By Zoriana N. Mangione, Quality Care Opticians, Ballston Lake, NY
MOBILE OPTICIANRY
Becoming a mobile optician for nursing home residents requires, above all else, patience and compassion. Next, one should expect much planning and organization, the willingness to travel from site-to-site in a variety of weather conditions, adaptability to various working conditions at the facilities, the willingness to carry the contents of an entire office to each site, and different communication skills and protocols. For example, getting signatures on file for insurance poses an entirely new set of challenges, since patients are usually either physically unable to sign the forms or are cognitively impaired due to dementia, their need for numerous medications or catastrophic illnesses. In the majority of cases, family members are not present when the nursing home resident is receiving his or her optical services. As a result, most business practices that are relatively routine in an office setting require significantly different approaches in a mobile practice.
Another factor making nursing home work challenging is finding a way to carry an entire optician's office to each facility. Experience directs the type and quantities of items like hand tools, lensometers and frame warmers, and replacement parts (e.g., nose pads, temple tips, screws, etc) that are necessary for your mobile office. Frame inventories meeting the requirements of the major insurance companies in your area, and various forms of paperwork must also be brought to each facility, each time. A variety of options exist for carting the necessary equipment, ranging from rolling sales cases to stacked crates loaded onto a hand-truck. Creativity is key in making this part of the job far less physically taxing.
Then, the optician must be very open-minded as to what constitutes a useable workspace. Nursing homes generally do not have extra office space available for a makeshift optician shop. Often, the beauty shop or dental office is used for the optician clinics. Sometimes, a conference room might be used. In many cases, the space provided leaves much to be desired, as lighting is often inadequate for use as a dispensary, especially when trying to locate the slot in the screw head. Here, creativity and a sense of humor can save the day. Overcoming challenges like these are part of what make this job so fulfilling.
THE FRAME CHALLENGE
Other challenges include finding a frame inventory with deeper "B" dimensions, softer colors, and with sturdy endpieces and temples to accommodate those with physical impairments following a stroke or surgery. Boldly colored frames often make a poor choice for nursing home residents because their complexions are usually quite pale, due to a combination of age and frailty. Also, people often find it harder to accept change as they age. It's amazing to see how many people are still wearing the oversized frames that were popular in the 1980s. Still, there also are quite a few patients still wearing their original American Optical or Shuron frames with interchangeable top rims!
Even though it is possible to find frames with a deep "B" measurement relative to today's styles, most nursing home patients are looking for frames as deep as goggles, reaching from the top of the eyebrow to mid-cheek, preferably in a blue-rose color. While finding frames matching these descriptors can be quite a challenge, it can be just as challenging to convince the wearer that a slightly smaller "B" dimension will still provide ample room for reading through their bifocal. Seniors get so accustomed to the deep frames that they find themselves looking under the bifocal, not through it, when reading with a narrower frame. Shortening the vertex distance of the eyewear helps to minimize this effect.
The quality and durability of frames that meet most insurance pricing guidelines usually leave a lot to be desired. Many of these frames would be of passable quality for someone who is able to handle their eyewear properly, but for a nursing home resident that generally has limited use of their arms; the frames bend or loosen continually. These frames require frequent, routine adjustment. Conditions like Parkinson's disease, multiple sclerosis, arthritis, and paralysis following a stroke significantly impair the wearer's ability to handle eyewear in the manner usually recommended by professionals. After a few weeks of one-handed handling, the eyewear winds up at the end of the wearer's nose, or with the temples bent out so far that it's physically impossible for both temples to touch both ears at the same time. In addition, one must also consider the damage from repeated naps with the glasses on, eyeglasses being run over by the wheelchairs, eyewear getting stuck in the hospital beds, and carelessness in handling the eyewear by the residents' caregivers.
To be continued... Watch this page for more about frames, lenses and the mobile optician.
