Steinman, Bernard A. ; Moore, J. Elton

Collaborative activities by state older blind independent living programs.(Research Reports)

Steinman, Bernard A.; Moore, J. Elton

Journal of Visual Impairment & Blindness, Nov, 2007, Vol.101(11), p.715(6) [Peer Reviewed Journal]

The need for greater collaboration between agencies that serve persons with disabilities and the aging network has been widely acknowledged by researchers and advocates who have recognized the emergence of a common and rapidly expanding consumer base, made up of older individuals who have aged with disabilities and those who have developed disabilities as a result of aging (Ansello, 1992, 2000; Crews, 1994, 2003; Orr & Rogers, 2006; Putnam, 2002, 2007; Torres-Gil & Pynoos, 1986). Whereas the need for and cost of long-term care services are expected to continue to rise over the next 40 years (Gonyea, 2005), service providers who are faced with ever-tightening budgets will need to strengthen their network bonds to enhance the flow of information and to ensure that scarce resources are used effectively.

In particular, public and private agencies that serve older people who are visually impaired (that is, are blind or have low vision) under the Older Blind Independent Living program (Title VII, Chapter 2, of the Rehabilitation Act of 1973, as amended--hereafter, VII-2) may have much to gain by creating interactive relationships with agencies within the aging network. The unprecedented growth of the oldest demographic group portends a greater number of individuals who will acquire vision-related disabilities as they age (Crews, 1994). Lighthouse International (2005), a nonprofit advocacy, training, and research organization for people who are visually impaired, estimated that some 14.8 million Americans aged 65 and older will report some form of vision loss by 2030. Presumably, many of these individuals could benefit from vision rehabilitation services, in conjunction with other long-term-care services provided by the aging network.

Collaborative relationships that are formed between VII-2 programs and the aging network have the potential to be mutually beneficial among programs because of the unique services provided by each of the programs. Independent living services for older people who are blind are regulated by the Rehabilitation Services Administration (RSA) and are administered by designated state units (DSU) in each state. VII-2 independent living services that are available (but not necessarily provided) under the program include services to help correct blindness (including visual screening and surgical or therapeutic treatment); hospitalization related to such services; the provision of visual aids (such as magnifiers or eyeglasses); and other specific services that are designed to assist older individuals to adjust to blindness, maintain independence, and become more mobile and more self-sufficient (for example, information and referral services, peer counseling, individual advocacy training, mobility training, or braille instruction) (Orr, 1998). In addition, services provided under VII-2 may include functional skills training that enables older adults who are visually impaired to make better use of programs that are otherwise available to older adults in general by increasing their confidence and improving their mobility.

Agencies and organizations that address long-term-care needs in the aging network offer an array of services that complement those that are provided under VII-2. Nevertheless, administrators of state VII-2 programs who seek to form relationships with entities within the aging network face a fragmented, often daunting, array of public and private services, charitable organizations, and clubs with which they could collaborate. Often, entities are only loosely structured within a larger network, and a diverse array of aging services may be provided by any number of organizations in an area. Therefore, the type and quality of services that are available is likely to vary from region to region. To compound the problem of fragmentation, private service providers (many of whom contract with state vocational rehabilitation agencies) may join or leave the network at any time, resulting in an aging network that is always in flux. The dynamic nature of the aging network, as well as administrative differences (such as inconsistent eligibility requirements) may make collaborative relationships difficult to form and maintain over long periods.

Nevertheless, consumers in VII-2 programs may have much to gain by partaking of services that may be available to them through the aging network. Building stronger alliances that focus on the sharing of information and resources among service providers could enhance the use of long-term-care services by VII-2 consumers. Conversely, agencies that serve primarily older adults could benefit by referring their consumers who are visually impaired to VII-2 programs. The Older Blind Independent Living program has been shown to improve consumers' ability to move confidently around their homes, prepare meals for themselves, manage housekeeping tasks, and engage in other activities that are consistent with the general goal of long-term care--to help elderly people maintain an independent lifestyle (Moore, 2003; Moore, Steinman, Giesen, & Frank, 2006).

Effective integration of the VII-2 program into the larger long-term-care system depends on the development of collaborative relationships among agencies that are mutually beneficial to each agency. The purpose of this article is to summarize efforts made by state independent living programs for older people who are blind to interact with other agencies, with the goal of developing a more effective service-delivery system for older long-term-care consumers who are visually impaired.

METHOD

We examined the Annual Report for Independent Living Services for Older Individuals who are Blind (Form ED [RSA]-7-OB), collected by RSA. Analyses included reports submitted to RSA by all 50 states and the District of Columbia for fiscal year 2005 (the territories were excluded). In particular, we analyzed Part V, Section A(3), which asked DSUs to describe any new methods and approaches related to collaborative activities that were undertaken during fiscal year 2005 to improve or expand community services or programs for older individuals who are visually impaired. Activities that are listed in this section of the report are recommended for incorporation into the State Plan for Independent Living under Section 704, which spells out each state's goals and objectives, plan for the provision of resources, and evaluation plan for independent living programs.

Responses to Part V, Section A(3), were coded and categorized by theme into 10 major categories and a miscellaneous category that represented the most frequently mentioned means for collaborating with outside organizations and agencies. Specific subgroups within the larger aging network grouping were tallied and reported to provide greater detail about the types of collaborations that were undertaken by state or federal independent living programs for older people who are blind with state and local aging agencies. The results are presented in Tables 1 and 2 as percentages of DSUs that participated in each type of collaboration, with frequencies in parentheses.

RESULTS

The number of collaborative efforts reported by DSUs ranged from 0 to 25 (M = 8.22, SD = 6.14). Table 1 presents the percentage and frequency of DSUs that reported collaborations within each major category.

Other rehabilitation programs

The type of collaboration was most frequently mentioned in the report we analyzed was that with other federally funded programs that provided rehabilitation or related services to older adults with disabilities. The majority of DSUs (55%) reported a collaborative relationship with at least one different rehabilitation program, including state independent living centers that are authorized by Title VII, Chapter 1, of the Rehabilitation Act; state community rehabilitation programs; and agencies of the U.S. Department of Veterans Affairs (VA).

Aging network

Overall, 49% of the DSUs reported working collaboratively with programs and agencies that make up the aging network. The formal aging network is funded through the Administration on Aging and is administered by the states and local regions through 57 State Units on Aging (SUAs) and 670 Area Agencies on Aging (AAAs), respectively. Services are provided directly by AAAs or are contracted out to more than 25,000 associated private service-providing agencies. Twenty-nine percent of the DSUs explicitly mentioned a collaborative relationship with their state's SUA, and 29% mentioned a relationship with at least one AAA in their state (see Table 2).

Collaborations with agencies within the aging network that provided specific long-term-care services were mentioned frequently by the DSUs (see Table 2). The services that were mentioned included transportation, senior centers, nutrition programs, housing, legal assistance, and information and referral services.

Organizations composed of persons who are visually impaired

Many DSUs (41%) reported collaborative relationships with organizations or groups that are composed of and operated by members who are visually impaired, including relationships with two national consumer groups or their state affiliates--the National Federation of the Blind and the American Council of the Blind--and consumer support groups developed and attended by older adults with visual impairments.

Universities or colleges and libraries

Thirty-seven percent of the DSUs reported a collaborative relationship with at least one university or college or library facility. For example, one DSU collaborated with the Rehabilitation Research and Training Center (RRTC) on Blindness and Low Vision at Mississippi State University and received training in cutting-edge vision rehabilitation services developed at RRTC from an array of local community providers. Similarly, libraries for persons who are blind provided any number of resources that could benefit DSUs and their consumers, including large print, braille, and Talking Books. Public libraries also provided space for holding informational meetings about the VII-2 program and displayed or distributed pamphlets that described available vision rehabilitation services to the general public.

Charitable and service organizations

Overall, 35% of the DSUs reported collaborative relationships with nonprofit charitable organizations, including charitable fraternal or community service organizations, and faith-based charities or religious organizations. The most frequently mentioned community service organization was Lions Club International, which devotes a large proportion of its financial and volunteer resources to eliminating preventable blindness by supporting eye hospitals and vision clinics.

Professionals and facilities

More than a third of the DSUs (35%) reported collaborating with at least one medical or other vision professional or facility. This category included interactions with ophthalmologists, optometrists, and low vision specialists, as well as other health professionals such as social workers, occupational therapists, and physical therapists.

Organizations serving persons who are visually impaired

Overall, 24% of the DSUs mentioned working collaboratively with at least one organization that serves individuals who are visually impaired. This category contained agencies that advocate for and may provide services to older adults who are visually impaired, including the American Foundation for the Blind, and national or state-level organizations, such as schools for people who are blind or deaf-blind (such as Hadley School for the Blind and Helen Keller National Center for Deaf-Blind Youths and Adults).

Health groups

Many DSUs (almost 20%) reported collaborative relationships with agencies or organizations that provide information about the maintenance of visual health (such as diabetes awareness) or the prevention of age-related vision diseases and mental health.

Assistive devices and technology

Approximately 20% of the DSUs reported collaborating with at least one organization that sold assistive devices or provided training in the use of assistive technology to older adults who are visually impaired.

Professional organizations

Nearly 12% of the DSUs reported collaborative relationships with organizations whose members are professionals (researchers, educators, practitioners, and policy makers) in the fields of aging or disability (including the Gerontological Society of America, American Society on Aging, National Council on Aging, and Association for Education and Rehabilitation of the Blind and Visually Impaired or its state chapters).

Miscellaneous

Virtually all the DSUs reported some innovative collaboration that could not easily be categorized within the themes just described. For example, many of the cited collaborations were designed to improve outreach and services to consumers with special vision-related needs. Several DSUs reported becoming involved with agencies that provided unique services that are designed to alleviate social isolation among elderly people. Some DSUs focused on forming collaborations that would address timely problems faced by their aging consumers. For instance, several states teamed with Medicare representatives and insurance information programs to disseminate information about the new Medicare Part D prescription drug program to their consumers.

DISCUSSION

Our research shows that collaboration between DSUs that administer state VII-2 programs and agencies that serve older adults is widespread. Although our data source provided general information with respect to the intensity and outcomes of collaborations maintained by VII-2 programs, our findings suggest that DSUs have formed important relationships with an array of outside agencies. Bridging the gap between aging services and VII-2 independent living services is a mandatory step if gaps within the continuum of care are to be adequately filled. Effective integration of the VII-2 program into the larger long-term-care system is dependent on adequate communication and information sharing between these groups of programs. Developing relationships among agencies can lead to collaborative efforts (big and small) that mutually benefit each agency or organization.

Implications for agency administrators

The results of our research suggest several implications for DSUs and administrators of state vocational rehabilitation agencies. One would expect that all DSUs would be actively involved with other rehabilitation or independent living programs in their states and especially with the aging network (SUAs and AAAs). For example, every DSU should have collaborative relationships with the rehabilitation program of VA, especially given the number of veteran baby boomers who are experiencing vision loss. Likewise, given the number of nonveteran baby boomers older than age 55 with severe vision problems, every DSU should be actively involved with its local aging network, especially AAAs and senior centers.

On the basis of our experiences in conducting the program evaluation component for several state VII-2 projects, we suspect that DSUs are far more involved with organizations of and for persons who are visually impaired than these data suggest. This limited level of collaborative activity with the aging network (especially SUAs and AAAs) and organizations of and for persons who are visually impaired may be more reflective of reporting deficits in the RSA Form 7-OB. It is essential that program managers who administer the VII-2 program encourage their own state and contractor service-delivery staff members to become more actively involved in establishing collaborative relationships with community rehabilitation programs, independent living centers, VA centers, and especially their local AAA and SUA. These efforts should also be reflected in the State Plan for Independent Living, as required in Section 704 of the Rehabilitation Act of 1973, as amended. There is every reason to believe that enhanced collaboration among such entities will improve the quality of independent living services that are provided to some 66,000 consumers annually under the VII-2 program.

The authors express their gratitude to Suzanne Mitchell and Veronica Hogan at the Rehabilitation Services Administration in Washington, DC, for providing access to the data that are used in this analysis.

REFERENCES

Ansello, E. F. (1992). Seeking common ground between aging and developmental disabilities. In E. F. Ansello & N. N. Eustis (Eds.), Aging and disabilities: Seeking common ground (pp. 9-24). Amityville, NY: Baywood.

Ansello, E. F. (2000). Aging and disabilities: Collaborative practice and public policy. In J. E. Crews & F. J. Whittington (Eds.), Vision loss in an aging society: A multidisciplinary perspective (pp. 181-209). New York: AFB Press.

Crews, J. E. (1994). Aging and disability: The issues for the 1990s. In S. E. Boone, D. Watson, & M. Bagley (Eds.), The challenge to independence: Vision and hearing loss among older adults (pp. 47-60). Little Rock: Rehabilitation Research and Training Center for Persons Who Are Deaf or Hard of Hearing, University of Arkansas.

Crews, J. E. (2003). The role of public health in addressing aging and sensory loss. Generations, 27(1), 83-90.

Gonyea, J. G. (2005). The oldest old and long-lived society: Challenges for public policy. In R. B. Hudson (Ed.), The new politics of old age policy (pp. 156-180). Baltimore, MD: Johns Hopkins University Press.

Lighthouse International. (2005). Projected estimates of vision impairment. Retrieved October 10, 2007, from http://www.lighthouse. org/research/statistics-on-vision-impairment/ projected

Moore, J. E. (2003). Using program evaluation to improve service delivery for older individuals who are blind. Journal of Visual Impairment & Blindness, 97, 42-45.

Moore, J. E., Steinman, B. A., Giesen, J. M., & Frank, J. J. (2006). Functional outcomes and consumer satisfaction in the older blind independent living program. Journal of Visual Impairment & Blindness, 100, 285-294.

Orr, A. L. (1998). Issues in aging and vision: A curriculum for university programs and in-service training. New York: AFB Press.

Orr, A. L., & Rogers, P. A. (2006). Aging and vision loss: A handbook for families. New York: AFB Press.

Putnam, M. (2002). Linking aging theory and disability models: Increasing the potential to explore aging with physical impairment. The Gerontologist, 42, 799-806.

Putnam, M. (2007). Moving from separate to crossing aging and disability service networks. In M. Putnam (Ed.), Aging and disability: Crossing network lines (pp. 5-17). New York: Springer.

Torres-Gil, F., & Pynoos, J. (1986). Long-term care policy and interest group struggles. The Gerontologist, 26, 488-495.

Bernard A. Steinman, M.S., research assistant, Andrus Gerontology Center, University of Southern California, Los Angeles, CA 90089-0191; e-mail: <bsteinma@usc.edu>. J. Elton Moore, Ed.D., professor and associate dean for research and assessment, College of Education, Mississippi State University, P.O. Box 9710, Mississippi State, MS 39762; e-mail: <jemoore@colled.msstate.edu>.

Table 1

Percentage and frequency of collaboration, by

category, reported by designated state units.

Categories Percent Frequency

Rehabilitation programs 54.9 28

Aging network 49.0 25

Organizations of persons

who are blind 41.2 21

Universities or colleges

and libraries 37.3 19

Charitable organizations 35.3 18

Professionals or facilities 35.3 18

Organizations for persons

who are blind 23.5 12

Health groups 19.6 10

Assistive devices or

technology 19.6 10

Professional organizations 11.8 6

Table 2

Percentage and frequency of designated state

units reporting collaboration with formal

aging-network entities providing specific

long-term-care services.

Service and subgroup Percent Frequency

State Units on Aging 29.4 15

Area Agencies on Aging 29.4 15

Transportation 25.5 13

Senior centers 25.5 13

Nutrition 11.8 6

Housing 3.9 2

Legal assistance 3.9 2

Information and referral 1.9 1

Steinman, Bernard A.^Moore, J. Elton

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