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    Consider nursing home optometry as practice option

    Increasing elderly population and disease incidence means more need for care

     

    Keep in mind

    Other considerations address ethical challenges when providing nursing home care. They include:

    • Provision of spectacles for need versus profit

    • Decisions to treat and provide interventions

    • Expectations to evaluate residents only as requested by the attending physician

    • Following rules set by third-party and government organizations

    Embrace the benefits from providing optometric care in a nursing home. They can be financial, emotional, flexibility, and growth.

    In my experience, a typical half-day in the nursing home can generate up to $1500 or more at the outset if you are able to schedule 12 new patients during a morning or afternoon clinic. As efficiency improves, these numbers increase. Remember there is little provider overhead compared to a brick-and-mortar office.

    There are also many emotional benefits to providing nursing home care, such as working directly in your community with those who have the greatest need. Many residents want to share their colorful stories during the exam. Helping to prevent disease or disease progression and providing vision correction that can help delay the onset of dementia can lead to greater personal and professional satisfaction.

    The time commitment and amount of clinic days can be flexible for someone just starting. It can help a young OD add more clinical days if a full-time opportunity is not available or if starting a new practice with an unfilled appointment book.

    An established practice can incorporate this modality to expand services for associate ODs to keep their schedules busy with little overhead. It is likely that by providing this service in your community, nursing home staff and resident families will learn about your services and may seek you out in your office or become a valued referral source.

    Practicing optometry in a nursing home setting is not for everyone, but in my opinion it is well worth it for ODs who are willing to get out of the office and expand their practice capabilities as well as their comfort zones.

    Related: How to offer concierge-like care without the fee

    References

    1. Bernard, D. The Baby Boomer Number Game. U.S. News World Report.  2012 Mar 23.  Available at: http://money.usnews.com/money/blogs/on-retirement/2012/03/23/the-baby-boomer-number-game. Accessed 4/18/17.
    2.Yoder S. The Coming Nursing Home Shortage. The Fiscal Times. January 26, 2012. http://www.thefiscaltimes.com/Articles/2012/01/26/The-Coming-Nursing-Home-Shortage#sthash.5Yn5Q0gu.dpuf.

    3.Swanson MW, Achiron LR, Beebe KL et al. Optometric Care of Nursing Home Residents. by American Optometric Association. Available at: http://www.aoa.org/Documents/optometrists/QI/FINAL%20Version%204-24-14.pdf. Accessed 4/18/17.

    4. Tielsch JM, Javitt JC, Coleman A, Katz J, Sommer A. The prevalence of blindness and visual impairment among nursing home residents. New Engl J Med. 1995 May 4;332(18):1205-9.

    5. Horowitz, A. The Prevalence and Consequence of Visual Impairment among Nursing Home Residents. Final Report.. New York: Lighthouse, 1988. Print.

    6. Agency for Healthcare Research and Quality. Cataract in adults: management of functional impairment. Available at: https://archive.ahrq.gov/clinic/medtep/catguide.htm. Accessed 4/18/17.

    7. Marx MS, Werner P, Cohen-Mansfield J, Feldman R. The relationship between low vision and the performance of activities of daily living in nursing home residents. J Am Geriatr Soc. 1992 Oct;40(10):1018-20.

    8. Centers for Medicare and Medicaid Services. MDS 3.0 for Nursing Homes and Swing Bed Providers. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30.html. Accessed 4/18/17.

    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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