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

RSA-7-OB for Georgia Vocational Rehabilitation Agency - H177B130058 report through September 30, 2013

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year817,689
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 2776,495
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)80,165
A4. Third party0
A5. In-kind0
A6. Total Matching Funds80,165
A7. Total All Funds Expended856,660
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs50,404
C. Total expenditures and encumbrances for direct program services806,256

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 0.6900 0.0000 0.6900
2. FTE Contractors 6.8200 19.4000 26.2200
3. Total FTE 7.5100 19.4000 26.9100

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 19 7.3500
2. Employees with Blindness Age 55 and Older 9 4.2900
3. Employees who are Racial/Ethnic Minorities 16 4.2850
4. Employees who are Women 47 19.7600
5. Employees Age 55 and Older 34 14.6150

C. Volunteers

3.00

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 FY391
2. Number of individuals who began receiving services in the reported FY1,027
3. Total individuals served during the reported fiscal year (A1 + A2) 1,418

B. Age

1. 55-59153
2. 60-64162
3. 65-69132
4. 70-74154
5. 75-79163
6. 80-84232
7. 85-89228
8. 90-94155
9. 95-9936
10. 100 & over3
11. Total (must agree with A3)1,418

C. Gender

1. Female952
2. Male466
3. Total (must agree with A3)1,418

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race11
2. American Indian or Alaska Native25
3. Asian15
4. Black or African American435
5. Native Hawaiian or Other Pacific Islander3
6. White890
7. Two or more races10
8. Race and ethnicity unknown (only if consumer refuses to identify)29
9. Total (must agree with A3)1,418

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)107
2. Legally Blind (excluding totally blind)751
3. Severe Visual Impairment560
4. Total (must agree with A3)1,418

F. Major Cause of Visual Impairment

1. Macular Degeneration645
2. Diabetic Retinopathy133
3. Glaucoma229
4. Cataracts24
5. Other387
6. Total (must agree with A3)1,418

G. Other Age-Related Impairments

1. Hearing Impairment469
2. Diabetes437
3. Cardiovascular Disease and Strokes763
4. Cancer80
5. Bone, Muscle, Skin, Joint, and Movement Disorders387
6. Alzheimer's Disease/Cognitive Impairment45
7. Depression/Mood Disorder55
8. Other Major Geriatric Concerns376

H. Type of Residence

1. Private residence (house or apartment)1,264
2. Senior Living/Retirement Community89
3. Assisted Living Facility42
4. Nursing Home/Long-term Care facility21
5. Homeless2
6. Total (must agree with A3)1,418

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)856
2. Physician/medical provider22
3. State VR agency36
4. Government or Social Service Agency27
5. Veterans Administration0
6. Senior Center13
7. Assisted Living Facility4
8. Nursing Home/Long-term Care facility1
9. Faith-based organization1
10. Independent Living center5
11. Family member or friend144
12. Self-referral130
13. Other179
14. Total (must agree with A3)1,418

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 381,989
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 875
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 485

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 124,136
1b. Total Cost from other funds 0
2. Provision of assistive technology devices and aids 731
3. Provision of assistive technology services 1,042

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 296,367
1b. Total Cost from other funds 0
2. Orientation and Mobility training 224
3. Communication skills 713
4. Daily living skills 807
5. Supportive services (reader services, transportation, personal 53
6. Advocacy training and support networks 250
7. Counseling (peer, individual and group) 464
8. Information, referral and community integration 1,176
. Other IL services 35

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 3,764
1b. Total Cost from other funds 0
2. Information and Referral 21,036
3. Community Awareness: Events/Activities 167 24,983

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) 1,293,330 856,660 -436,670
2. Number of Individuals Served 1,606 1,418 -188
3. Number of Minority Individuals Served 563 528 -35
4. Number of Community Awareness Activities 186 167 -19
5. Number of Collaborating agencies and organizations 257 280 23
6. Number of Sub-grantees 49 39

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 1,042 100.00%
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) 789 75.72%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 117 11.23%
B1. Number of individuals who received orientation and mobility (O & M) services 224 100.00%
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) 92 41.07%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 73 32.59%
C1. Number of individuals who received communication skills training 713 100.00%
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) 579 81.21%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 99 13.88%
D1. Number of individuals who received daily living skills training 807 100.00%
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) 625 77.45%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 85 10.53%
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) 419 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) 17 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) 245 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 26 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) 35 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.

Project Independence: Georgia Vision Program for Seniors (also referred to as the Older Blind Program — OBP) implements the Title VII-Chapter 2 program through 7 main sub-grantees. Many of our sub-grantees further subcontract with various vision specialists throughout Georgia. The sub-grantees in Georgia are: • Center for the Visually Impaired • Vision Rehabilitation Services • Visually Impaired Foundation of Georgia • Savannah Center for Blind and Low Vision • Visually Impaired Specialized Training and Advocacy Services (VISTAS) • Walton Options for Independent Living

Mississippi State University - The National Research and Training Center on Blindness and Low Vision is our sub-grantee who conducts our annual evaluation and customer satisfaction surveys as well as serves as consultant to our program.

We maintain working relations with the following entities that increase our outreach efforts in order to reach the underserved and unserved older blind in Georgia: • Helen Keller National Center • Georgia Radio Reading Services • National Federation of the Blind of Georgia • Georgia Council of the Blind • Business Enterprise Program • Albany Advocacy Resource Center/Albany Center for the Blind • Native American Representative • Statewide Coalition on Blindness • Georgia Vision Collaborative • Statewide Independent Living Council

Our main initiatives to reach underserved and/or unserved populations in Georgia this year were 1) increasing our peer support groups throughout different areas around the state, 2) continuing to increase awareness, training and services to seniors with a dual sensory loss, and 3) setting up a Georgia Confident Living Program for our deaf-blind seniors.

Our primary subcontractors implemented outreach in various ways. The reports are in their words.

Visually Impaired Specialized Training and Advocacy Services (VISTAS) VISTAS CENTER has been serving the Northeast Georgia area for over 10 years. We have tried to reach the communities close by as well as those further away in need of our services. We try to attend as many Health Fairs for seniors as possible to distribute our brochures on Project Independence and let the public know what services we offer. Our funds have really been limited this fiscal year and we were not able to attend as many as fairs that invited us. Our seven sub-contractors are a major help in signing new clients and distributing the information in the community. These subcontractors provide the following skills/training: Technology, Orientation & Mobility, Vision Rehabilitation Therapy, Personal Adjustment Counseling to Blindness, Braille Instruction and Low Vision.

VISTAS has been fortunate to serve clients because our past and present clients recommend our services. We continue to hold membership in the Senior Network that collaborates with other agencies that serve seniors in the area, thus increasing our outreach efforts.

Savannah Center for Blind and Low Vision (SCBLV) Savannah Center for Blind and Low Vision (SCBLV) incorporates the Title VII-chapter 2, Older Blind (OB) program, into our overall service delivery model so that many of the (OB) seniors receive essentially the same services as seniors in other service categories. The general service delivery model follows a progression of intake and eligibility, low vision examination, functional assessments in vision rehabilitation therapy, orientation and mobility, assistive technology, service plan development, skills training, plan reviews and closure, and finally follow-up case management.

Training is either Center or home based, depending on the senior’s individual needs and living situation. The type, duration and location of services delivered are determined and noted in the service plan. Many seniors receive a full range of compensatory skills training while some receive short term services for either a refresher of skill sets or immediate specialized needs. Sometimes seniors identify new goals and other times a situation may arise when they need short term additional help.

Center based services are usually long term, incorporating all service areas while home based services are generally shorter term and focused on home safety concerns and skills. In the past the services have been provided through in-house and contractual staff. This year we are utilizing certified staff along with Dr. Emerson Brown, our contract optometrist to provide all services.

SCBLV outreach activities are provided through in-service trainings and office visits with medical professionals, service agencies and senior residential facilities and centers. In addition, staff attends community events and health fairs as well as providing outreach through our website and new social media outlets.

Visually Impaired Foundation of Georgia (VIFGA) Implementation of the Program: VIFGA subcontracts with numerous professionals to provide services in southwest Georgia. Those subcontractors provide services/skills training in the following areas: Low Vision Evaluations, Technology, Orientation & Mobility, Vision Rehabilitation Therapy, Personal Adjustment Counseling to Blindness, Braille Instruction, and Peer Support.

New Organization: For the past 20 years Mons International, Inc. was awarded the Older Blind grant and the non-profit arm of Mons International, the Visually Impaired Foundation of GA, Inc., helped fund devices or individuals not covered under the Older Blind grant. This year, the Older Blind grant was handled through the Visually Impaired Foundation of GA, Inc. (VIFGA).

The Referrals: Eye care professionals, family members, friends, rehabilitation counselors, etc. refer a senior with low vision to the Visually Impaired Foundation of GA, Inc. (VIFGA). A copy of the senior’s eye medical is faxed by the doctor to VIFGA or to the clinic where the senior will be seen. The senior is called, and if appropriate, is scheduled in one of our nine clinics in South Georgia closest to the senior’s home.

The Low Vision (LV) Exam: At the clinic, the doctor checks the refraction and makes suggestions about LV products or services. The LV Specialist discusses services, resources, and advocacy with the senior. Products that are matched to the seniors needs are demonstrated and recommended. A typed summary of the exam is given to the senior and attending doctor at the time of the exam. A product catalog, the Client Assistant Program brochure, the Project Independence resource brochure, list of peer support groups, resource lists, business card, library application, and the Helen Keller registry application are also given to the senior if available and/or applicable.

Products and Services: The recommended products totaling no more them $500.00 are sent directly to the senior together with a packing slip for the senior to sign and return to VIFGA.

When special services are needed, the appropriate teacher is contacted and he/she contacts the senior. Additional devices may be recommended by the vision professionals and sent to the senior.

The senior may also choose to attend the Albany Center for the Blind as a residential or non-residential senior to receive daily living, orientation and mobility, adjustment to blindness, and/or computer skills services on a more intense schedule.

Center for the Visually Impaired (CVI) CVI’s Title VII- Chapter service model is a mixture of group and one on one service provision. The low vision clinic service model is one on one service provision. All participants receive a low vision examine from an Optometrist or Ophthalmologist. Following the assessment, the client receives individualized therapy with either a Low Vision Occupational Therapist or a Certified Low Vision Therapist to address all aspects of daily living and to provide further training of the doctor’s recommendations. Often clients require follow-up services to address all the clients’ challenges and to ensure that the client has been able to successfully use devices and apply modifications and compensatory strategies. Accepting several insurances for both the Optometrist and the Occupational Therapist has allowed the Low Vision Clinic to make OBP funds stretch across as many individuals as possible. All participants served by CVI’s Community Based Team receive one on one assessments followed by provision of individualized training. Assignment to group classes is case by case and occurs only if appropriate for the particular individual.

CVI implements Title VII-Chapter 2 programming primarily in-house, with support from fully qualified contractors. The Maxwell Low Vision Clinic has 3 part-time sub-contracted optometrists in the Atlanta Low Vision Clinic, and one part-time optometrist for the clinical low vision evaluations conducted on the premises of Gainesville Eye Associates. Maxwell Low Vision Clinic staff includes a full-time Low Vision Clinic Director who also functions as a practicing Occupational Therapist, one Certified Low Vision Therapist, and a Medical Secretary. There is also an Occupational Therapist who works at the monthly Gainesville clinic and as needed in the community for follow-up visits. Program staff also includes a Program Director, Case Manager, one full-time Certified Vision Rehabilitation Therapist, and a full-time Certified Orientation and Mobility Specialist.

At CVI’s headquarters in Atlanta two to three clinical low vision evaluations are scheduled weekly, with occasional additional clinic days during the month, as workload demands. One monthly clinical low vision evaluation day is scheduled with Gainesville Eye Associates, the agency’s primary ophthalmologic partner in Northeast Georgia. There is another clinical low vision day in Macon at the Eye Center of Central Georgia, in Middle Georgia, which began monthly in February 2013.

Outreach efforts to reach unserved/underserved populations during the past year have included 56 unique presentations, spread across metro Atlanta, Central Georgia and Northeast Georgia, conducted by 15 CVI staff members.

Vision Rehabilitation Services of Georgia (VRS) Implementing the Title VII-Chapter 2 program, Vision Rehabilitation Services of Georgia (VRS) offers comprehensive vision rehabilitation services to any resident of our 33 county, north Georgia service area, who is over 55 and who meets the state requirements regarding functional vision loss. This year approximately 64% of our seniors began their program with a comprehensive low vision evaluation (LVE) conducted by one of our three consulting optometrists who specialize in low vision. We continue to average five low vision clinic days per month; typically 3-4 days in our Smyrna office and 1-2 days in different towns within our rural service delivery area.

VRS program participants often purchase their own prescribed devices and most receive at least one follow-up visit from an instructor to go over the use and care of the device. The instructor will also follow-up with the findings from the initial assessment performed by one of our counselors during the intake process. The Individualized Service Plan is created at the time of the LVE or initial visit from a VRS staff member. Generally, training sessions are scheduled once a week, until the training goals are met. All follow-up vision rehabilitation services are provided by university trained and Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) Orientation and Mobility and Vision Rehabilitation Therapist certified staff. Additionally, we provide Technology Access Training, personal adjustment to blindness counseling and peer support groups. To provide all of these services we utilize a core of staff teachers, as well as some independent contractors who reside in various regions within our service delivery area. To reduce continually increasing mileage reimbursement costs and our instructor’s driving time, we encourage seniors to assume the responsibility of coming to centralized training sites or to our main office. We strive to provide services in a timely and efficient manner to maximize the funds we have.

Walton Options for Independent Living (WO) Walton Options contracts with Vocational Rehabilitation to provide Chapter 2 services throughout a 16 county region. Because WO borders a state line, we also often get referrals from South Carolina that come to Georgia to access services. We have one full time instructor who travels throughout the counties to consumers’ homes to deliver training and resources. This encompasses an area approximately 125 miles wide and 150 miles deep from furthest points. This one person provides services to an average of 100 people in their homes each year, majority of whom are living in rural, impoverished counties. Because the program is located within an Independent Living (IL) Center, there are peer mentors and IL Coordinators who can provide support services and information and referral services beyond what the Chapter 2 program may provide. The Center conducts Outreach on a regular basis at Senior Centers, Schools, and other partnering agencies. This outreach is provided under our Part C and B grants.

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

The project manager conducted presentations and presented details of our program both as a collaborative and community awareness effort of our program at the annual conventions of the Georgia Council of the Blind - GCB (Augusta) and the National Federation of the Blind of Georgia - NFBGA (Columbus), the semiannual Statewide Coalition on Blindness held in Atlanta and Savannah, the Georgia Statewide Independent Living Council meetings, the Business Enterprise Program (Duluth), Division of Aging, Blinded Veterans, Fort Valley State University the Columbus Library for the Blind and the Georgia Vision Collaborative*.

*In spring 2013, the Georgia Vision Collaborative was rejuvenated. The Collaborative is a statewide coalition of about 28 (so far) public and private agencies addressing aging eye disease in Georgia. Project Independence is a part of this group. As a Collaborative member, Project Independence and other members shared resources resulting in a comprehensive resource guide listing programs and services designed specifically to enhance the quality of life for aging adults. All Statewide Independent Living Centers are included in the resource guide. We look for this relationship to expand further in FFY14, thus increasing collaborative activities and community awareness of vision programs for seniors in Georgia.

Assistive listening devices (ALD’s) were brought to meetings for use with those having a dual sensory loss and were a major hit in the presentations throughout. More and more blind and low vision seniors are letting it be known they are having hearing difficulties. The use of ALD’s aided other entities in the benefit of this technology and enhanced further awareness in the community of a needed resource. Information was distributed and discussions were held with interested parties at these various locations. This collaboration and community awareness resulted in numerous phone calls and referrals for Project Independence.

One of our providers is an Independent Living Center, Walton Options, whose director is very involved in blind and deaf-blind services. We are proud that one of our peer support group leaders is on the Statewide Independent Living Board of Directors having been appointed by the Governor for this fiscal year.

As part of Project Independence collaborative activities, two contractor meetings were held this fiscal year (in person and phone conference) with providers and partners in attendance. Both meetings enhanced our collaborative activities and increased community awareness of various programs. The meeting held in Atlanta in February 2013 included various contractor staff and a variety of presenters on subjects pertinent to services e.g. a special presentation on equipment for deaf-blind. The new GVRA executive director and deputy director presented to the participants. As a group, participants were able to share concerns, ask questions and highlight Project Independence to them. The participants also provided feedback from training attended, shared resource information and discussed program services for seniors.

In August 2013, the Project Independence contractor meeting was conducted via conference call to discuss the proposed contracts, policies, and confident living program training. We held a contractor/partner phone meeting in FFY12 and participants voiced positive feedback with this method commenting that it provided others a chance to participate not otherwise possible due to travel limitations. The group concluded this means of collaboration was most beneficial in terms of cost and time so we continued this approach for FFY13.

Georgia Radio Reading Service (GARRS) continued dissemination of public service announcements (PSA) about the Georgia Vision Program for Seniors about twice weekly. Their audience reached approximately 16,000 this year.

Activities of the Project Independence Manager continued further collaborative activities and community awareness: 1. Increased community awareness and greatly enhanced visibility of our program as the Project Independence website was up and running for the first time — access the address http://gvra.georgia.gov/vocationalrehab/project-independence. 2. Initiated a demonstration project on a communication device to test it for use with our seniors. The outcome of this project will be concluded in FFY14. Three staff that is blind/low vision was selected to test this product and determine the efficacy of use for our seniors. 3. Distributed a number of training webinars and informational resources from various entities to our partners and the IL system so as to increase private and public awareness of services to seniors. In turn, the IL system sent various informational resources to Project Independence — we have a very good information and resource network setup. 4. Initiated a plan to set up Confident Living Program (CLP) training in Georgia using Georgia providers. This project is currently under way and Project Independence is scheduled to conduct the first training in December 2013 (FFY14). We worked with Paige Berry, the National CLP trainer, to guide us in the project. We have worked with Paige over the years and she has conducted CLP training in Georgia numerous times. This idea was spurred by our IL provider so we would have a cost effective CLP model for Georgia by using homegrown trainers. 5. Conducted program reviews of all seven contractors. These reviews helped ensure uniformity and standardization of services throughout the state. The process pinpointed any problems/issues that needed addressing and proposed recommendations that would improve our program and expand our services in Georgia. This year Project Independence focused on proposed guidelines regarding methods in the low vision rehabilitation process, visual aids/devices procurement, and Braille instructor qualifications.

Our primary subcontractors collaborated and incorporated new methods and approaches in various ways. Highlights are noted:

Visually Impaired Specialized Training and Advocacy Services (VISTAS) The Senior Resource Network is a provider of home health, transportation and other services to and for seniors in the Northeast Georgia area. Through this resource agency we are able to collaborate with the companies that can directly and indirectly bring services to the blind community. The Talking Book center has been very helpful in getting information about the program distributed through their monthly mailing list.

When VISTAS receives a call inquiring about our program we explain as much as we can over the phone and then mail out an information package that includes an application and other papers that are required to become a part of the program. We provide brochures to local eye doctors and in return receive referrals from them. We work closely with the local independent living center. We continue to provide transportation when needed and when we are aware of the need - so our seniors can receive services and keep appointments for their various services.

Savannah Center for Blind and Low Vision (SCBLV) SCBLV’s video magnifier Lending Library program continues to serve a population of individuals who could not otherwise obtain these reading assistant devices. The program Coordinator also works with each individual to ensure that funding is secured so that they can purchase their own device.

As noted in last year’s report SCBLV met its goal of establishing a family rehabilitation program. This program is provided to families twice a year to enable them to have hands-on experience learning about vision loss and the skills training that their loved one is receiving as well as what their loved one is experiencing. This program provided a much needed support for families.

Visually Impaired Foundation of Georgia (VIFGA) The Visually Impaired Foundation of GA, Inc. attends consumer group conferences, teacher, counselor, and library conferences, and meetings involving the visually impaired or the elderly throughout the state to promote awareness of Project Independence. We also provide workshops on low vision aids to senior centers, libraries, doctors’ offices, universities, and school systems. We call ophthalmologists throughout the state on a monthly basis reminding them of the services available in their area. The Visually Impaired Foundation of GA, Inc. maintains a website (vifga.org) and a toll free number (1-877-778-4342) to help people find the Georgia resources available to them. We also provide eye exams twice a year at the Indian Reservation in Whigham, GA.

VIFGA incorporates new methods, collaborative and community awareness by a variety of means: • The Albany Advocacy Resource Center for the Blind: This is a four year old program that opened in South Georgia. I refer seniors to the residential program for intense services in mobility, computer access, independent living, and social skills. All seem to enjoy the atmosphere, learn quickly, and usually want to stay longer. This option has worked well for training, especially in the rural areas. The seniors can receive an immersion in training and then follow up with teachers coming to their home. The combination of residential training and in-home training is ideal. • Support Groups and Support Group List: This is an essential piece of the vision rehabilitation process. We started three new support groups this year, one in Bainbridge, one in Valdosta and one in Macon. All are struggling, but I believe they will grow in this coming year. That brings our total to eight that have direct contact with the Older Blind program. There are two other support groups, one in Columbus and one in Milledgeville, where I also refer seniors. At the end of the fiscal year, VIFGA sends all seniors the Support Group List to remind them of the support groups. • Helen Keller Registry: VIFGA has incorporated into the Low Vision Exam the distribution of the Helen Keller Registry for those with dual sensory loss. I have found that nearly 40% of VIFGA seniors have a dual sensory loss. • The “iCanConnect” service from the Georgia Council for the Hearing Impaired has helped purchase and train at least five of VIFGA’s dual sensory loss seniors. • Assistive Listening Devices: I have found that I use the “Pocket Talker” in 40% of my exams to enable our seniors to communicate with me. • Presentations, Brochures and Resource Guides: I enjoy presenting at various doctor’s offices, support groups, and civic clubs and distributing Project Independence Brochures and Resource Guides at every available opportunity. These are invaluable tools!

Center for the Visually Impaired (CVI) Collaborative/community awareness activities included 56 unique marketing and outreach events to visually impaired seniors, senior facilities, and organizations serving seniors. These activities were conducted by 15 different staff members, including the CVI President, Vice President for Programs, Public Education Coordinator, Case Managers and Instructors from the New View Community Based and Facility Based Programs, Volunteer Services staff, and the Low Vision Clinic Director and Case Manager. Collectively, these presentations reached 2450 unique individuals.

The Low Vision Clinic Director outreach efforts specifically targeted the doctors of ophthalmology practices and their staff to reach unserved/underserved populations during the past year. These outreach visits included speaking directly to doctors and staff to provide education on the benefits of low vision examinations and therapy, as well as providing information on all CVI programs. The Low Vision Clinic Director attended two Atlanta ophthalmology conferences and spoke at an annual meeting for one large local ophthalmology practice. These efforts have proven beneficial as we have added a Macon clinic and two extra clinic days in the Atlanta location.

Vision Rehabilitation Services of Georgia (VRS) Collaborations with other organizations continue to be a priority as VRS looks for ways to grow and maximize our funding to meet the needs of more clients. In FFY13 we continued to work together with Helen Keller National Center (HKNC) and Georgia Council for the Hearing Impaired (GACHI) to provide services to our seniors with a dual-sensory loss. VRS is now an official contracting partner with GACHI in the implementation of their iCanConnect program. VRS will continue to refer clients to their program for services and equipment and in turn will be able to provide some evaluative and training services to clients that need these services. A staff member is close to completing her Certificate Program in “The Rehabilitation of Persons who are Deaf-Blind” through Northern Illinois University - this will allow VRS to continue to provide high quality services to this population. In FFY13 we worked with two seniors who are deaf-blind and needed interpreting services as part of their program. VRS continues to work to locate both resources and volunteers to help provide training and communication support to our clients who are deaf-blind.

VRS continues to work with the United Way of Metro Atlanta to provide specialized services to all clients who may have unmet needs. In July we were awarded a grant to create a Diabetic Education program which we have started offering to all clients who have the combined challenges of Diabetes and Vision Loss; we are thrilled with the response to date as clients share how important this information is to them and their families. We had three seniors participate in our first class.

One way that VRS hopes to address the growing needs for services in Rural Northwest Georgia is to provide support and mentorship to new professionals living in these regions. This year VRS has hosted three Vision Rehabilitation Therapy and Orientation & Mobility interns as they work through their university programs and prepare themselves for work in the world of Vision Rehabilitation. These individuals allow us to provide services to clients at a reduced cost as their time spent in field work is on a volunteer basis. By identifying and mentoring local candidates, we are able to guarantee additional well-trained staff for our program moving forward.

Volunteer time spent on Project Independence work has had a significant impact on our ability to provide services this year and document the data from this work. One volunteer designed and managed the database system which we use for all client services documentation. With her help we have been able to collect, track and use data very efficiently. Her work has allowed other staff to spend time providing services and/or developing new programs and funding sources.

In order to resolve some of the funding struggles, VRS has worked to maximize its fundraising impact through increased number of special events and the use of social media. This year’s October Spooktacular Chase drew a record number of participants. Other businesses within our territory held “VRS Days” whereby we were the beneficiary of their awareness and fundraising efforts. A focus on our 30th Anniversary has drawn new donors to the fold as well as an increase in the average gift. The Development and Marketing Team has been able to increase our visibility in our various communities through multiple news stories and articles in local newspapers and on various television stations. Paired with the use of twitter, Facebook and email updates, our community partners are able to more easily follow what we do and know how to locate and contact us in regard to our working with community resources and at community events.

VRS has ended FFY13 with an eye towards growth. With partnerships and collaborations we have been making this year with both the non-profit and business communities we feel poised to do good things in FFY14. We are working with Leadership groups to help us address funding initiatives, grant writing and the development of new programs to meet the needs of our clients young and old who would like to work. We are excited to be able to support our seniors in all of their life endeavors.

Walton Options for Independent Living (WO) Walton Options attends regular Statewide Independent Living Council (SILC) meetings and supports ongoing training of staff in areas that will serve consumers. The three year state plan for Independent Living was developed and submitted for approval to begin 10-1-2013. The executive director of Walton Options was very involved with the process and responsible for part of the communication with RSA. We also coordinate with Tools for Life Program and the SILC in efforts to identify needs that the state plan should address as well as the progress of the plan objectives. Our agency work plan addresses technology and utilization for whom people with vision loss may benefit, such as training on phone and Ipad apps, as these are more affordable options that are proving to enhance independence.

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.

GA contracts with The National Research and Training Center (NRTC) on Blindness and Low Vision at Mississippi State University to provide a program evaluation of the Project Independence program. As part of the evaluation consumers are interviewed about their customer satisfaction experiences with the program. The six contractors providing direct services send names of closed consumers to NRTC on a quarterly basis. An experienced telephone interviewer then contacts consumers to complete the satisfaction surveys.

The comprehensive program evaluation report is prepared each year by the NRTC. This report includes consumers’ feedback regarding satisfaction with services and how services have impacted their ability to live independently, demographic and service data from the annual 7OB report, findings from site reviews of contractors, and any recommendations. This report will be completed in early 2014.

The GA program has contractual agreements with six regional agencies for provision of direct services to eligible seniors. A regional service delivery approach enhances the ability of project staff to be sensitive to and familiar with the needs of local consumers. Depending upon the contractor and/or individual consumer’s needs, an itinerant, center-based, or combination of itinerant/center-based model is used in providing services. An itinerant model is generally used to serve consumers in outlying rural areas who might not otherwise be able to participate in such a program.

During this project year, 211 consumers participated in telephone interviews. The majority of participants (52%) were between 55 and 74 years of age. More than two-thirds (71%) were female. About 85% of participants reported living in a private residence; the others living in senior living/retirement communities, assistive living facilities, or nursing home. The most reported reason for vision loss was macular degeneration (42%); the second most reported reason for vision loss was glaucoma—20% of respondents indicated they had glaucoma. Consumer satisfaction levels among those participating in the survey were very high. In responding to satisfaction questions regarding delivery of services, i.e., manner of service delivery, types of services provided, and perceived outcomes of services—almost all of the participants expressed satisfaction. Participants were most satisfied with the attentiveness, concern, and interest of staff (98%); followed by the timeliness in which those services were received (96%), and overall quality of services (93%). Consumer ratings of functioning after receiving different types of independent living service areas follow: • 99% reported that they were better able or had maintained their ability to travel independently • 97% reported that they were better able or had maintained their ability to function more independently having received assistive technology devices • 97% reported that they were better able or had maintained their ability to function more independently having received communication skills training • 98% reported that they were better able or had maintained their ability to function more independently having received daily living skills training • 62% reported that they had greater control and confidence in their ability to maintain their current living situation; 35% indicated no change; and 3% indicated less control and confidence

Program participants were asked what the biggest difference the program had made in their lives. Typical comments include the following:

• Being able to read again is just amazing. Able to read the newspaper and magazines. • Everything! Everything has totally made my life functional. They helped me to learn absolutely everything. They’ve taught me to identify, categorize, and many other things. The biggest difference is going from the dark and lonesome to moving back into the world of reality. I have no idea of what I could do without them. • It made me aware of the gadgets and things that may help me manage my life without too much expense. Also, the support system they offer has helped me cope with my visual impairment. • Less fear of losing my independence visually and I know that I can always call them for assistance and that’s comforting. • To be able to communicate and read with people through braille. And to be able to know how to use a computer and to communicate with people through it. Also, communicating with people who are in my same situation has made a huge difference. • It’s helped us live more independently and we are able to stay in our own place instead having to go to a nursing facility. • It made a huge difference. I now know how to use a computer and can see using my magnifier. It’s enriched my life. • I’ve been going to a support group through them and I find that helpful. Just talking to other individuals who can do things with little vision or even no vision is encouraging. • It helped me to start walking around and stop being afraid to go places. It’s helped me to learn to make my bed and clean my own room.

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).

Senior 1 Recently we had a newly signed client who passed away rather suddenly. Her family donated her computer and video magnifier to the agency. We were able to pass both items to seniors who were in need and had an interest in the equipment. The senior that wanted computers lessons was finally able to receive them and has been very grateful. After receiving the computer he would call the office several times thanking me for the donation and how it had changed his life. He even stated that “you may have to come pick up the computer, because every time I pass by it, it calls me to sit.” He was so please to receive it and is now scheduled regularly to receive technology lessons. (Program Manager’s comment: all of our providers have “lending libraries” and “loaner” equipment. This case provides a good example of how reissued equipment can impact our seniors in a major way.

Senior 2 A 97 year old lady navigated her electric wheelchair down the hall to the low vision clinic. She came alone. She had been dropped off by her nursing home’s transportation. She is totally deaf. She only has the use of one arm. I wrote questions and instructions to her under the CCTV video magnifier. She answered orally. She just wanted to READ and be able to communicate. The CCTV video magnifier was the only device that would help this inspiring woman! She agreed to let me and her social worker at the nursing home ask “iCanConnect” for help in purchasing the CCTV for her. The device was approved! I am so thankful for this new special fund through the FCC and Helen Keller and our collaborative efforts.

Senior 3 Mr. WB lost his vision and most of his hearing by age 9. He never let it defeat him as he graduated from college with a 3.0 GPA and became a counselor for juvenile delinquents. Then a horrible car accident took the life of his girlfriend and left him in a nursing home for five years. He states he gave up on living. Afterwards someone encouraged him to contact SCBLV. He received services to help him get out of the nursing home; he began using the computer. He was connected with resources to obtain specialized equipment for people who are deaf-blind and is now able to use a refreshable braille display and IPad to communicate with others. He writes poetry and short stories that he shares in a major tourist area of Savannah on a monthly basis- along with a group of poets and musicians. He is able to research the internet to obtain news information, especially about the Atlanta Braves scores! Mr. WB stated that having access to this equipment has been a true “miracle” and has “opened up a whole new world to him.” He is in the process of moving from a supported living center about an hour away from Savannah to his own apartment in Savannah.

Senior 4 James S., in his late 50s, suffered a series of strokes that took his eyesight and made his speed almost unintelligible. He was in hospital for a long time, then a nursing home, and at present is living in a personal care home. He had made progress but still wanted to be more independent in some ways and to have some activity that would stimulate his brain. Talking with him, with the help of one of the aids, we learned that he would like to have a talking watch so at least he would be independent in the area of telling time. He also agreed to try the Talking Books program. Both of these made him much happier than he had been; he expressed his appreciation for our services. We found that, more than anything, he wanted to learn to speak more clearly so as to be able to carry on conversations with people. We provided guidance to the personal care home staff so that they could obtain a prescription from his physician for speech therapy at one of the local medical centers. He has already had a few sessions with the therapist, and we are all very pleased that he has been able to get the help he wanted in learning to speak more intelligibly again.

Senior 5 Prior to his wife’s death, Mr. P. had relied on his wife to assist with tasks of daily life. After her death, he moved to his daughter’s home. When he came for his first low vision evaluation (LVE), Mr. P. felt there was nothing left for him. He had challenges with daily living skills (including not being able to see the food on his plate) and moving around safely. As a result of the first LVE, daily living skills and Orientation & Mobility training were recommended. Mr. P. was reluctant to work with an instructor. His daughter, the low vision consulting doctor, and the Director of Low Vision Services had a lengthy conversation with Mr. P. and convinced him of the importance of learning techniques and skills that would enable him to live independently and enjoy a quality of life. He was encouraged to “give it a try”. For over two years, Mr. P. has been working with VRS instructors. He returned for another LVE because his vision declined. His entire outlook on life, his motivation to learn new skills, and his ability to be independent has “given him a new lease on life”. He now uses a cane and has advanced to using an iPhone. Without the funding provided by Project Independence, Mr. P. would be inside his house, without hope.

Senior 6 Mr. E. is a 64 year old man who is a single amputee living alone with very limited support from family and friends. He travels using an electric wheelchair. Current vision is described as no light perception in right eye and object perception in left eye. He attended the Low Vision Clinic and with the aid of a magnifier he could read standard print letter by letter. Initially he declined the magnifier offered because of the extent of his vision loss and the effort needed to use it. Part of his travel route to the nearest bus stop required him to travel in the traffic lanes of busy six lane road because of sporadic sidewalks. He reported having has fallen out of his chair into the street because of a lack of curb cuts.

At the time of the initial interview with the case manager Mr. E. could not reliably measure his insulin or monitor his blood glucose level. He was guessing at insulin dosage by feeling the position of the plunger on the syringe. When cooking, he was guessing at settings on his stove and oven. He could not always reach or identify food items in his cabinets. He reported having difficulty cutting and preparing food for cooking. After the case manager brought him the recommended magnifier from the Low Vision Clinic assessment and demonstrated its use, Mr. E found it useful for reading labels on food items and expiration dates on food and medications.

The case manager provided supportive counseling to address Mr. E’s coping skills and reviewed resources. He was encouraged to follow up with a scheduled appointment with the Diabetic Specialist, who recommended a talking glucometer. He was referred first to a vision rehabilitation therapist (CVRT) and later to an orientation and mobility specialist (COMS). From the VRT he learned to monitor his glucose using the talking glucometer and to accurately measure insulin; as a result, blood glucose is under better control. Mr. E also learned safe methods for preparing meals, as well as how to organize his cabinets for ease of locating and identifying foods. Increased lighting and use contrast on countertops contributed to success.

The COMS and Mr. E identified better routes and techniques for him to travel for safe street crossings. The COMS used white paint to mark curb cuts to facilitate his identifying them. Mr. E was issued a cane and taught to use it to verify location and depth of curbs or uneven pathways. He now uses a reflective vest on the back of his wheelchair for higher visibility for motorists. At the time of his initial interview with the case manager Mr. E. stated, “I’m looking for a better way to do things and I want to make life easier”. He has been successful in accomplishing his goals.

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

In Georgia, services have been available to eligible seniors regardless of income for little or no cost. However, due to the rising costs and demand for visual aids and devices, more consumer involvement is being asked to help cover the cost of visual aids and devices. Participants will continue to be given information on financial third party resources as well as provide loaner equipment when available. This allows Project Independence to maximize resources to pay for those direct services where third party funding is generally not available. Independent Living plans will not be impacted regarding the cost of visual aids and devices i.e. no senior will be denied a service if the cost of a visual aid or device cannot be covered by a third party.

Funding As we continue to struggle with reduced funding and to look for additional funding some of the providers are applying for grants to help with administrative costs, increased services and marketing of the program.

In FFY13, several providers completed their contracts with no funds remaining with about three months before the end of the fiscal year. There were more seniors who needed services than available funding. Despite using creative methods to ensure that all available funds were appropriately utilized and stretched as far as possible, many of the providers were unable to make the money stretch until the end of the fiscal year. Some seniors were able to receive basic services through private funding and other program grants. However, others had to wait until the new fiscal year to get what they needed. This delay acted as a de-motivation for many seniors; their health is not good and they cannot meet instructors, they are no longer interested in services or just don’t see the need. The inability to have the funds needed to provide services throughout the year has a very negative effect on the programs outcomes. If these funds continue to be flat-lined in national and state budgets, it seems inevitable that the number of seniors served or the amount of service offered each year will begin to decline in the not-too-distant future and could be disastrous both to programs and service provision. This situation has become more of an annual challenge within the overall system.

In FFY13, in-kind and third party funding were not included in this report. In previous years, carry over funds were used, but we did not have any carry over funds for FFY13. The award was also reduced for FFY13. These funding changes account for the difference in the comparison of FFY13 and FFY12 costs.

Staffing We still struggle to have certified staff who can deliver Orientation and Mobility and Vision Rehabilitation Therapy services, so the loss of Master’s level classes at schools is not helping to rectify the issue. Scholarships and funding to help encourage careers in this area should continue.

Finding qualified professionals who are willing to travel long distances to spend time with seniors in some of the more remote rural areas in Georgia has proven to be a difficult task.

During FFY 13, one provider was forced to decrease their teaching staff by 30% and their direct service non- contract staff in their low vision clinic by 50%.

FFY12 correction in FTE’s: Program Manager inadvertently included the FTE’s for MSU in the State Agency total. The State total should have been recorded as .69 instead of 1.05 and the contractor total as 21.74 instead of 21.38. The grand total of 22.43 FTE’s remained as reported for FFY12.

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 byKay McGill
TitleProgram Manager, GA Project Independence
Telephone770-414-2676
Date signed12/19/2013