Wisdom Tooth Project Webinar Series
Oral Care in Long Term Care
August 30, 2016
Connect with OHA! /Oral Health America
@Smile4Health
/Oral Health America
@Smile4Health
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ORAL HEALTH AMERICA’S MISSION IS TO CHANGE LIVES BY CONNECTING COMMUNITIES WITH RESOURCES TO DRIVE ACCESS TO CARE, INCREASE HEALTH LITERACY AND ADVOCATE FOR POLICIES THAT IMPROVE OVERALL HEALTH THROUGH BETTER ORAL HEALTH FOR ALL AMERICANS, ESPECIALLY THOSE MOST VULNERABLE.
OHA PRIORITIES OHA’s Programs and Campaigns are designed to improve access to care, oral health literacy and policies that prioritize the impact of oral health on the overall health of all Americans – particularly those most vulnerable.
ACCESS
HEALTH LITERACY
ADVOCACY
2016 CAMPAIGN: Oral Health Across the Lifespan Educate the public, including policy makers, about the importance of oral health for overall health Emphasize the need to prioritize oral disease alongside other serious health conditions Lead, participate and observe on legislative issues impacting oral health policies critical to OHA, our programs and stakeholders
toothwisdom.org
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Professional Symposia
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Technical Assistance
Today’s Webinar: Oral Care in Long Term Care • Identify the at-risk population • List the needs of this vulnerable population • Understand the oral care situation in residential care facilities • Describe what the HyLife Oral Health Alliance is doing to keep dependent adults healthy, both orally and systemically.
Today’s Speakers
Angie Stone, RDH, BS
Mary Jensen, RDH, MS
Heidi Halverson, RDH, BSDH, LAP
Angie Stone Founder and CEO HyLife Oral Health Alliance
Mary Jensen HyLife Oral Health Alliance Independent Oral Care Specialist
For Me It’s Personal
COPD People with periodontal disease have 60% more chance to develop COPD
How Do Elders Receive Dental/Dental Hygiene Services? • There are not a lot of resources available to
dependent adults
GRAM HELEN
July 2010
June 2012
60% OF TEETH LOST IN 2 YEARS
CNA’S, NURSES, DENTIST RESPONSIBLE FOR AND OVERSEEING ORAL CARE
An interest Continues‌
Older Patient Challenges • Dry Mouth • pH
• Plaque Retention • Root Exposure • Home Care Regimens • Dietary Habits • Medical Issues • Cognitive Changes • Physical Changes
THE GOAL IS TO KEEP PEOPLE HEALTHY AND HAPPY
Instrumental Activities of Daily Living (IADL’s) • Perform housework • Prepare meals
• Shop for groceries • Use telephone and other technology • Take medications • Manage finances • Use transportation
Activities of Daily Living (ADL’s) • Walking • Dressing
• Bathing (Personal Hygiene) • Eating • Getting in and out of bed • Toileting
Disabilities • Of people 65 and older over,18 million people have a disability of
ADL’s or IADL’s
Disabilities • Studies have shown that elders with a functional disability have
more unreated caries, higher prevelance of edentulism and use dental services less regularly than their non disabled counterparts.
Cognitive Impairment • Cognitive impairment is common among older adults • Frequency of oral health problems increases significantly in
cognitively impaired older adults, primarily those with dementia • It is estimated approx 3.85 million Americans may suffer from the
condition (National Institutes of Health 2010) • The numbers are expected to double by 2050
Percent of Nursing Home Residents Needing Assistance With ADL’s 100 90 80 70
60 50 40 30 20 10 0 Bathing
Dressing
Toileting
Eating
According to the Surgeon General‌ Elderly‌residents have extensive oral disease and poor oral hygiene and suffer the worst oral health of any population. Journal American Geriatrics Society, 2006
(U.S.Department of Health and Human Services. Oral Health in America: A report from the Sugeon General. 2000)
Basic Oral Care Tasks
Basic Oral Care is Left up to Nursing Staff
CNA Oral Care Education • The topic of oral care has one hour dedicated to it out of a 120 hour
program • This includes both lecture and hands on practice with other students
Lack of Effective Oral Care
Education is Always a Good Idea‌But it is NOT Enough • An oral care educational program did not result in
improvement in the delivery of routine oral care to nursing home residents
J AM MED DIR ASSOC 2009 Nov;10(9):658-61. doi: 10.1016/j.jamda.2009.09.001. Epub 2009 Oct 12. Nursing education and improvement in oral care delivery in long-term care. Gammack, JK Pulisetty S
Oral Care Specialist, HyLife Oral Health Alliance • The “Silver Tsunami” 10,000 people every day in the US turn age 65 • By 2030, almost 60 million aged 66-84 • Profound Health Care Implications
• Better oral hygiene care is a must for improved overall health!!
Oral Care Specialist, HyLife Oral Health Alliance • Heart Disease and Stroke • Lung Disease-COPD • Diabetes • Arthritis • Dementia • Aspiration Pneumonia
Oral Care Specialist, HyLife Oral Care Alliance • What we know• Periodontal/Gum Disease is the MOST common inflammatory
disease
• We also know-
• There is an oral/systemic link • Any type of inflammation increases overall health risks
Oral Care Specialist, HyLife Oral Health Alliance • We need to practice PREVENTATIVE dentistry • Mouth Care=Infection Control • Our Seniors have a right to oral care
• Neglect can lead to serious health risks
• Toothbrushing is not grooming, like hair combing, it is INFECTION
CONTROL!!
Oral Care Specialist, HyLife Oral Health Alliance • Oral Hygiene is provided to: • Improve overall health • Prevent pain and dental disease and bad breath
• Decrease cost of medical/dental care
• It also feels good to have a healthy clean mouth!!
Oral Care Specialist, HyLife Oral Health Alliance • Where did it all start? • Local component meeting….ADHA
• Research! • CE courses and Caregivers Association Certificate • Organized legal details
Oral Care Specialist HyLife Oral Health Alliance • FINALLY-- time to “step off the curb!”
• Marketing materials
• Make a list of everyone you know and who you can share your new
found passion within the profession
Oral Care Specialist, HyLife Oral Health Alliance • Look into area senior networking groups
• Contact via email and letter all assisted living communities in your
area • Research senior health fairs • Local senior community groups • Visit local assisted living communities
Oral Care Specialist, HyLife Oral Health Alliance • WATCH OUT!!
• You will grow professionally! • Speaking engagements, presentations, dental conventions
exhibits, articles and interviews with dental publications. • YOU are the expert in oral hygiene care!!
Oral Care Specialist, HyLife Oral Health Alliance • It is all about the PURPOSE: • Helping our seniors with their oral hygiene care • Profoundly rewarding • Relationships with clients and growing an independent business • Advancing the profession
Oral Care Specialist HyLife Oral Health Alliance • SENIORS
• Dentistry’s forgotten population
• HyLife is a model that puts the dental hygienists where they are
most needed—Providing preventative oral hygiene care
Oral Care Specialist, HyLife Oral Health Alliance • The routine: • Weekly clients • Weekly presentations • Monthly senior networking meetings
• Preparing for presentations • Monthly coaching and team conference calls • Hygienist decides involvement level
Oral Care Specialist, HyLife Oral Health Alliance
• Again, it is about the purpose! • Helping those who need help!
Oral Care Specialist, HyLife Oral Health Alliance • Proven combination for better oral health:
• Weekly oral hygiene care visits by OCS/RDH • Daily xylitol product protocol—mints, gum, toothpaste, rinse • The ideal future will include dental hygienists in every assisted
living senior community
Oral Care Specialist, HyLife Oral Health Alliance • Who do you know?
• Family or friend in assisted living? • ASK: how often are their teeth being brushed/flossed and by
whom? • Mouth infections can enter the bloodstream and affect overall health!
Oral Care Specialists, HyLife Oral Health Alliance • “Bringing Oral Care to Elder Care”
• Reach out to any of the HyLife Oral Care Specialist
Together We Can Make A Difference Primary Care Provider
Dental Team
Nurse
Nursing Assistant
Oral Care Specialist
Everyone does what they are best at to keep elders healthy!
ELDER Benefits • Receive Professional Oral Care • Prevent Oral Disease
• Lower Risk of Heart Attack & Stroke • Reduce Dental Emergencies • Lessen Pneumonia Rates • Improve Overall Quality of Life
Care Team Benefits • Support Care Teams in Keeping Residents Healthy • Care Team Oral Care Training • Care Team Support • Resident and Family Camaraderie
• Family Group Presentations • Oral Health Advocacy • Assistance with Oral Care Tasks
Dental Office Benefits
• Someone to help keep patients healthy when they are not able to
get in to the dental office • Superior oral care • Appropriate referrals to the dental office • Patients who have been in the dental practice for years, maybe even decades, are taken care of through the end of life • Dental office can be involved in patients care • Patients have oral health for their ENTIRE life
RDH Benefits • Utilize Your Existing Skill Set • Make a Difference in the Elder Community
• Promote Oral-Systemic Health • Earn Additional Income • Work Flexible Hours • Be Part of a Dedicated Alliance
Additional Income
Support
Autonomy
Service
Thank You Angie Stone, RDH, BS
Mary Jensen, RDH, MS
Oral Health Alliance
608.884.0038 astone@hylifellc.com
630.877.3151 maryjensenrdh@gmail.com www.hylifellc.com
Shout Out Segment
Heidi Halverson, RDH,BSDH, LAP Dental Hygiene at Home • I have been a RDH since 1980, I have worked in the bush of Alaska and the United States Peace Corps. Current president of the Montana Dental Hygiene Association. • I work in private practice 3 days a week and have been in the same practice since 1989.
• I started my business, “Dental Hygiene at Home” in September of 2013, where I work in Long Term Care facilities or travel to homes of individuals who can’t get to a traditional dental office. • I work 3 days a week in Long Term Care facilities and currently I am working in 19 different facilities.
I started my business because:
I was talking to one of my elderly patients about the dental hygiene crisis in nursing homes and she said I will pray for you and send you money so you can start. Well she did…she sent me enough money so I could purchase my light for my loupes and other items. I was motivated and encouraged to go for it.... Once I had my Access Permit, Medicaid Provider Number (NPI), Tax Identification number (TIN), malpractice insurance, Facebook page: Dental Hygiene at Home, proper forms, Fax machine, Business Cards etc.
My First day was so shocking…I called our local paper and said, “you must do an article on the dental crisis in Long Term Care facilities”!
“With Help From Donations, Dental Hygienist Treats Residents at Missoula Care Facilities�
Our local paper wrote an article about my new dental hygiene services that I was providing to the residents in long- term care facilities. I see residents ages 25-102 years old!
I provide care to all individuals no matter what disease, accident, alcohol and drug abuse or any other condition.
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Montana LAP…since 2003! 37-4-405. Dental hygienist to practice under supervision of licensed dentist – exceptions (1) A licensed dental hygienist may: (b). Provide dental Hygiene services in a “Public Health Facility” under “Public Health Supervision”. “Public Health Supervision” means the provision of dental hygiene preventative services without the prior authorization or presence of a licensed dentist in a “public health facility”. (3)(c) “Public Health Facility” means: nursing homes, extended care facilities; home health agencies; group homes for the elderly, disabled, and youth; head start programs, migrant worker facilities; local public health clinics and facilities; public institutions under the department of public health and human services; and mobile public health clinics; and other public health facilities
and programs identified by the board.
I put everything in a bag and carry it over my shoulder along with a kneeling pad.
I use Zip Lock bags for each resident: Hand Instruments, 4 pieces of gauze, fl varnish, toothbrushes: OraBrite soft post perio brush, Nimbus TB, Sulcabrush. I use one cup for rinsing and another for expectorating. I see residents in Wheelchairs, Recliners, and even in Bed.
One facility’s set up – Dream situation
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Services by a Dental Hygienist
Scaling either for a prophylaxis or Quadrant Scaling Brushing with manual toothbrushes, Sulcabrushes or electric toothbrushes Flossing, Bridge cleaners, Interdental cleaning with proxybrushes or other interdental aides Fluoride Varnish Treatments, recommending Prescription Fl- Toothpaste or gels Polishing with cordless polishers Take X-rays and sending to appropriate Dentists Dental Health Education for CNA’s, all other health professionals and family members Denture Identification Referrals to Dentists, Oral Surgeons and Denturists and sometimes medical providers Recommending Supplies: ex: denture cups and tablets, RX toothpastes, Dry mouth therapy: ordering tablets, sprays or gels and working with Pharmacists Collaborate with Speech Therapists, Physical Therapists, Occupational Therapists Work with Social Workers (in charge of residents dental) and Nutritionists Tobacco Cessation (both smoking and smokeless) for both staff, residents and medical providers Work with Home Health Agencies including Hospice Companies Work with Local Aging Services Work with Local County Health Departments Collaborate with state and local Ombudsman and State Surveyors Work with Director of Nursing (DON), Executive Directors and Admissions Directors Billing Medicaid, Private Pay and Dental Insurance
• • • •
I am a Medicaid Provider, Delta Dental Preferred Provider, Take Private Pay Bill all Dental Insurance Companies Medicaid in Montana includes: Quadrant Scaling: D4341, D4342 Prophylaxis: D1110 Unlimited Fluoride Varnish: D1206 Smoking Cessation: D1320
Physical Therapists, Occupational Therapists and Speech Therapists work full time and get paid for full time work in Long Term Care Facilities! RDH’s need to be added to the team!
Embrace a positive attitude and never give up the fight‌persistence Dental Hygienists are the most educated and trained professional to provide dental hygiene services to elders and disabled individuals
Example #1. Not even an Emergency room doctor was able to do an oral assessment on a resident.
Example #2. A CNA and broken denture
Thank you! Contact Info: Heidi Halverson, RDH, BSDH, LAP hlmontana@aol.com
Contact Information Andie Kyros, RDH, MPH Older Adults Program Coordinator andie.kyros@oralhealthamerica.org
Today’s webinar recording will be uploaded to: Oral Health America’s YouTube channel Brief evaluation survey will be sent following the webinarWe greatly appreciate your feedback!
If you are interested in: • Presenting an upcoming webinar Or • Having your organization or your efforts highlighted in the “Shout Out” section Please contact: wisdomtoothproject@oralhealthamerica.org
Questions?
THANK YOU!