Transcript Vision and eye care in Residential Aged Care Facilities

Vision and eye care in
Residential Aged Care Facilities
(RACF) in Tasmania
Tim Powell
Optometrist
The proposal
Survey Tasmanian nursing homes to
establish how vision and eye care is
assessed on initial placement of a resident
in a RACF, what ongoing eye care services
are provided or facilitated by the RACF
and what RACF most want with respect to
vision and eye care in the future.
 Expanded to Tasmanian optometrists
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Methods
 Survey
of Tasmanian
optometrists and Tasmanian
RACF
 38/80 Tasmanian optometrists
replied
 11 RACF responded representing
more than 1063 residents.
Caring for Older Australians
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Productivity Commission 2011, Caring for Older
Australians
Significant increase in demand with the ageing of
Australia’s population, significant shifts in the
type of care demanded
the number of Australians receiving aged care
services is expected to increase from 1 million, as
it currently stands, to 3.5 million in 2050
“Future challenges include the increasing
numbers and expectations of older people…”
Vision and eye health status of
persons in RACF
It is generally acknowledged that Vision
Impairment (VI) and eye diseases such as
cataract, macular degeneration and
glaucoma are over-represented in RACF
 Well documented/supported in literature –
The Blue Mountains eye study; The Beaver
Dam eye study
 Visually impaired people have 2-3 times
the risk of admission to RACF
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Pre-admission assessment - ACAT,
CMA, WTF?
Aged Care Assessment Team (ACAT)
responsible for pre-admission assessment
- Vision assessment limited.
 Comprehensive Medical Assessment (CMA)
from GP, basic vision assessment, most
likely VA
 RACF own, in-house assessment – may be
guided by improved resident management
software eg Autumn Care
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Pre-admission assessment - ACAT,
CMA, WTF?
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55% of respondents (Tasmanian optometrists)
indicated there was no information on a resident’s
file of their vision and eye health status.
78% of respondents (Tasmanian RACF) found that
there was little or no information on a resident’s
vision and eye health coming from an ACAT
assessment and 100% of respondents felt there
was little or no information coming from a
resident’s CMA
89% of RACF respondents found that their own
RACF based vision and eye health assessment
provided adequate information on a resident’s
vision and eye health
Pre-admission assessment - ACAT,
CMA, WTF?
Recommendation 1
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That optometrists play an active role in co-ordinating
the provision of information to RACF on new
residents. This will have the benefit of providing
useful information to RACF on a person’s vision and
eye health status and eye care management plan,
and also facilitate efficient and effective vision and
eye health care by any visiting optometrist. In light
of the findings of a survey of Tasmanian optometrists
and Tasmanian RACF, it is recommended that the
information listed in Table 1 be included in any Aged
Care Assessment of Vision and Eye health form.
Aged Care Assessment of Vision
and eye health
Optometrist Aged Care Assessment of Vision and Eye Health
Name, Address, Date of Birth
Community Optometrist
Ophthalmologist (if applicable)
Previous Ocular history including, but not limited to, current diagnoses, previous surgery, current ocular
medications
Visual Acuity (aided and/or unaided distance and near)
Visual aids, including low vision aids
Rx R&L
Lens design and lens material
Low Vision aids
Advised wearing schedule of current glasses:
Slit lamp:
Ophthalmoscopy:
Slit lamp and or retinal photos:
Visual Field results:
Functional Assessment of vision given current VA and eye health
Vision and eye care management plan including advised review date and possible risks of vision and eye
health into the future
Supply and Demand
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2006 Census - “Of the 71,141 persons aged 65
years and over usually resident in Tasmania on
Census night in 2006, 91.9% lived in private
dwellings, and the remaining 8.1% lived in nonprivate dwellings”
2006 Census - “Of persons aged 65 years and
over living in a non-private dwelling, 86.0% lived
in cared accommodation. Of these, 57.8% lived
in nursing homes, 16.8% lived in accommodation
for the retired or aged (not self-contained), and
11.3% lived in hospitals.”
2011 census - Tasmania had 79,100 persons
aged 65 years and over, an increase of 11%.
Supply and Demand – Living arrangements of
persons over 65 in Tasmania (ABS 2006)
Supply and Demand – domiciliary
item numbers
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Designed as an add-on or loading
10931 - performed on one patient at a single
location on one occasion
10932 - performed on two patients at the
same location on one occasion
10933 - performed on three patients at the
same location on one occasion
If four or more patients are seen, bill each of
the first three patients the appropriate
consultation item plus item 10933, then bill
the other patients only the appropriate
consultation item.
Supply and Demand – domiciliary
consultations in Tasmania
Supply and Demand
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In Tasmania in 2011, services claimed for MBS
item numbers 10931, 10932 and 10933 were,
72, 22 and 75 respectively (in 2006 they were
79, 10 and 75)
This range of domiciliary consultations this could
represent is 72+22+75 = 169 to 72+
22+(25x15) = 469.
Census data
Based on these figures, it appears as though as
few as 14% of residents in RACF are receiving inhouse optometric consultations
Supply and Demand
2 in 3 Tasmanian RACF have 30% or more
of residents who would be unlikely to have
their eyes examined if optometrists did
not provide eye examinations within the
facility
 If we extrapolate from this figure, there
are at least 629 residents who require inhouse optometric consultations
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Delivery of eye care services in
RACF - barriers
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A survey of Tasmanian optometrists found
that 42% of respondents did not provide
optometry services to RACF with reasons
including a lack of portable equipment and
the resultant feeling of not providing a
satisfactory eye examination, lack of support,
lack of time and the significant cost and
opportunity cost of providing these services
Low prevalence of eye care services in RACF
is multifactorial
Recommendation 2
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Recommendation 2: That the funding available
for optometrists providing eye care
consultations in RACF be reviewed with the
intention of finding ways to increase the rebate
for MBS item numbers 10931, 10932 and 10933
to better reflect the cost of providing
comprehensive eye care services to RACF.
That costs surrounding provision of an initial
aged care vision and eye health assessment
report be investigated to ensure optometrists
are recompensed for work in this area.
Future needs
Low levels of provision of eye care
services in RACF are not a new
phenomenon
 What do RACF and their residents most
want from their vision
 How does optometry fit into that?
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Future Needs - Ratings of presenting complaints/reasons for
requesting eye exam (0 = never reason, 5 = only reason)
Future needs
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Reduced vision is a driver for seeking optometric
consultations
The need for good vision for enhanced Quality of Life
(QoL) in nursing homes is well documented
“dispensing spectacles to treat uncorrected refractive
error in nursing home residents leads to improved
vision-targeted health-related quality of life, less
reported difficulty in the visual activities of daily
living, and decreased depressive symptoms.”
Primary eye care is required to address these needs
Conclusion
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Tasmanian optometrists show a clear
willingness to provide consultations in RACF but
a lack of resources, time and information within
a residents file make the job of providing
ongoing, in-house vision and eye care
assessments even more inefficient and difficult.
Information gathered from surveys of
Tasmanian optometrists and Tasmanian RACF
goes some way to identifying what is required
and, it is hoped, some way to facilitating the
efficient passage of this information
Thanks
Tasmanian Optometry Foundation
 IBIS Care Wynyard
 Tasmanian optometrists and RACF
 Paul Graveson
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