Older Americans Month and Vision Loss

Older Americans Month, Vision Loss, and Medicaid 

The month of May was older Americans Month and it got me thinking about blindness services for older adults with acquired vision loss. This May, were also in the midst of a federal budget that suggests cutting some 11 million people off Medicaid. Several years ago, when I worked for a non-profit, the director at the time, a former lawyer, who himself was blind, presented testimony at the state house, describing how vision rehabilitation services actually saved taxpayers money. He explained, for example, how an older person with an acquired vision loss, may assume they need the services of an assisted living or nursing home, if they could no longer cook, shop, or manage their medications independently. This is often the thinking that comes with a loss of vision. Afterall, if you’ve had vision your whole life, you generally have no idea how these things can be done independently with reduced vision or no vision at all.

 How much does the nursing facility cost Medicaid per year? $100K a year? More? OK, what is the salary of a Vision Rehabilitation Therapist (also called a VRT), whose job it is to teach adapted daily living skills, like shopping, cooking, and medication management—about $65K a year. And, of course, the VRT will not be spending their full-time with just one client, they might see a client one or two hours a week over a series of weeks to provide the needed training. So which is cheaper for taxpayers? The nursing facility, or40 hours of Adapted Daily Living training, with a VRT to remain independent in their home? Of course, it’s some adapted daily living skills training with the VRT.

 Ironically, the much cheaper solution, some vision rehabilitation training is also the one that most people want—they want to remain independent in their own home. Unfortunately, the cheaper solution is also the one that in nearly all cases is the more difficult to find. Why? Because there are very few VRTs—less than 600 nationally, and only about 3000 orientation and mobility specialists who teach similar daily living skills related to  independent outdoor travel with a vision loss. And, here’s the biggest kicker, Medicare, Medicaid and private insurance don’t cover their services. As a result, nearly all services from vision rehabilitation therapists and orientation and mobility specialists are funded through the Veteran’s Administration, the Rehabilitation Services Administration (RSA), part of the Department of Education, or private pay, out-of-pocket. The upside of the federal RSA funding is that it permits state agencies to provide vision rehab services at no cost to clients or on a reduced, sliding scale. The downside is, this funding is woefully inadequate, and it’s not been increased in years. Additionally, many states do such a poor job utilizing RSA funding that it never gets to clients in the form of meaningful services, and has to be returned to the federal government for redistribution. For an example, check out the article in the Atlanta Constitution on services in Georgia, July 25, 2024, “How a Broken Georgia Vocational Rehabilitation Agency Failed Disabled People.” And sadly, Georgia is not an outlier in terms of the mismanagement of rehab services.

 In addition to the mismanagement of RSA funding in some states, the overall pool of money for rehab services for Older Individuals who are Blind is totally inadequate at $33.3 million dollars annually. This is sufficient to fund services for only 3% of adults with a vision loss.

Sounds a bit grim doesn’t it? There are several things that you can do to advocate for positive change. First, if the senator or congress representative in your state voted for a budget that reduces Medicaid, call their office and demand it not be cut. Here’s the number 202-224-3121. Second, while you have them on the phone, remind them there is proposed legislation called Teddie-Joy’s Law that will increase the funding to the Older Individuals who are Blind (OIB) program, part of the RSA funds. Lastly, remind them that the most qualified, nationally certified, vision rehab professionals, like vision rehabilitation therapists and orientation and mobility specialists are not currently covered by Medicaid or Medicare.  Covering these services will save taxpayers money in the long run and help people with vision loss, live more independently. One more time, here’s the phone number to call your senator or congress member, 202-224-3121.