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It is helpful if a contact lens-wearing staff member can be identified. Visual impairment is extremely common in the nursing home population and many nursing home residents may benefit from low vision devices and/or environmental modifications. Again, the cognitive and physical abilities of the nursing home resident to use low vision devices need to be evaluated. It is important early on in the negotiations to assist the nursing facility in setting an ophthalmic materials policy. Points to be considered include: what is the emergency and urgency policy; what to do in case of lost or broken spectacles and frame repairs; and the expected length of time for ordering and delivering materials. Setting these policies early can avoid the frustration of receiving an emergency call only to find out that a screw is missing from a frame. It is extremely helpful to train one of the contact persons in the nursing home to make simple repairs on spectacles. One of the important but frequently overlooked aspects of nursing home care is rehabilitation. Patients are frequently admitted to nursing homes for rehabilitation after acute care hospitalizations. These rehabilitation stays can be related to conditions such as injurious falls resulting in hip fractures and cerebrovascular accidents. Rehabilitation may involve many disciplines including occupational, physical, and speech therapists. The optometrist, as the vision consultant for the rehabilitation team, may be called upon to evaluate and make recommendations for vision rehabilitation, document the cause and nature of the vision loss, certify residents as legally blind, make recommendations for visual impairment precautions, provide recommendations to reduce falls, and conduct vision rehabilitation for residents with impairments due to stroke. The optometrist should coordinate treatment recommendations with the resident's physician and therapists. Good communication with the rehabilitation team is imperative for quality patient care. Low vision care is an essential component of a comprehensive rehabilitation program. A functional, problem-specific approach is recommended. As with most aspects of nursing home care, the level of cognitive ability of each individual is frequently the limiting factor in the type and complexity of low vision care. A suggested list of low vision devices is found in the Instruments and Equipment section of this Manual.
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