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The federal requirements for Long Term Care Facilities also describe the types and roles of various health care professionals, who must be available to provide services to the residents. Brief descriptions of these professionals and the services they provide, as set forth in the federal regulations, are described below.
1. Attending Physicians. Each resident is under the supervision of a physician (M.D. or D.O.), selected by the resident or resident's guardian. That physician evaluates and monitors the resident's immediate and long-term needs and prescribes measures necessary for the health, safety, and welfare of the resident. The number of physicians at any facility may vary from one to many. Residents may be admitted and discharged only upon the direct order of a physician. A physician is required to evaluate the resident every 30 days for the first 90 days after admission and once every 60 days thereafter. When absent, an attending physician is required to make arrangements for the medical care of his/her residents. At the time of each visit, the physician reviews the resident's medications and other orders, reviews the plan of care required, and writes, dates, and signs a note on the resident's progress.
2. Dental Consultant. Facilities are required to provide routine and emergency dental care for their residents. Each nursing facility must retain a consultant dentist to meet this requirement. The frequency of required routine dental care is specified by state regulations. Each nursing facility makes arrangements for dental care for residents who do not have a private dentist, including arrangements for transportation to and from the dentist's office. It also arranges for emergency dental care when a resident's attending dentist is unavailable.
3. Pharmacy Consultant. Each facility is required to retain the services of a consultant pharmacist. The pharmacist’s role is to establish record keeping and oversight monitoring for all medications and biologicals maintained and administered within the facility.
4. Rehabilitation Consultants. Each nursing facility either arranges or provides for specialized rehabilitative services as needed by the resident to improve and maintain functional abilities as outlined in the resident’s care plan. Specialized services may include, but are not limited to, physical therapy, speech language therapy, occupational therapy, and mental health rehabilitation services.
5. Other Consultants. The services of a variety of other consultants may be needed within the nursing home such as optometry, podiatry, psychiatry, psychology, and physiatry (i.e., physical medicine). Optometry or other vision care services are not currently mandated for nursing home residents. Nursing homes are required to assist the resident in obtaining an examination if the resident or his or her family makes a request or if a visit is deemed medically necessary.
As with other areas of practice, determining the need for optometric services within local nursing homes is a logical starting point. Lists of nursing homes may be obtained from the state regulatory agency, the state nursing home association, the local area agency on aging, and the local hospitals. More recently, multidisciplinary groups, which supply doctors and other staff to nursing homes, have been formed. These groups typically consist of optometrists, podiatrists, physicians, and physical and occupational therapists among others. Determining if such groups are operating in the local area is also an avenue that can be explored. Sending a letter to local nursing home administrators introducing yourself, your background, and letting them know of your interest in the area of vision care within long term care facilities is an appropriate starting point. The nursing home administrator is the chief administrative official within the nursing home and will ultimately make the decision as to whether optometric services will be provided in-house. In some rare cases a board of directors may need to approve appointments to nursing home staffs, similar to the system for hospital appointments. Credentialing may be required by some nursing homes as well. Most nursing homes are delighted to have optometrists interested in providing care within the facility; however, if no contact is received from the nursing home, a follow-up phone call to arrange a face-to-face meeting should be the next step.
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