Last year, 2017 marked the 30th anniversary of the enactment of the Nursing Home Reform Act as
part of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), that established standards
focused on quality of life in Long-term Care Facilities (LTCFs), that require LTCFs to provide
comprehensive data collection to be reimbursed by Medicare and Medicaid.
According to the most current report conducted by the Centers for Disease Control and
Prevention’s National Center for Health Statistics (NCHS), nearly 8 million older adults in the United
States received services from Long-Term Care Facilities (LTCFs) such as adult day services
centers, residential care communities, home health agencies, hospices, and nursing homes. This
total number of Americans in need of long-term care is projected to more than double to 27 million
in 2050. Shocking estimates of the annual amount spent on long-term services are between $10.9
billion and $306 billion.
The NCHS report profiles users of Long-Term Care services (by gender, with users overwhelmingly
women (72.0%), followed by race and functional characteristics. At least three-quarters of users are
Non-Hispanic white persons with Alzheimer’s disease or other dementias and depression. Most of
these elderly individuals require assistance with activities of daily living such as bathing, dressing,
toileting (personal hygiene), oral hygiene, and eating.
Alarmingly, Washington State’s national daily use of
residential care communities by residents aged 65 and
over was significantly higher than that of the national rate
Unregulated care aids, known as certified nursing
assistants (CNAs) are the predominant providers (up to
80%) of direct resident care in LTCFs (Figures 6 & 8).
These frontline caregivers have little formal training,
manage high workloads, and frequently experience
responsive behavior from residents.
Further they are
faced with tremendous challenges each day to provide
high-quality care to clients, unrealistic expectations of
brushing every resident’s teeth three times a day and
flossing once a day is impossible. No wonder LTCFs are
plagued with an inability to recruit and retain nursing
assistants. Turnover among direct care workers is reported
as has high as 100 percent in some organizations.
According to the Federal government, LTCFs must provide routine oral care and emergency dental
services to Medicaid residents.
Most long-term older patients are medically compromised or
frail, unable to provide oral hygiene self-care and often resistant to mouth care from nursing
Many CNAs admit to failing to provide this service because of this resistive
Not surprising oral health status of nursing home residents has been described as poor
and even “deplorable”.
In addition to LTC residents having greater oral hygiene needs than any other segment of the
population including fungal infections, xerostomia, root caries, periodontal disease, and other oral
health concerns, more residents are living longer with natural teeth
restored with expensive
crown and bridge work, and infection vulnerable implants.
Now is the time to develop collaborative practice models for oral health promotion and disease
prevention in these primary care facilities, utilizing educational resources such as Smiles for Life
curriculum and mobile dental professionals. Action needs to be taken to improve frontline
caregiver’s knowledge in oral health practices, motivate LTCFs residents in oral healthcare and
develop strategies to reduce resistive behaviors.
Regular assessments, monitoring and management of oral care through routine dental care
provided by mobile dental hygienists will improve oral quality of life, with direct effects on general
quality of life and well-being.
Improvement of LTCFs resident’s oral health will require
interdisciplinary training and the collaboration of dental health professionals and LTCF primary
Together we can have Washington State ready to meet the needs of this projected “silver tsunami”
both in primary care and oral care!
Copyright 2000 Alliance of Dental Hygiene Practitioners. All rights reserved.
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Our Aging Population and Oral Health
Long-Term Care Settings and Oral Care Call-to-Action
(MacEntee, M. I., Müller, F., & Wyatt, C., 2011)
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