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

RSA-7-OB for Maryland Division of Rehabilitation Services - H177B130020 report through September 30, 2013

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year542,720
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year8,675
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2551,395
A2. Total other federal89,505
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement89,505
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other0
A3. State (excluding in-kind)78,836
A4. Third party0
A5. In-kind67,741
A6. Total Matching Funds146,577
A7. Total All Funds Expended787,477
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs7,075
C. Total expenditures and encumbrances for direct program services780,402

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 0.7500 4.0000 4.7500
2. FTE Contractors 2.1800 14.7100 16.8900
3. Total FTE 2.9300 18.7100 21.6400

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 12 7.0000
2. Employees with Blindness Age 55 and Older 6 3.7500
3. Employees who are Racial/Ethnic Minorities 10 3.2500
4. Employees who are Women 24 11.2500
5. Employees Age 55 and Older 5 2.4600

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 FY382
2. Number of individuals who began receiving services in the reported FY683
3. Total individuals served during the reported fiscal year (A1 + A2) 1,065

B. Age

1. 55-59112
2. 60-64166
3. 65-69169
4. 70-74152
5. 75-79107
6. 80-84147
7. 85-89115
8. 90-9474
9. 95-9923
10. 100 & over0
11. Total (must agree with A3)1,065

C. Gender

1. Female688
2. Male377
3. Total (must agree with A3)1,065

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race19
2. American Indian or Alaska Native6
3. Asian10
4. Black or African American455
5. Native Hawaiian or Other Pacific Islander5
6. White533
7. Two or more races10
8. Race and ethnicity unknown (only if consumer refuses to identify)27
9. Total (must agree with A3)1,065

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)444
2. Legally Blind (excluding totally blind)298
3. Severe Visual Impairment323
4. Total (must agree with A3)1,065

F. Major Cause of Visual Impairment

1. Macular Degeneration318
2. Diabetic Retinopathy161
3. Glaucoma262
4. Cataracts27
5. Other297
6. Total (must agree with A3)1,065

G. Other Age-Related Impairments

1. Hearing Impairment74
2. Diabetes94
3. Cardiovascular Disease and Strokes60
4. Cancer7
5. Bone, Muscle, Skin, Joint, and Movement Disorders79
6. Alzheimer's Disease/Cognitive Impairment9
7. Depression/Mood Disorder11
8. Other Major Geriatric Concerns111

H. Type of Residence

1. Private residence (house or apartment)447
2. Senior Living/Retirement Community608
3. Assisted Living Facility10
4. Nursing Home/Long-term Care facility0
5. Homeless0
6. Total (must agree with A3)1,065

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)309
2. Physician/medical provider121
3. State VR agency33
4. Government or Social Service Agency68
5. Veterans Administration0
6. Senior Center30
7. Assisted Living Facility10
8. Nursing Home/Long-term Care facility0
9. Faith-based organization3
10. Independent Living center1
11. Family member or friend147
12. Self-referral300
13. Other43
14. Total (must agree with A3)1,065

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 9,956
1b. Total Cost from other funds 1,474
2. Vision screening / vision examination / low vision evaluation 81
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 297

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 276,416
1b. Total Cost from other funds 119,089
2. Provision of assistive technology devices and aids 358
3. Provision of assistive technology services 226

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 244,795
1b. Total Cost from other funds 106,186
2. Orientation and Mobility training 225
3. Communication skills 138
4. Daily living skills 195
5. Supportive services (reader services, transportation, personal 55
6. Advocacy training and support networks 97
7. Counseling (peer, individual and group) 159
8. Information, referral and community integration 113
. Other IL services 124

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 20,288
1b. Total Cost from other funds 2,258
2. Information and Referral 616
3. Community Awareness: Events/Activities 110 2,791

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) 873,955 787,477 -86,478
2. Number of Individuals Served 1,001 1,065 64
3. Number of Minority Individuals Served 627 505 -122
4. Number of Community Awareness Activities 108 110 2
5. Number of Collaborating agencies and organizations 33 41 8
6. Number of Sub-grantees 2 2

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 226 100.00%
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) 119 52.65%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 107 47.35%
B1. Number of individuals who received orientation and mobility (O & M) services 225 100.00%
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) 76 33.78%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 102 45.33%
C1. Number of individuals who received communication skills training 138 100.00%
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) 89 64.49%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 49 35.51%
D1. Number of individuals who received daily living skills training 195 100.00%
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) 127 65.13%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 68 34.87%
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) 241 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) 6 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) 12 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 83 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) 9 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.

During FY13, the Maryland Division of Rehabilitation Services (DORS) worked collaboratively with two sub-contractors: Blind Industries and Services of Maryland (BISM) and Columbia Lighthouse for the Blind (CLB) to increase and enhance services to older blind individuals in Maryland. In addition, in-house staff continues to serve consumers being referred through various means. When needed, consumers are cross-referred to a sub-contractor to ensure that appropriate services are provided in a timely manner.

Services provided by DORS and the sub-grantees included education, demonstration, and instruction in: Daily Living Skills for Independent Living, Braille/Communication, Orientation & Mobility, Adapted Computer Technology, Adjustment and Advocacy, Diabetic Management & Nutrition, Community Activities, Peer Interaction, Low Vision and Blindness Resources, plus adaptive aids, devices, and equipment. Statewide outreach efforts included speaking engagements, presentations, media exposure, conferences, and literature dissemination targeting senior consumers, senior centers, retirement communities, blindness-related agencies, and professionals in the field in an effort to reach seniors in all areas of the state including those in rural, remote, and underserved areas.

During this fiscal year, a heavy email recruiting campaign was part of BISM’s networking effort to reach underserved and unserved populations. Email flyers with event details where sent in a wide distributional area, and OBVS/DORS was instrumental in getting the word out to teachers, counselors, staff members, and partners about the Life Enhancement workshops. Email blasts and other communications, including NFB list serves, LBPH patron lists, and Department of Aging offices, resulted in thousands of blind persons and professionals in the field of blindness learning about this quarter’s workshop offerings. Community partners did an excellent job sharing information. Literature packages and applications were also sent via USPS.

BISM had 73 presentations with over 2,766 participants. In addition, countless other people both Nationally & Internationally received information about BISM services via the Internet and website.

CLB has incorporated an Independent Living skills program that includes instruction in Braille, daily living skills, assistive technology, orientation and mobility, housekeeping and organizational skills. CLB’s support groups provided activities in knitting, exercise, Spanish and cooking just to name a few. Activities also include tours, recreational activities and subject matter speakers. During FY2013 CLB staff serving seniors committed a great deal of time to providing diabetic and vision screenings as well as follow-up services. The mobile vision Care Unit has proven to be a great resource for identifying individuals in need of services and vision care. With diabetes being so prevalent, a great deal of focus was given to education and resources, in this area. Continuously, CLB has ensured workshops had specific topics related to health and wellness, exercise, and nutrition.

Additionally, Support Service Provider (SSP) services continues to offered to MD deaf-blind residents to assist them with going shopping, reading emails, friendly visitors, and exercise activities. This is very important as visually impaired seniors begin to experience a dual sensory loss of vision and hearing. Since CLB is the Maryland contractor for the Deaf-blind equipment distribution program, eligible deaf-blind seniors may be provided with needed adaptive equipment and training.

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.

DORS and the Sub-grantees continue to effectively utilize networking and personal contact with professionals to structure and enhance activities that are useful to the consumers targeted.

This year included outreach presentations to 110+ entities, with over 2791 attendees as well as meetings and communications with service providers of the elder blind population. Presentations were made at senior residential facilities, churches, transportation agencies, governmental agencies, state and national conventions of the blind, centers for independent living, local events, & to medical professionals. Some ways that ILOB events are publicized include webcasts, radio and TV, publicity campaigns, health and wellness fairs, magazine articles, community partner newsletters, conference presentations, program advertising, DVD distribution, and the DORS and BISM website updates.

Furthermore, DORS continues to co-sponsor the Possibilities Fair. The National Federation of the Blind of Maryland Possibilities Fair for Seniors Losing Vision is an annual event that brings together many participants, vendors, families, government agencies and visually impaired consumers. The purpose of the Fair is to enhance the participant’s knowledge of low vision and blindness resources through a variety of presentations, demonstrations, networking and a keynote speaker. It serves as a mechanism to reach out to seniors throughout the state in a systematic manner. Each year that it has been held, more than 250 seniors who are losing vision have attended the Possibilities Fair for Seniors held at the National Federation of the Blind’s Jernigan Institute. Past participants have included organizations like the Maryland Library for the Blind and Physically Handicapped, the Maryland Transportation Authority, AARP, National Aquarium, and the Wilmer Eye Institute.

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.

A Satisfaction Survey is administered to each ILOB program participant; this is an important tool used to assess consumer feedback following each training event.

Following are results from this 4rd quarter’s training event:

Overall Rating: 96% Financial Independence Workshop 1, Baltimore, MD 98% Financial Independence Workshop 2, Baltimore, MD

97.0% Overall Satisfaction Rating

SURVEY SATISFACTION RATING Q4FY13 *numbers are shown in % of satisfaction Library f/t Blind 1 Baltimore, MD Library f/t Blind 2 Baltimore, MD 9.11.13 9.12.13 Financial Independence Financial Independence 1 The services I received have helped me 92% 98% improve my quality of life and/or independence now. 2 The services I received will aid in my quality 94% 100% of life and/or independence for the future. 3 Services were well organized. 97% 100% 4 I learned new information and skills. 97% 98% 5 Instructors were knowledgeable. 100% 100% 6 I was satisfied with the overall experience 97% 100% of the program. 7 I would recommend this program to others. 95% 100% 8 I liked the program hours & the scheduled day. 100% 98% 9 Rate the training facilities. 98% 90% 10 The hotel accommodations were n/a n/a TOTALS 96% 98%

OVERALL RATING Library f/t Blind 1 96% Library f/t Blind 2 98% 97%

D. Briefly describe the impact of the Title VII-Chapter 2 program, citing examples from individual cases (without identifying information) in which services contributed significantly to increasing independence and quality of life for the individual(s).

Numerically weighted Satisfaction Survey results provide the data contained in “C” above. In addition, workshop participants have the opportunity to provide important narrative comments, highlights of which follow: - I’m 94, and I want to learn all I can! - Accessibility to instructors most important; wonderful experience - Very interactive; enjoyed learning the Pen Friend - Most helpful were writing checks, recorders, Wilson, downloading - Talking checkbook software excellent - Dispelled stereotypes about low vision vs. blind - Liked different types of wallets and NEW SARA, new technology - Liked ATM discussion during lunch and money folding session - Banking accommodations, checking, and Pen Friend sessions very good - Planned to leave early but stayed all day and am grateful for all I learned - I am supportive of this good work; please continue serving the community - I’m happy to come somewhere I feel comfortable about my blindness - Would like to learn more about on-line banking; liked hands-on experience - Thank God for BISM and their generosity!

A seventy-five year old African American woman living in Montgomery County at a senior facility is an ongoing member of CLB’s support groups and training made tremendous strides in completing her basic goals. Although she has had low vision services for a number of years, now her vision fluctuates a great deal. She received IL, O&M and case management services. As a result, she has gained a new sense of freedom, purpose and confidence.

A 56 year old African American male living in Prince George’s county lost a majority of his vision due to age related Macular Degeneration. He relies on magnification and his remaining vision to perform his job the Federal Government, and in his home. He has lost more and more vision as he grows older. He has been seen in CLB’s low vision clinic, and received case management, O&M, and ILS services. He described feeling very hopeless and dismal about his future as a totally blind man. However, after receiving training, and new resources for technology and magnification he expresses a new sense of hope and promise for his future. He now realizes all challenges pertaining to blindness can be overcome and he gives the credit for these advancements in his outlook due to his training from CLB. He now feels like retirement is he can continue to support his family.

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

Delivering low vision services that effectively influence senior’s safety, functioning, and independence in the community requires coordinated screening, evaluation, equipment purchase and training so that these resources are timely, relevant to the home/community context and accessible to the consumer. It continues to be a challenge to guide consumers through what at times appears to them as fragmented patchwork of services from various providers, often times inaccessible geographically, and with frustratingly inadequate training on how to integrate equipment or resources into the context of their home.

Furthermore, in FY13 we continue to experience many of the same challenges as in previous years. These issues include, but are not limited to: • Transportation -- Seniors have difficulty securing transportation for travel to training programs. It can be extremely costly to provide roundtrip transportation for these seniors. Often times, they live in rural or remote locations where public transportation is not an option, and hired transportation costs are prohibitive. Seniors who have not had the benefit of training are often fearful of traveling alone, with a stranger, to an unfamiliar destination. Seniors don’t often have family or friends available to assist them in commuting to training programs. It is costly to provide staff transportation for outreach presentations, training events, and visitation. • Funding -- Training for blind senior consumers is costly in terms of staff time required as training is often presented in a one-to-one format of staff to senior. Limited funding can limit program design. • Health -- Health issues, medical appointments, and secondary disabilities can prevent seniors from participating in training. Last minute cancellations may occur due to health issues and changing medical situations. • Growing incidences of senior diabetics facing challenges of vision loss. • Rapidly growing population of blind and low vision senior citizens in this state and nationwide. Growing number of senior blind in need of services. • Professionals who are not trained in the unique service needs of the older blind population -- diabetes educators, senior center and senior housing staff, medical professionals, teachers of the blind. • Latest technology not affordable for many seniors. Seniors anxious for technology training! • Need for additional funding for expansion of ILOB program 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 byTandra Hunter-Payne
TitleProgram Manager
Telephone410-554-9107
Date signed01/03/2013