VR-SFP Chapter 10: Independent Living Services for Older Individuals Who Are Blind

Independent Living Services for Older Individuals Who Are Blind (ILS-OIB) focuses on adjustment to blindness and development of skills so that customers can live confidently and independently in their homes and communities. The program's goals are to empower individuals with disabilities; maximize their leadership potential, independence, and productivity; and ensure their integration and full inclusion in society.

The ILS-OIB program promotes independent living by encouraging self-control, self-help, and self-determination, and by promoting equal access and individual and systemic advocacy. The program assists customers address the impact of their loss of vision so that each customer can achieve their independent living goals.

ILS-OIB helps customers:

• who are age 55 and older;
• whose have significant visual impairment;
• whose ability to function independently in the home, family, or community is substantially limited due to visual impairment; and
• for whom the delivery of independent living (IL) services will substantially improve their ability to function, continue functioning, or move toward functioning independently in the home, family, or community.

IL services provided by a contractor can only be provided when authorized by the TWC-VR OIB worker to address goals in a customer’s Independent Living Plan (ILP).

IL services are provided in person with the trainer and customer at the same location. IL services within this chapter cannot be provided remotely.

Any request to change a Service Definition, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director, using the VR3472, Contracted Service Modification Request for Blind and Visually Impaired Services, before the change is implemented. The approved VR3472 must be maintained in the provider’s customer case file. For more information, refer to VR-SFP 3.6.4.2 Evaluation of Service Delivery.

A provider's services can include one or more of the following:

• IL Skills Training
• Orientation and Mobility (O&M) training
• Diabetes Management Training
• Braille Instruction
• Equipment
• Guide Services
• Reader services
• Transportation
• Information and Referral (I&R)
• Peer counseling
• Individual and family advocacy training
• Advocacy training for the family
• Transition services, for moving a customer from a nursing home or other institution to the customer's home or other residence in the community, along with the necessary individual support services

For information on O&M training and Diabetes Management Training, see Chapter 5: Orientation and Mobility Services and Chapter 7: Diabetes Self-Management Education Services.

Other services include referral to and information to outreach services such as visual screening, surgery, or therapeutic treatment to prevent, correct, or modify disabling eye conditions, and hospitalization related to these services.

For information on acceptable signatures refer to VR-SFP 3.11.1 Documentation and Signatures.

10.3.1 Service Description

Scope of Services

Providers of IL skills services offer a variety of services in the customer's home or community.

Providers may provide one or more of the following, as authorized by the OIB worker:

• Application Assessment—the process of gathering referral data and information about the customer's preliminary need for services. The information, along with eye medical reports, is used by the OIB worker to determine an individual's eligibility for the ILS-OIB program.
• Comprehensive Assessment—the process of working with the customer to identify the issues that prevent him or her from functioning independently. The assessment, which occurs after the OIB worker determines eligibility, can also help a customer maintain or increase his or her independence. Comprehensive assessment includes listening to the customer describe problems related to the loss of vision, conducting an in-depth interview to gather information, observing as the customer demonstrates his or her skills at home, and talking with family members or caregivers to gather any additional information. The comprehensive assessment is used by the OIB worker to develop the Independent Living Plan (ILP).
• Independent Living Skills Training—training in techniques that enable a customer to perform daily living skills in alternative ways. IL skills are divided into the following categories:
  • Personal management—including grooming, eating, health, safety, clothing identification and coordination, and the use of medications
  • Home management—including sewing, cleaning of clothing, housekeeping, meal preparation and kitchen safety skills, planning for grocery shopping, and minor home maintenance
  • Communication—including telling time and time management, using the telephone, money management, writing, organization, and using adaptive devices
  • Information access and technology—including training on the use of magnifiers, CCTVs, and other devices for low-vision, as well as adaptations of computers and other types of technology.
• Information and Referral (I&R) —services that help the customer identify and use alternative resources, such as Meals on Wheels and the Texas State Library to meet his or her individual needs. I&R services can be provided at any point in the independent living process.

10.3.2 Process and Procedure

Directing IL Skills Training

The OIB worker coordinates casework and directs the IL skills provider in the provision of services.

The OIB worker:

• sends referrals to the IL skills provider for initial contact and application assessment;
• enters application information into the electronic case management system;
• determines customer eligibility for IL services;
• refers eligible customers to the IL skills provider for comprehensive assessment;
• develops the ILP with the customer and enters it into the electronic case management system;
• authorizes IL skills training hours;
• manages case records;
• reviews the documentation of services provided by the IL skills provider;
• authorizes the purchase of recommended equipment and services;
• documents the purchase of equipment and services in each customer's ILP; and
• arranges or provides for more complex services, including (but not limited to) braille instruction, orientation and mobility training within the customer's community, and diabetes education and training.

Case Management

The OIB worker:

• determines a customer's eligibility for IL services;
• refers an eligible customer to the IL skills provider for specific IL services;
• manages case records for an eligible customer;
• reviews and approves individual training programs jointly developed by the IL skills provider and the customer;
• incorporates approved individual training programs into each customer's ILP;
• reviews documentation on the IL services provided by the IL skills provider;
• authorizes the purchase of recommended equipment and services;
• documents the purchase of equipment and services in each customer's ILP; and
• arranges or provides for more complex services, including braille instruction, orientation and mobility training within the customer's community, and diabetes education and training.

IL Skills Provider Responsibilities

The authorized IL skills provider:

• completes the application assessment;
• provides services as directed by the OIB worker and as described under the scope of services identified in the assessment;
• conducts a comprehensive assessment;
• submits the appropriate documentation for each type of service to the OIB worker for review and approval;
• provides training in basic independent living skills, as described in the comprehensive assessment and ILP;
• periodically assesses each customer's progress toward goals and timelines with the OIB worker;
• submits appropriate recommendations for purchasing products and services for each customer to the OIB worker; and
• provides the OIB worker with a written report of each contact and includes details of the assessment or service provided and the outcome.

Initial Contact

The IL skills provider must make the initial contact with a customer who is referred for independent living skills training within 15 working days of the referral.

Application Assessment

The application assessment must be completed within one to two hours of the initial contact.

The initial contact and application assessment must be conducted individually and must be documented using the following forms:

• VR5051, Application for Services
• VR5053, Application Statement—ILS-OIB
• VR5060, Permission to Collect Information
• VR5061, Notice and Consent for Disclosure of Personal Information
• VR2891, Customer Services Report: ILS-OIB Progress Report

Comprehensive Assessment

The IL skills provider must contact a customer who is referred for a comprehensive assessment within 30 calendar days of the referral.

The IL skills provider must document the comprehensive assessment on VR2954, Comprehensive Assessment for Independent Living Program. The recommendations section of the form must list the IL skills training sessions and services that the IL skills provider has identified for inclusion in the customer's ILP.

Independent Living Skills Training

After the OIB worker has developed the ILP, the IL skills provider provides monthly training services as authorized by the OIB worker. The OIB worker documents the services each month using VR2891, Customer Services Report: ILS-OIB Progress Report.

The monthly progress report (VR2891) must:

• detail the services provided to the customer;
• document the outcome of each service; and
• include any recommendations for changes to the ILP.

Provider Authorization

Services must not begin until a service authorization has been issued.

Providers must have written authorization from ILS-OIB before providing services to a customer. If a service is provided before a service authorization is issued by ILS-OIB and received by the provider, ILS-OIB will not authorize payment for the service.

For additional information about provider authorization, see

• Chapter 1: Introduction to Vocational Rehabilitation,
• Chapter 2: Obtaining a Contract for Goods and Services, and
• Chapter 3: Basic Standards.

10.3.3 Outcomes Required for Payment

To facilitate payment after the assessment and/or training period, the provider of IL skills services submits the following (as applicable) at least every 35 days, using clear and descriptive terms:

• VR5053, Application Statement—ILS-OIB—after an application assessment is completed
• VR2954, Comprehensive Assessment for Independent Living Program—after a comprehensive assessment is completed
• VR2891, Customer Services Report: ILS-OIB Progress Report—at the end of the assessment and/or training period

The information entered must demonstrate the following:

• Attendance was recorded (include the total number of hours that the customer participated in services).
• All necessary accommodations were provided, compensatory techniques were used, and special needs were met for the customer to successfully participate in the services.
• The customer's performance, skills, and needs were assessed and the results summarized for the reporting period.
• The goals and objectives were measurable and established for all skills to be addressed.
• A projected timeline, including training hours, was established for each goal.

ILS-OIB does not pay fees related to excused or unexcused absences or holidays.

Payment for IL skills services is made when the OIB worker approves a complete, accurate, signed, and dated:

• invoice; and
• form (as applicable):
  • VR5053, Application Statement; and/or
  • VR2954, Comprehensive Assessment for Independent Living Program; and/or
  • VR2891, Customer Services Report: ILS-OIB Progress Report.

10.3.4 Fees

For more information, refer to 10.6 IL Skills Training Fee Schedule.

Diabetes self-management and education services are used to:

• assess the customer's ability to independently manage his or her diabetes at home;
• assess the customer's ability to independently manage his or her diabetes in the workplace;
• prepare a customer to make informed choices about his or her diabetes; and
• help the customer develop the confidence and skills to implement his or her choices.

For the definition of this service and for information on related guidelines, processes, and fees, refer to Chapter 7: Diabetes Self-Management Education Services.