Cornwall Partners in Care News

Maintaining vision and eye health: an essential part of residential care

Covid-19 outbreaks in care homes have caused disruption and been extremely challenging for the care sector. Homes have often had to balance managing national guidance and local health protection advice with families’ wishes and expectations, whilst dealing with workforce shortages and supply chain issues. Keeping care home staffing numbers to an adequate level has been a key priority, and at times a struggle, for all providers throughout the pandemic and will continue to be as the country adjusts to living with Covid-19.

Healthcare provision in care homes has undoubtedly been affected throughout the pandemic. Care homes and public health teams have been asked to make decisions on when and how to allow visitors entry, conversely at times finding it difficult to secure visits from healthcare providers. The assessment of the risk of exposing residents to Covid-19 infections against the risk of delaying the diagnosis of other health conditions have therefore understandably yielded different outcomes depending on a whole range of local factors.

This has in turn impacted on residents’ access to eye care services. Visits, clinics and spectacle deliveries have had to be cancelled, at times at short notice. From a clinical perspective this gives cause for concern. Like other medical care, early detection and intervention is often crucial. Whilst keeping residents safe from avoidable Covid-19 infections is the number one priority, delaying eye care also has the potential for causing unintended harm to some residents’ vision. For examples, for older people with less capacity for adjustment two weeks or more without good vision correction is a long time.

The Department of Health and Social Care updated the guidance on care home visiting on 24 February 2022. It confirms that there are no nationally set direct restrictions on visiting in care homes, and contains a key message around professional visits:

“Health, social care and other professionals need to visit care home residents to provide services. Care homes should facilitate these visits while ensuring necessary testing, IPC and PPE measures are adhered to. The arrangements for visiting professionals differ from those for family and friends visiting the care home.

During an outbreak visiting professionals should normally be able to continue to visit, provided they adhere with all necessary IPC precautions.”

Care homes are therefore strongly encouraged to offer visiting optometrists the same access as other visiting health professionals such as District Nurses and GPs.

Eye care is essential medical care.

As highlighted in the Primary Eyecare Sector’s Domiciliary Eyecare Committee issued guidance on 27 September 2021, visual impairment in older age is high risk because it can lead to:

• increased falls and often mortality, especially in female patients following hip fractures
• becoming more socially isolated as people are unable to carry on with their usual activities including reading, watching TV, conversing with other residents
• becoming reluctant to join in arranged activities or have meals
• losing confidence in many areas in their lives
• depression, loneliness, and cognitive decline

Timely intervention through regular eye care prevents sight loss. Eye health decline can happen very rapidly and there is substantial evidence of people in care home settings living with undetected retinal or macular damage. This has been exacerbated during the pandemic and is leading to health inequity between patients in care homes and those who live in their own homes or with family.

Working together

We want to support you and will do everything we can to get this right. The national care home associations, the Domiciliary Eyecare Committee and NHS England are all in agreement. Enabling domiciliary eye care providers to access residents in care homes, including, as far as possible, during outbreaks or lockdowns, is an essential part of maintaining their general health and wellbeing.

We encourage care homes to review their risk assessments for healthcare professional visits, in line with national and local guidance. As with all other visiting healthcare professionals, domiciliary eye care service providers have robust infection prevention and control procedures in place, including rigorous use of PPE, testing and travel and equipment hygiene.
Thank you for all you are doing to ensure care home residents have timely access to healthcare professionals.