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

RSA-7-OB for Services for the Blind, Vocational Rehabilitation Program - H177B130007 report through September 30, 2013

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year364,255
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year240,355
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2300,224
A2. Total other federal18,496
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other18,496
A3. State (excluding in-kind)686,170
A4. Third party0
A5. In-kind0
A6. Total Matching Funds686,170
A7. Total All Funds Expended1,004,890
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs275,905
C. Total expenditures and encumbrances for direct program services728,985

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 4.0000 8.8000 12.8000
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 4.0000 8.8000 12.8000

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 2 1.2000
2. Employees with Blindness Age 55 and Older 2 1.2000
3. Employees who are Racial/Ethnic Minorities 3 1.4500
4. Employees who are Women 14 8.0000
5. Employees Age 55 and Older 6 4.0000

C. Volunteers

1.00

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 FY574
3. Total individuals served during the reported fiscal year (A1 + A2) 803

B. Age

1. 55-5948
2. 60-6456
3. 65-6943
4. 70-7466
5. 75-7964
6. 80-84124
7. 85-89193
8. 90-94153
9. 95-9948
10. 100 & over8
11. Total (must agree with A3)803

C. Gender

1. Female570
2. Male233
3. Total (must agree with A3)803

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race32
2. American Indian or Alaska Native1
3. Asian3
4. Black or African American54
5. Native Hawaiian or Other Pacific Islander0
6. White709
7. Two or more races4
8. Race and ethnicity unknown (only if consumer refuses to identify)0
9. Total (must agree with A3)803

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)26
2. Legally Blind (excluding totally blind)758
3. Severe Visual Impairment19
4. Total (must agree with A3)803

F. Major Cause of Visual Impairment

1. Macular Degeneration531
2. Diabetic Retinopathy64
3. Glaucoma74
4. Cataracts1
5. Other133
6. Total (must agree with A3)803

G. Other Age-Related Impairments

1. Hearing Impairment224
2. Diabetes158
3. Cardiovascular Disease and Strokes424
4. Cancer41
5. Bone, Muscle, Skin, Joint, and Movement Disorders324
6. Alzheimer's Disease/Cognitive Impairment27
7. Depression/Mood Disorder23
8. Other Major Geriatric Concerns284

H. Type of Residence

1. Private residence (house or apartment)701
2. Senior Living/Retirement Community11
3. Assisted Living Facility63
4. Nursing Home/Long-term Care facility28
5. Homeless0
6. Total (must agree with A3)803

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)513
2. Physician/medical provider10
3. State VR agency9
4. Government or Social Service Agency9
5. Veterans Administration0
6. Senior Center3
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center1
11. Family member or friend75
12. Self-referral179
13. Other4
14. Total (must agree with A3)803

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 12,885
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 68
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 62

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 12,773
1b. Total Cost from other funds 70,430
2. Provision of assistive technology devices and aids 591
3. Provision of assistive technology services 417

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 129,653
1b. Total Cost from other funds 451,626
2. Orientation and Mobility training 268
3. Communication skills 384
4. Daily living skills 444
5. Supportive services (reader services, transportation, personal 45
6. Advocacy training and support networks 25
7. Counseling (peer, individual and group) 376
8. Information, referral and community integration 305
. Other IL services 311

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 6,097
1b. Total Cost from other funds 0
2. Information and Referral 3
3. Community Awareness: Events/Activities 21 643

Part V: Comparison of Prior Year Activities to Current Reported Year

A. Activity

a) Prior Year b) Reported FY c) Change ( + / - )
1. Program Cost (all sources) 1,014,265 1,004,890 -9,375
2. Number of Individuals Served 781 803 22
3. Number of Minority Individuals Served 100 94 -6
4. Number of Community Awareness Activities 69 21 -48
5. Number of Collaborating agencies and organizations 50 50 0
6. Number of Sub-grantees 0 0

Part VI: Program Outcomes/Performance Measures

Provide the following data for each of the performance measures below. This will assist RSA in reporting results and outcomes related to the program.

Number of persons Percent of persons
A1. Number of individuals receiving AT (assistive technology) services and training 417 100.00%
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) 290 69.54%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 89 21.34%
B1. Number of individuals who received orientation and mobility (O & M) services 268 100.00%
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) 139 51.87%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 97 36.19%
C1. Number of individuals who received communication skills training 384 100.00%
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) 254 66.15%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 93 24.22%
D1. Number of individuals who received daily living skills training 444 100.00%
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) 293 65.99%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 99 22.30%
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) 400 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) 3 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) 1 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 Title VII, Chapter 2 OIB program in Connecticut is administered by the Bureau of Education and Services for the Blind (BESB), one of five agencies recently consolidated into a new independent agency, the Department of Rehabilitation Services (DORS). The new agency includes the general VR agency, the Bureau of Rehabilitation Services. As BESB is a separate bureau within DORS and has an approved State plan, BESB remains DSU for both the BESB VR program and the Chapter 2 program.

BESB’s Chapter 2 program is an in-house program housed within the Adult Services Division of BESB. The Adult Services division of BESB serves clients over 55 that have approved independent living plans or waivers. The percentage of elderly blind clients vs. younger adult clients is typically 75-80% of the total number of clients that receive independent living services through the agency.

Vision related rehabilitation and independent living services provided by BESB include but are not limited to social work services; case management; rehabilitation teaching; orientation and mobility services; low vision training; consumer advocacy; volunteer services; purchase of low vision services from qualified eye doctors; purchase of adaptive equipment, independent living aids, assistive technology and related training; and volunteer services.

BESB conducts outreach activities to promote awareness of BESB services and programs to seniors and the elderly service provider network through a variety of approaches including periodic mailings to eye doctors to promote understanding of their statutory obligation to report patients who are legally blind to BESB. BESB retains a confidential blind registry, and as a result, is able to conduct periodic mailings targeted to elderly clients based on geography, community, and other factors to promote specific programs and events. In the past year, for example, BESB collaborated with the Bureau of Rehabilitation Services to send out applications to its deaf-blind clients concerning the National Deaf-Blind Equipment Distribution Program. Elderly clients of BESB who were severely hearing impaired were sent information that enabled them to apply for amplified phones and computer technology (if eligible). Elderly clients of BESB with severe hearing impairment within the Greater Hartford area were also sent flyers promoting the agency’s second annual deaf-blind campaign, "Losing Sight and Sound without Losing Your Identity," co-sponsored by the North Central Area Agency on Aging.

BESB staff also participated in various outreach events targeted to seniors such as Senior Health Fairs and Expos, assisted living facilities, and retirement communities. The agency also promoted low vision support groups with targeted mailings that are sponsored by Senior Centers and other organizations.

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.

BESB continued to collaborate with the State Independent Living, Council, the Centers for Independent Living, and CT’s five Area Agencies on Aging to promote awareness of our services.

Of particular note this past years is its continued campaign to seniors with dual hearing and vision loss, based on the Helen Keller National Center’s theme of "Losing Sight and Sound without Losing Your Identity." In September the North Central Area on Aging and BESB collaborated to to deliver a seminar aimed at seniors with dual vision and hearing loss, family members and caregivers held at the New England Assistive Technology Marketplace in Hartford. Keynote speakers featured an audiologist and an ophthalmologist who are leading experts in their fields. Information from CT’s NDBEDP (Access Through Technology) were distributed to the audience and low vision devices and independent living devices including inexpensive "pocket talkers" were demonstrated. This project will be extended to the end of the state fiscal year, June 30, 2013 with support from CT’s audiological society. 800 seniors who identified themselves as hearing impaired through the Chapter 2 program in the last three years were also sent information concerning amplified phones and potential eligibility to receive them from the NDBEDP. This collaboration is ongoing.

BESB continues to collaborate with the CT SILC and the CILS in CT to facilitate access of adults who are blind to computer computer equipment, adaptive software and training. The SILC purchased an accessible computer for each CIL that wanted to collaborate on this program two years ago. During this past year two older blind individuals with no usable vision were taught how to use GUIDE and Talking Typing Tutor using the accessible computer at one of the CILS by a legally blind IL Counselor. Subsequently, BESB purchased this software for use by the client in their home and collaborated with the National Federation of the Blind to purchase a computer for one of these clients. This project is ongoing; additional BESB funding will be available through another grant source in the next year to expand tthis model. BESB recognizes that it has limited Rehabilitation Technology services available internally to serve its IL clients, particularly seniors who have not been exposed to computer technology prior to losing their vision and will continue to seek collaborations with other agencies to reduce the "digital divide."

BESB also continues to provide quarterly trainings of new Transition Coordinators that transition adults from nursing homes and rehabilitation hospitals to the community through the CMS Money Follows the Person Medicaid Waiver program. In addition, BESB staff work directly with the Transition Coordinators to successfully transition our IL clients, including older blind clients, to the community and to prevent re-entry.

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.

BESB did not conduct a consumer satisfaction survey this past year. Case management staff facilitated the completion of program outcomes/performance benchmarks.

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).

The Chapter 2 OIB program has significantly impacted the ability of older adults who are legally blind to improve or maintain their level of independence.

Client MK: Newly registered with BESB for independent living and vision related rehabilitation services. Client is 62 years old and is LB as result of 2 strokes and P:arkinson’s disease in addition to M.S. Her mobility is severely impacted and she utilizes a power scooter and wheelchair for mobility as well as a white support cane for limited walking and transfers. Client was evaluated for low vision and was dispenses handheld and electronic magnification devices in addition to a lap desk to improve position of reading and writing material. A task lighting evaluation was also performed with recommendations of for using undercabinet lighting, replacement with alternative light bulbs, etc. Client was provided a task lamp to improve ability to write, as well as writing guides. Adaptive kitchen equipment was improve efficiency including a low vision cutting board, Ove gloves, liquid level indicator, etc. Client was also provided jumbo medication boxes with tactile markings in addition to provision of strategies to to help organize medication bottles and improve accessibility of labels. The client also received a referral for talking book services, and provision of LP cards to improve recreation and leisure activities in addition to a referral to the SC AAA for homecare assistance.

Client AI is a political refugee from Africa who has recently lost his sight due to glaucoma. He is sponsored by a refugee resettlement agency. BESB purchased Arabic interpreter services to enable the client to receive low vision services provided by a low vision specialist and also trained staff and the client in sighted guide technique.

Client MU is a 81 year old man living in a skilled nursing facility. Prior to becoming legally blind due to ARMD, he was very active. Staff members confined the client to a wheelchair because they didn’t realize that he still had usable vision. His BESB O & M instructor taught the client to use his walker independently following a voice cue to travel down the hall. In addition he was able to utilize his remaining limited vision to help guide his movements by following the moving feet of a guide walking in front of the walker. With practice and training MU is now able to talk to meals and activities in the building. He has become stronger and has increased his walking pace.

RD is a married 89 year old male who is legally blind and severely hearing impaired. Client was evaluated by a BESB RT for low vision services and was trained to use a handheld video magnifier enabling him to read most standard print. Recommendations were also made to improve dim lighting and reduce glare in some areas of the home and he was also issued a daylight desk lamp. Client also received communication aids including signature guide, large print calendar, and 20/20 pen and related training. He also received daily living skills aids and training including marking of his microwave with bump dots. To further his communication needs he was issued a pocket talker by BESB and referred to CT’s National Deaf Blind Equipment Distribution program for an amplified phone. The client was also referred to the VA for evaluation and dispensing of new hearing aids.

SB isa a 70 year old woman who experienced significant decline in her vision from RP during this past year She had delayed seeking O & M training and use of the long cane until her vision loss made her fearful about traveling outside her home on her own. An extremely active woman, SB had previously enjoyed taking part in programs at a local community center and prided herself in getting to her appointments at a nearby medical facility. O & M training was provided for several months and as a result, the client is now able to use a long cane to independently get around the community center and the medical building. She now has the confidence to use ADA paratransit services to get to a varieyt of destinations in the community and no longer feels trapped in her own home.

Client M.B., is a 67 year old totally blind woman who is totally blind. She has a master’s degree in counseling and remains very active in her community and also is chairperson of her local NFB Chapter. MB received training in screen reading software (JAWS) in the past but due to to her busy schedule she had difficulty memorizing commands and retaining the knowledge that she needed to master the program. Finally she lost all hope of becoming proficient in computer technology. Through outreach to seniors in conjunction with the Deaf Blind Equipment Technology Program, the client heard that a new software program was potentially available and contacted BESB. The client was referred to her local CIL for computer training on an accessible consumer computer equipped with computer technology for the blind. The client participated in 1:1 computer training using a Talking Typing Teacher program to improve her speed and GUIDE, a simple screereading software program, and within six weeks, she able to type 15 wpm and learned how to browse the internet and access email. BESB then collaborated with NFB to purchase a new computer for the client equipped with GUIDE purchased by BESB. Her IL counselor installed the software for her and continues to provide her with ongoing technology support. She contacted her case manager at BESB to say that with BESB’s help, she had "become a computer guru!"

Client WA is a 98 year old male whose vision is significantly reduced because of ARMD. Although physically he appears to be frail, he has a strong constitution and is determined to remain independent and continue to live by himself in his own home. The client was referred for O & M services to obtain a white support cane and to assist him with stability, obstacle location, and drop off location. He selected a cane with a crook which was adjusted for his height and comfort and filters to reduce inside and outside glare. He and his son who lives nearby were also shown how to use Sighted Guide technique for safety.

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

DORS recently purchased an upgrade to the agency’s computerized database (System 7). Updates to IL OIB forms were included to conform more closely with reporting requirements of the 2008 revisions to the 7OB report. However, the implementation of the system which took place on October 1, 2013 had some glitches which took seveeral weeks to correct. Staff had to be trained on the new forms that were created for the IL OB program including performance benchmark data. The new system improves the ability to more closely monitor data including performance outcomes as it includes an auditor report.

Concerns remain over pending cuts to funding at both the federal and state level which could negatively impact the delivery of services to older blind clients. To date the agency has been able to absorb funding cuts due to the agency’s decision to cap purchase of low vision devices particularly glasses prescribed by low vision specialists. In addition, BESB Rehabilitation Teachers received additional training in low vision through local resources and online courses to improve their skill level in evaluating clients for low vision services and providing handheld and electronic magnifiers.

The agency recently lost one state funded special assistant position and it is not clear if this position will be replaced. This puts additional stress on the agency to serve clients on an itinerant basis in a timely way.

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 byMarsha Brown
TitleOlder Blind Grant Program Manager
Telephone860-602-4046
Date signed12/30/2012