Getting dental care to elders in nursing homes
By Mary Otto
Getting oral health care services to elders in nursing homes is a crucial task, yet one that is often overlooked, stressed panelists who participated in a May 15 AHCJ webcast.
Untreated oral disease can have a devastating impact on the lives of these frail patients, leading to suffering and tooth loss, poor nutrition and serious, even fatal infections.
“Brushing teeth becomes a life or death thing for many patients,” said Greg Folse, D.D.S., who operates a Lafayette, La.,-based mobile nursing home practice.
Yet there are significant barriers to getting care to an estimated 1.4 million seniors in nursing homes.
One significant challenge is this: The majority of elders living in nursing homes suffer from dementia. They are often not able to care for themselves and may resist receiving help, even with routine daily care such as toothbrushing.
“We see the use of care declines as dementia increases,” noted Judith Jones, D.D.S., a professor at Boston University’s Henry M. Goldman School of Dental Medicine and a spokeswoman for the American Dental Association.
While federal law requires nursing homes to assist patients in obtaining routine and emergency dental care, state laws vary. In addition, nursing home directors, staff and family members may overlook the importance of oral health care, not only for the increasing number of seniors who have kept their teeth into old age, but for those who use dentures.
There are financial barriers as well.
Medicare, the nation’s health care program for the elderly, does not cover routine dental services. Medicaid dental services for poor adults are extremely limited in many states. A shortage of dentists in many communities as well as in nursing homes makes it difficult for many seniors to get adequate care, added Beth Truett, executive director of the nonprofit Oral Health America.
Awareness about the importance of oral health for frail elders must be raised, she added. “It’s not OK to brush my hair and put a pretty dress on me and not take care of my mouth.”
The American Dental Association has set a goal of training 1,000 dentists to provide care in nursing homes by 2020 as part of an Action for Dental Health initiative. Check with your state or local dental society to see if providers are getting this training or are already providing care in local nursing homes.
For additional state and community angles on this story, check with these groups:
The Special Care Dentistry Association works with oral health care professionals to raise awareness and increase access to oral healthcare for patients with special needs.
The American Dental Hygienists’ Association represents these licensed oral care providers nationwide. Currently, laws in many states allow hygienists to provide care in community settings such as nursing homes.
For a look at laws related to oral care in nursing facilities:
The University of Minnesota School of Public Health has compiled a guide to federal requirements related to the provision of dental care in skilled nursing facilities. This site also includes listings of state laws (be sure to also check with your own state for the most current information.)
The Federal Omnibus Budget Reconciliation Act of 1987 set standards for nursing home care, including dental care. Under the law, nursing homes are required to assist patients in obtaining both routine and emergency dental services. For more about the law, see this Kaiser Family Foundation report.
For a better understanding of the impact of poor oral health on overall health among America’s seniors, this Centers for Disease Control and Prevention fact sheet gives a broad overview.
For more information about getting services to frail and impaired patients, this guide from the Iowa Geriatric Education Center at the University of Iowa offers practical advice to caregivers about the importance of oral care for cognitively impaired nursing home residents and how to provide it.
This paper from the Journal of Gerontological Nursing, "Oral Hygiene Care for Functionally Dependent and Cognitively Impaired Adults," offers a summary of the health implications of poor oral health among frail adults, a glossary of terms and links to research.
This paper looks at the associations between oral infections and pneumonia.
This article offers a look at research into the connections between oral health and chronic disease among vulnerable patients.
For an advocacy group’s perspective on some of the larger barriers facing all elders, both in and out of nursing homes, Oral Health America released a report last fall entitled "State of Decay," which takes at state-by-state look at issues related to the oral health of seniors.
For more on America’s aging population, check out this report from the U.S. Department of Health and Human Services Administration on Aging, which reports on the living arrangements, income, insurance status and disability levels of the elderly.