Domiciliary care is a specialised area of optometry and audiology that is conducted within a patient’s home. It is a service for those who are unable to visit a high street practice because of physical or mental illness and therefore requires a particular set of skills and abilities.
Varying patient needs and additional pathologies means domiciliary care workers are among the most knowledgeable and adroit in the optical and hearing care sectors.
The Optical Confederation says: ‘For patients who require a domiciliary service, the majority of whom are vulnerable adults, good eye care can have an enormous impact on their independence and well-being.
‘Providers will ensure that all staff understand and have the necessary skills for effective communication with domiciliary patients, particularly those with cognitive impairment.’
In the UK, three companies dominate the provision of domiciliary eye and hearing care: OutsideClinic, Specsavers and Visioncall.
Optician spoke to them, and others, to investigate their reach, business structure, the number of people they serve and the challenges facing the sector.
Challenges
Given the nature of domiciliary care and the complexity of some patients’ situations, it should be viewed as a completely distinct area of optometry and audiology – one with its own challenges and issues. Optician asked what providers saw as the biggest issues and opportunities facing the sector today.
‘Each day is different and unique,’ says Stephan Kirely, a Visioncall optometrist in Scotland. ‘Each venue or setting we visit represents a new set of challenges. In comparison with high street practice it is very different and often very difficult, but it is hugely rewarding.’
Kirely says that the ‘vast majority of the patients we see have dementia of varying stages’, and that the ‘testing techniques we use are specific to each patient we see’.
‘Lots of patients we see have varying ocular health issues and may be unable to verbalise the difficulties they have. To be able to help these patients is one of the things I love most about domiciliary eye care,’ he adds.
Professional service optometrist and CET lead at OutsideClinic Matt Burford has seen significant shifts in domiciliary care since he started working at the company 15 years ago. ‘The majority of these have been hugely positive for both providers and patients; technology has allowed OutsideClinic to provide ever more comprehensive examinations in an efficient manner. However, there still remain
significant challenges ahead.’
According to Burford, awareness is ‘perhaps the most substantial challenge for both providers and patients’ as he often hears patients say they did not know a particular service exists. This, he says, ‘represents how we as a sector must do more to signpost all available services to everyone’. One way Burford does this is through involvement with his LOC.
He welcomes the work put in by various optical bodies to strengthen and improve domiciliary care provision in the UK and sees a large role for companies such as OutsideClinic to do the same.
‘OutsideClinic was one of the founding members of the Optical Confederation’s Domiciliary Eyecare Committee in 2003,’ he says. ‘We hope our ongoing contribution and commitment to ensuring all providers promote the highest standards of patient care for those unable to attend a high street practice unaccompanied makes that difference to a patient’s experience of an eye or hearing test at home.’
Clinical director for Specsavers’ domiciliary service and optometric adviser to NHS England in Yorkshire and the Humber, Dawn Roberts has worked in domiciliary care all of her career. She identifies a number of challenges to both patients and practitioners working in the sector. ‘Pre-notification of sight tests makes it impossible to see a patient in an emergency in England, this is not the case in Scotland or Northern Ireland where patients can be seen without notification if urgent,’ she says.
‘In care home situations it can be difficult to be certain who has the authority to give consent for the patient to be tested if they are not able to give it themselves. Sometimes providers are asked to provide a sight test by care staff and the family is not informed about it.’
Also the co-chair of the Optical Confederation’s Domiciliary Eyecare Committee, Roberts explains that referrals can often be ‘complex due to the fact that a clinical team may be in several different CCG areas’, which might all have different schemes and pathways and that ‘it is a massive challenge to carry out all relevant paperwork, understand the nuances of each scheme in each area and ensure that the referral has been made correctly’.
When it comes to patients, Roberts says the presence of an NHS domiciliary service is ‘not well known’ and, should a patient need urgent attention, ‘they have no alternative but to go to A&E’.
Meanwhile, ‘many of the NHS Enhanced Services, glaucoma refinement and OHT monitoring do not lend themselves to being provided in a home setting, so these patients are disadvantaged,’ says Roberts. She also points to care home and notification pressures – in a home where more than two people need to be seen, the provider must give three weeks’ notice of the visit – that mean a lack of attention given to homes where only one person needs domiciliary care. Even if diary and staff pressures allow a visit to a home with one person needing care, 48 hours’ notice must be given to the NHS. ‘Is this in line with the Equalities Act?’ she asks.
Considering the importance of domiciliary care to some people’s quality of life, more needs to be done to ensure the sector is properly supported and available services are made clear. If this happens, through collaboration between optical bodies and providers, then domiciliary care will continue to make a tangible difference to people’s lives.
OutsideClinic
Area: England, Scotland and Wales
Domiciliary OOs: 150
Domiciliary DOs: 100
Eye exams conducted in the past year: 150,000
Spectacles dispensed in the past year: N/A
Low vision aids supplied in the past year: N/A
Visits to care homes vs private homes: N/A
Portable equipment – funded camera, Eyeris digital patient record-keeping tablet and slit lamp
Company statement
For over 30 years OutsideClinic has been at the forefront of digital technology, having introduced a hugely successful bespoke digital patient record-keeping system, Eyeris, 10 years ago, along with portable slit lamps and fundus cameras in recent years. Its director of professional services, optometrist Nick Wingate, has also been in discussions with an American-based company about their new portable OCT technology, to further add to its diagnostic toolkit. ‘As a company we are very forward thinking and have already invested heavily in portable slit lamps and portable fundus cameras, with a portable OCT being the natural progression in providing an even better service to our group of patients and improved diagnostic capabilities for our optometrists,’ he says. OutsideClinic hopes to roll-out this new technology to its 150 mobile optometrists in early 2020.
Eyeris digital patient record-keeping tablet
Specsavers
Area: UK and Ireland
Domiciliary OOs: 49 solely-domiciliary, some cross-over from high street optometrists
Domiciliary DOs: 130
Eye exams conducted in the past year: 126,418
Spectacles dispensed in the past year: 153,522
Low vision aids supplied in the past year: N/A
Visits to care homes vs private homes: Care Homes: 22%, Private Homes: 78%
One of Specsavers’ domiciliary vehicles
Company statement
‘2018/19 was a fantastic year for our home visit service in the UK and Republic of Ireland as we provided optical care for over 126,000 housebound people,’ says Specsavers. ‘We provided our offer of excellent customer service and unbeatable value to those who are unable to visit our stores, with sales increasing by 15% in the UK and 14% in the Republic of Ireland. We are now a truly multi-category business with optics, home visits, contact lenses, audiology and broader eye care services all playing a part in us becoming recognised as a trusted healthcare brand.’
Visioncall
Area: England, Scotland and Wales
Domiciliary OOs employed: 85
Domiciliary DOs: 1 in every local practice
Eye exams conducted in the past year: N/A
Spectacles dispensed in the past year: N/A
Low vision aids supplied in the past year: N/A
Visits to care homes vs private homes: Visioncall specialises in care home visits
Visioncall
Company statement
Since 1994, Visioncall has been a leading eye care provider to the UK care home sector, delivering home sight tests to those unable to visit a high street optician. It uses the latest digital mobile testing equipment including digital eye charts, retinoscopes and autorefractors to make an accurate and precise recommendation at home. Visioncall understand the need to safeguard older individuals who live in care homes, often living with complex needs. The contribution that can be made by optometry professionals during a sight test to aid the safety, quality of life and dignity of residents is exceptional. This is the mission that drives its team to deliver a person-centred eye care service across the UK.
East England Eyecare
Area: East Anglia and London
Domiciliary OOs: 4
Domiciliary DOs: 6
Eye exams conducted in the past year: 1,499
Spectacles dispensed in past year: 600
Low vision aids supplied in past year: 130
Visits to care homes vs private homes:
care homes 40%, private homes 60%
Company statement
East England Eye and Hearing Care started off as a domiciliary optician service covering Colchester and surrounding areas. Over the years it has grown and expanded services to cover all of East Anglia and London. It is now able to offer a domiciliary audiology service too, which has been extremely popular. Its small but growing team of fully qualified opticians and audiologists pride themselves in offering a friendly and bespoke service to patients in the comfort of their own home. All its staff receive extra in-house training to ensure they are competent in visiting patients who may have special needs or requirements.
Eyecare Oncall
Area: Northwest, West Yorkshire and North Wales
Domiciliary OOs: 7 locums
Domiciliary DOs: 5
Eye exams conducted in past year: 8,547
Spectacles dispensed in past year: N/A
Low vision aids supplied in the past year: N/A
Visits to care homes vs private homes: 98% care homes
Company statement
Optometrist director of Eyecare Oncall Mashucul Mannan says: ‘We are a forward-thinking domiciliary optician set up by professionals who have years of experience in this field and felt the care sector needed a fresh approach to deliver the type of eye care our patients deserve, where promoting person-centred care and dignity are absolutely paramount. Our core ethos is to work with our patients, partners in healthcare and our staff so we can understand their needs in terms of relevant reports, communication and management advice to stay compliant with the CQC as well as fulfil our mission which is to improve peoples’ quality of life.’
Home Eyecare
Area: West Midlands
Domiciliary OOs: 1
Domiciliary DOs: 1
Eye exams conducted in the past year: N/A
Spectacles dispensed in the past year: N/A
Low vision aids supplied in the past year: 30
Visits to care homes vs private homes: 80% private homes, 20% nursing homes
Company statement
Home Eyecare was established around 2001 after its optometrist had gained experience of home visiting through working with an experienced dispensing optician. The practice has grown organically over the years and now covers Warwickshire, Worcestershire, Wolverhampton, Sandwell, Dudley and South Staffordshire. Home Eyecare has one optometrist with 20 years’ experience of domiciliary eye care. It does not employ a dispensing optician as the dispensing is carried out by the optometrist.
Home Vision Care
Area: North Wales
Domiciliary OOs: 1
Domiciliary DOs: 1
Eye exams conducted in the past year: 600
Spectacles dispensed in the past year: 100
Low vision aids supplied in the past year: N/A – has conducted 400 assessments
Visits to care homes vs private homes:
90% private
Chris Gould of Home Vision Care
Company statement
Home Vision Care specialises in providing the Low Vision Wales service on a domiciliary basis to housebound patients. It also provides GOS home eye examinations and offers full threshold visual field testing, Zeiss portable digital retinal photography, Perkins and i-Care tonometry, pachymetry and indirect BIO (headset). Optometrist director Chris Gould believe he is, ‘the best equipped provider in this area and also the most experienced – I have 13 years full time domiciliary experience and 40 years total on the GOC register. I do not advertise but receive referrals mainly from the hospital eye service, social services, GPs and voluntary organisations’.