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

RSA-7-OB for Maryland Division of Rehabilitation Services - H177B120020 report through September 30, 2012

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year575,569
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year79,845
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2655,414
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)63,952
A4. Third party95,770
A5. In-kind67,444
A6. Total Matching Funds227,166
A7. Total All Funds Expended882,580
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs8,625
C. Total expenditures and encumbrances for direct program services873,955

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 0.7500 4.0000 4.7500
2. FTE Contractors 2.1800 14.7100 16.8900
3. Total FTE 2.9300 18.7100 21.6400

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 12 7.0000
2. Employees with Blindness Age 55 and Older 6 3.7500
3. Employees who are Racial/Ethnic Minorities 10 3.2500
4. Employees who are Women 24 11.2500
5. Employees Age 55 and Older 5 2.4600

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 FY375
2. Number of individuals who began receiving services in the reported FY626
3. Total individuals served during the reported fiscal year (A1 + A2) 1,001

B. Age

1. 55-59107
2. 60-64127
3. 65-69150
4. 70-74135
5. 75-7990
6. 80-84150
7. 85-89136
8. 90-9478
9. 95-9926
10. 100 & over2
11. Total (must agree with A3)1,001

C. Gender

1. Female642
2. Male359
3. Total (must agree with A3)1,001

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race15
2. American Indian or Alaska Native7
3. Asian11
4. Black or African American370
5. Native Hawaiian or Other Pacific Islander3
6. White556
7. Two or more races11
8. Race and ethnicity unknown (only if consumer refuses to identify)28
9. Total (must agree with A3)1,001

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)436
2. Legally Blind (excluding totally blind)266
3. Severe Visual Impairment299
4. Total (must agree with A3)1,001

F. Major Cause of Visual Impairment

1. Macular Degeneration337
2. Diabetic Retinopathy130
3. Glaucoma228
4. Cataracts22
5. Other284
6. Total (must agree with A3)1,001

G. Other Age-Related Impairments

1. Hearing Impairment89
2. Diabetes107
3. Cardiovascular Disease and Strokes49
4. Cancer11
5. Bone, Muscle, Skin, Joint, and Movement Disorders72
6. Alzheimer's Disease/Cognitive Impairment9
7. Depression/Mood Disorder18
8. Other Major Geriatric Concerns114

H. Type of Residence

1. Private residence (house or apartment)899
2. Senior Living/Retirement Community44
3. Assisted Living Facility40
4. Nursing Home/Long-term Care facility18
5. Homeless0
6. Total (must agree with A3)1,001

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)329
2. Physician/medical provider91
3. State VR agency25
4. Government or Social Service Agency48
5. Veterans Administration6
6. Senior Center43
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center13
11. Family member or friend140
12. Self-referral281
13. Other25
14. Total (must agree with A3)1,001

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 11,371
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 105
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 339

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 268,000
1b. Total Cost from other funds 22,341
2. Provision of assistive technology devices and aids 340
3. Provision of assistive technology services 257

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 501,411
1b. Total Cost from other funds 22,343
2. Orientation and Mobility training 293
3. Communication skills 104
4. Daily living skills 190
5. Supportive services (reader services, transportation, personal 31
6. Advocacy training and support networks 111
7. Counseling (peer, individual and group) 187
8. Information, referral and community integration 110
. Other IL services 132

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 34,770
1b. Total Cost from other funds 22,344
2. Information and Referral 974
3. Community Awareness: Events/Activities 108 3,166

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) 846,485 873,955 27,470
2. Number of Individuals Served 855 1,001 146
3. Number of Minority Individuals Served 379 627 248
4. Number of Community Awareness Activities 174 108 -66
5. Number of Collaborating agencies and organizations 27 33 6
6. Number of Sub-grantees 2 2

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 257 100.00%
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) 170 66.15%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 87 33.85%
B1. Number of individuals who received orientation and mobility (O & M) services 293 100.00%
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) 140 47.78%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 153 52.22%
C1. Number of individuals who received communication skills training 104 100.00%
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) 76 73.08%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 28 26.92%
D1. Number of individuals who received daily living skills training 190 100.00%
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) 163 85.79%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 27 14.21%
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) 326 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) 18 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) 36 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 114 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) 16 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.

During FY12, the Maryland Division of Rehabilitation Services (DORS) worked collaboratively with two sub-contractors: Blind Industries and Services of Maryland (BISM) and Columbia Lighthouse for the Blind (CLB) to increase and enhance services to older blind individuals in Maryland. In addition, in-house staff continues to serve consumers being referred through various means. When needed, consumers are cross-referred to a sub-contractor to ensure that appropriate services are provided in a timely manner.

Services provided by DORS and the sub-grantees included education, demonstration, and instruction in: Daily Living Skills for Independent Living, Braille/Communication, Orientation & Mobility, Adapted Computer Technology, Adjustment and Advocacy, Diabetic Management & Nutrition, Community Activities, Peer Interaction, Low Vision and Blindness Resources, plus adaptive aids, devices, and equipment. Statewide outreach efforts included speaking engagements, presentations, media exposure, conferences, and literature dissemination targeting senior consumers, senior centers, retirement communities, blindness-related agencies, and professionals in the field in an effort to reach seniors in all areas of the state including those in rural, remote, and underserved areas.

CLB has incorporated an Independent Living skills program that includes instruction on Braille, daily living skills, assistive technology, orientation and mobility, housekeeping and organizational skills. CLB’s support groups provided activities in knitting, exercise, Spanish and cooking just to name a few. Activities also include tours, recreational activities and subject matter speakers.

Additionally, Support Service Provider (SSP) services continues to offered to MD deaf-blind residents to assist them with going shopping, reading emails, friendly visitors, and exercise activities. This is very important as visually impaired seniors begin to experience a dual sensory loss of vision and hearing. Since CLB is the Maryland contractor for the Deaf-blind equipment distribution program, eligible deaf-blind seniors may be provided with needed adaptive equipment and training.

Lastly, during this fiscal year, a heavy email recruiting campaign was part of BISM’s networking effort to reach underserved and unserved populations. Email flyers with event details where sent in a wide distributional area, and OBVS/DORS was instrumental in getting the word out to teachers, counselors, staff members, and partners about the Life Enhancement workshops. Email blasts and other communications, including NFB list serves, LBPH patron lists, and Department of Aging offices, resulted in thousands of blind persons and professionals in the field of blindness learning about this quarter’s workshop offerings. Community partners did an excellent job sharing information. Literature packages and applications were also sent via USPS.

BISM had 73 presentations with over 2,766 participants. In addition, countless other people both Nationally & Internationally received information about BISM services via Internet and website.

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.

DORS and the Sub-grantees continue to effectively utilize networking and personal contact with professionals to structure and enhance activities that are useful to the consumers targeted.

For example, in addition to having at least five workshops on Life Enhancement, diabetes and financial independence, BISM also provides information via two BISM newsletters, community partner newsletters, BISM website updates and partner websites announcements. This has been instrumental in targeting individuals who are considered unserved and or underserved.

BISM had the opportunity and good fortune this year to perform personal, face-to-face outreach engagements to over 370 people through 15 different venues. While electronic media is fast, wide-spread, instantaneous, and very effective, it is also important to meet people in person to describe BISM’s many and varied services for blind seniors, answer questions, and identify opportunities for collaboration. When BISM staff can personally meet professionals in the field of service delivery to the older blind population, as well as others with interest in this population, they establish a rapport for continuing communication, recruitment, service provision opportunities, and collaboration.

A senior Initiative for 2012 was developed, and implemented. This initiative is one of the primary focuses of CLB. Due to this new outreach efforts to senior centers, and other community partners; old and new relationships were reestablished and new agreements to collaborate on workshops and training for seniors both with hearing loss, and other disabilities was planned and developed. A series of workshops have been created, and will continue to be marketed to Senior Source, rider Wood, Seabury Facilities, and Leisure World, and many other hospitals and community care centers.

Furthermore, DORS continues to co-sponsor the Possibilities Fair. The National Federation of the Blind of Maryland Possibilities Fair for Seniors Losing Vision is an annual event that brings together many participants, vendors, families, government agencies and visually impaired consumers. The purpose of the Fair is to enhance the participant’s knowledge of low vision and blindness resources through a variety of presentations, demonstrations, networking and a keynote speaker. It serves as a mechanism to reach out to seniors throughout the state in a systematic manner. Each year that it has been held, more than 350 seniors who are losing vision have attended the Possibilities Fair for Seniors held at the National Federation of the Blind’s Jernigan Institute. Past participants have included organizations like the Maryland Library for the Blind and Physically Handicapped, the Maryland Transportation Authority, AARP, National Aquarium, and the Wilmer Eye Institute.

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.

Overall SATISFACTION SURVEY RATING -- 7 events: 92.8%

%

93.3 Florence Bain 10.25.11 Life Enhancement Workshop 90.3 Vantage House 11.8.11 Life Enhancement Workshop 98.4 S.T.C. 12.7.11 Life Enhancement Workshop 86.7 Gull Creek 1.9.12 Life Enhancement Workshop 92.7 BISM Retreat 6.5.12 to 6.8.12 Retreat - Residential 91.9 Allegany Co. 9.25.12 Life Enhancement Workshop 96.1 BISM-Baltimore 9.27.12 Life Enhancement Workshop

92.8% Overall SATISFACTION SURVEY Rating

..\FY2012 Reports\ILOB SURVEY SATISFACTION RATING 2012.docx

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).

In addition to participant Satisfaction Survey questions weighted from a 1 (low) to 5 (high) which provide overall percentage-based ratings, participants have the opportunity to include individualized comments. This year’s event participant ages ranged from 55 to 89 with the two highest age-range categories being 85-89 and 65-69. Comments from the Satisfaction Surveys included: -- Very well prepared workshop; very good introduction to skills. -- Answered all questions; took the time; didn’t rush anyone thorough. -- Most enjoyed “Show & Tell” devices; SARA, technology. -- Enjoyed hearing from all blind staff and their experiences. -- You have it all—teachers & knowledge; best program I ever attended! -- I’ve confidence in your program; I speak from my heart with relief in your help. -- Everything was well done & on time; I enjoyed the camaraderie. -- Make the workshop 2 days long; make a program like this world wide! -- Did not know any Braille before today; I want to learn more Braille. -- Blindness discussion talking with staff meaningful; I needed it emotionally. -- Cane travel was most useful, helpful, and very detailed; would like more! -- Braille & cane travel very helpful; cane travel is more comfortable now.

A seventy-five year old woman living in Montgomery County is an ongoing member of CLB’s support groups. She has had low vision a majority of her life, and has passed through life using a hat to protect her vision from the sun, and special glasses with specialized prisms. However, now her vision and hearing are decreasing, and she finally requested O&M services. This training completely transformed her life, and her life is worth living. Based on her accounts her happiness and joy have returned.

She was a ballerina for many years, and wrote books regarding her experiences. Her enthusiasm and terrific attitude have sparked hope and a sense of possibility into other seniors in her group. She has completed the cooking course, and wants to become less fearful and more independent in her home. With her support systems, and amazing outlook on life her potential is great. She feels all of her successes and newly acquired freedom is due to her start with training in O&M.

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

In our work with the senior blind population and in particular seniors within the “baby boomer” age range, there appears to be increased interest in training on higher technology adapted equipment. Within in this group there are those interested in working longer or returning to work from retirement that may be in need of specialized technology training on adapted hardware and software. Also within this group there are those not pursuing employment that are very interested in learning and utilizing the latest adapted technology for internet research, emailing friends and family, creative writing, and quality of life enrichment. Presenting hi-tech training on the wide variety of popular devices now available for use by the blind would be very costly in terms of state-of-the-art equipment purchase and staffing of well-trained professional instructors. These costs could be seen as problematic and of concern as budgets are tightened and agencies struggle to “do more with less.”

Furthermore, in FY12 we continue to experience some of the same challenges as in previous years. These issues include, but are not limited to: • Transportation -- Seniors have difficulty securing transportation for travel to training programs. It can be extremely costly to provide roundtrip transportation for these seniors. Often times, they live in rural or remote locations where public transportation is not an option, and hired transportation costs are prohibitive. Seniors who have not had the benefit of training are often fearful of traveling alone, with a stranger, to an unfamiliar destination. Seniors don’t often have family or friends available to assist them in commuting to training programs. It is costly to provide staff transportation for outreach presentations, training events, and visitation. • Funding -- Training for blind senior consumers is costly in terms of staff time required as training is often presented in a one-to-one format of staff to senior. Limited funding can limit program design. • Health -- Health issues, medical appointments, and secondary disabilities can prevent seniors from participating in training. Last minute cancellations may occur due to health issues and changing medical situations. • Growing incidences of senior diabetics facing challenges of vision loss. • Rapidly growing population of blind and low vision senior citizens in this state and nationwide. • Professionals who are not trained in the unique service needs of the older blind population -- diabetes educators, senior center and senior housing staff, medical professionals, teachers of the blind. Delivering low vision services that effectively influence senior’s safety, functioning, and independence in the community requires coordinated screening, evaluation, equipment purchase and training so that these resources are timely, relevant to the home/community context and accessible to the consumer. It continues to be a challenge to guide consumers through what at times appears to them as fragmented patchwork of services from various providers, often times inaccessible geographically, and with frustratingly inadequate training on how to integrate equipment or resources into the context of their home.

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 byTandra Hunter-Payne
TitleProgram Manager
Telephone410-554-9107
Date signed12/28/2012