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

RSA-7-OB for Maine Division for the Blind and Visually Impaired - H177B130019 report through September 30, 2013

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year225,000
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 2225,000
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)406,949
A4. Third party0
A5. In-kind240,000
A6. Total Matching Funds646,949
A7. Total All Funds Expended871,949
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs95,000
C. Total expenditures and encumbrances for direct program services776,949

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 0.6000 4.3500 4.9500
2. FTE Contractors 1.1000 11.2500 12.3500
3. Total FTE 1.7000 15.6000 17.3000

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 6 2.0500
2. Employees with Blindness Age 55 and Older 2 0.2000
3. Employees who are Racial/Ethnic Minorities 3 1.4000
4. Employees who are Women 28 11.9000
5. Employees Age 55 and Older 9 5.0500

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 FY146
2. Number of individuals who began receiving services in the reported FY148
3. Total individuals served during the reported fiscal year (A1 + A2) 294

B. Age

1. 55-593
2. 60-644
3. 65-6915
4. 70-7419
5. 75-7930
6. 80-8462
7. 85-8987
8. 90-9447
9. 95-9924
10. 100 & over3
11. Total (must agree with A3)294

C. Gender

1. Female229
2. Male65
3. Total (must agree with A3)294

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race1
2. American Indian or Alaska Native1
3. Asian1
4. Black or African American1
5. Native Hawaiian or Other Pacific Islander0
6. White290
7. Two or more races0
8. Race and ethnicity unknown (only if consumer refuses to identify)0
9. Total (must agree with A3)294

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)7
2. Legally Blind (excluding totally blind)83
3. Severe Visual Impairment204
4. Total (must agree with A3)294

F. Major Cause of Visual Impairment

1. Macular Degeneration159
2. Diabetic Retinopathy10
3. Glaucoma22
4. Cataracts2
5. Other101
6. Total (must agree with A3)294

G. Other Age-Related Impairments

1. Hearing Impairment50
2. Diabetes40
3. Cardiovascular Disease and Strokes74
4. Cancer13
5. Bone, Muscle, Skin, Joint, and Movement Disorders33
6. Alzheimer's Disease/Cognitive Impairment5
7. Depression/Mood Disorder12
8. Other Major Geriatric Concerns5

H. Type of Residence

1. Private residence (house or apartment)220
2. Senior Living/Retirement Community20
3. Assisted Living Facility41
4. Nursing Home/Long-term Care facility13
5. Homeless0
6. Total (must agree with A3)294

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)101
2. Physician/medical provider12
3. State VR agency2
4. Government or Social Service Agency6
5. Veterans Administration0
6. Senior Center1
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility1
9. Faith-based organization1
10. Independent Living center0
11. Family member or friend52
12. Self-referral69
13. Other49
14. Total (must agree with A3)294

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 10,000
2. Vision screening / vision examination / low vision evaluation 139
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 0
1b. Total Cost from other funds 15,000
2. Provision of assistive technology devices and aids 14
3. Provision of assistive technology services 7

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 0
1b. Total Cost from other funds 0
2. Orientation and Mobility training 36
3. Communication skills 0
4. Daily living skills 11
5. Supportive services (reader services, transportation, personal 0
6. Advocacy training and support networks 0
7. Counseling (peer, individual and group) 64
8. Information, referral and community integration 0
. Other IL services 104

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 0
1b. Total Cost from other funds 0
2. Information and Referral 0
3. Community Awareness: Events/Activities 29 323

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) 864,000 871,949 7,949
2. Number of Individuals Served 411 294 -117
3. Number of Minority Individuals Served 4 4 0
4. Number of Community Awareness Activities 35 29 -6
5. Number of Collaborating agencies and organizations 8 8 0
6. Number of Sub-grantees 1 1

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 7 100.00%
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) 0 0.00%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 6 85.71%
B1. Number of individuals who received orientation and mobility (O & M) services 36 100.00%
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) 0 0.00%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 15 41.67%
C1. Number of individuals who received communication skills training 0 100.00%
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) 0 0.00%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 0 0.00%
D1. Number of individuals who received daily living skills training 11 100.00%
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) 0 0.00%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 7 63.64%
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) 6 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) 1 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) 3 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 6 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) 0 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 Division for the Blind & Visually Impaired (DBVI) implements its IL-Older Blind program through the use of in-house staff to include Independent Living Managers, Orientation & Mobility Instructors, Vision Rehabilitation Therapists, and Low Vision Therapists and through the use of a sub-grantee/contractor, the Iris Network. Some of the services provided by the Iris Network are some Vision Rehabilitation Therapy, Personal Adjustment Counseling, some Orientation and Mobility instruction and some intake services.

The recent census confirmed the very small percentage of minority groups in Maine. In the larger cities, outreach is being done for Asian, Middle Eastern, Spanish-speaking, French Canadian, African, and other minority groups. In Lewiston, Somalis are being served in the Lewiston CareerCenter with an interpreter who works for the Center. The French Canadian community in Lewiston has also been served for many years by staff interpreting for that population. In addition, DBVI continues to maintain ongoing communications with the four Maine tribes of Native Americans:

Passamaquoddy Tribe

Penobscot Indian Nation

Houlton Band of Maliseets

Aroostook Band of Micmac Indians

DBVI has a representative from the American Indian Vocational Rehabilitation Services on the DBVI State Rehabilitation Council.

The Division continues to work with the Native American health centers doing outreach for all of our programs. These centers, managed by each of the tribes in Maine, have served as a contact point and focus for outreach efforts by the Division.

Discussions continue in an effort to provide information about the Divisions programs in the Health Center newsletter that goes to all of the registered Penobscot tribal members on and off the island.

The process is based upon a plan which identifies the achievement of independent living goals which will enable an individual who is blind or has low vision to secure a level of independent living consistent with his or her current interests, capacities and abilities. Services provided to individuals who are blind or visually impaired must be necessary and must be provided as cost effectively as possible.

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.

DBVI is involved in numerous activities throughout the state to expand or improve IL services to the older blind population. Some of these activities are working collaboratively with doctors to improve the referral process so consumers are aware of DBVI’s services; working with the state’s Veterans Administration (VA) to improve services for older veterans who are blind or have low vision and participating in health fairs around the state.

In addition, DBVI recently entered a collaborative partnership with the Division for the Deaf Hard of Hearing and Late-Deafened, the University of Southern Maine Linguistics Program, The Iris Network, Helen Keller National Center, and consumers with dual sensory impairment to develop a professional training program for Interpreters fo people who are deaf-blind, and to create and build a volunteer Support Service Provider (SSP) program. To date, we have trained over 20 professional Deaf-blind Interpreters, have trained over 35 volunteer SSP’s, and have approximately 15 individuals who are deaf-blind or dual sensory impaired accessing these services.

The Community Connections project continues to enhance activities with therapeutic components and increase the involvement of vision rehabilitation professionals to provide therapeutic services as part of these activities. Some of her activities include: presenting to the Aging with Grace group regarding updates in Community Connections and upcoming events; contacting the Lion’s Club regarding information booths at their annual convention; setting up a Community Connections booth at the National Multiple Sclerosis Society Health and Wellness Fair; and facilitating various Visually Impaired Persons (VIP) groups around the state.

DBVI’s redesigned comprehensive statewide low vision delivery system will benefit older individuals who are blind or visually impaired. All professional staff involved in providing low vision rehabilitation services have received training in this field, which will result in a more cost effective system. Low vision kits have been put together by a group that focused on the needs of those individuals with low vision and the kits have been dispersed around the state since the protocol for the delivery of these aids and appliances is in place.

Currently the DBVI State Rehabilitation Council (SRC) has a representative that has been attending the State Independent Living Council (SILC) to represent the division. This representation allows the division to stay current with efforts to expand or improve IL services as well as participate in the various activities throughout the state.

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.

DBVI uses a sub-grantee for a large portion of the IL-Older Blind program. They use a survey instrument with questions (and/or statements that require the consumer to attach a number representing the level of satisfaction) that measure consumer satisfaction and collects demographic data (optional). The questions measure the consumer’s level of satisfaction as it pertains to courtesy of staff, availability of informed choice and decision making, timeliness of servces and overall satisfaction with the quality of services that he/she received.

During the period of 7/12 through 6/13, one hundred and nine surveys were returned. Of those, they all reported that they felt they were treated with courtesy and respect; one hundred and four felt that the service providers worked on the areas that were important to them; seventy-two felt they had a better understanding of their eye condition; and one hundred and eight felt that services were provided within an acceptable time frame. Below is a sample list of the comments receiveds:

Staff were especially helpful and personable and I benefited and enjoyed how they helped me. I did not need as much help w/ the computer for what little I do on it. I was well satisfied with staff. I get my eyes injected every 6 - ___ (hard to read the writing) weeks at the retina clinic. I also have hearing loss and Iris has told me to call anytime. Thank you. Transportation is always a problem but _______ never refused me and taxi worker quite experienced for them. Love my books. Staff was very nice. Thank you. Staff was wonderful to work and was very helpful. Staff was tops in my training — so patient, with lots of ideas “new” to me. I especially love talking books. Iris took the scary part away by giving me control so that I can still manage to live in my own home. God Bless you. I don’t understand my eye condition, I do wish someone could explain it to me, ? will it effect both eyes?? Would like magnification tools. Would like to have someone to talk to about my vision loss. No eye contact; service was timely in Portland. Was excellent as usual! Got some good info. Help read a menu — eating skills when dining out. Talking books have been a life saver! Thank you! Bought a Victor Reader as a result of the April seminar I attended, but so far have been unable to use it (It arrived with only a packing slip + Humana customer service was minimally helpful). The person who services my computer took the Victor, at my suggestion, to find out + instruct me on a few basic uses. He will be coming to my home tomorrow to do that. Wasn’t informed on my eye condition, how it will effect my everyday living. Took over 6 months. Was disappointed that the Braille didn’t continue; was not really shown any writing skills. I found the staff most courteous and helpful. Staff person was very helpful. I can now use my oven and microwave. I love the large spaced notepaper and pens. I thank your wonderful organization. I’m not sure how to answer these questions. Staff person came to see me several times and found a better lamp for me (for which I paid) and gave me a magnifier which I find very useful. Great services. Wish we could access them more but ________is elderly and times when she feels good enough to coordinate this is short. If only we had used your service 10, 20 years ago — she is 97! She didn’t feel she needed services earlier “I’m fine”….but didn’t incorporate them into her life when it could have been easier and more seamless….Keep up the outreach! Had to make several calls to get service- did however get satisfactory response after calls; representatives were courteous and helpful upon arrival. ______ enjoyed staff’s visit very much. Staff is very good at what she does. Felt lucky to work with her. This is a great program. All of the people that have helped me have been great. Thanks again!! Your staff was very helpful. Thank you. Would like to consult a little more about why I am continuing to have decrease vision/colors & shapes appearing. The representative was very nice and saw my needs and made suggestions on how the services would benefit me. My mom recently passed away by your services prior to were very helpful and comforting to her. I think you did a wonderful job. Would still like to go to a group gathering in Skowhegan if you could get it going and enough people to come to it. I have been declared legally blind by doctors; staff were very helpful and I have since purchased a CCTV from Dr. ________ - I can read again. I am deeply appreciative of this wonderful service. The services I received from Iris were much more than I expected….loved the people who worked with me…all is well. Excellent help. Telephone — need a automatic dialing pad that holds more than 9 digits & names. I already know everything there is to know about my condition. One time my voicemail request/return call was not asnwered I have had no help in locating/trying LV products that would be helpful to me. Where do you get them? The two workers that were sent to help me helped me a lot. Have company demonstrations of LV/mags. Maybe someone could check on client every other month — phone call or visit >>>>helped me a lot w/special glasses for TV; adjustable light/ eye patches and talking book program. Calendar should be free There were suggestions given to me. I was given a radio to listen to that really did not suit my needs. I returned it; the talking radio has not shown me many good stories that I enjoy. >>>is the best. Lots of ideas and suggestions that have helped me greatly. You are so luck to have someone like____working with people like us. ____understands our problems. I would recommend your company to anyone. I loved all that worked w/me. I had felt overwhelmed but all that they did improved my life. Thanks to all! Thank you Don’t understand how anyone can understand this condition. It seems to change daily. Happy that the abouve services were available. They were very helpful. Everyone was very nice to me. I appreciate all of their support and kindness. Further vision loss will result in no desire to live any longer. No suggestions on improvements because your services are very good. Enjoyed working with my instructors. Have heard about a place called System of Sight in Orlando Fl. If you know of them let me know too. I felt my help was very useful and professionally handled. Make contact w/sight challenged at 6 month intervals after cessation of staff visits. The glasses we got for music reading did not help very much and were soon outdated with the loss of sight. Need new phone w/large numbers or speech recognition; maybe speed dial; help w/reading mail and newspapers; occasional help with the housework Probably could use more info and help. Could use hellp locating and purchaseing items like talking thermometer and full spectrum lightingetc; help w/transprotation. I am housebound. To come up w/more or new crafts that I can do. Maybe domething around peer support like a contact that would be willing to email ortalk on phone. Excellent!! I receivved encouragemetnand many tips which made my days go more smoothly. Thank you for your support. I appreciatedthe services very much and know that there is a resouce available for me Thank you. Terrific service!!! Thank you so much for your help w/my condition.

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).

Case 1

This gentleman’s vision loss is due to Macular Degeneration. Best corrected OD — 20/200 and OS — counts fingers. The Certified Vision Rehabilitation Therapist (CVRT) worked with him on various daily living skills including cooking, reading mail, personal care, etc. He is highly motivated and continues to bake beans, do all of his own shopping, and his house cleaning. The training and adaptive equipment he received from the Division for the Blind & Visually Impaired allowed him to safely continue living alone and independently.

The CVRT reported that this individual was delightful to work with. Some of the items that were purchased for this individual were a 7X hand held magnifier, amber/orange glare shields, a large print address book, large print shopping list pads, and a check register.

Upon closing the case, he was encouraged to contact DBVI should his needs change.

Case 2

This lady’s vision loss is due to vascular disease and epi-retinal membrane OU. She has many heart issues and consequently, has great difficulty with her respiratory system and function. She has had several heart surgeries including mitral valve repair. Her vision loss is an added stressor, as her health is fragile at best. At this point in time, she has been told there is little that can be done to improve her physical state and she feels as though it is only a matter of time before her life ends. This causes her great anxiety and frustration. In addition to her vascular episodes, she has had cancer of various kinds and she is very frail.

The casework manager has seen her many times in her home to talk about her needs and her health. This woman has been widowed twice and is obviously lonely and distraught. She worked with the CVRT and the following equipment was provided to her: two deluxe floor lamps, new lenses, and frames. Arrangements were made for this woman to see a low vision specialist but she declined. Though this consumer was unsettled regarding her participation with the Division for the Blind & Visually Impaired, she benefited from our services in numerous ways. She was able to acquire knowledge about her eye condition and was given ample opportunity to experience training and to obtain adaptive equipment that would help with her independence and her safety.

Case 3

This consumer was a bookkeeper for many years and her eye condition was severe Macular Degeneration. Despite her prognosis, she continued to live independently and safely. Her best corrected vision is 20/150 OS and 20/400 OD. She decided to give up driving of her own free will and settled herself down with the knowledge that she was going to have to do most everything just a bit different now. This individual worked with a CVRT, and the following equipment was provided to her: a 4x8D pocket magnifier, a super bright 6X stand magnifier, a low vision exam, and ZoomText Express to assist her on her computer.

She was encouraged to contact us should her needs or her vision change.

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

The state of Maine has an increasing population of the individuals over the age of 55. Approximately, 60% of Maine’s population that is eligibile for DBVI services falls into that age category. The dilemna is that the resources fall well below the need for independent living services for the older blind population.

Maine is such a rural state that transportation continues to be an issue for consumers in the IL-Older Blind program. These consumers find it difficult to find transportation in order to attend appointments and other support group activities. The Communities Connection Coordinator has done a great job of researching the various community activities and support groups but DBVI has found that consumers are still finding it difficult to get transportation to and from these events.

An increase in the Title VII-Chapter 2 grant would allow Maine to provide services for a greater number of consumers and allow them the opportunity to maintain their independence and increase the quality of life in their communities.

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 byJohn M. Mc Mahon
TitleDirector, DBVI
Telephone207-623-7949
Date signed12/23/2013