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

RSA-7-OB for Maine Division for the Blind and Visually Impaired - H177B120019 report through September 30, 2012

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year225,000
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year0
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2225,000
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)399,000
A4. Third party0
A5. In-kind240,000
A6. Total Matching Funds639,000
A7. Total All Funds Expended864,000
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs86,400
C. Total expenditures and encumbrances for direct program services777,600

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 0.6000 4.0500 4.6500
2. FTE Contractors 1.1000 6.4000 7.5000
3. Total FTE 1.7000 10.4500 12.1500

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 7 2.3000
2. Employees with Blindness Age 55 and Older 1 0.2500
3. Employees who are Racial/Ethnic Minorities 3 1.4000
4. Employees who are Women 25 11.7000
5. Employees Age 55 and Older 9 3.8500

C. Volunteers

2.00

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 FY229
2. Number of individuals who began receiving services in the reported FY182
3. Total individuals served during the reported fiscal year (A1 + A2) 411

B. Age

1. 55-591
2. 60-643
3. 65-6931
4. 70-7428
5. 75-7942
6. 80-8483
7. 85-89113
8. 90-9477
9. 95-9925
10. 100 & over8
11. Total (must agree with A3)411

C. Gender

1. Female313
2. Male98
3. Total (must agree with A3)411

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race1
2. American Indian or Alaska Native1
3. Asian1
4. Black or African American1
5. Native Hawaiian or Other Pacific Islander0
6. White393
7. Two or more races0
8. Race and ethnicity unknown (only if consumer refuses to identify)14
9. Total (must agree with A3)411

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)2
2. Legally Blind (excluding totally blind)98
3. Severe Visual Impairment311
4. Total (must agree with A3)411

F. Major Cause of Visual Impairment

1. Macular Degeneration103
2. Diabetic Retinopathy7
3. Glaucoma9
4. Cataracts1
5. Other291
6. Total (must agree with A3)411

G. Other Age-Related Impairments

1. Hearing Impairment41
2. Diabetes19
3. Cardiovascular Disease and Strokes34
4. Cancer9
5. Bone, Muscle, Skin, Joint, and Movement Disorders12
6. Alzheimer's Disease/Cognitive Impairment2
7. Depression/Mood Disorder2
8. Other Major Geriatric Concerns2

H. Type of Residence

1. Private residence (house or apartment)324
2. Senior Living/Retirement Community29
3. Assisted Living Facility42
4. Nursing Home/Long-term Care facility16
5. Homeless0
6. Total (must agree with A3)411

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)80
2. Physician/medical provider6
3. State VR agency2
4. Government or Social Service Agency3
5. Veterans Administration0
6. Senior Center0
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center1
11. Family member or friend20
12. Self-referral30
13. Other269
14. Total (must agree with A3)411

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 0
1b. Total Cost from other funds 10,000
2. Vision screening / vision examination / low vision evaluation 411
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 0
1b. Total Cost from other funds 25,000
2. Provision of assistive technology devices and aids 411
3. Provision of assistive technology services 411

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 225,000
1b. Total Cost from other funds 496,484
2. Orientation and Mobility training 411
3. Communication skills 411
4. Daily living skills 411
5. Supportive services (reader services, transportation, personal 36
6. Advocacy training and support networks 186
7. Counseling (peer, individual and group) 142
8. Information, referral and community integration 244
. Other IL services 0

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 0
1b. Total Cost from other funds 0
2. Information and Referral 0
3. Community Awareness: Events/Activities 35 187

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) 828,000 864,000 36,000
2. Number of Individuals Served 298 411 113
3. Number of Minority Individuals Served 3 4 1
4. Number of Community Awareness Activities 15 35 20
5. Number of Collaborating agencies and organizations 8 8 0
6. Number of Sub-grantees 1 1

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 411 100.00%
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) 374 91.00%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 37 9.00%
B1. Number of individuals who received orientation and mobility (O & M) services 411 100.00%
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) 400 97.32%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 11 2.68%
C1. Number of individuals who received communication skills training 411 100.00%
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) 395 96.11%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 16 3.89%
D1. Number of individuals who received daily living skills training 411 100.00%
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) 391 95.13%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 20 4.87%
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) 48 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) 6 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) 0 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) 0 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 Division for the Blind & Visually Impaired (DBVI) implements its IL-Older Blind program through the use of in-house staff to include Orientation & Mobility Instructors, Vision Rehabilitation Therapists, and Low Vision Therapists and through the use of a sub-grantee/contractor, the Iris Network. Some of the services provided by the Iris Network are some Vision Rehabilitation Therapy, Personal Adjustment Counseling, some Orientation and Mobility instruction and some intake services.

The recent census confirmed the very small percentage of minority groups in Maine. In the larger cities, outreach is being done for Asian, Middle Eastern, Spanish-speaking, French Canadian, African, and other minority groups. In Lewiston, Somalis are being served in the Lewiston CareerCenter with an interpreter who works for the Center. The French Canadian community in Lewiston has also been served for many years by staff interpreting for that population. In addition, DBVI continues to maintain ongoing communications with the four Maine tribes of Native Americans:

Passamaquoddy Tribe

Penobscot Indian Nation

Houlton Band of Maliseets

Aroostook Band of Micmac Indians

DBVI has a representative from the American Indian Vocational Rehabilitation Services on the DBVI State Rehabilitation Council.

The Division continues to work with the Native American health centers doing outreach for all of our programs. These centers, managed by each of the tribes in Maine, have served as a contact point and focus for outreach efforts by the Division.

Discussions continue in an effort to provide information about the Divisions programs in the Health Center newsletter that goes to all of the registered Penobscot tribal members on and off the island.

The process is based upon a plan which identifies the achievement of independent living goals which will enable an individual who is blind or has low vision to secure a level of independent living consistent with his or her current interests, capacities and abilities. Services provided to individuals who are blind or visually impaired must be necessary and must be provided as cost effectively as possible.

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.

DBVI is involved in numerous activities throughout the state to expand or improve IL services to the older blind population. Some of these activities are working collaboratively with doctors to improve the referral process so consumers are aware of DBVI’s services; working with the state’s Veterans Administration (VA) to improve services for older veterans who are blind or have low vision and participating in health fairs around the state.

In addition, DBVI entered a collaborative partnership with the Division for the Deaf Hard of Hearing and Late-Deafened, the University of Southern Maine Linguistics Program, The Iris Network, Helen Keller National Center, and consumers with dual sensory impairment to develop a professional training program for Interpreters fo people who are deaf-blind, and to create and build a volunteer Support Service Provider (SSP) program. To date, we have trained over 20 professional Deaf-blind Interpreters, have trained over 35 volunteer SSP’s, and have approximately 15 individuals who are deaf-blind or dual sensory impaired accessing these services.

The Community Connections project continues to enhance activities with therapeutic components and increase the involvement of vision rehabilitation professionals to provide therapeutic services as part of these activities. Some of her activities include: presenting to the Aging with Grace group regarding updates in Community Connections and upcoming events; contacting the Lion’s Club regarding information booths at their annual convention; setting up a Community Connections booth at the National Multiple Sclerosis Society Health and Wellness Fair; and facilitating various Visually Impaired Persons (VIP) groups around the state.

DBVI’s redesigned comprehensive statewide low vision delivery system will benefit older individuals who are blind or visually impaired. All professional staff involved in providing low vision rehabilitation services have received training in this field, which will result in a more cost effective system. Low vision kits have been put together by a group that focused on the needs of those individuals with low vision and the kits have been dispersed around the state since the protocol for the delivery of these aids and appliances is in place.

Currently the DBVI State Rehabilitation Council (SRC) has a representative that has been attending the State Independent Living Council (SILC) to represent the division. This representation allows the division to stay current with efforts to expand or improve IL services as well as participate in the various activities throughout the state.

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.

DBVI uses a sub-grantee for a large portion of the IL-Older Blind program. They use a survey instrument with questions (and/or statements that require the consumer to attach a number representing the level of satisfaction) that measure consumer satisfaction and collects demographic data (optional). The questions measure the consumer’s level of satisfaction as it pertains to courtesy of staff, availability of informed choice and decision making, timeliness of servces and overall satisfaction with the quality of services that he/she received.

During the period of 1/11 through 12/11, one hundred and eight surveys were sent out and fifty-five were completed and returned. Of those, they all reported that they felt they were treated with courtesy and respect; thirty-one felt that they were informed that they had choices in their plan of service; forty-one played an active role in decision making; forty-two felt that services were provided in an acceptable timeframe; and forty-two responded that they are overall satisfied with the quality of services that were received. Below is a list of the questions:

1. The agency staff that worked with me treated me with courtesy and respect.

2. I was informed that I had choices in the development of my plan of service.

3. I had an active role in deciding what services I would receive.

4. Services were provided within a timeframe that was acceptable to me.

5. My specific needs were addressed during my training.

comments:

6. Overall I am satisfied with the quality of the services that I received from Iris.

7. What was the greatest difference this program made in your life?

comments:

There were a number of comments received in response to this question. Here is a sample of them:

+ she was able to build up self confidence, offered companionship and support; great listener; a really positive perspective; + marking all appliances was really helpful & eyeglasses +helped me with lost of things — button on appliances so I can be independent; + showed how to cook etc., but hasn’t really changed anything for him + I have a reader which is the only way I can read + the machine that magnifies all my mail and my bible (greatest difference) + appreciated the magnifier + got some equipment/different things to help/ money to go to Boston to see doctor + provided with aids that help me do what I can + loves the talking books — listens to them ALL the time; buttons on the washer, etc. very helpful + made things easier around the kitchen, reading books, talking clock. Reader + daughter — “couldn’t be more thrilled with the services provided” + different assistive aids, being able to talk w/ someone and learn more about what is available; talking books, etc. + feels like she is at a standstill; helped to have someone to talk with; received multiple products and assistance; loves reading machine; + the services gave me hope and reasons to heal; gave me new ways to think about my disability; made all kinds of changes to my houseā€¦..I just made cookies! + someone to talk to and she was so nice + talking books helps; visits and encouragement were helpful + talking calendar was extremely but helpful; worker was nothing but helpful and it was great that she called if she wasn’t able to make the visit + became more independent and self assured, talking to someone and the different tools that are helpful; recorder, talking watch, book program, marking household items; she is marvelous; there are not enough good things to say about her + mainly being able to see better — gooseneck lamp and other services like marking appliances. + worker was great in general, resourceful and looking our for my needs + went to the VA for me and got things done for me; arranged for different services from the state; the best things is a buzzer on my coffee cup so I know when it’s filled and not pouring our on the counter + now I know how to cross streets , directional abilities; I have a cane that enables me to move about without being jostled; feel more confident + I couldn’t get around at all; they helped me mentally and with other things + the devices provided were great; fixed my stove, needle threader; advocated on issue with landlord + some items were helpful: light, household aids; connecting me with services + help with the bus system helped my independence + rents a reader which allows her to continue reading the paper and her bills + I enjoyed my worker and became more accepting of vision loss + my mom learned how to deal with low vision problems; light was helpful; new ideas. + magnifier helped a bit + I now have new special glasses and magnifiers that help me in my life

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).

Case 1 One example is of a woman who, although she lived in a nursing home, wanted to be able to continue to read for pleasure (she had difficulty with reading, glare, and inappropriate lighting). Through collaboration with the Vision Rehabilitation Therapist (VRT), Low Vision Therapist, Occupational Therapist, and DBVI, this woman was able to obtain the appropriate task lighting to supplement her training done with the VRT.

Case 2 A woman from Aroostook County had been visually impaired for a number of years and became a client of DBVI. She lost the sight in her right eye in 1969 and in 2005 she had retinal detachment which was reattached. Over the years she had periodically had retinitis and it was controlled with medication. In August, she had what she believed was another flare up and began taking her medications again. After a few days it became obvious that was not the case and she contacted her doctor who immediately sent her to Boston where she was hospitalized for several days. When she contacted us she could only see white light in the upper right quadrant of the left eye. Doctors told her they were not sure what the outcome would be and how much, if any, vision she would regain. She was very anxious to still remain independent but at that point could not. Over the months, her vision has not returned but through VRT services and O&M she has progressed to the point that she is no longer relying on her husband for everything but taking back her life.

Case 3 This 81 year old lady lives alone in Caribou and remaining independent is crucial to her. She is a former bookkeeper and homemaker who struggles with reading, financial management, and bill paying. She has Macular Degeneration and with the assistance of the Certified Vision Rehabilitation Therapist (CVRT), she has had a low vision assessment and exam. She was given adaptive equipment in the form of magnification, as well as follow-up training. Because this lady is very computer savvy, the CVRT was able to recommend ZoomText Express and download it as well. This lady is now able to use her computer to complete a great deal of her financial business and correspondence. The Independent Living Program was able to provide Low Vision services, rehabilitation teaching, and computer access.

Case 4 This 81 year old man lives in an assisted living home and is an avid history buff. He is a former teacher and he has saved careful documentation of history in the Houlton area for most of his life. He has Macular Degeneration. He inquired about getting some sort of audio recorder that would allow him to document his history tidbits. The CVRT is working with him on the documentation of this historical information. She has also assisted him with using “TV” glasses. He continues to remain open, as his enthusiasm and his plans for projects continue to grow daily.

Case 5 This 85 year old lady with failing health, lives with her daughter. She has Macular Degeneration and has great difficulty doing many tasks, including telling the time and reading her mail. Because she has been hospitalized so many times, her services have been put on pause at various times until she feels well enough again to receive training. The CVRT was finally able to begin some work with her and recommended a talking watch and a talking clock. This lady receives care from her daughter and has no need or desire to manage her finances or do any sort of homemaking. For now, the talking watch and clock fulfill her needs.

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

The state of Maine has an increasing population of the individuals over the age of 55. According to recent data from the American Community Survey (ACS), more than 60% of Maine’s population that is eligibile for DBVI services falls into that age category. The dilemna is that the resources fall well below the need for independent living services for the older blind population.

Maine is such a rural state that transportation continues to be an issue for consumers in the IL-Older Blind program. These consumers find it difficult to find transportation in order to attend appointments and other support group activities. The Communities Connection Coordinator has done a great job of researching the various community activities and support groups but DBVI has found that consumers are still finding it difficult to get transportation to and from these events.

An increase in the Title VII-Chapter 2 grant would allow Maine to provide services for a greater number of consumers and allow them the opportunity to maintain their independence and increase the quality of life in their communities.

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 byJohn McMahon
TitleDirectore, DBVI
Telephone207-623-7949
Date signed12/28/2012