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

RSA-7-OB for Montana Disability Employment and Transitions Division - H177B140026 report through September 30, 2014

Instructions

Introduction

The revised ED RSA-7-OB form incorporates revisions to the four established performance measures for the Independent Living Services for Older Individuals who are Blind (IL-OIB) program. Added in 2007, these measures aim to better reflect the program’s impact on individual consumers and the community.

Added to capture information that may be required to meet GPRA guidelines, the performance measures can be found under Part VI: Program Outcomes/Performance Measures as follows:

Measure 1.1

Of individuals who received AT (assistive technology) services and training, the percentage who regained or improved functional abilities previously lost as a result of vision loss.

Measure 1.2

Of individuals who received orientation and mobility (O & M) services, the percentage who experienced functional gains or maintained their ability to travel safely and independently in their home and/or community environment.

Measure 1.3

Of individuals who received services or training in alternative non-visual or low vision techniques, the percentage that experienced functional gains or were able to successfully restore and maintain their functional ability to engage in their customary life activities within their home environment and community.

Measure 1.4

Of the total individuals served, the percentage that reported that they are in greater control and are more confident in their ability to maintain their current living situation as a result of services.

Revisions to these established program performance measures consists of the following additional five items:

E1. Enter the 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)

E2. Enter the 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)

E3. Enter the 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)

E4. Enter the number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only)

E5. Enter the 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)

Submittal Instructions

OIB grantees are expected to complete and submit the 7-OB Report online through RSA’s website (https://rsa.ed.gov), unless RSA is notified of pertinent circumstances that may impede the online submission.

To register with RSA’s MIS, please go to https://rsa.ed.gov and click on Info for new users. The link provides instructions for obtaining an agency-specific username and password. Further instructions for completing and submitting the 7-OB Report online will be provided upon completion of the registration process.

OIB grantees submitting the 7-OB Report online are not required to mail signed copies of the 7-OB Report to RSA, but they must certify in the MIS that the signed and dated 7-OB Report and lobbying certification forms are retained on file.

The Report submittal deadline is no later than December 31 of the reporting year.

Part I: Funding Sources for Expenditures And Encumbrances — Instructions

Please note: Total expenditures and encumbrances for direct program services in Part I (C) must equal the total funds spent on service in Part IV. Part I C must equal the sum of Part IV A1+B1+C1+D1.

A. Funding SourceS for Expenditures and encumbrances in reported fy

A1. Enter the total amount of Title VII-Chapter 2 funds expended or encumbered during the reported FY. Include expenditures or encumbrances made from both carryover funds from the previous FY and from the reported FY grant funds.

A2. Enter the total of any other federal funds expended or encumbered in the Title VII-Chapter 2 program during the reported FY. Designate the funding sources and amounts in (a) through (e).

A3. Enter the total amount of state funds expended or encumbered in the Title VII - Chapter 2 program. Do not include in-kind contributions (e.g., documented value of services, materials, equipment, buildings or office space, or land).

A4. Enter the total amount of third party contributions including local and community funding, non-profit or for-profit agency funding, etc. Do not include in-kind contributions (e.g., documented value of services, materials, equipment, buildings or office space, or land).

A5. Enter the total amount of in-kind contributions from non-federal sources. Include value of property or services that benefit the Title VII-Chapter 2 program (e.g. the fairly evaluated documented value of services, materials, equipment, buildings or office space or land).

A6. Enter the total matching funds (A3 + A4 + A5). Reminder: The required non-federal match for the Title VII-Chapter 2 program is not less than $1 for each $9 of federal funds provided in the Title VII-Chapter 2 grant. Funds derived from or provided by the federal government, or services assisted or subsidized to any significant extent by the federal government, may not be included in determining the amount of non-federal contributions.

A7. Enter the total amount of all funds expended and encumbered (A1 + A2 + A6) during the reported fiscal year.

B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs

Enter the total amount of expenditures and encumbrances allocated to administrative, support staff, and general overhead costs. Do not include costs for direct services provided by agency staff or the costs of contract or sub-grantee staff that provide direct services under contracts or sub-grants. If an administrator spends a portion of his or her time providing administrative services and the remainder providing direct services, include only the expenditures for administrative services.

C. Total expenditures and encumbrances for direct program services

Enter the total amount of expenditures and encumbrances for direct program services by subtracting line B from line A7.

Part II: Staffing — Instructions

Base all FTE calculations upon a full-time 40-hour workweek or 2080 hours per year. Record all FTE assigned to the Title VII-Chapter 2 program irrespective of whether salary is paid with Title VII-Chapter 2 funds.

A. Full-time Equivalent (FTE) Program Staff

A1. Under the “Administrative & Support” column (A1a), enter the full-time equivalent (FTE) of all administrative and support staff (e.g. management, program directors, supervisors, readers, drivers for staff, etc.) assigned to the Title VII-Chapter 2 program from the State agency. (For example, if 20% or 8 hours per week of a staff person’s time were spent on administrative and support functions related to this program, the FTE for that staff person would be .2). Under the “Direct Services” column (A1b), enter the FTE of all direct service staff (e.g. rehabilitation teacher, IL specialist, orientation and mobility specialist, social worker, drivers for individuals receiving services, etc.) assigned to the Title VII-Chapter 2 program from the State agency. If administrative or support staff of the State agency also provide direct services, report the FTE devoted to direct services in the “Direct Services” column (A1b). (For example, if 80% of a staff person’s time were spent in providing direct services, the FTE for that person would be 8). Finally, add across the “Administrative & Support” FTE (A1a) and “Direct Service” FTE (A1b) to enter the total State agency FTE in the TOTAL (A1c) column.

A2. Under the “Administrative & Support” column (A2a), enter the full-time equivalent (FTE) of all administrative and support staff (e.g. management, program directors, supervisors, readers, drivers for staff, etc.) assigned to the Title VII-Chapter 2 program from contractors or sub-grantees. Under the “Direct Services” column (A2b), enter the FTE of all direct service staff (e.g. rehabilitation teacher, IL specialist, orientation and mobility specialist, social worker, driver for individuals receiving services, etc.) assigned to the Title VII-Chapter 2 program from contractors and sub-grantees. If administrative staff of the contractors or sub-grantees also provides direct services, report the FTE devoted to direct services in the “Direct Services” column (A2b). Finally, add across the “Administrative & Support” FTE (A2a) and “Direct Service” FTE (A2b) to enter the total contractor or sub-grantee FTE in the TOTAL (A2c) column.

A3. Add each column for A1 and A2 and record totals on line A3.

B. Employed or advanced in employment

B1. Enter the total number of employees (agency and contractor/sub-grantee staff) with disabilities (include blind and visually impaired not 55 or older), including blindness or visual impairment, in B1a. Enter the FTE of employees with disabilities in B1b. (To calculate B1b, add the total number of hours worked by all employees with disabilities and divide by 2080 to arrive at the FTE)

B2. Enter the total number of employees (agency and contractor/sub-grantee staff) who are blind or visually impaired and age 55 and older in B2a. Enter the FTE of employees who are blind or visually impaired and age 55 or older in B2b. (To calculate B2b, add the total number of hours worked by employees who are blind or visually impaired and age 55 and older and divide by 2080 to arrive at the FTE)

B3. Enter the total number of employees (agency and contractor/sub-grantee staff) who are members of racial/ethnic minorities in B3a. Enter the FTE of employees who are members of racial/ethnic minorities in B3b. (To calculate B3b, add the total number of hours worked by employees who are members of racial/ethnic minorities and divide by 2080 to arrive at the FTE)

B4. Enter the total number of employees (agency and contractor/sub-grantee staff) who are women in B4a. Enter the FTE of employees who are women in B4b. (To calculate B4b, add the total number of hours worked by women and divide by 2080 to arrive at the FTE)

B5. Enter the total number of employees (agency and contractor/sub-grantee staff) who are ages 55 and older, but not blind or visually impaired, in B5a. Enter the FTE of employees who are ages 55 and older, but not blind or visually impaired, in B5b. (To calculate B5b, add the total number of hours worked by employees who are ages 55 and older, but not blind or visually impaired, and divide by 2080 to arrive at the FTE)

C. Volunteers

C1. Enter the FTE of program volunteers in C1. (To calculate C1, add the total number of hours worked by all program volunteers and divide by 2080 to arrive at the FTE).

Part III: Data on Individuals Served — Instructions

Provide data in all categories on program participants who received one or more services during the fiscal year being reported.

A. Individuals Served

A1. Enter the number of program participants carried over from the previous federal fiscal year who received services in this reported FY (e.g. someone received services in September (or any other month) of the previous FY and continued to receive additional services in the reported FY).

A2. Enter the number of program participants who began receiving services during the reported fiscal year irrespective of whether they have completed all services.

A3. Enter the total number served during the reported fiscal year (A1 + A2).

B. Age

B1-B10. Enter the total number of program participants served in each respective age category.

B11. Enter the sum of B1 through B10. This must agree with A3.

C. Gender

C1. Enter the total number of females receiving services.

C2. Enter the total number of males receiving services.

C3. Enter the sum of C1 and C2. This must agree with A3.

D. Race/Ethnicity

Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

D1. Enter the number of individuals served who are Hispanic/Latino of any race or Hispanic/Latino only. Hispanic/Latino means a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

D2. Enter the number of individuals served who are American Indian or Alaska Native. American Indian or Alaska Native means a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

D3. Enter the number of individuals served who are Asian. Asian means a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

D4. Enter the number of individuals served who are Black or African American. Black or African American means a person having origins in any of the black racial groups of Africa. Terms such as “Haitian” may be used.

D5. Enter the number of individuals served who are Native Hawaiian or Other Pacific Islander. Native Hawaiian or Other Pacific Islander means a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

D6. Enter the number of individuals served who are White or Caucasian. White means a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

D7. Enter the number of individuals served who report two or more races but who are not Hispanic/Latino of any race.

D8. Enter “race and ethnicity unknown” only if the consumer refuses to identify race and ethnicity.

D9. Enter the total of D1 through D8. This number must agree with A3.

E. Degree of Visual Impairment

E1. Enter the number of individuals served who are totally blind (e.g. have light perception only or no light perception).

E2. Enter the number of individuals served who are legally blind (excluding those recorded in E1).

E3. Enter the number of individuals served who have severe visual impairment.

E4. Add E1 + E2 + E3 and enter the total. This number must agree with A3.

F. Major Cause of Visual Impairment

(Please note that the primary site for the definitions of diseases is http://www.nia.nih.gov/AboutNIA/StrategicPlan/ResearchGoalA/Subgoal1.htm.)

Enter only one major cause of visual impairment for each individual served.

F1. Enter the number of individuals served who have macular degeneration as the major cause of visual impairment. Age-related macular degeneration (AMD) is a progressive disease of the retina wherein the light-sensing cells in the central area of vision (the macula) stop working and eventually die. The cause of the disease is thought to be a combination of genetic and environmental factors, and

It is most common in people who are age 60 and over. AMD is the leading cause of legal blindness in senior citizens.

F2. Enter the number of individuals served who have diabetic retinopathy as the major cause of visual impairment. Diabetic retinopathy is the leading cause of new cases of legal blindness among working-age Americans and is caused by damage to the small blood vessels in the retina. It is believed that poorly controlled blood sugar levels are related to its progression. Most persons with diabetes have non-insulin-dependent diabetes mellitus (NIDDM) or what is commonly called “adult-onset” or Type II diabetes, and control their blood sugar with oral medications or diet alone. Others have insulin-dependent diabetes mellitus (IDDM), also called "younger or juvenile-onset" or Type I diabetes, and must use insulin injections daily to regulate their blood sugar levels.

F3. Enter the number of individuals served who have glaucoma as the major cause of visual impairment. Glaucoma is a group of eye diseases causing optic nerve damage that involves mechanical compression or decreased blood flow. It is permanent and is a leading cause of blindness in the world, especially in older people.

F4. Enter the number of individuals served who have cataracts as the major cause of visual impairment. A cataract is a clouding of the natural lens of the eye resulting in blurred vision, sensitivity to light and glare, distortion, and dimming of colors. Cataracts are usually a natural aging process in the eye (although they may be congenital) and may be caused or accelerated by other diseases such as glaucoma and diabetes.

F5. Enter the number of individuals served who have any other major cause of visual impairment.

F6. Enter the sum of F1 through F5. This number must agree with A3.

G. Other Age-Related Impairments

Enter the total number of individuals served in each category. Individuals may report one or more non-visual impairments/conditions. The National Institute on Aging (NIA) Strategic Plan identifies age-related diseases, disorders, and disability including the following categories.

G1. Hearing Impairment: Presbycusis is the gradual hearing loss that occurs with aging. An estimated one-third of Americans over 60 and one-half of those over 85 have some degree of hearing loss. Hearing impairment occurs when there is a problem with or damage to one or more parts of the ear, and may be a conductive hearing loss (outer or middle ear) or a sensorineural hearing loss (inner ear) or a combination. The degree of hearing impairment can vary widely from person to person. Some people have partial hearing loss, meaning that the

Ear can pick up some sounds; others have complete hearing loss, meaning that the ear cannot hear at all. One or both ears may be affected, and the impairment may be worse in one ear than in the other.

G2. Diabetes: Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Type 2 diabetes, which results from insulin resistance and abnormal insulin action, is most prevalent in the older population. Diabetes complications, such as heart disease and loss of sight, increase dramatically when blood sugar is poorly controlled and often develop before diabetes is diagnosed.

G3. Cardiovascular Disease and Strokes: Diseases of the heart and blood vessels are the leading cause of hospitalization and death in older Americans. Congestive heart failure is the most common diagnosis in hospitalized patients aged 65 and older.

G4. Cancer: The second leading cause of death among the elderly is cancer, with individuals age 65 and over accounting for 70 percent of cancer mortality in the United States. Breast, prostate, and colon cancers, are common in older people.

G5. Bone, Muscle, Skin, Joint, and Movement Disorders: Osteoporosis (loss of mass and quality of bones), osteoarthritis (inflammation and deterioration of joints), and sarcopenia (age-related loss of skeletal muscle mass and strength) contribute to frailty and injury in millions of older people. Also contributing to loss of mobility and independence are changes in the central nervous system that control movement. Cells may die or become dysfunctional with age, as in Parkinson's disease. Therefore, older people may have difficulty with gross motor behavior, such as moving around in the environment, or with fine motor skills, such as writing.

G6. Alzheimer’s Disease/Cognitive Impairment: Alzheimer’s disease is the most common type of dementia (a brain disorder that significantly affects an individual’s ability to carry out daily life activities) in older people. It and other cognitive impairments impact parts of the brain that control thought, memory, and language.

G7. Depression is widespread, often undiagnosed, and often under-treated in the elderly. It is believed to affect more than 6.5 million of the 35 million Americans who are 65 or older. Depression is closely associated with dependency and disability. Symptoms may include: loss of interest in normally pleasurable activities, persistent, vague or unexplained somatic complaints, memory complaints, change in weight, sleeping disorder, irritability or demanding behavior, lack of attention to personal care, difficulty with concentration, social withdrawal, change in appetite, confusion, delusions or hallucinations, feeling of worthlessness or hopelessness, and thought about suicide.

G8. Other Major Geriatric Concerns: Several conditions can compromise independence and quality of life in older persons including weakness and falls, urinary incontinence, benign prostatic hyperplasia, and co morbidity (co morbidity describes the effect of all other diseases an individual might have on the primary disease).

H. Type of Residence

H1. Enter the number of individuals served who live in private residence (house or apartment unrelated to senior living).

H2. Enter the number of Individuals served who live in senior living/retirement community (e.g. housing designed for those age 55 and older).

H3. Enter the number of individuals served who live in assisted living facility (e.g. housing that provides personal care and services which meet needs beyond basic provision of food, shelter and laundry).

H4. Enter the number of individuals served who live in nursing homes/long-term care facility (e.g. any facility that provides care to one or more persons who require nursing care and related medical services of such complexity to require professional nursing care under the direction of a physician on a 24 hour a day basis).

H5. Enter the number of individuals served who are homeless

H6. Enter the sum of H1, H2, H3, H4 and H5. This number must agree with A3.

I. Source of Referral

I1. Enter the number of individuals served referred by an ophthalmologist or optometrist.

I2. Enter the number of individuals served referred by a medical provider other than an ophthalmologist or optometrist.

I3. Enter the number of individuals served referred by a state vocational rehabilitation agency.

I4. Enter the number of individuals served referred by a government or social services agency defined as a public or private agency which provides assistance to consumers related to eligibility and securing entitlements and benefits, counseling, elder law services, assistance with housing, etc.

I5. Enter the number of individuals served referred by the Veterans Administration

I6. Enter the number of individuals served referred by a senior program defined as a community-based educational, recreational, or socialization program operated by a senior center, nutrition site, or senior club.

I7. Enter the number of individuals served referred by an assisted living facility defined as housing that provides personal care and services which meet needs beyond basic provision of food, shelter and laundry.

I8. Enter the number of individuals served referred by a nursing home/long-term care facility defined as any facility that provides care to one or more persons who require nursing care and related medical services of such complexity to require professional nursing care under the direction of a physician on a 24 hour a day basis.

I9. Enter the number of individuals served referred by a faith-based (religious affiliated) organization.

I10. Enter the number of individuals served referred by an independent living center (ILC) defined as a consumer-controlled, community-based, cross-disability, nonresidential private nonprofit agency that is designed and operated within a local community by individuals with disabilities, and provides an array of independent living services.

I11. Enter the number of individuals referred by a family member or friend.

I12. Enter the number of individuals who were self-referred.

I13. Enter the number of individuals referred from all other sources aside from those listed above.

I14. Enter the sum of I1, I2, I3, I4, I5, I6, I7, I8, I9, I10, I11, I12, and I13. This number must agree with A3

Part IV: Types of Services Provided and Resources Allocated — Instructions

Please note: Total expenditures and encumbrances for direct program services in Part I C must equal the total funds spent on services in Part IV. Part I C must equal the sum of Part IV A1+B1+C1+D1.

In addition, salary or costs associated with direct service staff or contractors providing

direct services should be included in the cost of services provided in A, B, C, and D.

A. Clinical / Functional Vision Assessments and Services

A1. Enter the total cost from Title VII-Chapter 2 federal grant funds (A1a) and the total cost from all other sources of program funding (A1b) for clinical and/or functional vision assessments and services, whether purchased or provided directly.

A2. Enter the total number of program participants who received clinical vision screening or vision examinations from qualified or certified professionals such as ophthalmologists or optometrists, and who received functional vision assessments or low vision evaluations to identify strategies for enhancing visual performance both without and with optical and low vision devices and equipment. Assessment areas may include functional visual acuity and fields, efficiency of vision in the performance of everyday tasks, and evaluation for low vision aids or equipment. These assessments are typically provided by skilled professionals or those who are certified or have a master’s degree in low vision rehabilitation. Do not include evaluations for orientation and mobility. These should be included in C3.

A3. Enter the total number of program participants who received surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions; and, hospitalizations related to such services. Include prescription optics in this service category. Nonprescription optics should be reported in B2.

B. Assistive Technology Devices, Aids, Services and Training

B1. Enter the total cost from Title VII-Chapter 2 federal grant funds (B1a) and the total cost from all other sources of program funding (B1b) for the provision of assistive technology devices, aids, services and training.

B2. Enter the total number of program participants who received one or more assistive technology devices and aids. As defined in Section 3(4) of the Assistive Technology Act of 2004 (Pub. L. 108-364), “assistive technology device means any item, piece of equipment, or product system whether acquired commercially, modified, or customized that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” Assistive technology devices may include such items as canes, slates, insulin gauges, CCTVs, computers, adaptive software, magnifiers, adaptive cooking items, adaptive recreational items, handwriting guides, Braillers, large button telephones, etc.

B3. Enter the total number of program participants who received one or more assistive technology services and training. As defined in Section 3(5) of the Assistive Technology Act of 2004 (PL 108-364), “assistive technology service means any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.” Services may include the evaluation of assistive technology needs of an individual, services related to acquisition of technology, costs of loan programs, maintenance and repair of assistive technology, training or technical assistance for the individual or professionals related to the use of assistive technology, programs to expand the availability of assistive technology, low vision therapy services related to the use of optical aids and devices, and other services related to the selection, acquisition, or use of an assistive technology device.

C. Independent Living and Adjustment Training and Services

C1. Enter the total cost from Title VII-Chapter 2 federal grant funds (C1a) and the total cost from all other sources of program funding (C1b) for the provision of services and adjustment training leading to independent living. Evaluation and assessment services (excluding those included in A2 or B3) leading to the planning and implementation of services and training should be included in these costs.

C2. Enter the total number of individuals who received orientation and mobility (O & M) services or travel training (i.e. learning to access public or private transportation and to travel safely and as independently as possible in the home and community with or without the use of mobility aids and devices).

C3. Enter the total number of individuals who received communication skills training (e.g. reading and writing Braille, keyboarding and computer literacy, computer skills training, using the telephone, handwriting guides, telling time, using readers, use of audio and tactile technologies for home, recreational or educational use; etc.). Training in the use of newspaper reading services and radio services should be included.

C4. Enter the total number of individuals who received personal management and daily living skills training (e.g. training in the use of adaptive aids and assistive technology devices for personal management and daily living, blindness and low vision alternative techniques for food preparation, grooming and dress, household chores, medical management, shopping, recreational activities, etc.)

C5. Enter the total number of individuals who received supportive services (e.g. reader services, transportation, personal attendant services, support service providers, interpreters, etc.) while actively participating in the program or attaining independent living goals.

C6. Enter the total number of program participants who participated in advocacy training or support network activities such as consumer organization meetings, peer support groups, etc.

C7. Enter the total number of individuals who received counseling (peer, individual or group) to assist them in adjusting to visual impairment and blindness.

C8. Enter the total number of program participants that received information and referral to other service providers, programs, and agencies (e.g. senior programs, public and private social service programs, faith-based organizations, consumer groups, etc.) to enhance adjustment, independent living, and integration into the community. Do not include individuals who received only information and referral and for whom no other services were provided.

C9. Enter the total number of individuals served who were provided any other service not listed above.

D. Community Awareness Activities / Information and Referral

D1. Enter the total cost from Title VII-Chapter 2 federal grant funds (D1a) and the total cost from all other sources of program funding (D1b) for providing information and referral services and community awareness activities/events to individuals for whom this was the only service provided (i.e. training for other professionals, telephone inquiries, general inquiries, etc.).

D2. Enter the number of individuals receiving information and referral services for whom this is the only service provided. (optional)

D3. Enter the number of community awareness events/activities in which the Chapter 2 program participated during the reported year (D3a) and the number or estimated number of individuals who benefited from these activities (D3b).

Part V: Comparison of Prior Year Activities to Current Reported Year — Instructions

A1. Program Expenditures and Encumbrances (all sources) Enter the total cost of the program for the prior fiscal year (A1a), and the fiscal year being reported (A1b). The total cost of the program can be found in Part I A7. Calculate the change (plus or minus) from the prior year to the reported year (A1c).

A2. Number of Individuals Served Enter the total number of eligible individuals served in the prior year (A2a), and in the current reported year (A2b). The total number of individuals served can be found in Part III A3. Calculate the change (plus or minus) in the numbers served from the prior year to the reported year (A2c).

A3. Number of Minority Individuals Served Enter the total number of minority individuals served in the prior year (A3a), and in the fiscal year currently being reported (A3b). The total number of minority individuals served is the total of Part III D1+D2+D3+D4+D5 +D7. Calculate the change (plus or minus) in the numbers served from the prior year to the reported year (A3c).

A4. Number of Community Awareness Activities Enter the number of community awareness activities or events in which the Chapter 2 program participated during the prior year (A4a), and in the fiscal year currently being reported (A4b). The number of community awareness activities is found in Part IV D3a. Calculate the change (plus or minus) in the number of events from the prior year to the year being reported (A4c).

A5. Number of Collaborating Agencies and Organizations Enter the number of collaborating organizations or agencies (formal agreements or informal activity) other than Chapter 2 paid sub-grantees or contractors in the prior year (A5a), and in the fiscal year currently being reported (A5b). Calculate the change (plus or minus) from the prior year to the year being reported (A5c).

A6. Number of Sub-grantees/Contractors If you provide services through sub-grantee agencies or contract, enter the number of sub-grantees or contracts in the prior year (A6a), and in the fiscal year currently being reported (A6b). Calculate the change (plus or minus) from the prior year to the year being reported (A6c). If you do not use sub-grantees, enter 0 in A6a, A6b, and A6c.

Part VI: Program Outcomes/Performance Measures — Instructions

A. Enter the number from Part IV B3 in A1. From available program data and evaluations, enter the 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 in A2. (closed/inactive cases only).

In A3, from available program data and evaluations, enter the number of individuals for whom functional gains have not yet been determined at the close of the reporting period (This number would not include those individuals who are no longer receiving services and who either did not make functional gains or maintain functional ability before case closure or inactivity).

B. Enter the number from Part IV C2 in B1. From available program data and evaluations, of those receiving orientation and mobility (O & M) services, enter 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 in B2 (closed/inactive cases only).

In B3, from available program data and evaluations, enter the number of individuals for whom functional gains have not yet been determined at the close of the reporting period (This number would not include those individuals who are no longer receiving services and who either did not make functional gains or maintain functional ability before case closure or inactivity).

C. Enter the number from Part IV C3 in C1. From available program data and evaluations, of those receiving communication skills training, enter the number of individuals who gained or maintained their functional abilities as a result of services they received in C2 (Closed/inactive cases only).

In C3, from available program data and evaluations, enter the number of individuals for whom functional gains have not yet been determined at the close of the reporting period (This number would not include those individuals who are no longer receiving services and who either did not make functional gains or maintain functional ability before case closure or inactivity).

D. Enter the number from Part IV C4 in D1. From available program data and evaluations, of those receiving daily living skills training, enter the 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 In D2 (Closed/inactive cases only).

In D3, enter the Number of individuals for whom functional gains have not yet been determined at the close of the reporting period (This number would not include those individuals who are no longer receiving services and who either did not make functional gains or maintain functional ability before case closure or inactivity).

E1. Enter the 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).

E2. Enter the 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).

E3. Enter the 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).

E4. Enter the number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss (Closed/inactive cases only). “Change in lifestyle” is defined as any non-vision related event that results in the consumer’s reduced independence, such as moving from a private residence (house or apartment) to another type of residence e.g. living with family, senior living community, assisted living facility, nursing home/long-term facility, etc. Reduced independence could also result in employing a caregiver to enable the consumer continue to live in his/her home. Examples of events that could result in reduced independence of the consumer include loss of spouse and onset or worsening of other health conditions such as diabetes, cancer, heart disease, etc.

E5. Enter the 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).

Part VII: Training and Technical Assistance — Instructions

On July 22, 2014, Public Law 113-128, the Workforce Innovation and Opportunity Act (WIOA) was enacted and included a new requirement under Section 751A that the RSA Commissioner shall conduct a survey of designated State agencies that receive grants under section 752 regarding training and technical assistance needs in order to determine funding priorities for such training and technical assistance. Please enter a brief description of training and technical assistance needs that you may have to assist in the implementation and improvement of the performance of your Independent Living Services for Older Individuals Who Are Blind grant (for example, financial management, reporting requirements on the 7-OB, program management, data analysis and program performance, law and applicable regulations, provision of services and service delivery, promising practices, resources and information, outreach, etc.).

Part VIII: Narrative — Instructions

Self-explanatory.

Part IX: Signature Instructions

Please sign and print the name, title and telephone number of the IL-OIB Program Director.

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)25,000
A4. Third party888
A5. In-kind0
A6. Total Matching Funds25,888
A7. Total All Funds Expended250,888
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs170,852
C. Total expenditures and encumbrances for direct program services80,036

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 0.0800 3.5300 3.6100
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 0.0800 3.5300 3.6100

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 4 0.5800
2. Employees with Blindness Age 55 and Older 1 0.0400
3. Employees who are Racial/Ethnic Minorities 1 0.0700
4. Employees who are Women 9 1.9600
5. Employees Age 55 and Older 5 1.9200

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 FY283
2. Number of individuals who began receiving services in the reported FY337
3. Total individuals served during the reported fiscal year (A1 + A2) 620

B. Age

1. 55-5925
2. 60-6429
3. 65-6932
4. 70-7448
5. 75-7987
6. 80-84112
7. 85-89159
8. 90-94103
9. 95-9923
10. 100 & over2
11. Total (must agree with A3)620

C. Gender

1. Female418
2. Male202
3. Total (must agree with A3)620

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race2
2. American Indian or Alaska Native17
3. Asian0
4. Black or African American1
5. Native Hawaiian or Other Pacific Islander0
6. White597
7. Two or more races3
8. Race and ethnicity unknown (only if consumer refuses to identify)0
9. Total (must agree with A3)620

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)13
2. Legally Blind (excluding totally blind)290
3. Severe Visual Impairment317
4. Total (must agree with A3)620

F. Major Cause of Visual Impairment

1. Macular Degeneration445
2. Diabetic Retinopathy25
3. Glaucoma51
4. Cataracts19
5. Other80
6. Total (must agree with A3)620

G. Other Age-Related Impairments

1. Hearing Impairment326
2. Diabetes134
3. Cardiovascular Disease and Strokes228
4. Cancer132
5. Bone, Muscle, Skin, Joint, and Movement Disorders291
6. Alzheimer's Disease/Cognitive Impairment47
7. Depression/Mood Disorder79
8. Other Major Geriatric Concerns119

H. Type of Residence

1. Private residence (house or apartment)486
2. Senior Living/Retirement Community85
3. Assisted Living Facility35
4. Nursing Home/Long-term Care facility12
5. Homeless2
6. Total (must agree with A3)620

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)128
2. Physician/medical provider12
3. State VR agency4
4. Government or Social Service Agency16
5. Veterans Administration29
6. Senior Center20
7. Assisted Living Facility2
8. Nursing Home/Long-term Care facility6
9. Faith-based organization3
10. Independent Living center8
11. Family member or friend182
12. Self-referral111
13. Other99
14. Total (must agree with A3)620

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 3,961
1b. Total Cost from other funds 440
2. Vision screening / vision examination / low vision evaluation 331
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 63,026
1b. Total Cost from other funds 7,891
2. Provision of assistive technology devices and aids 305
3. Provision of assistive technology services 315

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 2,464
1b. Total Cost from other funds 274
2. Orientation and Mobility training 61
3. Communication skills 208
4. Daily living skills 279
5. Supportive services (reader services, transportation, personal 6
6. Advocacy training and support networks 73
7. Counseling (peer, individual and group) 8
8. Information, referral and community integration 147
. Other IL services 1

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 1,781
1b. Total Cost from other funds 198
2. Information and Referral 302
3. Community Awareness: Events/Activities 63 100

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) 274,235 250,888 -23,347
2. Number of Individuals Served 675 620 -55
3. Number of Minority Individuals Served 22 23 1
4. Number of Community Awareness Activities 54 0 -54
5. Number of Collaborating agencies and organizations 35 0 -35
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 315 100.00%
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) 112 35.56%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 203 64.44%
B1. Number of individuals who received orientation and mobility (O & M) services 61 100.00%
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) 30 49.18%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 31 50.82%
C1. Number of individuals who received communication skills training 208 100.00%
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) 77 37.02%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 131 62.98%
D1. Number of individuals who received daily living skills training 279 100.00%
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) 104 37.28%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 175 62.72%
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) 239 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) 0 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) 0 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 0 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: Training and Technical Assistance Needs

Training or technical assistance needed for the administration of the Older Blind Program • Ways to increase the effectiveness of limited funds and staff with an increasing number of people needing services, • 7-OB Report—how other states are obtaining or calculating expenditure of money for each of the independent living categories, how to streamline information gathering for completing of the report, methods of computing time spent by staff in direct service for the categories in Part IV of the 7-OB, etc. • The formula for computing grants to states • Involving volunteers in Older Blind Program

Training or technical assistance for direct service staff • Working with deaf-blind and hard-of-hearing visually impaired individual • Assistive Technology—keeping up with changes in assistive technology, accessibility features of Apple, Windows and Android products • Alternate funding sources for assistive technology

Part VIII: 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.

Montana provides Older Blind Services in-house with no sub-grantees or contractors. Direct services and case management are provided by four orientation and mobility specialists, five vision rehabilitation therapists and an assistive computer specialist. The staff work from regional offices and one sub-office and they travel to communities within their territory. Counties covered by each office are based on population so the geographic area covered varies. The offices on the western side of the state have larger population bases and fewer counties. Each office also contains a low vision lab where Older Blind consumers can be evaluated for and work with a variety of low vision equipment before it is dispensed or recommended for their purchase. Most low vision aids and assistive technology which is dispensed is purchased through bulk orders from distributors. This has saved significantly on the cost of shipping from when items were ordered individually for each person. Underserved populations in Montana consist of Native Americans, people who reside in rural communities and Deaf-Blind individuals. Outreach activities consist of participating in community health fairs sponsored by senior centers, medical providers and community partners. Staff members contact the optometric clinics and senior centers on the seven Native American reservations in Montana.

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.

BLVS is working on getting a MOU with the Veterans Administration in Montana. The Vision Rehabilitation Therapists and Orientation and Mobility Specialists collaborate with the Veterans Administration (VA) Low Vision Clinic and VIST staff. BLVS assists veterans with contacting the Veteran’s Administration VIST coordinator to determine if the veteran qualifies for services through the VA Low Vision Clinic. The VA VIST Coordinator and the low vision specialist refer veterans to our program for follow-up and further training in the community as they are not able to get out different areas for months. Older Blind staff assists veterans with setting up and training on equipment the VA purchases, locating local training opportunities for computer equipment, identifying additional equipment for the VA to provide and connecting veterans with the local support groups. The Montana Association for the Blind (a consumer organization) runs a program to teach individuals new to vision loss independent living skills. BLVS staff provides information and applications to OB consumers. Following the program BLVS staff follows-up with review and additional training in the consumer’s home community. Frequent referrals are made to the M.A.B. Older Blind Loan/Lease program for assistance in purchasing low vision equipment like CC-TV’s and other high-end adaptive equipment. The National Federation of the Blind has a chapter in Montana and BLVS will be collaborates with them as well to obtain or give referrals. The O&M and VRT in the Butte office assist members of the Bozeman Chapter of the Montana Association for the Blind by doing low vision evaluations at monthly low vision days. The Bozeman chapter hosts the Low Vision Day monthly to encourage individuals to learn about functioning with low vision. Older blind individuals participate by mentoring new visually impaired individuals or seeking assistance from the BLVS staff and MAB members. The case management system mentioned in last year’s report is still in development. It will be web-based and fully accessible to staff with blindness and visual impairments. The case management program is anticipated to be implemented in March 2015. Staff works with the Montana State Library Talking Book program to refer and assist OB consumers with signing up for the program. The Talking Book Library has loaned equipment to the BLVS staff so they can demonstrate and teach consumers how to use the talking book machines. Consumers are also referred to the Newsline program for access to five of the Montana newspapers. The Orientation and Mobility specialists participate in one or more local Transportation Action Committees (TAC) to work towards improving transportation options for Older Blind consumers. Mark O’Brien, O&M Specialist, is a member of the Missoula Safety Community which is working towards improving traffic and pedestrian safety in the community through education, planning and other activities. He and Diane Gray are working on a video which can be shown in driver education classes regarding the white can traffic laws which will improve safety for Older Blind individuals. Disability Employment and Transitions (of which BLVS is part) has a transportation coordinator who can work with organizations in communities to coordinate public transportation options and also assist individuals identify and use local transportation options. Staff members refer individuals to iCanConnect. Referrals are also made to the Montana Telecommunications Program for individuals with hearing impairments to obtain telephones with amplification as well as enlarged buttons and /or screens. Staff also assists occasionally with equipment delivery, set-up or training. When an older blind individual requests services from BLVS, they are offered an opportunity to register to vote. If the person wishes, our staff assists them with completing the Voter Registration Card and submitting it to the appropriate county office. The Vision Rehabilitation Therapists and Orientation and Mobility Specialists are encouraged to participate in training activities to improve their knowledge and skills. Only one VRT is not certified through ACVREP, but he will follow through with certification when he completes his masters’ degree. Staff members maintain and improve their skill through • Local and national conventions for Association for the Education and Rehabilitation of Blind and Visually Impaired • On-line seminars on low vision topics provided by product manufacturers or distributors • Meeting directly with assistive technology distributors • Training from the staff assistive technology specialist • Training provided by dog guide schools • Webinars from Hadley School for the Blind, • Training from TACE centers.

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.

Surveys were sent to all the closed individuals in February 2014. Of the 110 surveys mailed, 73 were returned. Overall the individuals expressed satisfaction with the services provided to them with 70 indicating overall satisfaction and 3 not satisfied. The participants indicated the low vision evaluations and magnifiers (33 respondents), referral to the Talking Book Library (10 respondents) and Assistive technology (17 respondents) to be the most important services.

Suggestions to improve the program included better advertising the program, “fixing the person’s eyes”, additional services in the areas of computer technology and client evaluation, and more services in the home. Comments on the program were very positive.

The survey report is below.

Blind and Low Vision Services Older Blind Survey Fiscal Year 2014

1. Why did you seek assistance from Blind and Low Vision Services? Vision loss or eye disease 33 Referred by another individual 8 Obtain magnification 2 Independent Living 6 Mobility training 2 Other 4

2. Did training in low vison or magnifiers help?

Yes: 60 No: 6 Did Not Request: 9

3. Did adaptive aids, such as large-print calendar, talking watch, large-button phone, large-print address book or any other aid help?

Yes: 52 No: 4 Did Not Request: 20 4. Did training in the use of a white support cane or long white can help?

Yes: 15 No: 5 Did Not Request: 56

5. Did training in Braille and/or handwriting skills help you be more independent?

Yes: 6 No: 7 Did Not Request: 63

6. Did training in home and/or personal management, such as cooking, kitchen safety or cleaning help you do these tasks?

Yes: 19 No: 4 Did Not Request: 54

7. Did training on computers or other assistive technology device help you use the equipment better?

Yes: 17 No: 8 Did Not Request: 48

8. What services was most important for you?

Magnifiers/Low Vision 33 MSL Talking Book Program 10 Assistive Technology 17 clock/watch 7 computer product 1 wide line paper 1 calendar 7 large print 3 telephone 4 Mobility 9 Training 2 Marking appliances 2 Independent Living 2 Training 3 Support Group 1 Other 1

10. Are you satisfied with the services you received from Blind and Low Vision Services

Yes: 70 No: 3

9. Do you have any suggestions for improving services through this program? • Better equipment and fix my eyes. • The screen is kind of small (and I see) only a quarter a page at a time. • No suggestions the services are excellent. Employees are helpful, nice and kind. • A local rep or client advisor who would come and show/discuss options at my home. • More publicity and advertising of your services. • Encourage ophthalmologists and optometrists to suggest this service. We don’t read posters and signs well, need the spoken word. • More work with computer technology • 16 answered “no.” • Would like more access to services, training and magnifying aids and large print reading material; follow up at home. • Evaluate individual clients better. Some items received were not useful. Want more individual care

Comments: • It served me very well, I was very well pleased. • Diane stopped by and is a great help. She has taken care of many of my problems. And has offered many good suggestions • Excellent services and conscientious staff • Excellent program • Very important service • I was unaware of computer training. I declined a cane. Will need shortly. The staff is very helpful. I do not hesitate to call on them. • I need a couple 7x hand magnify glass plus 20-20 pens (always breaking & used up. I get mine through blind and low visional Services. • I am very pleased with all you have done for me. • I am not on the program at this time. Melanie informed me they were taking me off as I did not need help at this time. I purchase my magnifiers and other needs myself in the catalogs as these are available for only the first time from Blind Vision • I am a physician filling this out for my mother. I did not know about the service until I needed it personally. I now refer patients. Thank you • I found your service helpful and in need I will contact your office • I really enjoy the tapes from the library in Helena. They are a God sent! Is this service a part of your program? Thank you. • My digital viewer quit working twice and Jeff was very helpful in sending it in for repair and installing it when it came back. • They were very helpful and the light makes it easier for me to read. • Jeff was a wonderful help to me. He is so kind and understanding. The lamp is such a help to me--I can now continue with my knitting and craft work. • May be interested in help with computer; I appreciated the services I have received. • Very nice people work for your organization. • The V.A. furnished most of equipment that I am using--tremendous help towards maintaining my independence. • I am being evaluated for assisted living 7/21/14 • The two ladies mentioned on your letter have never come to see me. Any services I have received were from Mark O’Brien. • I’d like magnifying glasses. The small magnifying glass helps a little. • Without your help I could not manage. I can tell dark colors from white and I use a dark sheet and can write above it, though I can’t see what I am writing. Numbers are horrible and double. I appreciate your help so much. Thank you. • Unable to complete. C. T. was taken ill the first week of the program and died Thursday. 7/7/14. • I’m answering the question for my mother. We have not met either Cindy or Stacie. Diane Gray called on my mother several times. She was super. She worked with my mom trying to find something to help her with no luck. In this stage of my mom’s blindness I’m afraid there is nothing that can help her. • Thank you. • Please let her know when you are coming. She said that the calendar she got was only good for 3 months. She really misses her calendar. • I greatly appreciate the services that are available. I was fortunate to go to Rocky Mtn. Eye in Missoula. Dr. Sippy gave several pamphlets about the services available including SOP. I believe more medical doctors should have a better awareness visual impairment and services available. • I didn’t know about the above services provided training • Appreciate all the help! Thank you. • Many of these little "helps" such as the black cut outs to help stay on line, etc. I did not know were available until she showed me. The little "cut out" to use to sign my name etc. all so much appreciated. Sorry my cut out guide slipped and I did not realize it. • Unable to use the assistive technology device

Comments to specific questions

Question 2: • Continue to need stronger magnifiers • Diane Gray came to my apt. at Grizzly Peak. She was a great help.

Question 3: • Did not know about all these things--would love the watch • Large print calendar, haven’t had other items • But would like to have these aids; • Diane came to my apartment and I could select what helped me most.

Question 4: • I did not request the cane but so grateful it was suggested. A man brought it to me. I do not remember his name.

Question 5: • Would be interested in training of handwriting skills • I never had any of that Diane helped me get a magnifier reader. I use it a lot. A resident where I lived died and I bought the new part. So grateful to her. • But would like training; • Training wasn’t offered in Missoula, only in Helena. • Managed okay on my own besides could not afford to buy a computer.

Question 7: • Had a reading & returned as the previous assisted living had one on location. • I got along great the way it is. I could not afford a computer.

Question 10: • Loved Diane Gray

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).

“Without your help I could not manage. I can tell dark colors from white and I use a dark sheet and can write above it, though I can’t see what I am writing. Numbers are horrible and double. I appreciate your help so much.” This comment was from an Older Blind consumer. She states what BLVS staff hear on a regular basis. The services provided allow the Older Blind individuals to maintain independence in their residences and to continue doing everyday tasks most people take for granted. The majority of individuals initially contact the program to find some way to be able to read again. Once they find (or don’t find) low vision devices to help, they continue with training in areas of independent living. While some it is a complete menu of training from basic daily living skills, cooking, mobility, communication skills, low vision and leisure activities, others request training in only one or two areas. Through the services of the Older Blind Program individuals are able to remain in their homes and communities, participate in social and volunteer activities and rely less on family and paid aids to function independently. Here are a few stories about individuals:

NM an 86-year-old man resides alone in the family home. NM has age related macular. NM was determined to maintain his health and independence. His daughter who lives across the street spends time with him but it was very important to NM to not rely on others for basic needs. Magnifiers assisted him with reading his mail and maintaining his check book. NM is an avid computer user and a demonstration version of Zoom Text allowed him to continue with this activity. NM is able to cook and maintain his home well enough for it to be neat and clean and up to his own specifications. With learning long cane skills NM continues to walk downtown and ambulate safely in his large yard. The Older Blind Program, with its equipment availability and instruction assisted NM with being successful in his home so that he would not have to move from his home.

JD, is an 89 year old with a severe visual impairment caused by Macular Degeneration, diabetes; hearing impairment; and bone, muscle, skin, joint and movement disorders. John lives with his wife in the home they have occupied for the past couple of decades. When asked what his visual expectations were, JD quoted, “I’d like to see better as I am writing up vignettes of earlier times in my life.” He held a variety of jobs throughout his working career — military, national park ranger, geologist, rancher and college professor. He wanted to re-capture his many interesting careers by writing about his life’s journey. A comprehensive low vision evaluation was completed with John. Both optical and non-optical aids were proved to him. These allowed him to freedom and accuracy for various activities like reading prices when grocery shopping and menus when eating out, ease in writing and keeping track of medical and personal appointments. As JD is a veteran, a referral was made to Veterans Affairs to purchase a Merlin CCTV for him. An assessment of his computer skills proved that he was familiar with the keyboard, but lacked the knowledge of how a computer operated. John’s issues using the computer are not vison related so he was referred Living Independently for Today and Tomorrow (independent living center) for training and brush-up on his computer skills. After his completion of his brush-up training on the computer, his computer access needs were again assessed and Veterans Affairs was asked to provide him with a copy of GUIDE (screen reading program). John can now pursue his dream of writing and recording his life’s professional journeys.

KM lives independently on a ranch near Hamilton that he built and has resided for almost fifty years. He is legally blind from macular degeneration and also has a severe hearing impairment. Because he was unable to pay for hearing aids, I had him apply to the Helen Keller “I Can Connect” program, and they provided him with hearing aids, assistive listening devices, as well as a Da Vinci video magnifier and other low vision aids. BLVS staff provided assessment and training on these devices. Although he is about 85 years old, he still gets up every morning and does whatever chores need to be done. This consumer also attends the Hamilton Support Group meeting whenever he is able to get a ride to it. He has adjusted well to his vision and hearing loss, and feels lucky that he does not have to live in a nursing home, where some of his friends and relatives reside.

Anita, a lovely, positive lady, wanted to live life independently and continue create hats for donation. Her priority was to do the simple task to read and write again and was referred to our agency by the VA. Anita co-presented with diabetic retinopathy and macular edema which has caused her to be very light sensitive due to permanent eye dilation. The tools that Anita found helped her most were to assist with monitoring and accurately caring for her diabetes. Given her health conditions, the tools were a proactive way for Anita to guard against further sight loss and assist in maintaining the best she can in her own health and wellbeing. Anita’s favorite piece of equipment that she could “not live without” is the Acrobat. This device allows her eyes to read again, assists with writing, continue making hats, the ability to read her syringe, insert the test strip into her glucometer, place the blood on the glucose testing strip accurately and see her face for grooming. Anita found some filter lenses to assist with her extreme light sensitivity which allowed her to once again be able to open her curtains at home. This case is an example of agencies collaboratively working together to get the best and most efficient outcome for the client. Blind and Low Vision Services, provided an assessment, training and provided adaptive aids. The majority of adaptive aids were purchased by the Veterans Administration. Anita attended training at the Summer Orientation Program which is operated through the Montana Association of the Blind. BLVS and the SOP provided orientation and mobility training. Anita lives in Seeley Lake which is a very rural area and is having transportation problems. This community still lacks assistance for needed medical transportation to Missoula which is a 55 mile distance. This client ended up meeting her own transportation needs through her church, family and friends. The rural nature of our state does not provide easy remedies for all our client needs.

Olive, a 79-year old, experiences vision loss due to macular degeneration. When she started with the Older Blind program she lived alone in her home in Townsend. Olive’s vision was approximately 20/100 and she struggled with reading, writing and activities of daily living. She received a low vision evaluation, 5x magnifiers, and a talking watch, a check writing guide, signature guide and pens. She was also provided a large print calendar for date management, a large print address book for information management and was signed up for Free Directory Assistance through the Townsend phone company. Olive was signed up and continues to receive Talking Books through the State Library. Olive eventually moved to Helena to be closer to family, doctors and medical facilities. Olive’s vision continued to decrease and she relied on support through the Older Blind Program as she was scared what she would do if she lost all her vision. She would often call and consult with us about what services we could offer if she went “totally blind”. Olive was especially worried about mobility and wanted to make sure she could ambulate “with grace”. Olive received orientation and mobility training for both travel and safety. Olive now lives in assisted living and uses a walker for all her mobility needs. Her walker has been marked with red and white reflective tape and Olive walks around her facility twice a day. Olive’s magnification needs have increased from her original 5x to a current 12x magnification. She now has wet macular degeneration and receives injections for this. Olive’s mind is still sharp but failing health has forced her to move into assisted living. She still has friends who come pick her up and take her places and she uses her low vision aids and blind techniques that we taught her to continue to live a quality life. She stated everything is going well and the Older Blind Program is a "ray of sunshine". She is so appreciative of our services and felt she would be extremely depressed if she had never known of our agency.

LM is a visually impaired person who resides in Great Falls during the summer and in Kingman, Arizona the rest of the year. He was a successful business owner in Arizona before experiencing vision loss due to diabetic retinopathy. The vision rehabilitation therapist taught LM how to administer his own insulin and use a talking glucometer. LM also received training on Guide (screen reader program) so he could send Email and perform other computer-related tasks. LM was signed up for the Montana Talking Book Program. The orientation and mobility specialist provided training in the use of the long white cane and how to navigate his neighborhood in Great Falls. He was also assisted with applying for a dog guide and in October 2012 he received a yellow Labrador dog guide and has been using him as his primary mobility aid ever since. LM and his wife decided to give up their home in Great Falls return permanently to Kingman where he resumed running his multiple location business. Because of the training offered by the vision rehabilitation therapist and the orientation and mobility specialist along with LM’s determination to succeed, he resumed his long-term career objective and has been able to live the life he wants.

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

Each year more individuals who apply for services as requesting services related to computer use. Providing consumers with both the training and assistive technology stresses the resources of the program is a large problem. While the Vision Rehabilitation Therapists (VRT) try to find solutions that don’t require the purchase of screen reading or screen enlargement programs, often the available “free” options are not sufficient for the consumers’ needs. Consumers must purchase the assistive technology programs themselves. Due to the large case sizes and time it takes to travel to communities across Montana, the VRT’s do not have time to properly train individuals in the use of the programs—they can only cover basic start-up training. They do make referrals to the Independent Living Centers and the one private company for additional training. The other aspect of this problem is how to keep the VRT’s current on the constantly changing technology. The other problematic issue relates to the size of Montana geographically. The Orientation and Mobility specialists and Vision Rehabilitation Therapists spend significant “windshield time” traveling from one community to another. They all spend an hour or more getting from one community to the next. In each region at least one community is three hours or more hours from the office; the longest being over eight hours away (500 miles). Because of the distance and three to six months of winter weather, the Older Blind individuals in those communities receive only a Band-Aid approach to services.

Part IX: Signature

Please sign and print the name, title and telephone number of the IL-OIB Program Director below.

I certify that the data herein reported are statistically accurate to the best of my knowledge.

Signed byJim Marks
TitleAuthorized Certifying Official
TelephoneOn file
Date signed12/31/2014