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

RSA-7-OB for Iowa Department for the Blind - H177B130015 report through September 30, 2013

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year315,669
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year110,865
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2426,534
A2. Total other federal16,226
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement16,226
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other0
A3. State (excluding in-kind)280,560
A4. Third party0
A5. In-kind0
A6. Total Matching Funds280,560
A7. Total All Funds Expended723,320
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs135,704
C. Total expenditures and encumbrances for direct program services587,616

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 0.7000 5.5700 6.2700
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 0.7000 5.5700 6.2700

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 2 1.4200
2. Employees with Blindness Age 55 and Older 1 0.6000
3. Employees who are Racial/Ethnic Minorities 0 0.0000
4. Employees who are Women 10 5.7700
5. Employees Age 55 and Older 5 2.2800

C. Volunteers

0.00

Part III: Data on Individuals Served

Provide data in each of the categories below related to the number of individuals for whom one or more services were provided during the reported fiscal year.

A. Individuals Served

1. Number of individuals who began receiving services in the previous FY and continued to receive services in the reported FY427
2. Number of individuals who began receiving services in the reported FY542
3. Total individuals served during the reported fiscal year (A1 + A2) 969

B. Age

1. 55-5944
2. 60-6436
3. 65-6952
4. 70-7464
5. 75-79107
6. 80-84165
7. 85-89230
8. 90-94198
9. 95-9952
10. 100 & over21
11. Total (must agree with A3)969

C. Gender

1. Female746
2. Male223
3. Total (must agree with A3)969

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race4
2. American Indian or Alaska Native1
3. Asian5
4. Black or African American22
5. Native Hawaiian or Other Pacific Islander1
6. White926
7. Two or more races0
8. Race and ethnicity unknown (only if consumer refuses to identify)10
9. Total (must agree with A3)969

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)0
2. Legally Blind (excluding totally blind)969
3. Severe Visual Impairment0
4. Total (must agree with A3)969

F. Major Cause of Visual Impairment

1. Macular Degeneration594
2. Diabetic Retinopathy70
3. Glaucoma67
4. Cataracts18
5. Other220
6. Total (must agree with A3)969

G. Other Age-Related Impairments

1. Hearing Impairment373
2. Diabetes106
3. Cardiovascular Disease and Strokes318
4. Cancer42
5. Bone, Muscle, Skin, Joint, and Movement Disorders182
6. Alzheimer's Disease/Cognitive Impairment58
7. Depression/Mood Disorder16
8. Other Major Geriatric Concerns70

H. Type of Residence

1. Private residence (house or apartment)608
2. Senior Living/Retirement Community171
3. Assisted Living Facility107
4. Nursing Home/Long-term Care facility83
5. Homeless0
6. Total (must agree with A3)969

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)83
2. Physician/medical provider28
3. State VR agency145
4. Government or Social Service Agency28
5. Veterans Administration3
6. Senior Center40
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization6
10. Independent Living center26
11. Family member or friend231
12. Self-referral302
13. Other77
14. Total (must agree with A3)969

Part IV: Types of Services Provided and Resources Allocated

Provide data related to the number of older individuals who are blind receiving each type of service and resources committed to each type of service.

A. Clinical/functional vision assessments and services

Cost Persons Served
1a. Total Cost from VII-2 funds 0
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 272
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 0

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 744
1b. Total Cost from other funds 518
2. Provision of assistive technology devices and aids 493
3. Provision of assistive technology services 426

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 284,807
1b. Total Cost from other funds 203,259
2. Orientation and Mobility training 150
3. Communication skills 488
4. Daily living skills 680
5. Supportive services (reader services, transportation, personal 50
6. Advocacy training and support networks 97
7. Counseling (peer, individual and group) 660
8. Information, referral and community integration 264
. Other IL services 972

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 3,000
1b. Total Cost from other funds 2,088
2. Information and Referral 153
3. Community Awareness: Events/Activities 126 3,150

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) 437,018 723,320 286,302
2. Number of Individuals Served 994 969 -25
3. Number of Minority Individuals Served 25 33 8
4. Number of Community Awareness Activities 99 126 27
5. Number of Collaborating agencies and organizations 5 5 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 426 100.00%
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) 403 94.60%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 245 57.51%
B1. Number of individuals who received orientation and mobility (O & M) services 150 100.00%
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) 89 59.33%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 46 30.67%
C1. Number of individuals who received communication skills training 488 100.00%
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) 391 80.12%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 64 13.11%
D1. Number of individuals who received daily living skills training 680 100.00%
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) 532 78.24%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 101 14.85%
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) 433 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) 45 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) 76 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 111 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) 24 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.

In-house Program: The Iowa Department for the Blind (IDB) operates an in-house chapter two program and does not sub-grant or contract to provide services. The IDB is a state agency and provides direct comprehensive services and programs for those Iowans who are blind or visually impaired. IDB also operates a regional library for the blind and physically handicapped, an adult orientation and adjustment center, a small aids and devices store, a Randolph-Sheppard program, and, in accordance with the Rehabilitation Act, it operates a vocational rehabilitation (VR) program as well as an independent living (IL) program. Agency programs are closely integrated in order to provide a seamless system of services to blind and visually impaired Iowans.

The chapter two program is an important component of the agency. There were nine regional rehabilitation teachers and a program supervisor. Program staff met with individuals in their homes and communities to provide direct training services. In addition to these services, the chapter two program provided outreach to 99 Iowa counties. During the year ended September 30, 2013, staff presented program and service information to consumer support groups, conducted multiple speaking engagements around the state, collaborated with the University of Iowa Hospitals and Clinics to organize a panel discussion surrounding issues and solutions to blindness and low vision faced by Iowans, and participated in a senior lifestyle seminar. As a result of these activities, the program received referrals and ultimately helped many who were previously unaware of the chapter two program. To ensure fiscal responsibility, program staff allocated their time on a work report to ensure cost allocations were accurately recorded for both vocational rehabilitation services and independent living services. Of possible interest, Dr. Mark Wilkinson, chair of the National Eye Health Education Program Low Vision Subcommittee and a clinical professor of ophthalmology at the University of Iowa Carver College of Medicine reported to the National Institute of Health that three million people currently have low vision. This is going to increase with the aging of the population and the prevalence is expected to increase to five million in 2030 and almost nine million in 2050. In addition, the American Foundation for the Blind tracks prevalence rates of vision loss in Iowa. Using the 2012 American Community Survey as their data source, their report indicated that vision loss from the previous year increased among Iowans from 2011. Between genders, vision loss for males decreased from the previous report period while females experienced an increase in vision loss from that same period. According to this data, while Iowans between the ages of 35 and 64 remain marginally at a higher risk for vision loss than those aged 75 years and older, individuals from both age categories saw increased vision loss from 2011 to 2012. The number of Iowans reported to have vision loss in these two age groups for the same respective periods were 19,488 and 15,193. These statistics do not include any other age group who also experienced vision loss. Those groups numbered to approximately 14,630 additional Iowans. In conclusion to this section of the report, our direct experience along with these documented studies and professional reports clearly indicate that the chapter two program is critically needed to serve the needs of blind and visually impaired Iowans. Chapter two program staff works very hard with limited financial grant resource in attempt to reach as many as these Iowans as possible. We are committed to continue our diligent work to meet as many needs as our financial resources will allow.

Outreach to underserved: Iowa has 99 counties. IDB’s chapter two program staff regularly conducts outreach activities to identified underserved rural areas. This past year, program staff conducted 126 statewide outreach activities to include presentations that reached community-leadership groups, professional groups, community rehabilitation organizations, and peer support groups. In addition, the program held two senior orientation trainings, where a group of blind and visually impaired seniors are able to travel to Des Moines to receive intensive blindness skills training. The training sessions are always full and response from senior orientation training is overwhelmingly positive as indicated by those individuals served who reported they gained more confidence about their blindness as well as more skills.

Additionally, IDB’s public relations (PR) director provided additional support to the efforts of our chapter two program. The IDB has a web site (i.e., www.idbonline.org) which features information about the chapter two program services (labeled Independent Living). Individuals and the interest of the general public will find various success stories, support group information, and contact numbers by area, advisory committee information, an additional resource link, program contact information, and an independent living tips section. Additionally, the PR director supports the chapter two program by coordinating and delivering statewide public service announcements (PSAs), xxx, xxx, and xxx. Through these organized efforts, individuals have and can continue to access additional information about the IDB chapter two program.

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 Relationships and Activities: The IDB’s chapter two program has multiple collaborative relationships. Program staff works closely with Iowa’s two newspaper reading services, Newsline (an over-the-phone, automated newspaper reading service) and IRIS (a radio reading program), by exchanging referrals, delivering radios, and providing instruction on accessing and using the Newsline system. Due to these relationships, individuals served by the program learn about these two free service options as a means to stay connected with events and news stories that occur in and around their communities, around the state, and even nationally.

The IDB also collaborates with the Department on Aging (DOA). A representative of the DOA serves on the independent living advisory committee. Two of IDB’s chapter two program staff serve on the statewide aging and disability resource council (ADRC) in different parts of the state and the chapter two program manager also served on ADRC.

Additional key partners in the development of independent living services for Iowans who are either blind and/or visually impaired are the statewide independent living advisory committee of the Iowa Department for the Blind. The committee is diverse and has minority representation consisting of 12 members. Of these members, 11 individuals are blind, and one member represents the Department on Aging. Committee members actively work to increase public awareness in their home communities by arranging and conducting speaking engagements, talking with new and current peer support group members, helping to promote the annual White Cane Safety Day, and participating in various other activities and organizations. These members also serve as peer advisors to other blind and/or visually impaired Iowans. The committee continues to be vital to the chapter two program through their willingness to help in the planning and delivery of services.

Finally, the chapter two program manager serves as an ex-officio member of the Iowa Statewide Independent Living Council (SILC). Participation with SILC allows for an important link to Iowa’s IL community and centers for independent living (CILs). This past year, the program manager was involved in the ongoing implementation and monitoring of the state plan for independent living (SPIL), which helps to ensure that the delivery of IL services is coordinated and unduplicated across the state. The SPIL was presented to, and accepted by, RSA so is in effect for FFY 2014 through FFY 2016.

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.

The IDB asked individuals served to complete a feedback form when they attend a group training. For this fiscal reporting year, IDB conducted 12 community-based training sessions held throughout Iowa for individuals who are blind and/or who were visually impaired. Each session largely consisted of either a two- or three-day training with a total of six hours of skills training. These sessions offer an array of skills training opportunities such as learning to travel with a cane and using blindness techniques to assist with home-management tasks, just to name a few. In addition, participants have a chance to interact and exchange information and ideas with participating peers. There were a total of 73 individuals who benefited from these trainings. The majority of responses from those who had attended were positive. The majority indicated they had learned a new skill and also had a more positive attitude about blindness. When asked what they thought was the most important thing they gained from the training, comments included: “With training, you can do anything…” “These training sessions are valuable,” and “Excellent, professional, well-trained…this provides more confidence to go out into society on your own.”

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).

A 67-year-old married female came to the older blind program with a progressive eye condition called disc drusen. She had only peripheral vision and no depth perception so was unable to read large print efficiently. She noticed that she was relying on family members more and more to complete everyday tasks. Frequently, she would ask her husband to double-check the temperature on the oven or request help for other simple kitchen tasks. She is an avid quilter and has many sewing talents. With the blindness, she was fearful of losing the ability to complete sewing projects and planned to curtail her participation with a local quilting club. She was fearful of walking anywhere alone and would wait for others to accompany her. The vision loss frustrated her and she felt the lack of control over everyday tasks. As a means to regain control, she chose to apply to IDB for independent living services (i.e., the chapter two program) in early 2012. One of the very first services she started using was the talking book services through the Iowa Library for the Blind & Physically Handicapped. She and the IL teacher worked in partnership to develop her plan where she would benefit from substantial rehabilitation services and regain her independence. Some of her in-home services included counseling and guidance, home-management, basic assistive devices and tools, integration, leisure, and orientation and mobility. Through delivery of these vital services, this individual was able to regain her independence as she now is able to listen to her favorite books, magazines, and read favorite recipes in an alternative format. In addition, she now uses her cane to travel independently, can identify and label medications, monitor her own health, prepare meals from scratch, and is now able to correspond with others. This individual shared that IDB’s independent living program services have been “life changing.” Before services she felt “useless” to her family and friends. The chapter two program has transformed her life so she can now “…start living again.” One of the independent living project specialists travels throughout the state to provide individuals with an opportunity to meet others with vision loss while learning some of the basic skills to enable them to stay independent and live in their own home. Community-based trainings (CBTs) offer a hands-on experience that not only boosts an individual’s self-confidence but often leaves the individual with wanting more. This holds true for a 74 year old male who has diabetic retinopathy and attended one of the chapter two program trainings in April, 2013. Following the training, he writes us to tell us he had no idea what tools and instruments were available to help him make life easier. He goes on to say, through the help of his teacher and the hands-on training it has “opened doors.” He felt the training built-up his self-confidence and created a means for him to become self-reliant. He reported the training and help from the chapter two IL program and its staff was a gift that offers him hope. An 86 year old female with macular degeneration from rural Iowa attended IDB’s senior orientation training. She writes us to share that the training was outstanding. She was very proud that she could now fill out her own envelope using writing guides. This opened her world to communicating with others and allowed her to gain independence to complete certain tasks on her own not having to rely on others to help her.

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

There were no remarkable problems concerning the implementation of the title VII chapter 2 program or program services. That said, it’s noteworthy to share that Iowa is a very rural state with 99 counties, making it necessary to have added human resources to ensure we can reach all chapter two program clients in a timely manner. While funding for this program is greatly appreciated, from a business model standpoint it cannot fully sustain the amount of manpower needed to operate the program in the manner required by federal standards. Through agency leadership, we have continued to maintain the required high standards needed to ensure quality service delivery to our clients and accountability to RSA; however, as the cost of doing business increases it would seem that funding would at minimum keep up at the same pace to ensure the program can be sustained to ensure high quality human resources can be retained and quality services sustained. The the report submitted on December 27, 2012 for the year ended September 30, 2012 reported $ 437,018 on V-1B. This is the amount reported for 2012 on I-C, rather than the $ 569,348 reported then for I-A7. For this report V-1C is now distorted because of the data reported for 2012. The 2013 report now indicates $ 286,302. Had the 2012 report reflected the $ 569,348 from I-A7 instead of $ 437,018, the 2013 report would now indicate $ 153,972 on V-1C, not $ 286,302.

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 byBruce K. Snethen
Titledeputy director
Telephone515-281-1293
Date signed12/03/2013