Our clients
- Most of our 400 clients are living in their own homes.
- 84% are elderly, 75% are over 75, 44% over 85, and 7% over 95.
- We also have a few school-age clients.
- Half our clients qualify under federal poverty guidelines.
- Nevada County has the largest and fastest growing population over age
65—currently over 30% and growing each year. Many have avoided costly
institutionalization with our help.
Who is Eligible for our Services?
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Any resident the foothill communities of Nevada and Placer counties is
eligible if their vision loss creates a change in lifestyle or impedes their normal way of
living. This includes reading, driving, and mobility.
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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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Sierra Services
for the Blind and Visually Impaired