Vision and eye care in Residential Aged Care

Facilities (RACF) in Tasmania

Tim PowellOptometrist

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

MethodsSurvey of Tasmanian

optometrists and Tasmanian RACF

38/80 Tasmanian optometrists replied

11 RACF responded representing more than 1063 residents.

Caring for Older Australians 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

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

Pre-admission assessment - ACAT, CMA, WTF? 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 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 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 non-private 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 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 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 in-house 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 in-house optometric consultations

Delivery of eye care services in RACF - barriers 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 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?

Future Needs - Ratings of presenting complaints/reasons for requesting eye exam (0 = never reason, 5 = only reason)

Future needs 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 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