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Newly admitted residents to a nursing facility need to be identified as to their needs for eye care services and whom they want to perform those services. The nursing facility may require the optometrist’s assistance in defining the process the facility will use first to identify when a resident needs an optometric examination, and then how he/she will receive it. Some nursing facilities may utilize a form asking the resident or his or her family to either select the in-house consultant as their eye doctor or to specifically name someone else. The form may also identify when the resident last had an examination, if one is needed immediately, or at what later point in time one may be needed. As discussed in Section VII, federal law requires that each new resident have a resident comprehensive assessment completed upon admission. The MDS section regarding visual problems will help identify who has reduced visual acuity or peripheral vision problems. A recent study, however, found that only 34 percent of these MDS evaluations actually were valid when compared to the results of an examination.13 The MDS does not trigger an optometric referral for other important criteria such as glaucoma follow-up, diabetes, high-risk medicines (e.g., corticosteroids), or previously diagnosed ocular diseases such as macular degeneration or cataract or the presence of an intraocular lens implant. The consultant needs to make the nursing facility staff aware of the limitations in the MDS and also assist them in properly administering the visual section of the MDS. Once a system has been established to identify a new resident's need for optometric care, one must develop a system to assure appropriate follow-up care. The optometrist needs to assist the nursing facility in addressing the mechanisms to identify residents in need of follow-up. Will the optometrist provide the recall of residents or is it the responsibility of the facility? Perhaps a system that provides checks and balances itself is desirable. The optometrist may want to indicate in the resident’s progress notes when he or she should be examined again. Be certain as to which nursing facility staff person is responsible for tracking this information and scheduling the next appointment. It may be advantageous to track the resident through an optometric recall system, keeping in mind that all visits are ordered by the attending physician and re-evaluation of residents is solely at the discretion of the attending physician.The optometric consultant will want to make emergency care personally available or through another source. Be certain that this has been discussed with the facility and that a plan has been established. Also, discuss with the appropriate nursing personnel what constitutes an eye emergency and what requires prompt but not immediate care. The optometrist should be available 24 hours a day. Management of eye health and vision conditions is an integral part of consultation responsibilities. Seventy-two to eighty-four percent of nursing facility residents have been found to have cataracts, 25-37 percent have macular degeneration, and 6-15 percent have glaucoma. The prevalence of dry eye, conjunctivitis, and blepharitis is quite high as well. A nursing home practice may grow into quite a challenging and satisfying primary care practice because of the prevalence of eye disease in this unique population.
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