Vision Rehabilitation Services for Older People who are Visually Impaired

Who are our nation's elderly who are blind or visually impaired?

6.5 million Americans age 55 and older are blind or severely visually impaired. This population is expected to more than double by the year 2030, when the last generation of baby-boomers reaches age 65. Each year, only a fraction of older Americans experiencing age-related vision loss receives the vision-related rehabilitation services for which they are eligible.

What do older visually impaired people need?

Older blind and visually impaired people need to learn new ways to accomplish routine daily tasks. These new skills enable older people to live independent and productive lives, minimizing the need for more costly in-home or nursing home care. Specially trained rehabilitation teachers, orientation and mobility specialists, and low-vision therapists teach essential skills, including:

• Independent living skills—using specialized adaptive devices and techniques for personal and household management.
  
  
• Communication skills—using large print, writing guides, and time-telling devices, and using braille for reading or labeling and making notes.
  
  
• Mobility skills—using specific orientation and mobility techniques, long canes, and other mobility tools for safe and independent travel.
  
  
• Low-vision therapy—using special low-vision optical and adaptive devices.
  
  

How are vision-related rehabilitation services provided?

State rehabilitation agencies and private nonprofit community-based organizations provide special training to older visually impaired people. Instruction, which is provided by professionals specially trained in vision-related rehabilitation services, takes place either at the agency or in the older person's home.

What are the challenges facing vision rehabilitation services for older people?

The population of older people experiencing severe vision loss is growing faster than available funding and the availability of qualified rehabilitation personnel. Funding is inadequate for specialized agencies and professionals to develop and deliver services to the geographically and culturally diverse population of older people with visual impairments.

The primary source of federal funds specifically earmarked for vision-related rehabilitation services for the older population is Title VII Chapter 2 of the Rehabilitation Act (Independent Living Services for Older Individuals Who are Blind). Currently Medicare, Medicaid, and private health insurances do not provide reimbursement for specialized vision rehabilitation services, unless prescribed by a physician, typically an ophthalmologist or adaptive devices. However, efforts are under way to make vision rehabilitation services and professionals reimbursable through Medicare as a result of the Omnibus bill of 2000.

What can you do to protect specialized services for older people who are visually impaired?

• Support funding that preserves specialized services provided by agencies that serve blind and visually impaired people.
  
  
• Advocate for increased funding for the Title VII Chapter 2 Program to $35 million from $32 million.
  
  
• Advocate for third-party reimbursement for vision-related rehabilitation services through Medicare, Medicaid, and private health insurances.
  
  
• Ensure that older visually impaired people receive vision-related services only from specially trained professionals, whether at home, at an agency, or at a health care facility.
  
  
• Provide sufficient funding for university-level programs in rehabilitation teaching, orientation and mobility, and low-vision therapy to ensure adequate numbers of specially trained professionals.
  
  

References

McNeil, J.M. Americans with Disabilities 1991-2, U.S. Bureau of the Census, Current Population Reports, P70-33. Washington, DC: U.S. Government Printing Office, 1993.

Orr, A.L. Vision and Aging: Crossroads for Service Delivery. New York: American Foundation for the Blind, 1992.

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