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

RSA-7-OB for Kentucky Office for the Blind - H177B120017 report through September 30, 2012

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year458,196
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year53,848
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2512,057
A2. Total other federal235,149
(a) Title VII-Chapter 1-Part B50,236
(b) SSA reimbursement184,913
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other0
A3. State (excluding in-kind)55,622
A4. Third party0
A5. In-kind0
A6. Total Matching Funds55,622
A7. Total All Funds Expended802,828
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs63,733
C. Total expenditures and encumbrances for direct program services739,095

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 0.7200 6.8500 7.5700
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 0.7200 6.8500 7.5700

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 3 2.2500
2. Employees with Blindness Age 55 and Older 0 0.0000
3. Employees who are Racial/Ethnic Minorities 1 0.7600
4. Employees who are Women 8 6.0500
5. Employees Age 55 and Older 2 1.5200

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 FY175
2. Number of individuals who began receiving services in the reported FY556
3. Total individuals served during the reported fiscal year (A1 + A2) 731

B. Age

1. 55-5961
2. 60-6468
3. 65-6948
4. 70-7460
5. 75-7998
6. 80-84132
7. 85-89157
8. 90-9479
9. 95-9923
10. 100 & over5
11. Total (must agree with A3)731

C. Gender

1. Female529
2. Male202
3. Total (must agree with A3)731

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race0
2. American Indian or Alaska Native0
3. Asian0
4. Black or African American40
5. Native Hawaiian or Other Pacific Islander0
6. White690
7. Two or more races1
8. Race and ethnicity unknown (only if consumer refuses to identify)0
9. Total (must agree with A3)731

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)49
2. Legally Blind (excluding totally blind)436
3. Severe Visual Impairment246
4. Total (must agree with A3)731

F. Major Cause of Visual Impairment

1. Macular Degeneration458
2. Diabetic Retinopathy82
3. Glaucoma48
4. Cataracts6
5. Other137
6. Total (must agree with A3)731

G. Other Age-Related Impairments

1. Hearing Impairment92
2. Diabetes154
3. Cardiovascular Disease and Strokes204
4. Cancer11
5. Bone, Muscle, Skin, Joint, and Movement Disorders111
6. Alzheimer's Disease/Cognitive Impairment11
7. Depression/Mood Disorder5
8. Other Major Geriatric Concerns68

H. Type of Residence

1. Private residence (house or apartment)649
2. Senior Living/Retirement Community55
3. Assisted Living Facility14
4. Nursing Home/Long-term Care facility13
5. Homeless0
6. Total (must agree with A3)731

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)177
2. Physician/medical provider45
3. State VR agency39
4. Government or Social Service Agency34
5. Veterans Administration3
6. Senior Center26
7. Assisted Living Facility1
8. Nursing Home/Long-term Care facility4
9. Faith-based organization2
10. Independent Living center0
11. Family member or friend189
12. Self-referral177
13. Other34
14. Total (must agree with A3)731

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 42,001
1b. Total Cost from other funds 23,626
2. Vision screening / vision examination / low vision evaluation 510
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 263,394
1b. Total Cost from other funds 122,850
2. Provision of assistive technology devices and aids 618
3. Provision of assistive technology services 495

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 167,028
1b. Total Cost from other funds 93,954
2. Orientation and Mobility training 208
3. Communication skills 610
4. Daily living skills 576
5. Supportive services (reader services, transportation, personal 47
6. Advocacy training and support networks 31
7. Counseling (peer, individual and group) 491
8. Information, referral and community integration 403
. Other IL services 54

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 16,795
1b. Total Cost from other funds 9,447
2. Information and Referral 0
3. Community Awareness: Events/Activities 240 7,924

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) 1,042,434 802,828 -239,606
2. Number of Individuals Served 767 731 -36
3. Number of Minority Individuals Served 58 41 -17
4. Number of Community Awareness Activities 218 240 22
5. Number of Collaborating agencies and organizations 9 7 -2
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 495 100.00%
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) 416 84.04%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 79 15.96%
B1. Number of individuals who received orientation and mobility (O & M) services 208 100.00%
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) 164 78.85%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 44 21.15%
C1. Number of individuals who received communication skills training 610 100.00%
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) 499 81.80%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 111 18.20%
D1. Number of individuals who received daily living skills training 576 100.00%
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) 477 82.81%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 99 17.19%
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) 564 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) 1 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) 46 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 21 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) 13 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 Kentucky Office for the Blind (OFB) provides Older Individuals Who Are Blind (OIB) services through an in-house program. OFB employs OIB counselors and services are made available in all 120 Kentucky counties. OIB counselors are assigned large geographic regions of the state and travel thousands of miles yearly meeting with consumers and promoting services through outreach efforts. Most consumers prefer to receive services in their homes, but when requested, meetings can be held in local community locations such as libraries, senior centers, and health departments, churches, and One Stop Career Centers. Currently, OIB counselors are housed in the OFB offices located in the Kentucky cities of Paducah, Owensboro, Bowling Green, Elizabethtown, Somerset, Louisville, Lexington, Florence and Prestonsburg. The OIB program administrator is housed in the Bowling Green office and carries a part time caseload in addition to administrative duties.

Outreach is a primary responsibility of counselors. Each counselor must develop and maintain referral sources within the assigned area. Outreach is incorporated into employee perfomance evaluations and is reviewed quarterly. Each year, counselors make contacts with various professionals and community leaders who are likely to come into contact with older persons. In addition, counselors give informational presentations to civic groups, church groups, consumer and peer support groups, etc in attempts to reach persons with low-vision/blindness especially in unserved and underserved parts of the state.

In every region, counselors engage in activities to enhance awareness of services and technology for persons with low-vision/blindness. Counselors participate in exhibits/expos, health fairs, job fairs, diabetes seminars, etc that give individuals opportunities to have first hand experience using adaptive devices. In FY2012, these events were well attended in both rural and urban areas with hundreds of people attending. As a result, there is greater awareness of services, training opportunities, available technology, and resources. Often, counselors receive immediate referrals for persons interested in receiving OIB services.

In FY2012, Counselors served at least one individual in 119 of Kentucky’s 120 counties. This is the highest number of counties served in one year since 2006 when this statistic began being tracked. This speaks to the dedication of the nine full time counselors to insure that as many people as possible are informed about how to obtain services. Six counselors had caseloads of over 90 people. Counselors working from offices located in Paducah (far western Kentucky), Elizabethtown (central Kentucky), and Florence (Northern Kentucky) all saw a substantial growth in the numbers of persons served in 2011. Much of this growth is due to counselors’ outreach efforts plus the word of mouth referrals from satisfied former consumers.

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.

The OIB program administrator represents the Office for the Blind on the Kentucky Statewide Independent Living Council (SILC) which promotes independent living to all persons including persons who are older and blind. The OIB program supports the goals set forth in the SPIL. The OIB program administrator has a good working relationship with each SILC member and the Directors of the Centers for Independent Living. The OIB counselors are encouraged to develop relationships with the Centers in their assigned geographic areas. Knowledge of resources is freely shared at both the state and local levels.

It is important for OIB counselors to work in cooperation with various service providers within their large assigned work areas. OIB counselors participate in interagency groups, diabetes education groups, etc. which allows them to inform others about OIB services and to learn themselves about resources that OIB consumers might need.

Counselors are encouraged to participate in trainings that will improve their abilities to provide services to individuals. In FY2012, counselors were given opportunities to participate in more on-line training rather than travel to on site conferences. For example, counselors have been expected to complete training modules offered by the American Foundation for the Blind. These modules help counselors develop methods for teaching ADL skill techniques to individuals.

Another attempt to improve service delivery was the updating of the assessment tool used by counselors when first meeting with a consumer. All counselors were permitted to participate in the process by submitting ideas for revising the assessment/plan document. Then a small committee of counselors and the program administrator reviewed each idea and made decisions regarding specific changes to the assessment. The final draft was made accessible for users with vision impairments. Although there is a learning curve with the start of any new tool, the counselors have been receptive and agree it will help facilitate a higher quality of service for consumers.

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 year the Office for the Blind completes a telephone survey with randomly selected OIB consumers whose cases were closed during the fiscal year. The survey calls are made by an Office for the Blind employee who is not directly connected to the OIB services provided. In FY2012, 15% (94) of the 611 consumers with closed cases participated in the survey. During the call, nine questions are asked with two being open ended giving the respondents opportunity to make comments regarding the program. When asked if services met their needs, 43% said "strongly agree" and 54% answered "agree". Another question asked if they feel better able to do activities around their homes, and 99% responded either "strongly agree" or "agree". Participants were asked if they feel more confident in their abilities and 98% said either "agree or strongly agree". The first open ended question gave individuals an opportunity to say what they most liked about the program. Some of the responses were: "markings on my appliances", "the kitchen items and telephone", "everything is useful", "counselor made several suggestions", and "counselor was easy to talk to". Finally, the participants were asked for suggestions to improve the program and answers included: "(more) suggestions on things I could do to get out of the house", "no, not unless you can purchase glasses", and "no complaints". The employee who made the calls stated that no one refused to participate. The caller said that most people seemed happy to be contacted as a follow-up and wanted to express appreciation.

As another attempt of insuring quality of services, the program administer completes regular case reviews for all OIB caseloads. The case files are randomly selected and feedback is given to the counselors. They are encouraged to discuss any questions with the program administrator and correct any problems found as appropriate to the situation.

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).

Ms. D lives in a small eastern KY mountain town. Family members live nearby and assist with transportation, grocery shopping, etc. During the initial assessment, she described to the IL counselor problems she was having with ADL tasks. Ms. D has full custody of a three year old grandson and she had concerns related to her ability to care for him. Upon an evaluation, magnification was provided and Ms. D was very happy to be able to read mail, see photos, and read to her grandson. She had concerns about preparing meals, but with tactile markings on the stove and microwave, she can independently operate them and cook meals. With a large button telephone and Directory Assistance Exemption, she can make calls as needed, especially in the event of an emergency. Ms. D was a good student in the use of various adaptive methods and devices restoring her confidence and independence. She expressed her appreciation by saying she will help spread the word about independent living services.

Mrs. A is 73 years old and lives with her husband in a rural area in Western KY. While in her thirties, she lost vision in one eye due to MS, and in more recent times, she has lost sight due to Macular Degeneration. She greatly values her independence and was eager to learn skills to stay as independent as possible. Between IL daily skills training sessions, she practiced new skills making them her own. She demonstrated her ability to take ideas provided during training and convert them so they best applied to her living environment such as placing a magnification mirror in a specific spot in the bathroom to capture natural light. She was a good candidate for using a CCTV, and when one was donated to OFB, it was provided to her. The Assitive Technology Specialist taught her to use the machine, and Mrs. A was quickly able to read her mail, etc. Upon completion of the planned independent living services, Mrs. A voiced her excitement over all the skills she has learned.

Mr. W lives alone in his south-central KY home. Although this 75 year old Navy veteran strongly desired to live independently, he was having difficulty with some activities of daily living due to decreasing visual abilities. The OIB counselor met with Mr. W in his home and completed an initial assessment and planned appropriate services. Mr. W was assisted in several ADL areas by being taught to use various adaptive items provided such as a talking clock and writing guides. He wanted to be able to write checks and maintain his account balance and he has learned to use guides and a talking calculator to help manage this chore. In the area of meal preparation, he was taught adaptive techniques for tasks such as pouring liquids, identifying food in packaging, using a can opener and plugging small appliances into electrical outlets. He has learned to use raised markings on his thermostat and even his house key for easier identification. He enjoys watching television, but viewing was difficult. By using sport glasses provided, he is now able to enjoy viewing favorite shows again. Fortunately, the Veterans Administration was able to provide a CCTV which has greatly improved his reading ability. Mr. W was also provided counseling and guidance by the OIB counselor to help normalize his experiences with visual impairment and the realization that he can continue to live independently by performing ADLs using adaptive techniques and aids/devices. Mr. W was pleased with services and his abilities to perform daily tasks and stated he would recommend the program to others.

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

Due to economic circumstances, it is becoming increasingly difficult to maintain the high quality of services we want to provide to every older Kentuckian who is blind/visually impaired. Resources at every level are limited and spending reductions are wide spread. In October 2011, an OIB counselor with several years experience retired and the vacated position was not filled as part of the fiscal management of program funds. In FY2012, counselor caseload budgets and money allotted for travel were both reduced. Unfortunately, that trend will continue into FY2013. Less travel funds results in counselors spending less time in the more removed parts of their work areas which is likely to lead to fewer persons being served.

Due to restrictions of funds, the program administrator was less able to travel to spend time with individual counselors for training and mentoring purposes. This is especially difficult for newer staff. Also, the staff was not able to meet together as a group for training and support. The program administrator is engaging in more activities by telephone and electronic means in efforts to provide appropriate staff training and technical guidance.

The Office for the Blind is a small agency with most employees engaged in many aspects of the daily work. At times, this might make the work seem overwhelming, but this agency remains committed to providing quality services, improving all phases of tracking and documenting services and related costs, and maintaining accurate records.

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 byGay Pannell
TitleRehabilitation Administrator
Telephone270-746-7479
Date signed12/21/2012