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Nursing home care is guaranteed to challenge your optometric and creative skills.

The primary goal for those involved in nursing home care should always be to provide the highest quality of care. It should be no different than what we strive for in our private or commerrcial setting practices. When I'm working at a facility, I often hear staff say to the residents, "The eye doctor is here. Do you want to get glasses?" This idea is far from what actually occurs at these exams. I see many more patients who have eye health concerns than who just need glasses.

They have problems

In most private practices, the majority of patients are refractive cases (unless you're in a more specialized setting). While a refraction is a part of every eye exam in a nursing home, the majority of patients exhibit one or more ocular pathologies. People commonly use the term "nursing home" instead of the more accurate name, long-term care center.

Residents are people who are unable to live on their own secondary to health issues or who need 24-hour care. Typically these are the elderly, in which the common ocular conditions are macular degeneration, cataracts, glaucoma and diabetic retinopathy.

Yet it isn't unusual to see residents in these homes who are under the age of 65. These are people commonly suffering from multiple sclerosis, long-standing, uncontrolled type-I diabetes mellitus, traumatic brain injuries, incapacitating health issues and psychiatric conditions. All of these people need your training in ocular disease, geriatrics, special populations and general optometry.

The patients are often challenging and just taking a case history can prove difficult, especially from those who have advanced dementia or Alzheimer's disease. You must often base exam findings entirely on objective testing, which is often difficult with poor head position and marginal cooperation. Patients suffering from Tardive dyskinesia, for example, have jerking motions that won't allow them to remain stationary for more than a few seconds.

Here's what you'll need

Nursing home care is probably one of the most challenging modes of optometry - one that requires all of your technical and creative skills. The following are skills and characteristics that are helpful in this practice setting.

* Background requirements. Because of the breadth of knowledge needed, eye care in a long-term care facility requires a strong optometric background. Although there aren't any training requirements, ocular disease residency training is recommended and beneficial. Being confident and comfortable in managing and treating ocular disease is required because this is a routine part of the patient care. This also includes being certified to treat therapeutically at the highest level allowed. Knowledge of low vision and experience with special populations is also beneficial.

* Equipment. In a regular practice setting, all of the equipment is fairly large and for the most part stationary. When working in a nursing home, however, the equipment needs to be portable yet adequate to provide a complete and thorough examination.

Probably the largest piece of equipment needed is the lensometer; everything else should be hand held. A retinoscope is an essential piece because objective data is most reliable.

Additional refractive instruments include a trial lens set and skiascopy bars, which will enable an adequate refraction. Optionally, a hand held autorefractor may be of use, but the retinoscope can generally give as good data, especially in most of the more challenging patients.

Equipment needed for the ocular health assessment includes a slit lamp instrument for the anterior segment, a direct ophthalmoscope and a binocular indirect ophthalmoscope for the posterior segment. As glaucoma is common, you should include either a tonopen or a Perkins tonometer. To perform comprehensive examinations, a supply of diagnostic pharmaceuticals, such as those used in a conventional practice, is needed.

As for therapeutic pharmaceuticals, these are generally available in the nursing home facilities. I do, however, recommend an acute angle closure kit. If you provide glasses to the residents, then you should include an inventory of frames for them to choose from.

Nurses are your friends

Generally, the point of contact in the facility is the social services department. In most instances, social services will coordinate all in-house ancillary health specialties such as eye care, podiatry, dental and audiology. The department will assign a room for the exams unless a patient is unable to leave his room.

# posted by Medical Information : 4:22 AM