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Who are the clients of Sierra Services, what is
the need Sierra Services endeavors to fill, and what is the nature of the
program designed to meet the broader community need?
These often asked questions seem
simple enough. However, the answers are found in one of our nation's
fastest growing and most complex problems. Although 5% of the senior
population lives in nursing homes, 66% of them have ambulation problems.
The second largest group (48%) has the forgotten disability, blindness snd visual impairment (some are in both groups).
Those individuals with vision problems are often lost in large
generalized agencies attempting to serve all disabilities, but not
adequately staffed to deal with the problems of blind and visually
impaired indivduals. This problem is reaching
epidemic proportions among the elderly not served by these agencies. The
situation is further complicated by the desire of the elderly to retire
to a more rural community where services are often sparse or
non-existent.
As our society ages, the unique
problems related to the blind and visually impaired grow dramatically. At
age 80, one in four will be legally blind. Nevada County, as an example,
has the fastest growing over age 85 community in California. Foothill
communities like those in Nevada County have seen a growth in senior
population from 16% to 32% in nine years. Similar figures are true in the
foothill communities of Placer County and other regions with large
retirement populations. At the same time, low income communities in rural
farm and small towns also see a rise in vision related need in all age
groups. Fast growing suburban communities also include large senior
developments like those recently opened by the Del Webb Corporation in
Roseville and Lincoln. Their present population is early in their
retirement, younger and more active. The face of these communities will
change dramatically in time as their populations
age.
Blindness is a disability caused
by progressive diseases such as Macular Degeneration, Diabetes, and many
others and causes a change in lifestyle as defined by the Americans with
Disabilities Act, the ADA. It also targets certain populations, such as
the incidence of diabetic retinopathy in Hispanic and Indian populations.
According to national statistics presently being provided by Dr. J.E.
Crews of Mississippi State University, "The senior problem is one
with dire future consequences in both human and financial terms."
(Source: Dr. J.E. Crews, Educational Gerontology, 1988, Journal
of Visual Impairment and Blindness, 1991.)
Although the diseases which cause
blindness cause no other disability in and of themselves, the blind are 3
times more likely to have difficulty walking or getting out of a chair or
bed. They are 2 times more likely to have arthritis or cardiovascular
disease. They are 6 times more likely to have difficulty getting outside.
The blind are more likely to be poorer, have multiple impairements,
be women, or of racial minority than the general population. At age 80,
25% will be legally blind, and 20% of those will reside in long term care
institutions. We spend $6.9 Billion a year to institutionalize older
blind, which will reach $9.5 Billion in the year 2020. Most
older people exhaust their personal resources within 4 months of
institutionalization; further long term care must then be paid for at
public expense. As an example of "the disparity within the medical
community and financial resources designated to issues related to the
blind, ...if an older person has a stroke, medical rehabilitation care is
provided immediately and in most cases intensely. Mo one questions
vocational objectives; they simply assume a third party like insurance or
Medicare will cover the bill. Stroke rehabilitation addresses the same
fundamental issues as blind rehabilitation: travel, meal preparation,
communication, as well as activities of daily living. In fact issues of
mobility are also a common factor, with orientation unique to the blind who must not only learn to travel using new
techniques, but must learn to "find their way". Although there
is a designated rehabilitation agency in each state, there is no national
entitlement rehabilitation program designed for all elders who are blind.
In other words, unlike other disabilities, being blind does not mean that
an individual is automatically "entitled" to federal or state
rehabilitation services. ...Less than $6 million is appropriated
nationally to serve 2.7 million people." This is approximately $2.22
per person, per year. "Simply put, most elders who are blind are on their own."
The number of older persons with
severe visual impairment increased from 2 million in 1980 to 3.2 million
in 2000, and is projected to reach 4.6 million by 2020. In 1960 the
number of seniors in the 85 and over group with severe visual impairment
was 232,000; in 1980, 560,000; and by 2010 it is projected that the
over-85 age group will exceeded 1.6 million.
Our society is aging, and with it
will come specific medical issues which we must face.
The financial resources which
will be required to accommodate health related problems associated with
blindness, and the premature institutionalization now documented, must be
addressed. So too, the cost in human terms to both the individual and the
family." Dr. J.E. Crews
At the same time these national
figures are being accumulated for the first time, local applications
apply. In Nevada County the population has changed dramatically over the
last six years. First, Nevada County has a senior population of over 32%,
up from only 18% six years ago, and the fastest growing California
population over the age of 85. This is an identifiable segment of the
population. At age 80 one in four will be legally blind, also an identifiable
segment of the population. Using Department of Rehabilitation, Blind
Services Division, figures and conservatively
adjusting them by one-half, there are over 2,500 blind or visually
impaired elderly in Nevada County alone. These numbers are held true by
the statistical figures related to Sierra Services for the Blind which
now has approximately 400 clients. 84% are elderly. Of those, 75% over
75, 44% over 85 and 7% over 95.
These figures hold true of all
foothill and valley communities where low income and senior populations
congregate. What applies to Nevada County will be found similar to
communities surrounding Redding, Oroville and Chico; as well as the
Highway 49 corridor of Placerville, Jackson, Sonora or Mariposa.
Sacramento area needs will relate directly to Roseville as Paradise and
Auburn and other foothill communities relate to the changes occurring in
Nevada County.
Were there any other disease, or
group of diseases, which will cause a segment of the population to become
disabled at the rate of one in four, it would be declared an epidemic.
This, like so many health
problems related to the aging of our population, is a social problem with
medical consequences. This is not a cyclical change in our society, it is a structural change in the fabric of
our communities." Dr. J.E. Crews
To solve it we have to look not
only at the client as an individual, but at the community and how the
needs of the individual relate to the need of the community. Through
service to the individual, does the community benefit greater by the
inclusion of the individual, or by their exclusion through
institutionalization. Exclusion through institutionalization has
historically been use to protect the individual who can not care for
themselves, or those who pose a threat to society. With the proper
education the blind of all ages can care for themselves quite easily, and
can continue to be contributing members of the community.
How do you adjust the program to
the individual and the community?
The program designed and operated
by Sierra Services for the Blind is directed to provide the support and
educational programs necessary to meet individual, family self
sufficiency and medical prevention services, and to address and diminish
the need for the emergency and institutional services which may result
from the loss of vision. This will reduce the human and financial cost
not only for the individual and their family, but to the broader
community as well.
Rural blind and visually impaired
have unique access problems for the most basic of necessities. Common
questions include: "How do you get around in a community with less
than regular streets and few if any sidewalks? How do I get to the
doctor, the store, or the pharmacy for medication if I don't know where
it is, or there is no formal transportation system available to me. What if it is located in another city? How do I
keep from being a burden to my children?" This is particularly true
of the elderly clients. It is important that they be educated in their
own community to make the adjustment to their specific need.
These problems require a
comprehensive program which includes not only dealing with the fears
impressed on us from childhood, ("Things go bump in the
dark."), but provides the counseling, transportation, training and
skills needed for community access and home safety. This program is in
fact an interconnected program dealing with the entire problem, not just
aspects of it. It is designed to work with the entire individual need, and that of the family and community as well.
Within the blind and visually
impaired community, problems related to equal access are unique, so are
the solutions. Each individual thus becomes "the program",
rather than a program the individual must adjust to typically found in
metropolitan areas. To this end Sierra Services shall provide a
comprehensive program designed to teach the client to use skills required
to maintain their health and independence, and design it around their
specific community and physical ability.
What is critical after these
personal adjustments have been made is support for all of those aspects
the individual needs after the "educational" need has been met.
Mobility and access to the community and medical services are critical
issues to the blind and visually impaired, and their family as a whole.
The more we can assist the client to demonstrate independence the less
they are in their own mind a "burden".
Simply stated, the more the client can do for themselves during the day,
the less adjustment the broader family has to make. For those without
family support it is the desire of this program that the client be skilled enough to remain in their own home and not
have to lose their ability to retain their independence. In the elderly,
it may be the difference between independence and institutionalization.
Orientation and Mobility
training, commonly known as "white cane" training, is far more
It allows the blind and visually impaired to access the community. It
includes how to cross the street at the corner, how to negotiate in
unfamiliar surroundings, access transportation, how to enter a business
or shop for basic necessities, and how to access their own immediate
neighborhood if you wish to go for a walk. If there is no major
intersection in town, or transportation Orientation and Mobility training
may be the trip down the dirt road to the mail box, or the local market.
The walking cane may have to be a support cane. Independent Living Skills
Instruction is the same process for home use. The client learns to
organize the kitchen and home for their use, how to cook without getting
burned on the stove, and how to avoid going out wearing the orange shirt
with the green pants and one tan and one red shoe.
To accomplish this we use not
only the unique nature of Sierra Services, but we work with those other
local agencies which provide other supportive services. County nursing
and counseling services are but one example. It is our policy to
cooperate rather than duplicate. Orientation and Mobility requires a
licensed professional and is a high cost program and is provided on an as
needed basis.
Two basic psychological needs
which are of absolute necessity to the rest of the program are also
included. First is the Peer Counseling Program out of which individual
assessment and the roots of rehabilitation occur. The loss of vision
creates depression and low self esteem in all clients. It is a part of
the emotional process, and it effects different
people in different ways. What is common is the loss of self confidence
needed to go out. The program is designed to build self esteem,
confidence, and a simple sense of humor about blindness. Blindness may
foster isolation, and the simple fact of finding others with your
problems lets you know you are not alone. Developing an active community
within a community is the often accomplished as new friends with similar
interests develops. All are needed before the client thinks they can
become independent. As example, once accomplished, we can provide a
series of community access and other programs to enhance the new found
independence. This socialization aspect is critical to bring the blind
back into the community with full participation.
Also critical is the
transportation to get there. The blind don't drive. In rural communities
fixed transportation is virtually nonexistent. Sierra Services must
provide transportation for it's own programs,
and for medical needs which if not attended can turn a simple vision
disability into a multiple disability and institutionalization. This
cause and effect between vision loss and general health is especially
true of the elderly. Sierra Services not only provides transportation to
and from it's programs, but use an extensive program of volunteers to
whom we pay mileage to fill in where the van can not. In outlying areas,
it is often easier to transport staff than every client, especially if
the staff person is a blind peer counselor. It is critical these services
be developed locally as each community varies both by the physical
barriers it presents and the level of other support services.
The overall program often
includes the ability of the client to maintain financial independence. If
the individual must move in with family, or placement in "the
home", they not only lose some personal independence, but in many cases the financial ability to use the resources of
the community. The blind and visually impaired would also like to access
the local restaurant or coffee shop with friends, buy the birthday
present, or get up in the morning and answer to themselves like they
always have. They have lost vision. The human need remains the same. Only
the methods the client uses to retain independence and access change.
Rural communities and isolation are an issue even if you have not lost
vision, and it is critical if you have.
The overall goal of the program
provided by Sierra Services and the client's hope of achievement are
essentially the same. We intend to give the rural and low income client
access to professional services, self esteem, confidence, and education
necessary to achieve optimum health and personal independence, to access
the broader community, and to reduce the risk of institutionalization,
which is expensive in both financial and human terms.
How does Sierra Services fund
itself in the smaller rural economy?
That is the biggest threat to the
program, and the agency. Most granting agencies and foundations are
centered around large metropolitan areas, and
don't fund outside their service area of interest. Also, blindness is the
least funded of all disabilities, partly because beyond early stage
magnification there is no mechanical fix. You can not say I will use your
money to buy this device which is proven to do this. We are a human
service, and that is hard to put a dollar amount to. Many grants require
you do something "new", and our program has been developed by
experience over 24 years. It is a program designed to ask what is needed,
not dictate a fixed generalized program. It is hard to explain 400
clients mean virtually 400 programs, and that a staff of as small as four
can do it.
As to the extent of the problem
as it relates to the availability of rural services, a recent federally
sponsored national survey conducted by the Lighthouse for the Blind in
New York City found that Sierra Services for the Blind is indeed unique.
Our program to bring low vision assistance to the community and access to
specialty equipment by maintaining equipment in our offices for use by
the clients own doctor unparalleled. All other low vision facilities are
centrally located and require the inconvenience and expense and duplication
of a new medical evaluation. They found no other full service agency for
the blind serving exclusively in rural communities in the nation.
Interestingly, the $850,000 which
funded the one year study could have funded Sierra Services for the Blind
and Visually Impaired for almost 8 years.
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