761
2. Male233
3. Total (must agree with A3)994

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race4
2. American Indian or Alaska Native1
3. Asian2
4. Black or African American17
5. Native Hawaiian or Other Pacific Islander1
6. White945
7. Two or more races0
8. Race and ethnicity unknown (only if consumer refuses to identify)24
9. Total (must agree with A3)994

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)61
2. Legally Blind (excluding totally blind)616
3. Severe Visual Impairment317
4. Total (must agree with A3)994

F. Major Cause of Visual Impairment

1. Macular Degeneration673
2. Diabetic Retinopathy66
3. Glaucoma55
4. Cataracts13
5. Other187
6. Total (must agree with A3)994

G. Other Age-Related Impairments

1. Hearing Impairment402
2. Diabetes107
3. Cardiovascular Disease and Strokes331
4. Cancer44
5. Bone, Muscle, Skin, Joint, and Movement Disorders193
6. Alzheimer's Disease/Cognitive Impairment57
7. Depression/Mood Disorder20
8. Other Major Geriatric Concerns63

H. Type of Residence

1. Private residence (house or apartment)645
2. Senior Living/Retirement Community162
3. Assisted Living Facility101
4. Nursing Home/Long-term Care facility86
5. Homeless0
6. Total (must agree with A3)994

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)72
2. Physician/medical provider20
3. State VR agency4
4. Government or Social Service Agency7
5. Veterans Administration0
6. Senior Center36
7. Assisted Living Facility17
8. Nursing Home/Long-term Care facility48
9. Faith-based organization3
10. Independent Living center0
11. Family member or friend235
12. Self-referral301
13. Other251
14. Total (must agree with A3)994

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 11,052
1b. Total Cost from other funds 2,058
2. Vision screening / vision examination / low vision evaluation 272
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 169,467
1b. Total Cost from other funds 31,562
2. Provision of assistive technology devices and aids 540
3. Provision of assistive technology services 540

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 176,835
1b. Total Cost from other funds 32,934
2. Orientation and Mobility training 148
3. Communication skills 476
4. Daily living skills 726
5. Supportive services (reader services, transportation, personal 47
6. Advocacy training and support networks 69
7. Counseling (peer, individual and group) 542
8. Information, referral and community integration 176
. Other IL services 751

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 11,052
1b. Total Cost from other funds 2,058
2. Information and Referral 0
3. Community Awareness: Events/Activities 99 3,000

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) 528,065 437,018 -91,047
2. Number of Individuals Served 1,036 994 -42
3. Number of Minority Individuals Served 22 25 3
4. Number of Community Awareness Activities 119 99 -20
5. Number of Collaborating agencies and organizations 5 5 0
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 540 100.00%
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) 391 72.41%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 134 24.81%
B1. Number of individuals who received orientation and mobility (O & M) services 148 100.00%
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) 93 62.84%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 42 28.38%
C1. Number of individuals who received communication skills training 476 100.00%
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) 304 63.87%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 93 19.54%
D1. Number of individuals who received daily living skills training 726 100.00%
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) 553 76.17%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 156 21.49%
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) 433 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) 17 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) 85 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 77 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) 11 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.

In-house Program: The Iowa Department for the Blind (IDB) operates an in-house Chapter 2 program and does not sub-grant or contract to provide services. The IDB is a state agency and provides a comprehensive range of services and programs for those Iowans who are blind or visually impaired. The IDB houses the Regional Library for the Blind and Physically Handicapped, it operates an Adult Orientation and Adjustment Center, a small aids and devices store, a Randolph-Sheppard program, and, in accordance with the Rehabilitation Act, it operates a Vocational Rehabilitation (VR) program and an Independent Living (IL) program. All programs are closely integrated in order to provide a seamless system of services to blind and visually impaired Iowans. The Chapter 2 program is an important component of this service system. The IDB has ten rehabilitation teachers. These teachers divide their time between serving clients receiving vocational rehabilitation services and those receiving independent living services. The teachers maintain time logs to ensure accurate cost allocation.

Chapter 2 services are provided on an outreach basis, with the teachers traveling the state to meet individuals in their homes and communities. Iowa is seeing some growth in the provision of low vision services. Several low vision centers have opened across the state. There is also an increase in the number of vendors of low vision aids and increased involvement of occupational therapists in the provision of vision therapy. With low vision services more readily available, the IDB places much emphasis on providing training in adaptive, non-visual techniques. This training is provided in conjunction with guidance and counseling in order to promote a positive adjustment to vision loss. Teachers also help individuals access other community resources and services as appropriate. The teachers are all experienced (the most junior has three years of field experience and the most senior has over thirty years) and are very familiar with the range of services and supports available to clients.

Outreach to underserved: Iowa has many rural counties. The IDB has experienced a low rate of referral from these areas and has identified the rural population as underserved. This past year, the counties in northwest Iowa were targeted for a major outreach effort. The Department receives few referrals from this area of the state even though, given the prevalence of age-related macular degeneration, a high concentration of older individuals would suggest it is likely that a number of people experience vision loss. In an effort to increase referrals, the IDB hosted a Low Vision Expo in Spencer, Iowa. The event featured several vendors of low aids, a presentation from a local optometrist, and presentations from blind individuals. Promotional efforts included mailings, fliers, advertisements in local papers, and radio broadcasts. The Expo was well attended and even drew local media coverage. Over 10 new referrals were obtained the day of the event, and it is hoped that the seeds planted will net more referrals in the future.

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 Relationships and Activities The IDB’s Chapter 2 program enjoys several ongoing collaborative relationships. The Chapter 2 program staff works closely with Iowa’s two newspaper reading services, Newsline (an over-the-phone, automated newspaper reading service) and IRIS (a radio reading program), by exchanging referrals, delivering radios, and providing instruction on accessing and using the Newsline system.

The IDB also enjoys a collaborative relationship with the Department on Aging (DOA). A representative of the DOA serves on the Independent Living Advisory Committee, and the Chapter 2 program manager has been asked to serve on the statewide Aging and Disability Resource Council (ADRC). In addition, two of the rehabilitation teachers serve on local ADRCs in different parts of the state.

As referenced above, a key partner in the development of IL services for Iowa’s blind and visually impaired population is the Independent Living Advisory Committee of the Iowa Department for the Blind. The Committee has statewide, as well as, minority representation and consists of 13 members: 12 individuals who are blind, and a representative from the Department on Aging. Committee members actively work to increase public awareness in their home communities by arranging and conducting speaking engagements, promoting White Cane Safety Day, and simply participating in various activities and organizations. Because members are so active and visible in their communities, they often serve as a point of referral and help many individuals access independent living services. Members also serve as peer advisors, participate in self-help groups, and assist with various program functions (i.e., Senior Orientation). The Committee has proven to be a vital asset in the planning and delivery of services.

The Chapter 2 program manager serves as an ex-officio member of the Iowa Statewide Independent Living Council. This affords an important link to Iowa’s IL community. This past year, the program manager was involved in the ongoing implementation and monitoring of the State Plan for Independent Living (SPIL), which helps to ensure that the delivery of IL services is coordinated and unduplicated across the state. No new service delivery methods were developed that required incorporation in the SPIL.

Community Awareness and other Activities In addition to the activities described above, Chapter 2 staff conducted 99 speaking engagements (including in-service training to other providers) and set up exhibits in 12 different community events (e.g., senior fairs, health fairs, diabetes resources, etc.) held across the state. Staff also actively network with other providers and attend meetings of various service coalitions in some of the more rural counties.

Finally, the Chapter 2 program is included in the overall promotional efforts of the IDB. For instance, the IDB has a very dynamic website, which features information on the Chapter 2 program. Each month a new tip on adaptive techniques for common, every day activities is added. Over 700 service providers and consumers are notified of this new technique via email with a link to the website. Additionally, the website includes short videos providing basic instruction on simple adaptive techniques. The IDB also publishes a quarterly magazine which always features an article on the Chapter 2 program.

C. Briefly summarize results from any of the most recent evaluations or satisfaction surveys conducted for your program and attach a copy of applicable reports.

The IDB asks individuals served to complete a “feedback form” when they attend a group training. Last year, the IDB conducted 17 group trainings, which were attended by 92 individuals. Responses were overwhelmingly positive. All indicated that they had learned a new skill and had a more positive attitude about blindness. When asked what they thought was the most important thing they gained from the training, comments included: “I got information you can’t get anywhere else.” “There’s still life after vision loss.” “It’s a lot easier for me to do my stuff around the house.” “It helps you get control of your life back.”

Finally, the number of independent living objectives set, met, not met, and in progress is used as an evaluation tool. Ninety percent of the objectives closed during this past reporting period were closed as successfully met. There is a higher success rate for daily living objectives than for mobility objectives. Anecdotal data suggests this is because of other factors unrelated to vision loss that interfere with a person’s mobility.

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).

Shared below are comments included on a feedback form recently received from Mary when her case was successfully closed. Mary is 76 years old and lives alone. When Barb, the teacher, first met Mary she was very anxious about her vision loss and concerned about her ability to continue to manage her own affairs, not to mention continue the many activities she enjoyed. Barb worked with Mary on a variety of areas but concentrated on home management and computer. Mary’s comments say it all:

Your services were just the best. I went to therapy a couple of times at Mayo and then they referred me to you. I know I was in complete denial at Mayo and when she showed me marking my stove or appliances I thought not for me. How wrong I was. Barb was truly amazing and knew how to get through me. Thank God for sending her. I looked forward to her coming. I still haven’t really sat down and worked on my computer — hopefully this winter. I play cards every week and the ladies are always very helpful to help me. I’m getting ready for Thanksgiving doing everything myself. I started some things today (Sunday). Takes me longer now but I’m happy to say I can do it! I love my CCTV don’t know what I’d do without it. Look up my recipes and then write them out large. Just finished by myself tying 3 quilts. Put them out on the floor, laid in the batting, and pinned together, then tucked them on the frame and tied. Going to do more. I like being busy and especially doing things for the grandkids. I love getting my books on tape. Everything you’ve done to help me I truly appreciate. Your services are outstanding. Thank you for everything. God Bless. Say Hi to Barb.

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

While not a problem, it should be pointed out that there is a possibility we are seeing a shift in our demographics. Specifically, the number of individuals referred who are aged ninety or older continues to increase, and this is accompanied by a decrease in the number of individuals who are living in their own homes, much like what we saw last year. If this does become a trend it will mean some changes in our outreach and service provision. Also of note is a slight increase in the number of non-English speaking referrals. This poses a challenge in terms of finding affordable, competent interpreters.

Finally, one of the rehabilitation teachers resigned at the close of the federal fiscal year. Due to budget constraints we will not be filling this vacancy. In fact, the budget is a looming concern and efforts are underway to obtain state funding to support the Chapter 2 program. If these efforts are not successful radical changes will need to be made, including a reduction in force.

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 byRebecca W. Criswell
TitleProgram Manager, Chapter 2
Telephone515-281-1299
Date signed12/27/2012