Aging with Loss of Sight Improving Independence for Older Blind Persons


To support independent living for older blind persons by:

  1. Authorizing training for independence for older blind persons under Medicare; and

  2. Covering the cost of devices providing blind persons with access to product labels and instructions as a part of any federally established prescription drug benefit.


Training for Independence: The Alliance on Aging Research reports that visual impairment is one of the top four reasons for losing independence, contributing to new medical and long-term care costs exceeding $26 billion annually. The average cost of care for each older person living independently is $4,800 annually, compared to $36,600 for an individual in custodial care, frequently a public expense. In addition, eighteen percent of all hip fractures among seniors have been attributed to age-related vision loss, and the average cost of care for one fracture alone is $35,000, resulting in an annual cost of $2 billion, mostly paid by Medicare.

The one-time cost of training provided to blind seniors is only a fraction of the continuing annual cost of custodial care, but only five percent are served with current funding. The rest fend for themselves or are warehoused in custodial care facilities at public expense. When trained, however, older blind persons can go safely from place to place, perform daily living chores, and use appropriate aids and devices. Consistent with the goals of Medicare, those who receive these services are able to continue living independently in their own homes and communities.

Accessible Prescription Information: Studies indicate that 75% of applicants for training due to vision loss report difficulty reading, citing prescription information as a primary concern. This is a growing problem as people age and lose sight, contributing to loss of independence due to fear over incorrect use of prescription drugs. According to the Alliance on Aging Research over 90% of persons age 65 or older use at least 1 prescription and most take two or more each day. At age 75 the average person can be expected to need 5 prescriptions daily, while many take 12 or more.

Currently, there is no requirement for prescription drug labels and instructions to be presented in any form other than standard print. This was the only means available until quite recently, but now easy-to-use digital speech technology is a practical low-cost alternative. Using this technology, prescription information can be spoken aloud without altering the visual appearance of the printed label. Widespread use of this technology will make it possible for older blind persons to use their prescriptions correctly, supporting their independence.

Existing Law

Chapter II of Title VII of the Rehabilitation Act of 1973, as amended, authorizes grants to state vocational rehabilitation agencies to provide independent living services to blind persons, beginning at age 55. These services include visual screening, independent living skills training, such as orientation and mobility and daily living skills, and other appropriate services needed for older individuals to live independently. This program is currently funded at $25 million annually. While funding has grown in recent years, this is still a very small program, leaving 95% of older blind individuals not served.

Acknowledging the need, the Centers for Medicaid and Medicare Services (CMS) has authorized payment for some rehabilitation assistance for blind Medicare beneficiaries when the services are performed by approved providers, such as physical or occupational therapists supervised by a physician. Although this is a beginning, CMS lacks statutory authority to designate state vocational rehabilitation agencies as approved providers. Consequently, the cost of assistance to older blind persons, provided by knowledgeable rehabilitation personnel, is seldom allowed as a Medicare expense.

Proposed Legislation

Congress should amend Title XVIII of the Social Security Act to authorize Medicare coverage of independence training for older blind persons, and to include coverage for the cost of devices providing blind persons with access to product labels and instructions as a part of any federally established prescription drug benefit. The combination of these provisions will ensure that older blind Medicare beneficiaries have the training and information they need to live with dignity and independence.

As an approved provider, the state vocational rehabilitation agency could receive reimbursement under Medicare. Services obtained from private providers chosen by beneficiaries would be supervised and paid for by the state with Medicare reimbursement. This approach would utilize a well-established and accountable system for the delivery of independence training services to be extended to older blind Medicare beneficiaries while also allowing them to exercise choice when selecting among service providers.

Training is essential, but having a means of access to printed information is also important for the blind. This is particularly so for older persons to manage use of prescription drugs when living independently. With advancements in miniature digital technology, several low-cost solutions to this problem have emerged. However, the pharmaceutical industry has no standard for their use, due to the lack of any widespread requirement and means of paying the minimal cost involved.

The devices presently available use small computer chips to produce product labels and instructions in an audio (spoken-word) format. In some instances, the information must be recorded by the pharmacist or another person. One device provides audio information in synthetic speech, produced from a special label printed at the pharmacy. The nominal cost for using any of this technology would apply only to prescriptions for individuals who require the information in a format other than print. Coverage under the Medicare program will lead to a nonvisual access standard in the industry and result in low-cost, wide-spread use.

Please assist blind Americans by supporting training for independence for older blind persons and accessible prescription drug information when legislation to achieve these objectives is introduced and considered in Congress.

Contact Information

James McCarthy
Director of Governmental Affairs
National Federation of the Blind
1800 Johnson Street
Baltimore, Maryland 21230
Phone: (410) 659-9314, extension 2240

Updated: May 2004