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

RSA-7-OB for California Department of Rehabilitation - H177B130005 report through September 30, 2013

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year3,212,792
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 23,283,627
A2. Total other federal24,774
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other24,774
A3. State (excluding in-kind)12,737
A4. Third party0
A5. In-kind352,110
A6. Total Matching Funds364,847
A7. Total All Funds Expended3,673,248
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs1,357,080
C. Total expenditures and encumbrances for direct program services2,316,168

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 1.0000 0.0000 1.0000
2. FTE Contractors 20.1800 60.8200 81.0000
3. Total FTE 21.1800 60.8200 82.0000

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 33 18.1500
2. Employees with Blindness Age 55 and Older 29 13.2500
3. Employees who are Racial/Ethnic Minorities 71 38.4700
4. Employees who are Women 145 79.5900
5. Employees Age 55 and Older 77 38.5700

C. Volunteers

65.00

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 FY2,333
2. Number of individuals who began receiving services in the reported FY3,895
3. Total individuals served during the reported fiscal year (A1 + A2) 6,228

B. Age

1. 55-59580
2. 60-64666
3. 65-69603
4. 70-74633
5. 75-79696
6. 80-84861
7. 85-891,076
8. 90-94836
9. 95-99247
10. 100 & over30
11. Total (must agree with A3)6,228

C. Gender

1. Female4,183
2. Male2,045
3. Total (must agree with A3)6,228

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race804
2. American Indian or Alaska Native29
3. Asian422
4. Black or African American512
5. Native Hawaiian or Other Pacific Islander29
6. White4,218
7. Two or more races52
8. Race and ethnicity unknown (only if consumer refuses to identify)162
9. Total (must agree with A3)6,228

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)411
2. Legally Blind (excluding totally blind)2,808
3. Severe Visual Impairment3,009
4. Total (must agree with A3)6,228

F. Major Cause of Visual Impairment

1. Macular Degeneration2,795
2. Diabetic Retinopathy558
3. Glaucoma832
4. Cataracts257
5. Other1,786
6. Total (must agree with A3)6,228

G. Other Age-Related Impairments

1. Hearing Impairment1,119
2. Diabetes1,262
3. Cardiovascular Disease and Strokes1,615
4. Cancer243
5. Bone, Muscle, Skin, Joint, and Movement Disorders1,227
6. Alzheimer's Disease/Cognitive Impairment194
7. Depression/Mood Disorder305
8. Other Major Geriatric Concerns1,533

H. Type of Residence

1. Private residence (house or apartment)4,714
2. Senior Living/Retirement Community1,169
3. Assisted Living Facility200
4. Nursing Home/Long-term Care facility118
5. Homeless27
6. Total (must agree with A3)6,228

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)1,657
2. Physician/medical provider293
3. State VR agency310
4. Government or Social Service Agency422
5. Veterans Administration76
6. Senior Center1,027
7. Assisted Living Facility41
8. Nursing Home/Long-term Care facility100
9. Faith-based organization71
10. Independent Living center58
11. Family member or friend880
12. Self-referral850
13. Other443
14. Total (must agree with A3)6,228

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 225,072
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 1,684
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 389

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 412,750
1b. Total Cost from other funds 0
2. Provision of assistive technology devices and aids 2,195
3. Provision of assistive technology services 1,473

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 1,387,993
1b. Total Cost from other funds 0
2. Orientation and Mobility training 1,067
3. Communication skills 976
4. Daily living skills 1,853
5. Supportive services (reader services, transportation, personal 1,836
6. Advocacy training and support networks 889
7. Counseling (peer, individual and group) 1,831
8. Information, referral and community integration 2,347
. Other IL services 1,119

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 290,354
1b. Total Cost from other funds 0
2. Information and Referral 1,890
3. Community Awareness: Events/Activities 698 25,782

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) 3,699,895 3,673,248 -26,647
2. Number of Individuals Served 7,268 6,228 -1,040
3. Number of Minority Individuals Served 2,359 2,010 -349
4. Number of Community Awareness Activities 610 698 88
5. Number of Collaborating agencies and organizations 0 0 0
6. Number of Sub-grantees 17 17

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 1,473 100.00%
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) 937 63.61%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 608 41.28%
B1. Number of individuals who received orientation and mobility (O & M) services 1,067 100.00%
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) 520 48.73%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 419 39.27%
C1. Number of individuals who received communication skills training 976 100.00%
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) 686 70.29%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 287 29.41%
D1. Number of individuals who received daily living skills training 1,853 100.00%
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) 1,142 61.63%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 676 36.48%
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) 3,058 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) 56 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) 250 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 241 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) 39 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 Department of Rehabilitation (DOR) provides comprehensive independent living services (ILS) to individuals age 55 years and older throughout California. The DOR, through its 17 sub-grantees, provides the majority of its services in the consumer’s everyday surroundings, whether it be home or community-based settings.

The program is implemented through sub-grant agreements with private, nonprofit community-based organizations that have expertise in providing effective services to individuals who are blind or visually impaired. The grant is advertised statewide and opened to application by eligible nonprofit agencies providing core ILS training in home and community settings. For purposes of providing Title VII, Chapter 2 services throughout the state, DOR divided the state into 14 separate geographical areas with a goal to award at least one grant in each of the designated areas.

DOR is considering a new methodology to distribute OIB funding for the grant period that begins October 1, 2014. DOR proposes to divide the state into service territories based on a county. Grant awards will be determined by a formula based on the population of those age 55 and older residing in the county, along with the geographical size of the county. This may result in decreased or increased funding for certain counties based on the make-up of its population and/or geography. Additional considerations are possible base funding for awarded grantees and funding for capacity building if a county does not have an applicant apply for funding.

In 2010 the sub-grantee applications were assessed, scored and three-year funding recommendations were made based upon the following criteria: • demonstrated ability to effectively provide ILS in a specified geographic area; • proven expertise in providing core in-home ILS to older individuals who are blind or visually impaired; • effective service provision to enhance consumers’ participation and integration in their communities; • establishment of innovative tools to identify, target and reach underserved, unserved and ethnically diverse population groups; • provision of culturally sensitive and linguistically appropriate ILS services; • development of a comprehensive plan of operation for delivery of services including referral processes; and • service delivery collaboration with local DOR offices of Blind Field Services (BFS) for DOR consumers and non-DOR consumers.

Outreach Efforts to Unserved and Underserved Populations Title VII, Chapter 2 sub-grantees are required to meet the State Plan for Independent Living (SPIL) outreach challenges by utilizing methodologies that help to ensure eligible consumers are aware of services and to focus upon unserved and underserved population groups.

The outreach challenges of the 17 sub-grantees to identify local needs of sub-population groups within their geographic area have been met with innovative and effective strategies that included: • hiring culturally sensitive and knowledgeable Outreach Workers; • encouraging inclusiveness of consumer involvement in impacted, underserved and unserved communities by coordinating peer-to-peer volunteer services and utilizing senior support groups to promote and advertise services; • providing translation services for non-English speaking populations; • incorporating gender and ethnic appropriate ILS promotional information via various media: specialty publications, ethnic-specific print, television, radio and public service announcements; • partnering with senior advocacy organizations to disseminate information on the availability of ILS services; • conducting ILS informational training to eye care medical specialists and physicians serving targeted population groups in underserved and unserved communities to increase referrals for services; • conducting presentations at adult day health centers and health/social service organizations located in unserved and underserved communities; • ensuring that allied organizations promote services and are oriented to the ILS referral process; • providing ILS information to organizations, agencies and businesses serving target populations; • utilizing ‘senior mentors’ to orient and demonstrate non-visual skills to members of targeted population sub-groups living in residential facilities, attending health and disability fairs and participating in culturally-based social activities and support groups; • recruiting volunteers who are representative of various cultures and languages of diverse populations, to identify and respond to service barriers (i.e., transportation, geography, cultural sensitivity, translation services, etc.); • identifying underserved and unserved communities with high demand for ILS services and finite resources to help fill in service gaps; and • distributing ILS information at faith-based organizations and establishments located in underserved and unserved diverse communities.

One of our sub-grantees, Blindness Support Services, Incorporated (BSSI), continues to be one of the top agencies in California serving underserved populations. Consumers are referred by family members, friends, medical professionals, and nonprofit/government organizations. Their second approach for recruiting consumers comes from attending fairs throughout Riverside and San Bernardino Counties and speaking with people who can benefit from their programs. During the 2012-13 Federal Fiscal Year (FFY) BSSI attended 25 fairs which targeted seniors or individuals with disabilities throughout Riverside County. Further, BSSI worked with other service providers within their area who referred potential consumers, family members, and friends.

In addition, BSSI expanded their program information to reach the CARE committee of Riverside County. This was a new entity for CARE, which requested that BSSI become a part of their committee. Also, BSSI presented their program to the Riverside County Mental Health Agency, and will be partnering with the agency to better serve the blind consumers’ needs throughout the rehabilitation process.

BSSI also organized 10 Spanish peer support meetings which discussed increasing the consumer’s ILS through peer discussions, social interactions, and a tactile friendly low vision and totally blind bingo game (referred to as “loteria” in the Hispanic culture). This game has really made consumers open up and feel comfortable and relaxed in the peer support meetings. This in turn allows for many low vision and blindness related topics to be addressed. With the participant feedback, BSSI realized that being able to speak English was holding many of the consumers from going out into their communities. BSSI has begun Basic English classes during the peer support meetings. For example, a consumer now is able to go to a restaurant using their mobility skills, place their own order in English, and eat with others without any issues.

For the FFY 2012-13, 63.1% of all consumers served by BSSI were from various ethnic groups.

Another sub-grantee, Society for the Blind, implements the Title VII Chapter 2 program utilizing a variety of delivery channels. Its monthly, eight-day senior retreat program provides instruction in orientation and mobility (O&M), daily living skills, communications, and adaptive technology (AT) to individuals who are blind or visually impaired age 55 and over in the greater Sacramento area. Spanish speaking consumers are provided translation services to enable them to fully participate in the retreat experience. Blind and visually impaired seniors with diabetes are also served through residential retreats designed to address their specific needs. Additional methods of service delivery to seniors experiencing vision loss include providing individualized in-home instruction, facilitating monthly support groups and community integration activities in both English and Spanish, and conducting outreach and training events throughout the Sacramento, Chico, and Mount Diablo service regions.

For the FFY 2012-13, Society for the Blind services to ethnic groups increased by 2.4%.

A third sub-grantee, The Center for the Partially Sighted (CPS), provides comprehensive low vision rehabilitation services with the goals of enhancing any remaining sight, providing emotional support, and training in independent living strategies. CPS offers optometric care, the latest in computer and AT, individual and group counseling sessions, ILS training, O&M instruction, a low vision store, as well as a variety of other services. Optometric evaluations are conducted on-site. Counseling is offered face-to-face or by telephone. Instruction in O&M and rehabilitation services are provided in consumers’ homes. CPS conducts outreach to low-income clinics and ophthalmology and optometric offices, and maintains a website.

CPS served 728 older individuals who are blind or visually impaired for the FFY 2012-13, 43.5% of that total were from various ethnic groups.

Of all consumers served during the FFY 2012-13, sub-grantees averaged serving 32.3% non-white consumers. This was a decrease of 0.2% from the prior reporting year. The primary reason for the consistent services to underserved/unserved populations is sub-grantees’ employment of 71 staff members who are representative of California’s diverse population groups. Below is a breakdown of the diversity of the consumers served by sub-grantee agency including agency location and counties served:

FFY 2012-13 Sub-grantees

Agency Non-white percentage Location Counties Served Blind and Visually Impaired Center of Monterey 16.7% Monterey Monterey Blindness Support Services, Inc. 63.1% Riverside Riverside, San Bernardino The Center for the Partially Sighted 43.5% Culver City Los Angeles, Santa Barbara, Ventura Community Access Center 45.7% Riverside Riverside Dayle McIntosh Center for the Disabled 36.9% Garden Grove Orange Earle Baum Center of the Blind 4.6% Santa Rosa Sonoma, Napa, Lake, Mendocino El Dorado Center for the Visually Impaired .02% El Dorado El Dorado Independent Living Services of Northern California 4.5% Chico Butte, Shasta, Tehama, Plumas LightHouse for the Blind 34% San Francisco Marin, San Francisco, Solano, Humboldt, Del Norte Lions Blind Center of Diablo Valley 50.9% Pittsburg Contra Costa Lions Center for the Blind, Oakland 53.5% Oakland Contra Costa, Alameda San Diego Center for the Blind 26.5% San Diego San Diego Santa Clara Valley Blind Center 35.7% San Jose Santa Clara, San Mateo Society for the Blind 28.7% Sacramento Sacramento, Butte Valley Center for the Blind 42.5% Fresno San Joaquin, Fresno, Kern, Merced, Madera, Tulare, Kings, Mariposa Vista Center for the Blind and Visually Impaired 24.4% Palo Alto Santa Clara, San Benito, Santa Cruz, Monterey VTC Enterprises 11.1% Santa Maria Santa Barbara, San Luis Obispo

B. Briefly describe any activities designed to expand or improve services including collaborative activities or community awareness; and efforts to incorporate new methods and approaches developed by the program into the State Plan for Independent Living (SPIL) under Section 704.

Collaborative Activities The goal of California’s Title VII Chapter 2 program is to prolong the independence of older individuals who are severely visually impaired. The sub-grantees participated in the following collaborative and community-oriented activities: • developed and implemented initiatives that strengthen existing relationships with public and private health agencies; • expanded partnerships with multi-cultural, ethnic and senior organizations to help close the gap to access to services among the state’s diverse population sub-groups; • participated in social marketing campaigns with other agencies serving seniors and the diverse senior communities; • referred appropriate related services such as mental health services and public assistance programs; and • established networks of care systems with various providers, medical providers, agencies, associations and organizations that emphasize ILS to improve access and ensure cost-effective use of resources.

An example of collaborative activities is the Vista Center for the Blind and Visually Impaired located in Palo Alto. The agency maintains close collaborative relationships with Long Term Care Commission of San Benito County, Santa Cruz Area on Aging, Asian Americans for Community Involvement, Self Help for the Elderly, Berryessa Senior Center, DOR Blind Field Services counselors, Santa Clara Valley Blind Center, Silicon Valley Council of the Blind, Foundation Fighting Blindness Silicon Valley Chapter, and city governments in Palo Alto, Santa Clara, Santa Cruz, Scotts Valley, Capitola, and the county of Santa Cruz. They also participated in White Cane Day with the Palo Alto Western Blind Rehabilitation unit as well as with BookShare that provides books, news, magazines in digital format.

Since April 2013, VTC Enterprises (VTC) has participated in a Shared Vision group (a collection of agencies who focus on low vision/blindness services). In May 2013, VTC initiated a monthly AT Group which focuses on accessibility for the blind and visually impaired. So far, the group has met five times. It includes nine OIB participants, their family, and friends. The group is self-run with provider assistance and guidance. Participants brought in existing technology and spoke about how it changed their lives. VTC is encouraged that individuals are beginning to act as a resource to each other and want to spread the instruction to others. The group is looking for resources to fund instructors.

Community Awareness In addition, sub-grantees participated in the following community awareness activities: • health forums sponsored by cities’ parks and recreation departments; • public awareness campaigns; • annual health/social services events and seminars sponsored by organizations that target seniors (i.e., Arthritis Foundation, Diabetes Association, American Stroke Foundation, etc.); • presentations at adult education schools; • coordinating public events with various foundations and organizations that specifically serve the visually impaired; • demonstrations in English as a Second Language classes; and, • distribution of culturally and ethnically sensitive agency information at various events conducted by or provided to individuals of ethnicities who are unserved or underserved.

The San Francisco LightHouse for the Blind (LightHouse) has been collaborating with On Lok Health Services which has been a growing and supportive system for many of the elders in San Francisco. In recent meetings with On Lok restorative therapy staff and social workers, LightHouse has put together a quarterly collection of shared insight trainings between their vision rehabilitation team and On Lok’s team of occupation, speech, and physical therapists so that LightHouse can provide a more thorough and successful training with students that have secondary health conditions. Over the years LightHouse has found that blindness and low vision may not be the primary disability that challenges an individual’s success for independence. The goal is to work collaboratively in supporting the success of the students. After several planning meetings this last quarter, the first shared insight training will be at the LightHouse and will focus on Blind Skills 101. On Lok provides services to a very multicultural population which will also be included as a component of each training, specifically how to best to reach individuals where culture and language present challenges to training, learning and independence.

On Lok’s reach into the San Francisco and Marin community of older adults is tremendous as they have become the medical provider for hundreds of seniors in both locations. Through collaboration On Lok is becoming the ‘ambassador’ to LightHouse services and the importance of skill training to their members. Without the collaboration, the impact of community awareness in their realm, which is large, does not exist.

Additionally, during the months of July and August LightHouse’s AT trainers provided training to 15 AT trainer-volunteers throughout the San Francisco area who work in senior centers and senior residences to learn about ZoomText, JAWS and Guide. This was done in collaboration with the city funded program of AT in centers throughout San Francisco including the LightHouse. The benefit to training such volunteers is that many LightHouse students live in or near community Tech Centers and all of the centers currently have Zoomtext installed. Increased access to computers in these centers is a plus to LightHouse students who may not have computers. This collaborative training will continue throughout the next year, and many of the volunteers will come to the LightHouse to learn more and provide one-on-one training with our seniors.

DOR continues to provide technical assistance and consultation to sub-grantees on strategic planning of delivery of comprehensive ILS.

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.

Currently, sub-grantees report quarterly on the outcomes of their Older Individuals Who Are Blind (OIB) programs. The evaluation of the reporting requirements for OIB is an in-house program evaluation activity. Careful documentation of service provision and consumer outcomes help measure sub-grantees’ effectiveness and identify technical assistance needs. Moreover, the evaluations increase accountability, strengthen quality assurance and identify where program policy revisions are needed. The evaluation process includes all components of the data collection requirements established by Rehabilitation Services Administration (RSA).

Below are a few examples of sub-grantees’ unedited narrative reports on their evaluations.

VTC Enterprises Since October 2012, individuals receiving ILS services met 82% of personal objectives; this represents 368 tasks that can now be performed independently. Since April 2013, 34 of 35 people who responded to our satisfaction survey for the Low Vision Program were satisfied with services; 35 felt it improved their Quality of Life; 33 are still using the equipment that they received; and 30 are using the training. When asked to comment about services, one individual responded, "Paul has gone out of his way to be so helpful." Regarding equipment, another individual responded, "I couldn’t manage without it. Appreciate it."

The Center for the Partially Sighted (CPS) CPS in Los Angeles assesses optometric services post hoc with phone interviews. Clients are questioned about the quality, helpfulness, and timeliness of the services provided by The Center. Overall, clients were very pleased with the services provided. Each question had a mean rating over “4.3” (out of 5), indicating satisfaction with our services. Clients were also asked if they felt as though they have greater control or confidence in maintaining their current living situation because of the services provided by the Center. Eighty-five percent responded with a “4” or “5” to this question. At the end of each interview, clients were also given the opportunity to provide their own feedback. Clients have commented on more than one occasion that they liked that the optometrists explained things in a way that they could understand and demonstrated visual aids. Many clients commented on the usefulness of their low vision aids in reading things such as bills, restaurant menus, and medicine labels. In addition, clients’ skills were assessed before and after training for each of the four rehabilitation services that are provided by The Center (Independent Living training, Diabetes Management, Low-Vision/Lighting training, and O&M training). Each area showed significant improvement in mean scores after training with one of their instructors. Ninety-seven percent of these clients reported being able to better complete everyday activities due to their training. In fact, 74% reported using the skills that they learned on a daily basis. Furthermore, most individuals were very appreciative of their instructor. Specific comments regarding the instructors included they were very patient and suggested strategies that the client had not considered before.

San Diego Center for the Blind (SDCB) SDCB routinely administers the AVL (Adjustment to Vision Loss) scale designed by the LightHouse for the Blind in New York as a pre-test in addition to the Burns Depression and Anxiety scales. Results from the pre- and post-tests have confirmed our research that approximately three months after entering program/services, consumers will experience an increase in depression, which rebounds to a significant decrease after the initial three months. SDCB’s Ph.D. Psychologist theorizes that upon entering the program, consumers are faced with the reality of their loss which results in a rise in depression and anxiety before gaining skills and coping techniques which leads to general improvement thereafter.

Consumer Satisfaction surveys are administered by student interns at SDCB to a random 50% of the consumers receiving services under Title 7 Chapter 2 at random times, some during programming, some after services. Results from this survey show a satisfaction rate of 97%.

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).

Below are a few examples of sub-grantees’ unedited narrative reports on their consumers.

70-Year Old Woman A woman in her 70’s is legally blind due to AMD (age-related macular degeneration). When she first began receiving services from the Blind and Visually Impaired Center of Monterey, she said she was floundering. She has received extensive O&M and now uses the public transit. One of her goals was to learn how to use her stove safely. Her appliances were marked and she received training, and now successfully uses her stove top. She has also learned to organize her medication. She uses a pocket video magnifier and other magnification systems. With some adaptations she is still able to sew. She enjoys the books she receives from the Braille and Talking Book Library. She is an active member of the peer support group. She proudly reports “I have my life back.”

Ms. J.S. Ms. J.S. is a 90-year old Caucasian woman who is visually impaired due to macular degeneration. She was recently widowed and now lives alone, although she has a caretaker who comes in a few hours a week and her children live close by. Her ophthalmologist referred her to The Center for the Partially Sighted. She is interested in getting help to live independently. Ms. S also has hypertension. She would like help to read, including sheet music, cook, sew, and take care of her own laundry. After a low vision evaluation, the Center was able to prescribe a magnifier that helped her read recipes and her mail. We also conducted a home visit to help her in the kitchen with lighting, use of contrast, cutting techniques, and marked her stove, washer and dryer. We demonstrated the benefits of lighting next to her sewing machine, her piano and near her reclining chair where she likes to knit and read. She feels the quality of her life is improved and is now interested in joining one of the Center’s support groups for older adults.

KH KH who is 60, has primarily been an active participant in the LightHouse Novato support group. This year KH has had a change in her vision and has retired her dog guide. With this change also came the need to refresh skills in independent living, O&M and AT. KH participated in the September Changing Vision Changing Life Immersion Training in Napa finding that the motivation of the group and the group discussions with the life coach regarding taking personal responsibility really set a fire in her to rethink going back to school and work. KH plans on taking classes at College of Marin in January, 2014 and will be meeting with Department of Rehabilitation, Blind Field Services in regards to reopening her vocational case. In addition to her renewed desire for learning blind skills, KH has demonstrated a strong interest in promoting awareness of services for the other seniors who are blind or low vision in Marin County. Come October she will facilitate two outreach/education workshops on behalf of the LightHouse of Marin. While she has always been a self-directed person, this recent reconnection with focus on redevelopment of skills has really been a positive move in her life.

Ms. N Ms. N is a 74-year old woman who lives with her husband and dog in Eureka. She came to vision rehabilitation about a year ago when she visited her Ophthalmologist and decided not to drive anymore due to her increasing vision loss as a result of macular degeneration. She had a long career as a Minister and recently opened a radio station with her husband to focus on issues in the community. Ms. N wanted to maintain her independence and immediately committed to vision rehabilitation services at the Lighthouse of the North Coast. Her goals were to maintain control of her ability to write and broadcast and to be able to access her computer. In addition to these goals, she wanted to be able to connect with others who have vision loss so that she could gain support and support others in her communities who have vision loss, as well.

Upon hearing about the Changing Vision Changing Lives Immersion at Enchanted Hills Camp, Ms. N decided this 5-day training would be a good vehicle for her to learn to maximize her independence. Despite the fact that she has severe Rheumatoid Arthritis, she signed up for this retreat and traveled to Napa for the training. From the beginning of the training, she exhibited a willingness to dive in and learn all that she could. Ms. N participated in Adaptive Cooking, AT, O&M training, Introduction to Braille and Advocacy and Support groups. She became convinced that she could continue all of her activities by adapting and seeking training when needed. Besides seeking training during this time, Ms. N served as a positive emotional Mentor for others and became the source of inspiration for many of the group members.

After attending the LightHouse Immersion, Ms. N’s confidence level increased and she resumed using her computer with better lighting, increased font and patience. She will be looking forward to learning new technologies as needed, but no longer lives in fear of not being able to continue her radio broadcasts.

MG MG is a 61-year old gentleman with Usher’s II who resides bi-coastally between New York City and San Francisco. Over the past year, MG’s vision has changed dramatically and thus requiring brush up mobility and tactile communication skills from the Lighthouse for the Blind San Francisco. Because of the language strengths, American Sign Language (ASL) of our Deaf-Blind Specialist, Martin, MG had saved his street crossing training skills and working with a longer cane until he came to San Francisco. The level of trust and respect he has for the LightHouse Deaf Blind Specialist is exhibited by the vast improvement he makes during his training — direct communication makes a difference. Additionally, MG utilizes the LightHouse AT Lab throughout his six months on the west coast. He has worked out a system with our AT Specialist, and designated a day, time and computer station that he comes in twice weekly to use for email communication. Once returning to New York City, MG will be receiving a lap top from the FCC Deaf-Blind Telecommunication Program, but from the New York provider, so he looks forward to finally having technology he can take on the road. This past stay in San Francisco, MG specifically took time teaching and encouraging LightHouse staff to learn and use basic sign language, his way of giving back to the LightHouse for services and training he receives. MG is unique to the program since we only see him seasonally, but he is always a welcome returning student as his vision changes and his needs increase … he believes by next summer he will be in for many hours of Braille instruction.

JB JB is a 66-year old Information Technology Professor from University of San Francisco. He contacted the LightHouse not more than one month prior to the CVCL Immersion training week in Napa. He let our Rehabilitation Counselor know that he had taken sabbatical from his teaching so that he could focus on obtaining the necessary skills so that he could maintain his career. Knowing the importance of getting the training and experiencing his motivation and level of acceptance, we signed him up for the week training at camp so that he would not lose valuable training time while waiting for his case to be secured through BFS. Throughout the week, JB, the professor had become one the most incredibly dedicated students we have seen. Providing our students with training shades, we encourage them to wear throughout training during the week - we rarely saw JB without his being worn. He embraced training from cooking to low vision training, intro to Braille, sucked up all that he could from the life coaching groups and then dove head first into AT. He spent endless hours with our AT Specialist and determined that even with functional vision, JAWS would be a more efficient program to learn - especially in meeting his needs as a professor. He connected with the other students constantly engaged throughout official training time, but doing any ’extra credit’ he could. Upon return to the San Francisco Bay Area his case was established with DOR, but it was for the opportunity of being ’of age’ that OIB funds truly opened up a new life for a brilliant man.

Sister K Sister K contacted the San Diego Center for the Blind after she was diagnosed with Wet Macular Degeneration. After doing research on her computer to get more information, she decided she needed to talk to someone from the San Diego Center for the Blind. Sister K is a nun who lives in a monastery, and has very specific duties she needs to perform (cooking, cleaning, etc.). The community of sisters is small. And in their cloistered community they all need to do their jobs, and they depend on each other. Several of the older sisters were concerned that Sister K would not be able to perform her duties, and revealed this to her. Sister K called and requested an outreach visit to learn about the services at the San Diego Center for the Blind. During her intake Sister K had many questions about Center services, would she be able to cook, clean, and perform her duties at the monastery. Sister K has enrolled in classes at the Center for the Blind so she can continue to remain at the monastery, and perform her duties. She feels more confident, and so do her fellow sisters. She will continue to educate them as she moves through the program. She also will enroll in O&M to help her be able to visit her mother who presently lives in a skilled nursing facility, and she is her power of attorney.

Margaret Margaret’s first experience with Society for the Blind was an in-home visit from a member of the Senior Impact Project staff. Widely travelled, and anxious to retain her independence in the face of increasing vision loss, Margaret called Society for the Blind’s Senior IMPACT Project for some “tips” on how to safely continue with her current activities. During the course of her in-home visit, Margaret found the instruction she received so useful to her, that she immediately signed up to participate in an 8-day retreat.

While attending the retreat, Margaret participated enthusiastically in all of the activities offered. An accomplished cook, Margaret was delighted to learn how to apply non-visual techniques to an already advanced skill set. Margaret embraced her mobility instruction, and proclaimed her cane her “new best friend”. She learned quickly, and ably applied her newfound skills in a variety of situations. Through the course of her instruction, Margaret came to realize that she was very comfortable using non-visual techniques in her activities of daily living. She admitted that she “felt relieved that she did not have to strain her eyes” to accomplish tasks. Since her retreat, Margaret has regained her confidence and begun to travel again, and at this writing, is in negotiations to purchase a vacation home in Mexico, where she plans to live for six months a year.

M. M. is a younger senior who reluctantly quit his job due to progressive vision loss. Now that he has become aware through VTC Enterprises of the technology devices that exist for individuals with visual impairment, he hopes to get back into the workforce. Through O&M instruction, he can now go to the larger communities that are located within and outside the county where he lives. Referral services have connected him with a variety of agencies that can assist with housing, employment, and health. He has attended the VTC AT Group where he learned about how individuals have incorporated various screen reading software to access the internet. Association with others with visual impairments is also helping him to get over the hurdle of using a white cane in public. Though he knows that he will likely lose even more vision, he is now aware that he can still function independently and get a job with the knowledge that he can still do the work with the technology that is currently available.

J J is another consumer of VTC Enterprises, and when his wife passed away two years ago, his daughter and grandson moved in to assist him. Since that time, the family has been in conflict over the belief that he is "faking" the severity of his vision loss. Because J is able to count the doctor’s fingers, they believe that he should be able to see the food on his plate. J’s regular eating spot faces a wall of picture windows that cause glare during the daytime. At night, bare-bulb lamps also produce glare that interferes with vision. The daughter was educated about the need for glare control, more subtle spot lighting, and placement of objects to the bottom left where J’s residual vision is located. She stated that she was unaware of these needs and that she looks forward to incorporating changes at a future visit. J was visibly more receptive after his needs were explained to the family. Future visits will focus on obtaining filters to reduce the effects of glare and on determining which type of lighting produces the most comfortable and beneficial illumination (CFL, LED, incandescent, wattage, type — daylight, bright white, or soft white). Lighting placement needs will also be determined.

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

Specialized Services Division, Older Individuals Who Are Blind Section The El Dorado Center for the Blind and Visually Impaired closed at the end of FFY 2012-13, mainly due to the loss of the lease of their center. Unfortunately, the El Dorado staff has not provided their final reports. Consequently, the demographics for consumers served by this center in Part III, Part IV, and Part VI reflect the first nine months of the fiscal year only.

The following are unedited responses from some of our sub-grantees:

Blind and Visually Impaired Center of Monterey The requirement of having an annual audit has been a major challenge for the Blind and Visually Impaired Center of Monterey. The cost to the agency for Financial Statements with an Auditor’s report is $15,000 each year. This is an expense that would not normally be done annually due to the cost.

Community Access Center The Community Access Center in Riverside reported that there was a vacant position for several months in the Palm Desert office which covers the Coachella Valley. This position was filled in the 4th quarter and the new employee is doing an excellent job. Consumers served and services provided in the 4th quarter reflect a typical volume of work. The new staff person has very strong connections with the underserved rural population and Hispanic culture.

The Center for the Partially Sighted The association of vision loss with the development of other health care issues is not widely recognized. Falls, medication mismanagement, poor diet, reduced exercise and isolation/depression resulting from impaired vision can be alleviated by comprehensive low vision services, but access is limited. In California, the elimination of optical devices from Medicaid coverage and the reduction in payment levels creates an added burden for Medicare/Medicaid beneficiaries. Medicare coverage also does not include rehabilitation services by rehabilitation specialists, O&M specialists or low vision therapists, nor do they include optical and electronic devices under covered durable medical equipment. As a result, older adults with limited resources have only OIB funding to rely on, and even this funding is facing threats of cutbacks. The need will only continue to outpace the availability with the aging of the population and the increase in diabetes related vision loss, especially in areas with large populations of Latinos and African Americans and others with limited access to healthcare.

LightHouse, North Coast Funding is our biggest concern in the North Coast as without funding the office may close.*

LightHouse, San Francisco Like many of the northern California agencies, we are concerned about decreased funding in October 2014.*

Lions Center for the Blind (LCB), Oakland LCB wishes to acknowledge the TVII Grants it has received making possible for many older individuals who are blind to connect with us for receiving our professional services. These individuals have learned new skills and strategies which have impacted them to maintain stability, in most cases improve their lives, and stay connected to their community. LCB has the passion, talent and expertise to extend its services to the growing needs of the OIB population and to those who have not yet received our services.

Society for the Blind One challenge Society for the Blind faces in serving Sacramento, Chico and Mount Diablo is the large geographic area these regions encompass. There are many blind and low vision seniors within this area who are either unserved or underserved as a result of their residing far from available services. Society for the Blind works to address the needs of these individuals by extending outreach efforts to far flung communities and attempting to organize training events that serve groups of seniors large enough to justify the time and resources necessary to serve communities many hours driving distance from Sacramento.

Linguistic and cultural differences also present challenges to serving blind and low vision seniors from ethnic minority groups. Outreach efforts to these seniors require engaging the services of translators to facilitate communications between service providers and potential clients. Also, time and effort must be given to establishing relationships that engender trust in service providers and willingness among blind and low vision seniors from ethnic minority groups to step outside the familiarity of their communities to receive beneficial services. Overcoming cultural beliefs that discourage full participation of blind and low vision seniors in many activities is one of the greater challenges faced in providing services to these individuals.

Valley Center for the Blind Lack of funds continues to be a significant challenge. We are grateful that a 5% reduction in our annual grant was not implemented as this would have had a negative effect on services in our program. With more funding, Valley Center for the Blind will be able to provide opportunities for instructors to enhance their skills, move into a new facility, provide transportation services to our clients, and launch our new website.

Vista Center for the Blind and Visually Impaired Transportation continues to be a growing challenge. The Para-transit companies are making cuts as to who can receive their services and where they will take them. They have limited services to within 3/4 mile of the bus line and use the bus line schedule. Our agency serves four different counties and the Para-transit organizations are county- based. Lack of funding is becoming a major area of need. Budget decisions may lead to the loss of good staff. Vista will be moving to a new facility next year (2014) as our building will be torn down.

VTC Enterprises Title VII funds alone are not sufficient to provide services to all who need it in all three counties, so we must continue to look for alternative funding for both support staff and direct services. The spread-out geographical area makes delivering cost-effective, personal services difficult. Group services are difficult to provide due to transportation costs and the variety of transportation services in each community.

*Note: See Part VII A. for discussion regarding new OIB funding methodology being considered by DOR.

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 byJoe Xavier
TitleDeputy Director Specialized Services Division
Telephone916 558 5822
Date signed12/31/2013