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    Consider nursing home optometry as practice option

    Increasing elderly population and disease incidence means more need for care


    Types of facilities

    There are five types of nursing home and care facilities:

    • Independent living communities

    • Assisted living facilities

    • Residential care facilities

    • Continuing care communities

    • Nursing homes (intermediate, skilled)

    In the independent living community, the resident has full choice and control over all aspects of his life. He must be independent in all aspects of daily living, including bathing and dressing; possess mental alertness and bowel/bladder control; and be able to walk.

    In an assisted living facility, the resident usually needs little to no help. Each resident lives in her own apartment and shares common-use spaces, including living, dining, and laundry rooms. Minimal services range from central dining programs to organized recreational activities; health, transportation, housekeeping, and security services are provided.

    In a residential care facility, services offered include assistance with personal care and medical needs. This facility is staffed 24 hours a day. Residents must be mentally alert and be able to dress, feed, and toilet. These facilities can have as few as two or up to 16 residents under one roof.

    Continuing care retirement communities, or multi-level care facilities, provide a balance between a skilled nursing home and independent living community. They offer a mixture of all types of care facilities.

    Optometric care is usually given at large intermediate and skilled nursing home facilities. They provide help for seriously ill recipients with 24-hour supervision, nursing care, rehabilitation programs, and social activities. Intermediate care is given to individuals who need assistance with activities of daily living, some health services, and nursing supervision  but not constant nursing care.

    Related: 5 steps to creating a budget

    Administrative tasks

    To begin offering your services at nursing homes, set up an administrator meeting at your selected facility to discuss establishing optometric services.

    If an agreement of need exists, discuss everyone’s expectations. This is the time to address contract negotiations including access to patients, terms and expectations, on-call services, and if and how you will supply glasses to residents. Discuss relevance of age and prevalence of eye disease in this population.

    Optometric services are billed by the provider using the resident’s insurance coverage, and those services will be budget neutral to the facility. It is much cheaper for facilities to provide optometric services in-house than to coordinate transportation for outside eye care.

    Most nursing homes today are large corporate entities, and in many cases there is an existing contract for eye care (as well as dental, podiatric, and other healthcare services). The contract explains the facility’s expectations, provider expectations, and details the level of liability coverage obtained by the providing doctor.

    A main consideration is after-hours calls from a facility, especially if there is a large geographic coverage area. Know what you are agreeing to do for after-hours care.

    As with all contracts, consider obtaining legal counsel because state laws differ.

    James Hill, OD, FAAO
    Dr. Hill provides nursing home care to multiple facilities in his area and holds a specialty low vision clinic at the Medical University ...


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