In the U.S., there are approximately 160,000 legally blind veterans. When you factor in the number of veterans diagnosed with low vision, the number jumps to more than one million veterans.
To treat these veterans and help them adjust to life with limited vision or blindness, the Department of Veterans Affairs (VA) has expanded their number of rehabilitation programs for blind and low vision veterans. Under this continuum of care, which started in 2007, the VA has established a total of 55 outpatient programs.
According to Tom Zampieri, director of government relations for the Blinded Veterans Association, this has markedly improved access for blinded and low vision veterans and decreased waiting time. "We've already seen a large increase in the number of veterans using the programs," said Zampieri. "In 2007, there were 46,000 blinded veterans enrolled in the VA. Today, there are 49,000."
There are many reasons for this increase. First of all, new types of outpatient services become available, those who didn't have access to care previously can (and will) go to the VA for care. Additionally, as Zampieri points out, state governments are slashing their social programs. As a result, veterans in some states are moving to VA-based care in greater numbers to gain access to the types of programs they need.
Continuum-of-Care Services
The VA uses a variety of blind rehabilitation services that follow a continuum-of-care model. In this model, services and programs extend from the veteran's home environment to a local VA-care site, as well as regionally based in-patient training programs to create a wide array of rehabilitative services.
In addition to the in-patient blind rehabilitation centers (BRC), the main components of continuum-of-care include:
- Visual impairment services outpatient rehabilitation programs (VISOR);
- Visual impairment centers to optimize remaining sight programs (VICTORS); and
- Blind rehabilitation outpatient specialists programs.
There are 10 BRCs across the country with locations in Illinois, California, Connecticut, Washington, Texas, Alabama, Puerto Rico, Arizona, Georgia and Florida. These in-patient programs offer an average of six weeks of training. Most of the veterans that use these programs either have experienced traumatic vision loss (rather than gradual loss of vision), or have other medical issues and require more supervision in training skills.
At the BRCs, highly qualified staff members help veterans achieve a realistic level of independence. The veteran is also assisted in developing a healthy attitude toward themselves, blindness and the future. They do this via a number of specific training programs including:
- Orientation and Mobility: These sensory training classes teach veterans how to use their remaining senses to help them as they move through a variety of environments.
- Living Skills: These include enhancing and restoring both written and spoken communication capabilities, addressing activities of daily living, and adjusting to independent living.
- Manual Skills: This program aims to develop and improve organizational skills, awareness of the environment, safe and efficient work habits, spatial relationships, and an understanding and mastery of tactual ability. Projects may include handicrafts, home mechanics, woodworking, metalworking, leatherwork, weaving, and ceramics.
- Visual Skills: To assess visual acuity, each veteran is given a comprehensive eye examination, and a thorough visual skills assessment is performed. Counselors then address the needs of veterans with remaining vision, and help these individuals gain a better understanding of their eye problems through therapy.
- Computer Access Training: This program provides a comprehensive adaptive computer needs assessment, recommendation of appropriate computer equipment, training on recommended equipment, issuance of equipment upon successful completion of training, and follow-up technical support as required.
- Physical Conditioning: A lack of exercise due to low vision or vision loss can cause a decrease in physical activity, which can lead to a decrease in muscular tone and stamina. BRCs offer medically supervised physical training programs to help regain muscle strength, both at the BRC and at home.
- Recreation: As the name implies, veterans are encouraged to participate in both group and individual outings, such as sporting events, theaters, movies, concerts, and other kinds of social gatherings.
- Adjustment to Blindness: This program uses individual counseling sessions and group meetings to teach veterans strategies for coping and adapting to vision loss.
- Family Program: This program involves the veteran's family in the rehabilitation process. Not only does it educate the family member(s) about the rehabilitation process, but it also helps to reinforce rehabilitation lessons once the veteran returns home.
- Group Meetings: Regardless of backgrounds, educational level, occupation, or financial status, one thing all veterans at a BRC have in common is their vision loss. Group meetings allow them to share their feelings concerning blindness.
Outpatient Services
Most outpatient clinics offer similar services to the BRCs. They often have three to five staff, including a blind rehabilitation specialist, a visual impairment services team (VIST) coordinator, and either an ophthalmologist or optometrist. They perform individual assessments of needs, training skills, home visits, etc., and make recommendations.
Veterans can also take advantage of the visual impairment services outpatient rehabilitation programs (VISOR). These nine-day outpatient intermediate rehabilitation programs provide comfortable and safe overnight accommodations for veterans who are visually impaired and require temporary lodging. The program offers skills training, orientation and mobility, and low vision therapy.
A key difference between a VISOR program and a BRC is that the veterans who attend VISOR must be able to independently perform basic activities or daily living, including the ability to self-medicate.
There are also blind rehabilitation outpatient specialists programs that offer a wide array of blind rehabilitation services, including assessments and visual skills, living skills, and orientation and mobility training. BROS services are provided to veterans wherever the veterans needs the assistance the most, be it a VA hospital, home setting, nursing home, assisted living environments, or even (in rare instances) at work.
Finally, for the approximately 85 percent of all veterans who enter a rehabilitation program who maintain some level of vision, there are visual impairment centers to optimize remaining sight programs (VICTORS) for veterans who are not yet legally blind. There are three VICTORS centers: Kansas City VA Medical Center, Chicago VA Medical Center and the Northport (NY) VA Medical Center.
Quality Care for All Veterans
When the continuum of care was established in 2007, the goal was to have 54,000 blinded using the VA system by 2015. With the number at 49,000 in just over two years, that goal will likely be met and surpassed well before 2015.
"As far as the BVA is concerned, this is the most significant change we've seen in 20 years," says Zampieri. That is good news for veterans of all ages.
For more information about the services available to blinded and low vision veterans, visit the following websites: