Getting Started In Nursing Home Optometry

The thought of caring for people who reside in nursing homes never really crossed my mind until I stumbled upon this mode of practice, which I’ll call nursing home optometry, via a career listing on a website. I was looking for a position for a few days per week to fill in my schedule, and this seemed to fit what I wanted. I decided to give it a try and have been working in nursing homes for over seven years running.

The biggest pros to this type of care are both the hours and the flexibility. I really liked the fact that my day would start around 9am and that the day would end when I was finished seeing patients, usually around 3pm. I could still take care of my private practice in between patients or see emergency cases after wrapping up my day.

Also another major plus is keeping up my skills in ocular disease. At my own practice, I see primarily younger patients as well as a lot of children, which results in not very much exposure to conditions such as glaucoma, macular degeneration and diabetic retinopathy.

When I first graduated optometry, I worked part-time for an independent practice that asked me to visit a nursing home with which they had a relationship. I remember trying to perform a refraction using trial lenses and feeling frustrated and not very confident in my results.

I believe that the easiest and most efficient way is to do what I currently do and find a company that you can work for as an independent contractor. In my situation, the company contracts with nursing homes to provide vision, podiatry, audiology, and dentistry services to their residents. They provide all the equipment, support staff, scheduling and coordination with the nursing homes. All you have to do is show up, see patients, with minimal to no administrative work to do on your end.

If you are not already a provider for medical insurance plans, your company will help assist in getting credentialed for the plans they will want you to take. You do not have to do any billing yourself as they will submit all claims based on the procedures you perform on each patient.

You will need to get familiar with portable equipment. The equipment required to do a thorough exam consists of a standard eye chart (handheld), handheld tonometer, pachymeter, portable autorefractor, handheld slit lamp with a 90D lens, and a portable fundus camera. The great part about the company I work with is that they supply everything for you, including a laptop computer for a cloud-based EMR system.

The more challenging procedures include epilation and punctal plug insertion. However, once you are able to master these without a stable chinrest, this will be a cakewalk at a traditional office. Performing an examination on those that are in bed can be tough depending on your height and how flexible you are. Even those that are in a wheelchair can be a challenge if they are bent over and not able to raise their head to face you.

I travel between 20 to 30 nursing homes during the year. Some are only a few minutes away from my home, but others are over two hours away. You will need to decide how far you are willing to drive as you may be asked to travel further. Some homes that I visit are in an urban area and others are in very rural areas. Typically you will set up in a conference room, and lighting control, chairs, equipment and so on can get tricky so you have to be ready to improvise with what you’re given.

The staff or your assistant will bring patients to you, unless they are bed bound or cannot come to your room. Once they are dilated and ready, the exam goes pretty quickly, depending on the patient and their cognitive ability. Some residents are talkative and good history givers, whereas others are non communicative or combative.

You will chart your exam notes on a laptop using EMR software, which includes a billing component. You will write orders for medications, order eyeglasses, refer to specialists for surgery or further testing. Your technician will print out your exam records and you will review any special notes with the staff of the home.

If you like structure and order, and expect everything to go smoothly, this career path is definitely not for you. I actually do yoga so I can bend, twist, and contort in order to examine patients. Sometimes the home will place you where the beautician does hair with very limited space for yourself, your patients and assistant. Some of the neighborhoods are less than ideal, and sometimes you have to take control to make sure residents are seen in a timely fashion.

At times you will have a long line of residents waiting for you. At other times you will be patiently waiting for residents to be brought down to you. They will want to add residents at the last minute, patients will be combative with you or refuse your services, just to name a few issues that will arise. As an independent contractor, you only get paid for the amount that you bill: you do not get paid for your drive time and gas, and the longer your drive the later you will get home.

So you may ask: why do I still do this? I believe it is the combination of several things. Being able to be home with my family at a decent hour, using my travel time and down time to work on my private practice, and keeping up my ocular disease skills are all reasons that this would be a good option for a new grad optometrist or for someone looking for flexibility in their schedule. You could see patients for a few days per month or 5 days per week if you wanted to. If you are interested in looking into this more, companies such as 360Care and Mobile Care Group offer job opportunities in the Midwest.