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Prevalence rates for virtually all eye diseases increase with age. Advanced age is a strong risk factor for nursing home placement, but the degree of eye disease among the nursing home population is far in excess of what would be predicted simply based upon age. Virtually all nursing home residents will have at least one ocular pathology, and almost half will have two or more ocular pathological conditions. The most commonly identified ocular problem within the nursing home population is cataract. The prevalence rate of cataract varies considerably from study to study in this population with ranges from 35 percent to over 80 percent. Age-related macular degeneration and glaucoma are also more common and found in excess of that in the ambulatory population. Visual status is important in the overall function of residents. It has been demonstrated that performance of activities of daily living is highly correlated with vision level (i.e., vision better than 20/70) in the nursing home population. Residents with low vision have been shown to have greater difficulty in transfer ability, washing the upper and lower body, and dressing than comparable residents without visual impairment. Newly visually impaired persons are known to undergo personality changes, which may manifest as disengagement from activities, low self-esteem, depression, and high anxiety levels. In the presence of what is assumed to be adequate visual acuity, the nursing home staff may surmise that personality changes due to visual impairment are the result of mental status deterioration. In turn, the visually impaired resident may become increasingly dependent on staff for activities that can possibly be performed with the assistance of appropriate visual appliances or training. Dependence resulting from severe impairment of vision may contribute significantly to the cost of long term care. Since it has been estimated that teaching a resident visual impairment adaptive skills for self feeding may reduce the annual institutionalized cost by more than $2,000,5 alternative interventions may not only increase independence for the individual but also may reduce the financial burden on society.
There are three basic types of long term care facilities which exist in the United States: Skilled Nursing Facilities (SNF), Intermediate Care Facilities (ICF), and Adult Congregate Living Facilities (ACLF). These facilities are categorized based on the type and intensity of care they provide. References to "nursing homes" are almost always describing Skilled Nursing and Intermediate Care Facilities. Within this Manual, Long Term Care Facilities (LTCF) will refer to all three types of facilities.
1. Skilled Nursing Facilities - provide rehabilitative and restorative services under the direct supervision of an attending physician or medical director. Residents are typically admitted for additional recovery after a hospitalization for conditions such as hip fracture, fall, or stroke. The length of stay of this type of resident is expected to be relatively short. Residents in this type of facility are assumed to require 24-hour supervision, with the emphasis being on restorative and rehabilitative care provided by speech, occupational, or physical therapists.
2. Intermediate Care Facilities - provide a level of care somewhere in between that of the SNF and ACLF. The basic services generally consist of help with activities of daily living (e.g., toileting, feeding, grooming, etc.) and medication management. The distinction between skilled and intermediate care can be blurred. Skilled nursing and intermediate care typically coexist within the same nursing home, with certain numbers of beds allocated to each. It is not uncommon for a person to be admitted as a skilled nursing resident and then be shifted to intermediate care. Intermediate care residents are characterized by the deteriorating Alzheimer's patient who may remain a nursing facility resident for many years.
3. Adult Congregate Living Facilities - also known as Residential Care Facilities - provide limited services to their residents which may include dietary, housekeeping, social and recreational support, and limited medical monitoring (such as blood pressure checks). Residents of these facilities are typically high functioning seniors who have sought out the social and recreational interactions of group living. While nursing staff may be available at these facilities, the services they provide are limited. They may provide services such as arrangement of transportation and scheduling of medical visits.
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