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

RSA-7-OB for Indiana Bureau of Rehabilitation Services - H177B130014 report through September 30, 2013

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year619,292
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year397,587
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 21,243,479
A2. Total other federal34,126
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement34,126
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other0
A3. State (excluding in-kind)0
A4. Third party305,330
A5. In-kind0
A6. Total Matching Funds305,330
A7. Total All Funds Expended1,582,935
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs68,430
C. Total expenditures and encumbrances for direct program services1,514,505

Part II: Staffing

FTE (full time equivalent) is based upon a 40-hour workweek or 2080 hours per year.

A. Full-time Equivalent (FTE)

Program Staff a) Administrative and Support b) Direct Service c) Total
1. FTE State Agency 1.0000 0.0000 1.0000
2. FTE Contractors 11.0570 24.6900 35.7470
3. Total FTE 12.0570 24.6900 36.7470

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 27 16.8170
2. Employees with Blindness Age 55 and Older 10 7.4540
3. Employees who are Racial/Ethnic Minorities 12 6.0970
4. Employees who are Women 40 23.3730
5. Employees Age 55 and Older 21 13.0525

C. Volunteers


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 FY726
2. Number of individuals who began receiving services in the reported FY1,062
3. Total individuals served during the reported fiscal year (A1 + A2) 1,788

B. Age

1. 55-59139
2. 60-64182
3. 65-69180
4. 70-74185
5. 75-79234
6. 80-84283
7. 85-89307
8. 90-94179
9. 95-9977
10. 100 & over22
11. Total (must agree with A3)1,788

C. Gender

1. Female1,333
2. Male455
3. Total (must agree with A3)1,788

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race16
2. American Indian or Alaska Native10
3. Asian4
4. Black or African American203
5. Native Hawaiian or Other Pacific Islander1
6. White1,545
7. Two or more races4
8. Race and ethnicity unknown (only if consumer refuses to identify)5
9. Total (must agree with A3)1,788

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)110
2. Legally Blind (excluding totally blind)762
3. Severe Visual Impairment916
4. Total (must agree with A3)1,788

F. Major Cause of Visual Impairment

1. Macular Degeneration788
2. Diabetic Retinopathy190
3. Glaucoma183
4. Cataracts218
5. Other409
6. Total (must agree with A3)1,788

G. Other Age-Related Impairments

1. Hearing Impairment496
2. Diabetes455
3. Cardiovascular Disease and Strokes486
4. Cancer164
5. Bone, Muscle, Skin, Joint, and Movement Disorders580
6. Alzheimer's Disease/Cognitive Impairment73
7. Depression/Mood Disorder180
8. Other Major Geriatric Concerns715

H. Type of Residence

1. Private residence (house or apartment)1,325
2. Senior Living/Retirement Community261
3. Assisted Living Facility106
4. Nursing Home/Long-term Care facility96
5. Homeless0
6. Total (must agree with A3)1,788

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)64
2. Physician/medical provider126
3. State VR agency22
4. Government or Social Service Agency393
5. Veterans Administration33
6. Senior Center127
7. Assisted Living Facility44
8. Nursing Home/Long-term Care facility71
9. Faith-based organization22
10. Independent Living center176
11. Family member or friend357
12. Self-referral247
13. Other106
14. Total (must agree with A3)1,788

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 31,847
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 314
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 416,025
1b. Total Cost from other funds 5,140
2. Provision of assistive technology devices and aids 1,513
3. Provision of assistive technology services 1,460

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 616,732
1b. Total Cost from other funds 272,459
2. Orientation and Mobility training 44
3. Communication skills 546
4. Daily living skills 994
5. Supportive services (reader services, transportation, personal 154
6. Advocacy training and support networks 346
7. Counseling (peer, individual and group) 547
8. Information, referral and community integration 1,254
. Other IL services 312

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 205,908
1b. Total Cost from other funds 209,716
2. Information and Referral 966
3. Community Awareness: Events/Activities 213 10,046

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) 1,234,310 1,582,935 348,625
2. Number of Individuals Served 1,499 1,788 289
3. Number of Minority Individuals Served 188 230 42
4. Number of Community Awareness Activities 263 369 106
5. Number of Collaborating agencies and organizations 270 248 -22
6. Number of Sub-grantees 18 16

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 1,460 100.00%
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) 1,010 69.18%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 249 17.05%
B1. Number of individuals who received orientation and mobility (O & M) services 44 100.00%
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) 12 27.27%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 29 65.91%
C1. Number of individuals who received communication skills training 546 100.00%
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) 412 75.46%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 111 20.33%
D1. Number of individuals who received daily living skills training 994 100.00%
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) 543 54.63%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 254 25.55%
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) 606 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) 40 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) 63 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 102 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) 34 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 Older Independent Blind Program administered by Indiana Blind and Visually Impaired Services (BVIS) provides skills training through grant contracting with eight (8) community based programs.

These eight (8) contractors utilize in total sixteen (16) subcontractors to provide specialized services not available on their employed staffs.

The following network of eight (8) contractors are utilized in delivering Older Independent Blind services: 1) Bosma Enterprises for the Blind is an Indianapolis based rehabilitation center for the visually impaired with Rehabilitation Instructors stationed in four areas of the state: Indianapolis, Valparaiso, Evansville and Lafayette. Bosma employs seven full time Rehabilitation Instructors and two part time RTs with defined territories covering all 92 counties in the state. Some other highlights of the program were training nineteen (19) outreach volunteers, a mass mailing to all ophthalmologists and optometrist in the state, new print marketing materials, and development of radio and print announcements, Public Service Announcements and advertising on cable television. Another outreach initiative is The Vision Venture Van purchased with ARRA funds which travelled to events and conferences throughout the state, mostly to southern counties where there is high need. Several events the van was utilized were the Mid-America Institute on Aging conference, the Vision Expo at the State Library and to several pre-planned visits at senior living facilities and senior centers around the State. Bosma, to outreach underserved areas in southern Indiana, was awarded an additional Two Hundred Thousand Dollars ($200,000) to provide low vision aids where visual services are generally insufficient. This project was for a one year time frame. 2) Access Ability is an Indianapolis based Center for Independent Living responsible for services in Boone, Hamilton, Hendricks, Marion, Hancock, Morgan, Johnson and Shelby counties providing services through one (1) Outreach Specialist and four (4) Senior Advocates . To increase minority outreach Access Ability networked with the Latino Resource Round Table, Indiana Minority Health Coalition, Julian Center, senior centers, assisted living facilities, and Area Agencies on Aging. One outreach advocate speaks Spanish and ensures that all information regarding services is available in that language. 3) The Wabash Independent Living and Learning Center is a Center for Independent Living located in Terre Haute and responsible for services in Owen, Vermillion, Parke, Putnam, Clay and Vigo counties with one Coordinator/Teacher and one Driver Assistant delivering independent skills training. The Will Center maintains outreach contacts with the Area Agency on Aging, residents of independent living communities, the Minority Health Coalition, and Senior Citizens Centers. Brochures and large print contact cards have been distributed throughout the service areas including eye clinics, local independent living facilities, and physician’s offices. Wabash provided services to nine (9) veterans during this grant cycle coordinated with the Veterans Hospital in Indianapolis. The number of minorities and veterans was the largest representation of those specific populations in the history of Wabash providing blind services. One subcontractor was utilized for Orientation and Mobility instruction. 4) The Independent Living Center of Eastern Indiana is a Richmond based Center for Independent Living responsible for services in Henry, Wayne, Rush, Fayette, Union, Decatur and Franklin counties with a Service Coordinator/Grant Administrator (1) and four (4) Service Coordinators providing independent skills training. In addition to their in-house staff they used eight (8) subcontractors. ILCEIN has expanded its outreach services by partnering with Southeastern Indiana ILC (SIILC) in six new un-served southeastern counties serving over 100 consumers. ILCEIN sponsored five low vision support groups in three counties. ILCEIN Increased their community outreaches and community education programs to a total of sixty one (61) reaching one thousand eight hundred thirty (1,830) individuals. The net effect was a twenty four percent (24%) in the number of individuals seen this FY. 5) The League for the Blind and Disabled is a Fort Wayne based Center for Independent Living responsible for services in Lagrange, Steuben, Noble, DeKalb, Whitley, Allen, Huntington, Wells and Adams counties with one (1) Rehabilitation Teacher and one (1) Driver/Assistant delivering independent skills training. The League supports nine (9) support groups with four (4) in counties outside of Allen County. The League for outreach purposes utilizes a scoring system assigning a county priority level that is based on the following factors: 1. Number and percent of older people with vision difficulty in each county, 2. County classification as a non-core, micropolitian, or metropolitan county, 3. educational level of county residence, 4. Size of the cultural/minority populations in each county, 5. Number of people who live in poverty and, 6. the services listed in Chapter II of the Rehabilitation Act of 1973, as amended. The League collaborated with the Center for Independent Living Future Choices for O&M instruction. 6) ADEC is a Bristol based rehabilitation center responsible for services in LaPorte, St. Joseph, Elkhart, Marshall and Kosciusko counties. Staff consists of two Rehabilitation Teachers (2) and the Director with one clerical (1) support. ADEC‘s outreach efforts were to community centers with large African American and Hispanic populations. Outreach efforts include community centers with a large African American presence, agencies that work with the Hispanic community and nutrition sites in five counties. 7) Future Choices is a Muncie based Center for Independent Living responsible for services in Blackford, Delaware, Grant, Howard, Madison, Randolph and Tipton counties. On staff are one (1) Coordinator, two (2) Outreach OIB Specialist, and one (1) Peer Counselor. Future Choices subcontracts with The League for the Blind utilizing their O&M Instructor and a Low Vision Specialist. Future Choices implemented the Bright Eye Senior program in seven counties which entailed information and referral, independent living skills, assistive devices, transportation and support groups. 8) Easter Seals Crossroads Rehabilitation Services provided a specialty program in which IPads were used as assistive technology for eligible participants. One IPad (1) trainer was utilized for this program serving one (1/4) of the state. As local resources and providers of information and referral, partner organizations (universities, senior living centers, independent living centers, libraries, churches and etc.) were engaged to provide outreach for this program. No subcontractors were used. To further outreach operations Indiana Blind and Visually Impaired Services bridged Four Hundred Thousand Dollars ($400,000) FY 2012 OIB funds into FY 2013. With these funds Blind and Visually Impaired Services developed a competitive Assistive Technology Request For Funding (RFF) soliciting proposals to allocate low vision aids to those consumers age fifty-five and older. The ninety-two Indiana counties were divided evenly among three awardees: Bosma Enterprises, The League for the Blind and Disabled and Easter Seals Crossroads Rehabilitation.

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.

Bosma Enterprises: • Collaborative efforts included supporting Area Agencies on Aging by providing in-service educational presentations to staff and providing informational material. Staff labor and additional funding focused on distribution of low vision aids to underserved areas in southern Indiana. • With ARRA funds Bosma purchased a custom built mobile training unit in 2011 for the purpose of expanding the Senior Program to underserved and un-served area s of the state. The mobile training unit has provided functional vision assessments, assessments for magnification and other adaptive aids, training for the use of aids, and instruction in the areas of communications, daily living skills and personal care. ADEC: • Staff routinely conducts in-service trainings in the community. Collaborative efforts have included working with area agencies to provide information and referral services. • During the past year, NILLS collaborated with The League for the Blind and Disabled to jointly serve customers through their Assistive Technology grant. This was additional OIB funds of $100,000 The League was awarded. NILLS staff would provide the assessment for customers and the The League provided the adaptive aids/assistive technology. During the year the two agencies provided services to a combined Sixty Five (65) customers. • Three (3) support groups are facilitated; in St. Joseph County with an average attendance of 25-30 individuals, in Kosciusko County with an average of 10-15 individuals attending and in Laporte County with an average of 10-15 individuals attending. Collaborative efforts have included working with the AAAs to provide information and referral. Independent Living Center of Eastern Indiana: • Mini Technology Expo/Holiday Open House had six demonstration stations at which consumers could try out new vision aids including household/self care items, diabetic aids, accessible phones, tablets, accessible software, CCTVs, Kindles, and talking book devices. • Collaboration with the Minority Health Coalition in Wayne County continued for the third year increasing access to African American and Hispanic communities. Working with this organization provided vision, blood sugar and hearing screenings establishing a promising base for minority outreach. • Partnered with Easter Seals Crossroads providing IPADs and training to fourteen individuals. In addition, ILCEIN formed an IPAD support group and eight (8) staff was trained on accessibility apps in order to provide face to face and phone support as needed between sessions.

Access Ability: • Advocates continue to conduct outreach and try to continuously improve by attending resource fairs, conduct presentations, and seek new partnerships. Also efforts are concentrated on finding underserved areas through audits of consumers’ locations and presenting information regarding older blind services. Specifically, these efforts involved visiting churches, community centers, senior centers, assisted living facilities, nursing homes and senior communities. The advocates set presentations in which they speak about the four core values, Chapter 2 program, and assistive technology.

The League f/t Blind and Disabled: • Eight five consumers’ assistive technology devices. (362 AT Grant consumers) • Thirteen (13) awareness activities were held. • Outreach population included 11% African American and 5% other racial minority groups. • Three hundred and sixty two (362) consumers were served by the special AT Grant.

The Wabash Independent Living Center: • The staff created large print cards with Older Blind contact information and distributed more than three hundred (300) cards to eye clinics. • Traveling and networking in seven (7) previously un-served counties. • Collaborated with Easter Seals Crossroads to ensure the latest technology is available to consumers. The Chapter 2 Program Manager serves on the advisory board of the Easter Seals Crossroads INDATA project. • Implemented a plan a low vision support group in Knox County. Also, the Center participated in forty (40) peer group meetings during the grant cycle. Future Choices: • Three (3) administrators and three (3) staff have become certified by completing the American Foundation of the Blind two (2) year certification program in blindness and issues of the elderly. The Bright Eyed Senior program expanded the program by collaborating with the two vision screenings in Delaware and Madison counties. A Partnership was established with Easter Seal Crossroads and referred consumers to the assistive technology program. Additional collaboration was established with the American Health Network Eye Specialist and Vocational Rehabilitation. Hispanic and African American outreach gains were made by receiving intake referrals from IU Health. Easter Seals Crossroads Rehabilitation: • Partner organizations not only assisted with awareness of this program but also provided physical space for training in many situations. Some partner organizations were involved to the point of actually learning about using the IPad as an assistive technology and were able to provide technical assistance to participants — thereby reducing the amount of support required from our staff.

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.

Total Surveys: 767 1. I feel confident in my ability to live independently with my vision loss? 1. Strongly Agree_______________280 2. Agree______________________426 3. Disagree____________________ 57 4. Strongly Disagree_____________ 4

2. I have considered moving to a nursing home or assisted living because of my vision? 1. Agree_____________214 2. Disagree___________553

3. As a result of this training, I will be more capable of remaining in my home? 1. Strongly Agree_____________256 2. Agree____________________456 3. Disagree__________________ 52 4. Strongly Disagree___________ 4

4. As result of this training, I am able to travel independently? 1. Strongly Agree____________90 2. Agree___________________165 3. Disagree_________________172 4. Strongly Disagree__________ 6 5. Was not an issue with me prior to services_________334

5. As a result of this training, I am able to read and manage my paperwork (e.g. mail, check writing, and correspondence)? 1. Strongly Agree____________ 253 2. Agree___________________310 3. Disagree_________________ 128 4. Strongly Disagree__________ 11 5. Was not an issue with me prior to services________65

6. As a result of this training, I am able to take care of my personal needs like grooming cooking, laundry, etc? 1. Strongly Agree____________189 2. Agree___________________299 3. Disagree_________________ 88 4. Strongly Disagree__________ 26 5. Was not an issue with me prior to services_________165

7. As a result of this training, I am less dependent on others? 1. Strongly Agree_____________231 2. Agree____________________385 3. Disagree__________________ 82 4. Strongly Disagree___________ 8 5. Was not an issue with me prior to services________61

8. As a result of this training, I am better able to participate with family, friends, and community life? 1. Strongly Agree_____________227 2. Agree____________________367 3. Disagree__________________ 89 4. Strongly Disagree___________ 3 5. Was not an issue for me prior to services________81

9. As a result of this training, you were able to meet all the goals you wanted to accomplish? 1. Strongly Agree____________265 2. Agree___________________398 3. Disagree_________________ 88 4. Strongly Disagree_________ 16

10. Would you recommend this program to others? 1. Strongly Agree___________546 2. Agree__________________216 3. Disagree________________ 4 4. Strongly Disagree________ 1

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 following personal consumer narratives were submitted by individual contractors.

John is an American Indian (Monacan Tribe), and an accomplished artist. He is legally blind and has diabetic retinopathy, peripheral neuropathy, polyps on his lungs and suffers from depression due to his limitations to fully enjoy his artistic talents. Although John has taken steps to be more independent, including repairing items around his home, and enjoying some outdoor activities with friends, his attempts to draw again have fallen short of his expectations. According to John, he could not see detail well enough and he gave up. Through the Assistive Technology Grant, John received an Acrobat Closed Circuit TV. This TV incorporates a camera that can rotate 340 degrees allowing John to view his artwork on the walls. The Acrobat Closed Circuit TV allowed has John to remain independent and continue to do his favorite hobby-artwork. In time, it is anticipated that John will get so accustomed to using this unit he will draw once again. In addition, John was so grateful he advised the case manager that he will be donating an original woodblock print to the League for the Blind’s silent auction.

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

There are no problematic areas or concerns in implementing the Indiana Older Independent Blind program at the State level. There are, however, the ongoing systemic concerns of limited funding and the ability to deliver statewide quality services. The current and future problem of having qualified personnel trained in the field of visual impairments is a persistent concern. Indiana is addressing the training issue by contractually mandating that all field staff involved with elderly services participate in online courses provided by the American Foundation for the Blind in the coming year 2013-2014. Another concern with the emphasis to study STEM courses in college there will be fewer graduates gravitating to the field of visual impairment rehabilitation. The field of rehabilitation should be incentivized to attract future rehabilitation specialists.

ADEC, Inc. will no longer contract with the Older Blind Program indicating its main emphases as a rehabilitation center lies in other areas of which it has stronger delivery service abilities. It also cited a diminution of funding as statewide competition from other organizations for OIB funds became more comprehensive. To maintain services in the ADEC catchment counties, a Request For Funding was issued allowing all OIB current contractors to compete for the counties and funding. There were two competing organizations and The League for the Blind and Disabled located in Fort Wayne, Indiana received the award to deliver services in the previously served ADEC counties. The League maintained employment of one ADEC certified Rehabilitation Teacher/Orientation Mobility Instructor providing continuity of services.

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 byLocket Phillips
TitleManager of Blind Services
Date signed12/17/2013