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Real Deal

Real Deal: The Case of the Bullying Son




An elderly patient may be depressed. Is it appropriate for her eyecare provider to get involved?

This article originally appeared in the April 2015 edition of INVISION.

Case studies for eyecare businesses

The town of Valley View, OR, was enjoying a beautiful spring afternoon. Valley View Eyecare’s waiting room was empty, except for one elderly woman slumped in a reception chair. “Good afternoon, Mrs. Abbott!” cheered Wendy, an optometric technician. The woman looked up timidly. “Please take my arm, we’re going to head in to see Dr. Shaw now,” Wendy said.


Wendy knew Mrs. Abbott well; she had been a teacher and was also a gifted oil painter. She’d been diagnosed with wet macular degeneration eight years ago; now 81 and widowed, she was losing her central vision, and Wendy had noticed her becoming increasingly withdrawn. Today, Mrs. Abbott did not smell clean and her clothes were shabby.

As Mrs. Abbott struggled through her Amsler Grid test, a man entered. “Ma, didn’t you tell them to wait for me?” he barked.

“I’m Ed,” he said. The man reeked of cigarettes and needed a haircut. “I take care of my mom. She can’t see so well, and when I got divorced last year I figured I’d move home so she’d have someone.”

“It must be nice to have someone in the house with you now!” Wendy said to Mrs. Abbott. The frail woman smiled but avoided eye contact.

Wendy went to let Dr. Shaw know his patient was ready. “Her son is here,” she said with a tone of warning. Dr. Shaw raised an eyebrow and took Mrs. Abbott’s chart from Wendy. “OK, thank you Wendy,” he said.

After the exam, Dr. Shaw spoke to both Mrs. Abbott and her son. “As you know, the macular degeneration is worsening your eyesight. I’ve been talking with your ophthalmologist, and we would like to get you a low vision evaluation. You might benefit from task-specific tools to augment your remaining vision,” he said. “That means you can start painting again.”


Mrs. Abbott’s face lit up, then she looked at her son. “Does insurance cover that?” he asked.


Real Deal is a fictional scenario designed to read like real-life business events. The businesses and people mentioned in this story should not be confused with actual eyecare businesses and people.



Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at

“They will likely cover the exam, but the equipment will probably be out of pocket,” said Dr. Shaw. “The low-vision aids are typically a few hundred dollars, but it would drastically improve your mother’s quality of life.”

Ed whistled. “Maybe next year. Ma, I’ll read to you,” Ed chuckled. He looked at Dr. Shaw. “Anything else?”

Dr. Shaw turned to Mrs. Abbott. “Is this something you would be interested in?”

Ed stood up and spoke to his mother. “You don’t have that kind of money, Ma. Can’t we just use the grocery store glasses, doc?”

“No, I’m afraid your mother requires something more complex than that,” replied Dr. Shaw, not looking at Ed. “Mrs. Abbott?”

The elderly woman looked conflicted, then replied, “My son manages my finances now, I’m not really sure …” and trailed off.

Dr. Shaw helped Mrs. Abbott up. “I hope you consider it,” he told her. “I know how isolating it can be to lose your vision.”

Later, Wendy approached Dr. Shaw. “Mrs. Abbott is depressed. I know that painting would really help. She needs those low vision aids!”

Dr. Shaw shook his head. “We don’t know her financial state. I’d be willing to work out a payment plan if she were prescribed a device, but beyond that, it’s really up to her.”

Wendy crossed her arms. “The thing is, I don’t think it is up to her. Her son isn’t caring for her. Can we report this to someone?”

“Who?” asked Dr. Shaw. “She didn’t tell me she was abused or scared. What would I report? That her son is keeping her from buying a low-vision aid?”

“I don’t know,” sighed Wendy. “I just feel like she needs help.”

T H E    B I G    Q U E S T I O N S

1. What would you have done differently in this scenario if you were Dr. Shaw?

2. Is it appropriate to call an agency if the patient isn’t making any complaints?

3. What are the pros and cons
of getting involved in Mrs. Abbott’s situation?

R E A L    D E A L    R E S P O N S E S


I would have taken Ed aside and explained patient privacy with him and if he had power of attorney, that should be on file with you. Before I got too involved in this, I would make sure that she could adapt and make use of the low vision devices. I would then contact a lawyer familiar with these things and get his or her advice on how to proceed. As much as we would like to help this lady, it is a very slippery slope, and you should proceed with great caution.


Doctors are mandated reporters in all states regarding vulnerable populations. This does not mean the doctor or the staff determine whether this person is being neglected or harmed; it simply requires that concern based on what was witnessed be reported. In this case, the state agency that investigates those reports, such as Adult Protective Services, should be notified.

Dr. G.R. M.
Lake Charles, LA

I would not have done anything different from Dr. Shaw. Unfortunately, the current climate is to tell someone when you disagree with another’s decision. With no overt signs of abuse, this is a personal issue between two adults. If you feel for Mrs. Abbott’s apparent situation and want to get involved, make a gift of the low vision aid to her.

Ballston Lake, NY

I am a mobile optician who has contracted with nursing homes to provide on-site optician services for over 15 years, and run into such situations repeatedly. I try to promote the idea of low vision aids by focusing on how the aids can improve the quality of life, and state that various factors influence the cost, so it’s difficult to predict out-of-pocket expenses until a specific product has been recommended following the low vision evaluation. This is sometimes successful, when the caregiver can witness the impact that regained ability to perform certain tasks can have on an elder. Sadly, greed often wins; the adult children try to protect their impending inheritance at the expense of their parents’ health and happiness.


This could be a case of elder abuse and should be reported to the appropriate agency. The patient does not need to complain to report it.

Avon, CT

If abuse is seen and noted by a medical professional, although not verbally said by patient, it can be reported. It’s worth a try to help if you really care and follow through with your word. Con: Son can call office and complain, or worse. Pro: You can make a difference in someone’s life and give Mrs. Abbott the confidence to stand up to her son. Her living conditions could be drastically improved.


It would be nice if Dr. Shaw could get Mrs. Abbott alone. While it is not his duty to determine if abuse is happening or not, it would be nice to ask Mrs. Abbott if she is OK or in need of services. I would let her know many healthcare companies are now providing in-home social workers for the aged and disabled. I would encourage her to ask for one. If Mrs. Abbott cannot be talked to alone, or if she indicates that there is abuse happening, I would call Adult Protective Services. Even if what is happening is not substantiated as elder abuse, APS can still help the family get resources that will help relieve some of the stress in that household, possibly even a grant to assist with low vision devices.


My wife works for the Chester County Department of Aging in Pennsylvania. Mrs. Abbott deserves an evaluation to determine whether she qualifies for senior citizen services. The evaluation is need- and financial-based. These folks are the experts. Dr. Shaw simply needs to provide Mrs. Abbott the phone number of the local Department of Aging. The doctor could call the agency on her behalf as well.



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