Safeguarding in a domiciliary setting

The scenario:

Jim, AOP member

“I’m starting a new role as a domiciliary optometrist after working in High Street practice. As some of my new patients are likely to be particularly vulnerable, can you provide advice on explaining the associated costs of providing them with eye care, so that I can ensure they fully understand what they will be paying for, along with any other specific things that I should be aware of?” 

The advice:

Paul Chapman-Hatchett, AOP domiciliary councillor and co-chair of the Domiciliary Eyecare Committee

Prior to your visit, ascertain whether the patient is eligible for an NHS sight test, explain this to them or their carer, and if they are requesting an NHS sight test, also confirm that they are unable to attend a High Street practice unaided.

The next step is to explain how an eye test will work in the home environment, including in terms of space and lighting, how long it will take, the equipment that will be used, our obligations as optometrists in completing an NHS test, and that you will issue a copy of the spectacle prescription and any recommendations. Explain that we can provide a full dispensing service, with a wide range of frames at different cost points, and access to the lenses that they would expect in the High Street.

Select a mutually convenient day and time, and advise the patient or their carer on who will be coming out to provide the service. If the person is not eligible for an NHS test, discuss the private sight test fee prior to the visit, so the patient and/or carer is aware of any costs involved.

During the visit

There are eight main reasons why I would recommend new glasses to a patient in a domiciliary setting:

• A change in prescription
• The condition and fit of their current glasses is poor
• The need for a lens upgrade, for example a move to tinted or photochromic lenses that they have not had before due to the patient now having cataracts
• A dedicated pair for use when completing specific tasks, for example pair of reading spectacles in addition to varifocals
• Patient preference for a different frame or lens type
• Change of lens design – for example if a patient wears bifocals and is considered to be at risk of falls, changing to separate pairs may be worth considering
• The need for an additional pair/back-up glasses.

We can ascertain whether we can maximise the quality of life of our patients by discussing these points during our history and symptoms.

You should provide the patient with information that explains the process, the frame and lenses differences and their cost so that we can explain our recommendations. This way we can ensure that all dispenses are clearly explained and how what we are recommending, solves the problem the patient has explained to us. Once all choices have been made by then making sure we clearly explain any costs and make sure the patient, or their carer is comfortable with those costs before proceeding we can avoid future problems. It is essential that all discussions are clear, honest and open and it is even more important to listen to the patient, and make sure they don’t feel pressured in any way.

It is a privilege to be invited into someone’s home to offer a service

Make sure you explain the expected delivery time, and that the patient has contact numbers for any aftercare required, or if they have any queries. As well as the full aftercare service we also offer the Care Plus package, which includes cover for maintenance and damage.

Remember that the patient also has same rights as they would on the High Street in terms of taking their prescription elsewhere.

After the dispense

A lot of our patients have pathology and resulting sight loss, so having open discussions about referral options and other support, such as sight loss charities and the appropriateness of a referral, are very important. For example, a mobile individual who drives may want referral for cataract surgery, but a housebound individual with the same level of cataract may feel that a referral is not in their best interests at this time.

It is important to understand what local pathways are available to our patients and discuss the pros and cons of referring. It’s also important to remember that if they decline a referral today it does not preclude them from changing their mind the following day, perhaps when they have discussed it with family and friends.

As domiciliary optometrists, we need to make sure we get it right the first time, every time. That means an appropriate dispense of frames and lenses that meet patients’ expectations, requirements and budget, and the correct measurements. It is a privilege to be invited into someone’s home to offer a service. This must be the first and foremost consideration in everything we do, and that trust must never be compromised. I advise using the ‘grandmother test’ – looking at the patient before you leave the room and asking yourself, ‘If this was my relative, would I be happy with the service I’ve provided?’ If you’re not 100% satisfied, then stop, go back, and fix it.

Author image by Will Almot