broad range annual perspective 2019 2019our annual perspective provides a look into our program...

ANNUAL PERSPECTIVE 2019 2019

Central Blind Rehabilitation Center, Edward Hines Jr. VA Hospital

5000 S. 5th Ave, Hines, IL 60141

Email: [email protected]

Website: www.hines.va.gov/services/blindrehab.asp

MISSION

To provide

high-quality

blind

rehabilitation

through the

provision of a

broad range

of

rehabilitation,

education,

and research

/ technology.

mailto:[email protected]

http://www.hines.va.gov/services/blindrehab.asp

Central Blind Rehabilitation Center Annual Perspective 2019

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TABLE OF CONTENTS

TO OUR STAKEHOLDERS _______________________________________ 3

MISSION ACT __________________________________________________ 4

Access To Care __________________________________________________________ 4

What the Mission Act Means for Blind Rehab ___________________________________ 4

COMMUNITY SERVICES OUTREACH ______________________________ 5

Midwest Region outreach initiatives in 2019 included: ____________________________ 5

Professional Organizations include: __________________________________________ 5

Program Drivers _________________________________________________ 6

Falls/Patient Safety _______________________________________________________ 6

Smart Home _____________________________________________________________ 7

Special Programs/Head Mounted Devices _____________________________________ 8

Clinical Video Telehealth (CVT) and Video on Demand (VOD) Rehabilitation __________ 9

1A FACILITY COMPREHENSIVE PATIENT SUPPORT ________________ 10

Complex Needs Patients __________________________________________________ 10

Whole Health ___________________________________________________________ 10

Continuum of Care Blind Rehab ____________________________________________ 10

VIST _________________________________________________________ 11

Central Area Region______________________________________________________ 11

2019 STATISTICS ______________________________________________ 12

Access to Care __________________________________________________________ 12

Blind Rehabilitation Programs ______________________________________________ 12

Visual Diagnoses 2019 ___________________________________________________ 12


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TO OUR STAKEHOLDERS Happy New Year! Another year of serving our Nation’s Heroes with pride has come and gone. We have made advancements in Blind Rehabilitation, all for the purpose of providing the best care for our Blind and Visually Impaired Veterans and Active Duty Service Members. Our Annual Perspective provides a look into our program additions, outreach, whole health, continuum of care, and performance improvement. Of noteworthy mention, The Mission Act became law in June 2019. This law was designed to enhance Access to Care for our Veterans. Ensuring the right care at the right time is an ongoing goal for VA as well as Blind Rehabilitation. While new targets have been established as a result of this new law, we continue to strive to meet them as part of our performance improvement plan. As time marches on, it continues to bring change. Enhancements to our Blind Center Program has included Smart Home education and implementation, Head Mounted Devices (HMD), and an increase in video on demand services. All of these enhancements allow us to remain current with technology as it applies to blind rehabilitation and continues to race forward. The staff continues to remain very active in Community Outreach including local, regional, and national levels. At times we feel we are the ‘best kept secret’ in the Midwest. We love our Midwestern Veterans! We look forward to working with all of you in 2020. Opportunities abound and we continue to seek out chances to improve, advocate, and serve for our Veterans, ADSM, advocates and stakeholders. Thank you for your continued support.

Denise Van Koevering Chief, Central Blind Rehabilitation Center Edward Hines Jr. VA Hospital


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MISSION ACT

Access To Care

The U.S. Department of Veterans Affairs (VA) launched its new and improved Veterans Community Care Program on June 6, 2019; the MISSION Act. The VA Mission Act:

1. Streamlines and improves community care 2. Establishes a new urgent care benefit 3. Expands caregiver’s eligibility 4. Strengthens VA workforce 5. Strengthens VA infrastructure

What the Mission Act Means for Blind Rehab

Qualifying under “VA Specialty Care,” Blind Rehabilitation wait time parameters for admission to an inpatient rehabilitation program are not to exceed 28 days from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider. This new goal established in 2019 has created a challenge for the Central Blind Rehabilitation Center. Being a premier Center that offers Whole Health care options afforded at 1A Complex VA Facilities only, our wait list includes applications from blind rehabilitation centers that cannot support complex needs patients in need of services such as dialysis, spinal cord injury, or polytrauma/traumatic brain injury (TBI) team support. Additionally, our Single Area, CATS, and Dual Programs, (largely consisting of technology specific instruction) accounts for approximately 73% of all applications submitted in 2019. In 2019 alone, 16% of admissions were from outside the Central Area Region, this represents an increase of 4% from 2018. These factors have made meeting the 28 day mandate problematic.

VA serves approximately 9 million enrolled Veterans at 1,255 health care facilities around the country every year.

The Central Blind Rehabilitation Center served 319 Veterans in 2019.


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COMMUNITY SERVICES OUTREACH Community Relations efforts continue to be a priority in the Central Blind Rehabilitation Center’s operational processes. Educating the community, stakeholders, and other professionals with whom we work, is a part of our culture and an ongoing initiative that we feel passionately about. Community members often include non-VA state and local agencies that provide support to the Blind and Visually Impaired individuals, local community organizations, allied health students, Blind Rehabilitation Family Program Participants, co-workers and colleagues from other hospital services within the facility where our Center is located. All of these community members make up our Visitor Program. In 2019, this program supported 863 educational hours and 125 visitors to our program.

Midwest Region outreach initiatives in 2019 included:

Presentations on Head Mounted Devices and Adaptive Sports at the National BRS

Conference, Tulsa, OK Presentations on Healthy Eating, Smart Home, and O&M Phraseology at the Illinois

Association for Education and Rehabilitation of the Blind and Visually Impaired Presented on Adaptive Golf at the National Tee Tournament, Iowa City, IA Career Fair Marist High School, Chicago, IL Ophthalmology Immersion and Low Vision Awareness Month Educational Table-

Edward Hines Jr. VA Presentation on Night Mobility Lessons at the North Central Orientation & Mobility

Conference, Milwaukee, WI Presented on Blind Rehabilitation Services at the ophthalmology Conference 2019,

Chicago, IL

Additionally, the staff is active through membership in Professional Organizations that support

and advocate on behalf of the blind and visually impaired community. These organizations

provide an environment for Blind Rehabilitation professionals to network on program

developments, initiatives, and progress at the Local, Regional, and National levels.

Professional Organizations include:

Commission for the Certification of Rehabilitation Counselors (CRCC) Choroideremia Research Foundation Illinois Talking Book and Braille Advisory Committee Illinois Association of Education & Rehabilitation (IAER) Illinois Association of Orientation & Mobility Specialist (IOMS)


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PROGRAM DRIVERS

Falls/ Patient Safety

Patient safety is always a priority for those participating in the Blind Rehabilitation Program. Falls are an area of focus, as the safety of our Veterans is always in the fore front. Over the last several years, the number of falls by Veterans in the Blind Rehabilitation Program were on the rise. In 2019 we were able to reduce falls by 25% from the previous years’ totals. To address the falls of our Blind Rehabilitation Veterans, a Falls Program was implemented. Utilizing a nursing fall score assessment upon admission, the Veteran’s potential for fall risk is ranked. Factors that contribute to risks for falling include but are not limited to:

Vision loss Types of medications Age Physical disability Co-morbidities

When a fall occurs, a fall report is reviewed along with the situations surrounding each incident. This is completed, so that corrective actions can occur and preventative measures continue to be implemented. By implementing this process, falls have been reduced. Going forward our goal for 2020 is to further reduce falls from last year, and continue to emphasize fall prevention, education, and safe practices.


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Smart Home

Advancements in Technology have found their way into our homes in a variety of ways. While early home automation began in the mid-1970’s, it has come a long way with the latest devices used to help with day to day home operations. These advancements can help individuals with disabilities like blindness or visual impairment remain more independent. Blind Rehabilitation has made strides to reach beyond our physical facility to look into the future of home automation and incorporate it into our rehabilitation program. Home Automation Lab To give Veterans an exposure to Accessible Smart Home technologies. The Blind Rehabilitation Center has installed Home Automation tools in the Independent Living Apartments. With these tools, Veterans can explore various voice-controlled options for homes. Multiple options are available for demonstration including Amazon Echo Dot, Smart Locks, and voice-controlled thermostats like the Nest. Additional options include smart lighting and smart televisions and streaming media.

For example, a Veteran can walk into the room and say “Hey Siri, turn the lights on.” Or they can say, “Alexa, what is the current news,” or “Hey google, what is the weather like?” Although the Smart Home Industry is still competing to see which technology is most accepted. As the Home Automation industry matures, the Blind Center will work to keep pace with developments.

Echo Dot resting on a kitchen counter, ready to assist via voice-controlled commands.


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Special Programs/

Head Mounted

Devices (HMD’s)

The Central Blind Rehabilitation Center (CBRC) continues evaluation of equipment available for the visually impaired. Head mounted devices, or (HMD’s), provide technological assistance, such as magnification, optical character recognition, increased contrast and other features that offer assistance to the user, all within one device. The CBRC has developed a training program for HMD’s for our Visually Impaired Veterans. Head mounted devices are revolutionizing the way the visually impaired view their environment. During the training program each Veteran will complete an assessment to determine their needs and goals. These assessments assist in determining the appropriate device. Some common uses for HMD’s include reading, watching television, playing games and watching a sporting event. As always, core Blind Rehabilitation skills are essential in participating in any specialized training program. Photos here provide an example of an individual using an E-Sight

device, one of the many HMD’s that have been evaluated and incorporated into blind rehabilitation training.


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Clinical Video Telehealth (CVT) and Video on Demand (VOD)

Rehabilitation

Providing the right care at the right time supports Access to Care initiatives, and promotes Veteran Satisfaction. Offering alternative methods of care allow Veterans to choose the mode of care delivery. The VA offers virtual models/methods for providing patient care. A Veteran can be seen at a CBOC by his health care provider from Hines VA main campus, in virtual mode. A Veteran can now be seen in their own home by their provider, via cell phone, tablet, or computer. This is known as VIRTUAL CARE.

• VIRTUAL CARE Clinical Video Telehealth (CVT) made its debut in Blind Rehabilitation in 2017. Clinical Video Telehealth is a type of Virtual Care that links hospital and hospital, and hospitals with clinics, using real-time video conferencing technology on VA’s secure network. It allows Veterans and Health Care Providers to come together, from great distances, via video technology, to manage patient care. Blind Rehabilitation began utilizing this modality for Blind Rehab Program Reviews conducted via CVT with Visual Impairment Services Team (VIST) Coordinators located at Veterans’ home VA’s all through the mid-west region. This video technology is similar to a television with a camera, or a computer screen and a camera. Each individual uses a government issued device, and these devices call into a number which connects them via a secure network. Both parties can see each other on a screen and hear each other speak. We conducted over 25 CVT sessions in 2019 and continues to be utilized today. In 2019, VIRTUAL CARE has included Video on Demand (VOD) Rehabilitation Sessions. In this modality, Rehabilitation Specialists are able to meet with patients via their personal technology devices, (cell phones, personal computers, etc.) to teach technology-based rehabilitation. This modality involves the Veterans’ cell phone, tablet or personal computer. The provider sends a secure link via e-mail and both parties select the link and enter a secure virtual room (or meeting space) where training occurs. Again, both parties can see each other on a screen. A similar system widely available to society today is Face Time via Apple® Products. This innovation included developing a curriculum specific to Computer Access Technology classes such as iPhone, iPad, and adaptive computer applications. Over 50 Veterans were trained to use the VOD applications in 2019. The year ahead will determine how many Veterans utilized this methodology for encounters. We are exploring the use of this modality for Family Training Program sessions, and possibly mental health or whole health services.

CVT Session with health care providers and a patient at another site via telehealth video technology.


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1A FACILITY COMPREHENSIVE PATIENT

SUPPORT Edward Hines Jr. VA Hospital is a 1A Facility which indicates a very complex health care facility with a broad range of services and programs to support Veteran Health Care in the 21st Century. The Central Blind Rehabilitation Center is fortunate to be stationed at such a facility. This allows us to afford a broader range of support for many unique and special needs.

Complex Needs Patients Dialysis PTSD Care and Broad Spectrum Mental Health Services Amputation System of Care Spinal Cord Injury Unit Support Polytrauma/Traumatic Brain Injury (TBI) Team Support Blind Rehabilitation

Whole Health The Whole Health Initiative was implemented VA wide in 2017. This initiative helped move VA care from the traditional model to a more patient driven model. Today, many program options are available to help the whole person, not just the ailment or condition they are being treated for. Hines Central Blind Rehab has integrated many whole health initiatives into the program that help make blind rehabilitation more successful.

Continuum of Care Blind Rehab VA Blind Rehabilitation includes a continuum of care model that includes both outpatient and inpatient models of care. Utilizing these different models is the best way to get blind rehab care and services to patients in a timely fashion.

Blind Rehabilitation Outpatient Services Intermediate Low Vision Clinics Advanced Low Vision Clinics VISOR Programs VIST

Gym Fitness Program

Robust Recreation Program

TranstionsClass/ Group

ClassPsychotherapy

Smoking Cessation

Family Proram and FIscher

House Services


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VIST

Central Area Region

The Visual Impairment Services Team Coordinators (VIST) are one of the first contacts for a referral for blind rehabilitation. The Central Area Region encompasses the Midwest states and typically refer patients to the Central Blind Rehabilitation Center.

VIST Coordinator Location Contact Number

Richard Alden Ann Arbor, MI (734) 845-3064

Bill Bernhard Battle Creek, MI (269) 223-6607

Michelle Hough Black Hills, SD (605) 347-2511 x7991

Natalie Duarte DeEscalante Chillicothe, OH (740) 773-1141 x7855

Brian Joos Cincinnati, OH (513) 559-3567

Marianne Ryan Cleveland, OH (216) 791-3800 X2108

Lauren Swift Columbia, MO (573) 814-6458

Matthew Page Columbus OPC (614) 257-5325

Jeff Stroud Danville, IL (217) 554-5406

Karla Riste Dayton, OH (937) 268-6511 X3514

Wesley Hodgson Des Moines, IA (515) 699-5410

Jennifer Troyer Detroit, MI (313) 576-4888

Jody Schommer Fargo, ND (701) 232-3241 X33056

NovaLea Welch Ft Wayne /Marion, IN (260) 426-5431 x72650

Pat Zeinstra Hines, IL (708) 202-2351

Deanna Austin Indianapolis, IN (317) 988-2576

Keith Queen Iowa City, IA (319) 338-0581 x6889

Debora Pate Iron Mountain, MI (906) 774-3300 X34514

Melinda Dunlap Chicago, IL (312) 569-7531

Paul Clary-Archuleta Kansas City, MO (816) 861-4700 x56294

Dawn M. Clouse Leavenworth/Topeka, KS (913) 682-2000 x53825

Melinda Ciampolillo Lexington, KY (859) 281-3916

Julie Kennedy Louisville, KY (502) 287-5049

Kurt Brunner Madison, WI (608) 256-1901 x11960

Betty Howerton Marion, IL (618) 997-5311 X54815

Daniel Snyder Milwaukee, WI (414) 384-2000 X41832

Jennifer Points/Meghan Michelotti Minneapolis, MN (612) 467-1814 (612) 629-7009

Helen Witt North Chicago, IL (224) 610-7168

Ronita Bland Omaha, NE (402) 995-3188

Erin Shaw Poplar Bluff, MO 573-686-9784

Leland Lewis Saginaw, MI (989) 497-2500 X11852

Anna Perry Sioux Falls, SD (605) 333-6891

Lois Thesing St Cloud, MN (320) 255-6480 X7802

Jennifer Bach St. Louis, MO (314) 652-4100 x54121

Kari Arch Tomah, WI (608) 372-3971 x61831

VACANT Wichita, KS (316) 651-3682

Beth Levine Youngstown, OH OPC (330)740-9200 X1580


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2019 STATISTICS

Access to Care

Discharges 319 Average Wait Time 91 Days Length of Stay 34 Days

Blind Rehabilitation Programs

Single Area* 54 CATS 79 Regular 85 Dual* 101

*Including but not limited to iOS (iPhone, iPad, Apple Watch), Head-Mounted devices, Optical Character Readers, GPS, and CCTV. Dual Programs continue to consist of a combination of Basic core blind rehabilitation and Computer Access Technology specific to individual needs.

Visual Diagnoses

75

74

36

31

26

24

26

23

20

13

10

0 10 20 30 40 50 60 70 80

MACULAR DEGENERATION

GLAUCOMA

RETINITIS PIGMENTOSA

DIABETIC RETINOPATHY

OTHER

OPTIC NERVE DISEASE

OPTIC ATROPHY

HEAD TRAUMA

CATARACT

STROKE

RETINAL DETACHMENT

Visual Diagnoses 2019

The 2019 Annual Perspective is published by the Central Blind Rehabilitation Center Staff for VA Blind Rehabilitation stakeholders. Contributors for this issue include: Supervisor, CATS/Visual Skills, Elgersma, M.; Supervisor, Living Skills, McCarthy, L.; Supervisor, Orientation & Mobility, Cleveland, A.; Blind Rehabilitation Technology Specialist, Smith, D.; Communications Outreach Specialist, Suchie, A.; Assistant Chief, Brancheau, C.; Chief, Central Blind Rehabilitation Center, Van Koevering, D. Hines VA does not endorse the use of, or purchase of, any prosthetic devices cited in this publication.

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