“People living in care homes experience some specific barriers in access to care and this needs to change”

This year Specsavers is celebrating 10 years of providing care in people’s homes and I’d like to pay tribute to all my colleagues, and everyone in our sector, working hard to reach and care for some of the most vulnerable people in our society.

As a society we are facing major changes with a growing and ageing population. The Health Foundation reports that at the age of 70, people will have an average of three long-term conditions, which rises to more than five by the age of 85, and this age group – the 85+ – is the fastest growing.

The number of people living in care homes is also increasing. Care Homes UK estimates there is nearly half a million people living in the UK’s care homes. They often have multiple needs and health conditions, including vision and hearing loss, mobility difficulties and memory loss or confusion.

It’s shocking that, on average, 14 people aged 65+ die each day from having a fall, and three quarters of severe falls that result in hospital admission through A&E are directly attributable to sight loss

Hearing and vision loss in older people has been proven to affect physical and mental health, and increase the speed of cognitive decline. Maintaining vision and eye health is an essential part of residential care especially because of the link between poor eye health and falls. Age UK’s Later life in the United Kingdom 2019 report highlights that falls are the largest cause of emergency hospital admissions for older people and cost the UK around £4.4 billion each year. It’s shocking that, on average, 14 people aged 65+ die each day from having a fall, and three quarters of severe falls that result in hospital admission through A&E are directly attributable to sight loss.

Undiagnosed and uncorrected

All too often eye health conditions go undiagnosed and uncorrected or untreated. This reduces independence and confidence and increases risk of injury, especially falls. Our profession can have a huge positive impact because uncorrected refractive error is the main cause of vision problems in this age group. With the right access to care people can maintain their eye health as a key part of aging well and living an active healthy life.

However, people living in care homes experience some specific barriers in access to care and this needs to change. In England, those who can’t leave their home unaccompanied, who may be entitled to a visit from an optometrist in their home, have to navigate a complex set of rules to check their eligibility. General Optical Services (GOS) regulations require optometrists to notify the NHS at least 48 hours before making a visit to one or two patients, and three weeks before seeing three or more patients at the same address, giving specific patient details. The rationale of this pre-visit notification (PVN) is difficult to understand, it requires administration by Primary Care Support England (PCSE) on behalf of the NHS, is a barrier to the timely provision of services, and appears to serve no practical purpose.

The requirement for the PVN means that, unlike you or I who can go into the High Street and have a sight test today, people living in care homes and indeed anyone who cannot leave home unaccompanied must wait at least 48 hours before they can have a sight test. One could question how that aligns with the Equality Act 2010.

Eye health decline can happen very rapidly and there is substantial evidence of people in care home settings living with undetected ocular pathology. They need timely intervention through regular eye care to prevent sight loss. The PVN requirement is a barrier to care and discriminates against those who need it most. In Wales the requirement to pre-notify is being removed as part of the Welsh reforms, and in Scotland it has not been reinstated following its suspension during the pandemic.

About the author

Dawn Roberts is an optometrist and clinical director for Specsavers Home Visits.