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

RSA-7-OB for Massachusetts Commission for the Blind - H177B120021 report through September 30, 2012

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year699,706
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year0
Other federal grant carryover from previous year271,409
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2826,962
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)140,358
A4. Third party0
A5. In-kind0
A6. Total Matching Funds140,358
A7. Total All Funds Expended967,320
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs108,468
C. Total expenditures and encumbrances for direct program services858,852

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 1.6000 3.4000 5.0000
2. FTE Contractors 0.0000 0.5000 0.5000
3. Total FTE 1.6000 3.9000 5.5000

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 0 0.0000
2. Employees with Blindness Age 55 and Older 0 0.0000
3. Employees who are Racial/Ethnic Minorities 1 1.0000
4. Employees who are Women 5 4.5000
5. Employees Age 55 and Older 5 4.5000

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 FY682
2. Number of individuals who began receiving services in the reported FY515
3. Total individuals served during the reported fiscal year (A1 + A2) 1,197

B. Age

1. 55-5921
2. 60-6444
3. 65-6948
4. 70-7497
5. 75-79159
6. 80-84272
7. 85-89300
8. 90-94190
9. 95-9959
10. 100 & over7
11. Total (must agree with A3)1,197

C. Gender

1. Female868
2. Male329
3. Total (must agree with A3)1,197

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race15
2. American Indian or Alaska Native2
3. Asian2
4. Black or African American34
5. Native Hawaiian or Other Pacific Islander0
6. White1,111
7. Two or more races15
8. Race and ethnicity unknown (only if consumer refuses to identify)18
9. Total (must agree with A3)1,197

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)30
2. Legally Blind (excluding totally blind)1,167
3. Severe Visual Impairment0
4. Total (must agree with A3)1,197

F. Major Cause of Visual Impairment

1. Macular Degeneration841
2. Diabetic Retinopathy89
3. Glaucoma113
4. Cataracts7
5. Other147
6. Total (must agree with A3)1,197

G. Other Age-Related Impairments

1. Hearing Impairment403
2. Diabetes221
3. Cardiovascular Disease and Strokes667
4. Cancer56
5. Bone, Muscle, Skin, Joint, and Movement Disorders544
6. Alzheimer's Disease/Cognitive Impairment74
7. Depression/Mood Disorder27
8. Other Major Geriatric Concerns227

H. Type of Residence

1. Private residence (house or apartment)1,066
2. Senior Living/Retirement Community47
3. Assisted Living Facility76
4. Nursing Home/Long-term Care facility8
5. Homeless0
6. Total (must agree with A3)1,197

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)46
2. Physician/medical provider8
3. State VR agency867
4. Government or Social Service Agency112
5. Veterans Administration0
6. Senior Center52
7. Assisted Living Facility1
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center2
11. Family member or friend17
12. Self-referral86
13. Other6
14. Total (must agree with A3)1,197

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 138,416
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 957
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 5

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 297,646
1b. Total Cost from other funds 0
2. Provision of assistive technology devices and aids 897
3. Provision of assistive technology services 395

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 321,426
1b. Total Cost from other funds 0
2. Orientation and Mobility training 16
3. Communication skills 497
4. Daily living skills 103
5. Supportive services (reader services, transportation, personal 66
6. Advocacy training and support networks 484
7. Counseling (peer, individual and group) 475
8. Information, referral and community integration 146
. Other IL services 38

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 101,364
1b. Total Cost from other funds 0
2. Information and Referral 108
3. Community Awareness: Events/Activities 149 3,338

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) 1,232,375 967,320 -265,055
2. Number of Individuals Served 1,342 1,197 -145
3. Number of Minority Individuals Served 78 79 1
4. Number of Community Awareness Activities 163 159 -4
5. Number of Collaborating agencies and organizations 128 64 -64
6. Number of Sub-grantees 6 5

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 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) 205 51.90%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 190 48.10%
B1. Number of individuals who received orientation and mobility (O & M) services 16 100.00%
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) 5 31.25%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 9 56.25%
C1. Number of individuals who received communication skills training 497 100.00%
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) 284 57.14%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 213 42.86%
D1. Number of individuals who received daily living skills training 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) 22 21.36%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 81 78.64%
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) 444 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) 35 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) 0 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 8 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) 70 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 Massachusetts Commission for the Blind’s (MCB) Title VII, Chapter 2 Program (the BRIDGE Program) utilizes a program design that includes both In-House and Sub-Grantee components. The In-House BRIDGE Program employs a full time Program Director and three Case Workers who provide direct independent living services to blind elders age 55+. The direct IL services include: case management, information and referral, adjustment to blindness counseling, advocacy, low vision services, low vision devices, assistive technology services and devices including the provision of magnifiers, cooking items, clocks and watches, communication devices, adaptive software, and assistive listening devices.

The Sub-Grantee component includes contracting with a Public Education Consultant on Aging and Blindness to conduct outreach that targets under-represented populations as well as raising community awareness about benefits and services available to blind elders in Massachusetts. Outreach activities include presentations to low vision support groups, senior centers, health fairs and professional conferences. During FY 12, the BRIDGE Public Education Consultant conducted 129 public education events with a combined audience of 3,252 individuals. Outreach to under-represented individuals included: Peer Empowerment Program Low vision support group at the Martin Luther King Apartments in Roxbury, In-Service training for the staff at the Multi-Cultural Independent Living Center of Boston, In-Service training for the staff of the Goddard House Skilled Nursing Facility in Jamaica Plain, "Health Care Revival" sponsored by the Mattapan Community Health Center, and In-Service training for the staff of Midtown Home Health Center in Chinatown - a total of 304 primarily African-American and Asian individuals were involved in these trainings.

The Public Education Consultant also targeted services to Deaf-Blind Elders. She was involved in an outreach collaborative to coordinate outreach activities to deaf/blind elders that included the Massachusetts Commission for the Deaf and Hard of Hearing, Massachusetts Equipment Distribution Program, Mass. Relay - the state 9-1-1 Program and the Verizon Center for Customers with Disabilities. Four meetings of this new group were held during FY 12 and all meetings were conducted with an ASL interpreter. The Public Education Consultant also attended the 11th Annual Deaf Community Health Fair at Northeastern University in Boston. Thirty-Seven deaf blind consumers visited the MCB table. The Public Education Consultant also targeted rural areas of Massachusetts in FY 12 with approximately 38% of her presentation being held in the more rural communities of Massachusetts.

During FY 12, MCB’s BRIDGE Program contracted with the following vendors: The Carroll Center for the Blind in Newton for Essential Skills Training (community and center-based), Senior Low Vision Evaluations (community and center-based), and community-based Diabetic Self-Management Training; Sight Loss Services of Cape Cod Inc. in W. Dennis to operate ten Low vision Support Groups on Cape Cod; The Massachusetts Association for the Blind in Brookline to operate thirty-four Low Vision Support groups throughout the Commonwealth; the National Research and Training Center at Mississippi State University to conduct program evaluation for the BRIDGE Program; and finally with Andrea Schein who is in her twelfth year as our Public Education Consultant for Aging and Blindness.

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 Massachusetts SPIL states that, "The priority of the public education component of the OIB program is the provision of information that will enhance the capacity for independent living to consumers and opportunities for collaboration and community awareness to service providers, with a particular emphasis on outreach to under-represented populations."

The SPIL further states that, "The BRIDGE Program contracts with a Public Education Consultant for approximately 1,000 hours/year to do outreach and in-service training. The contractor is selected through a competitive bidding process."

During FY 12, the BRIDGE OIB Program contracted with a consultant for outreach and public education on the issues of aging and blindness. She spoke to 684 seniors in low vision support groups, assisted living facilities, housing developments, etc. She provided in-service training to 593 staff at nursing homes, home health agencies, etc. She represented the OIB BRIDGE Program at 17 health fairs, She provided workshops and information tables at 9 conferences.

Outreach to the African American community included an information table at "Health Care Revival" in Mattapan, in-service training for the Multi-Cultural Independent Living Center and Goddard House Skilled Nursing Facility in Jamaica Plain, and a Low Vision Support Group at the Martin Luther King Apartments in Dorchester. Outreach to Asian American Communities included an interpreted in-service training to Midtown Home Health in Chinatown. Outreach to the deaf-blind Community included active involvement in an outreach coalition consisting of both blind and deaf agencies and the annual D.E.A.F., Inc. Community Health Fair.

The consultant has maintained a high level of provision of information, increasing the level of performance over the previous year in outreach to African-American and Asian-American communities, in-service training, and involvement in relevant conferences. The lack of information about benefits, services, and assistive technology continues to be a major barrier to independence for elder blind individuals.

Innovative programming included a collaboration with Carroll Center for the Blind and Perkins School for the Blind to provide a second annual training for leaders of Low Vision Peer Support Groups unaffiliated with MAB Community Services or Sight Loss Services.

The OIB BRIDGE Program continued to develop and present Community-Based Training in the areas of Essential Skills Training, Senior Low Vision Assessments and Diabetic Self-Management Training. During FY 12, seven week Community-Based Essential Skills Programs were conducted in Quincy, Northampton, Newburyport, Framingham and Leominster. These sessions were held one day per week for seven weeks for four hours each day. Twenty-seven blind elders attended this training which focused on activities of daily living skills - feedback from group participants is universally positive. Initially, the OIB Program used ARRA funds to develop the community-based model for Senior Vision Assessments, Diabetic Self-Management training and community-based Essential Skills Training with positive feedback and outcomes from our elder blind consumers. The expectation is to continue the community-based model for some of our programming and expand this model to other services which we provide i.e., adaptive software training. The community-based model facilitates collaboration with public and private agency partners and further expands the community’s awareness of the OIB program and services.

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 Massachusetts OIB (BRIDGE Program) contracts with the NRTS at Mississippi State University to conduct program evaluation and measure consumer satisfaction with OIB services. The final report for FY12 was recently completed and a copy of the final report will be mailed to Elizabeth Akinola.

A Program Participant Survey was conducted to determine the degree to which consumers are satisfied with the independent living services they received or are receiving through the BRIDGE Program. In addition, the survey gathers outcome data from consumers related to the level of independence they gained from their program. Included in the survey were four questions related to participant satisfaction with the manner in which services were provided, nine questions related to the types of services provided, five questions related to perceived outcomes of the program, and a question asking if consumers needed additional assistance with hearing loss, transportation, computer application, or some other service. In addition, the survey includes multiple demographic, health, secondary disability, and vision related questions. This unique survey was designed to allow the administrative team to gather outcome data to supplement reporting to RSA plus some additional data that would be useful in program analysis and planning. The survey is provided to a sample of successfully closed consumers throughout the fiscal year.

One hundred and forty individuals completed and returned the survey instrument. Results of the overall Program Participant Survey were extremely favorable. In fact, these are the highest scores in recent years.

Demographic characteristics of the respondents to the survey indicated an average age of 83.4 years ranging from age 58 to age 99. Seventy-eight percent were female, 104 individuals lived in their own home, 21 in a senior living/retirement facility and 4 in assistive living. Fifty percent reported a hearing loss, with 60.8% indicating a moderate to severe hearing loss. Forty percent of participants reported at least one health condition. Eighty-three percent reported macular degeneration as the cause of their vision loss, 20% reported glaucoma, 12.3% cataracts, 8% diabetic retinopathy, and 15.5% reported another condition causing their vision loss. A number of persons reported more than one eye condition which is why the numbers total more than 100%.

Section I of the survey revealed that consumer satisfaction with the manner in which services were provided was favorable among most of those who responded to the survey. Eight individuals expressed some level of dissatisfaction with the services/program.

Section II of the survey revealed that consumer satisfaction with specific services provided was favorable at a rate of 97.8%. During this reporting year, all areas were above the 90% rating that has long been a benchmark for the Chapter 2 Programs. All but one of the areas investigated sustained a satisfaction rate above 95%. The highest ratings of above 95% were given to Instruction Received (98%), Counseling and Guidance (96.5%), Information regarding Vision Loss (98.2%), O&M (95.9%), Assistive Technology Training (97.3%), Involvement in Peer Support Groups (98.3%), Low Vision Services through the Mobile Eye Van (100%), Community-Based Essential Skills Training (100%), Center-Based Essential Skills Training (100%), Community-Based Low Vision Training (100%), and Center-Based Low Vision Training (95.4%). This is a significant level of satisfaction for the BRIDGE Program and is especially significant due to the mean age and level of visual impairment of the consumers served by the program.

Section III of the survey queried participants regarding their perceived outcomes of the program. In section I consumer agreement with the overall outcome of services was favorable among most participants. In this section specific areas are addressed and the perceived outcomes from services they received were rated. All items started "As a result of services you received through the BRIDGE program...." However, comments seem to point to the fact that the question was not fully understood to be related to services. Several people commented and their comments appear in Appendix B of the full report. The overall perceived outcome rating was 85.3%. The percentage of persons who agreed that they had either gained or maintained their ability to travel independently was 84.3%. The percentage of persons who agreed that they had either gained or maintained their ability to engage in customary life activities was 86.2%. The number of persons indicating that they had either gained or maintained their ability to engage in activities was 82.5%. The lowest area score of 76.5% indicated that they had either gained or maintained their ability to engage in personal management activities. The overall rating of 85.3% is slightly below the target score of 90%, but appears to relate somewhat to the lack of understanding of participants that these questions were directly related to the program of services they received rather than life circumstances such as decreased health or change in living situation. Ninety-six percent indicated that they were in either the same or better control of their lives because of the services they received. Fifty-one percent indicated that they had experienced a decline in vision while in the program and 26.5% indicated that they had experienced a decline in general health while in the program.

In summary, more than 28,000 citizens age 55 and older who reside in the Commonwealth experience the consequences of legal blindness. These individuals comprise 80% of the Commonwealth’s registry of legally blind individuals. This number is expected to increase over the next 50 years. The BRIDGE Program continues to increase the numbers of consumers served each year.

The Massachusetts Commission for the Blind’s OIB BRIDGE Program has proven effective as a means of assisting older adults who are legally blind to maintain a reasonable level of personal independence. The program operates one of the most extensive and effective peer support networks for older blind individuals in the country. The success of the BRIDGE Program serves to extend the MCB’s tradition of providing a wide array of services designed to assist people who are legally blind to live up to their maximum potential.

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).

Consumer is a 73 year old married female who lives with her husband in a single family home located in a large city south of Boston. She is a retired public high school teacher.

Consumer became registered with MCB in November 2010 with a visual diagnosis of proliferative diabetic retinopathy OU. She has limited functional vision OD, but some useful vision OS. In addition to her visual condition, she has insulin-dependent diabetes, vasculitis, cardiac issues, fibromyalgia and rheumatoid arthritis.

Worker met with consumer for initial home visit in April 2011. At that time, she was struggling to cope with functional limitations resulting from her multiple medical conditions. Although she was feeling discouraged about her medical status, she decided to explore the potential benefits of blind rehabilitation services.

In an effort to increase consumer’s functional capacity, the BRIDGE Program provide her with the following independent living aids and services:

Talking desk clock and talking clock with keychain - these adaptive timepieces enable her to monitor the time independently. 20/20 Pens - with these markers, she is able to complete writing tasks with greater ease. LP address book - she is able to locate addresses more quickly. Ruby hand-held video magnifier- with this magnifier, consumer can read various items at home and in the community including mail, medication labels, food directions, price tags. She described this aid as "a godsend." Gooseneck reading lamp with full spectrum bulb - with improved lighting, consumer’s reading ability is significantly enhanced. Bump-dots - these tactile aids have been placed on the control buttons of various household appliances. Pen Friend audio labeler - consumer uses this device to label various items including her considerable compact disk collection. LP timer, color-coded measuring cups - these cooking aids make it easier to prepare meals. Eschenbach MAX-TV glasses - with these TV glasses, her enjoyment of television has increased dramatically including her ability to follow New England Patriots games. Home-based diabetic equipment evaluation by diabetes nurse educator from the Carroll Center - consumer is now using a Prodigy talking blood glucosemeter to independently monitor her blood sugar levels. ZoomText software, ZoomText LP keyboard and ZoomText software training. Prior to receiving this adaptive computer equipment, consumer hadn’t been able to use a computer for about 3 years. She is thrilled that she is able to use her computer again for various purposes ( e.g., web browsing, email and word processing.)

As a result of BRIDGE services, consumer has been able to realize significant functional gains in important areas of adult daily living including, time management, record keeping, meal preparation, leisure time activities, health management, and computer operation. She is especially grateful that she is able to use her computer again. Also, she is extremely satisfied with the versatile Ruby hand-held video magnifier. At the completion of IL OIB services, consumer appears much more confident and hopeful about her future as a visually impaired elder.

Consumer has been a very active 89 year old woman who recently moved into a one bedroom apartment in a senior citizen apartment complex. She has been registered as legally blind since 1988 due to macular degeneration. She has pulmonary problems which caused her to be hospitalized several times this year. Since 2011, her vision and overall health has deteriorated to a level where she feared that she would have to give up her present lifestyle and move into a nursing home.

The BRIDGE Program provided the following services to assist consumer to remain living in an independent setting:

12X pocket magnifier that consumer uses to read mail, food labels, medication labels, sales circulars, and grocery lists. Talking watch to assist her with time management. Talking oximeter that enabled her to monitor her oxygen levels and enabled her to decrease her need for visiting nurses. Talking scale that allows her to monitor her weight and possible fluid buildup - again, alerting her to medical problems before a full-blown medical emergency occurs. Bump dots were used for labeling consumer’s new stove which facilitated her meal preparation. MAB Low Vision support group which provides consumer with a safe social environment.

Through BRIDGE services, this consumer has gained many independent living techniques that have allowed her to complete household, personal, medical and recreational activities of daily living. She now feels confident that her overall level of independent functioning has improved within her home and community. She believes that BRIDGE services have been successful as she no longer depends on others for basic care and no longer considers nursing home living as a viable option.

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

The lateness of the Grant Award and Continuing Resolution letters continues to be problematic often resulting in service delays for Chapter 2 consumers.

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 byCheryl Standley
TitleProgram Director
Telephone617.626.7488
Date signed12/28/2012