{"id":30944,"date":"2018-11-15T16:34:13","date_gmt":"2018-11-15T22:34:13","guid":{"rendered":"http:\/\/stateimpact.npr.org\/oklahoma\/?p=30944"},"modified":"2018-11-29T16:26:53","modified_gmt":"2018-11-29T22:26:53","slug":"dental-care-often-ignored-in-nursing-homes","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/oklahoma\/2018\/11\/15\/dental-care-often-ignored-in-nursing-homes\/","title":{"rendered":"Dental care often ignored in nursing homes"},"content":{"rendered":"<div id=\"attachment_30946\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-30946 size-large\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home001_HR-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home001_HR-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home001_HR-672x448.jpg 672w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home001_HR-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home001_HR-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home001_HR-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home001_HR-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home001_HR-1620x1080.jpg 1620w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Kateleigh Mills \/ KOSU<\/p>\n<p class=\"wp-caption-text\">Dental hygienist Shelley Mitchell has traveled to 32 nursing homes so far in Oklahoma, teaching health care workers why oral care is so important, including its link to preventing pneumonia, a leading killer of nursing home residents.<\/p>\n<\/div><p><span style=\"font-weight: 400;\">Nurses and aides sit on couches and armchairs usually reserved for movie night. The workers recoil as pictures of severe plaque, tooth decay and bleeding sores are projected on the wall of the nursing center in Meeker.<\/span><\/p><p><iframe loading=\"lazy\" src=\"https:\/\/w.soundcloud.com\/player\/?url=https%3A\/\/api.soundcloud.com\/tracks\/530545809&color=%23ff5500&auto_play=false&hide_related=true&show_comments=false&show_user=true&show_reposts=false&show_teaser=false&visual=false\" width=\"100%\" height=\"150\" frameborder=\"no\" scrolling=\"no\"><\/iframe><\/p><p><span style=\"font-weight: 400;\">Dental hygienist Shelley Mitchell says this is what happens when nursing home residents don\u2019t get their teeth brushed.<\/span><!--more--><\/p><p><span style=\"font-weight: 400;\">\u201cA lot of the residents I saw this morning, I saw a lot of plaque, I saw <\/span><i><span style=\"font-weight: 400;\">a lot<\/span><\/i><span style=\"font-weight: 400;\"> of plaque, and I saw a lot of missing teeth,\u201d she said.<\/span><\/p><p><span style=\"font-weight: 400;\">Mitchell is part of an effort to fix that. She works for TMF Health Quality Institute, a company contracted by the state. The new program is funded with nursing home fines collected by the state health department. It was created in 2017 and may be renewed next spring. <\/span><\/p><p><span style=\"font-weight: 400;\">She\u2019s traveled to 32 nursing homes so far across the state to teaching health care workers why oral care is so important, including its link to preventing pneumonia, a leading killer of nursing home residents.<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cThe first visit I do the screenings on 10 residents at each home, and then I do three separate trainings at each [nursing] home,\u201d Mitchell said.<\/span><\/p>\n<div id=\"attachment_30947\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-30947 size-large\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home003_HR-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home003_HR-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home003_HR-672x448.jpg 672w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home003_HR-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home003_HR-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home003_HR-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home003_HR-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home003_HR-1620x1080.jpg 1620w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Kateleigh Mills \/ KOSU<\/p>\n<p class=\"wp-caption-text\">Just as nursing home workers are expected to help residents bathe, they are also supposed to brush the teeth of people who can\u2019t do it themselves.<\/p>\n<\/div>\n<h3><span style=\"font-weight: 400;\">Consequences aren&#8217;t limited to cavities<\/span><\/h3><p><span style=\"font-weight: 400;\">Just as nursing home workers are expected to help residents bathe, they are also supposed to brush the teeth of people who can\u2019t do it themselves. It\u2019s so important that it was federally mandated in a historic national <\/span><a href=\"https:\/\/www.aarp.org\/home-garden\/livable-communities\/info-2001\/the_1987_nursing_home_reform_act.html\"><span style=\"font-weight: 400;\">nursing home reform bill<\/span><\/a><span style=\"font-weight: 400;\"> passed in 1987. \u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Thirty-one years later, Mitchell says most resident\u2019s teeth that she sees still aren\u2019t being brushed. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cThe administrator has to do a pre-survey and a post-survey at the beginning and at the end of the training and that\u2019s one of the questions, how often are they brushing the resident\u2019s teeth,\u201d she said. \u201cAnd what I\u2019m seeing on paper and what I\u2019m seeing in the mouths, it\u2019s two different things.\u201d<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Who pays for dental care?<\/span><\/h3><p><span style=\"font-weight: 400;\">Older Americans often lose employer-based dental coverage when they retire \u2014 an age when many start suffering greater dental problems. <\/span><a href=\"https:\/\/www.cdc.gov\/oralhealth\/periodontal_disease\/index.htm\"><span style=\"font-weight: 400;\">Data from the Centers for Disease Control and Prevention suggest 70<\/span><\/a><span style=\"font-weight: 400;\"> percent of senior citizens have some form of periodontal disease. <\/span><\/p><p><span style=\"font-weight: 400;\">Yet <\/span><a href=\"http:\/\/www.justiceinaging.org\/wp-content\/uploads\/2018\/07\/Medicare-Dental-White-Paper.pdf\"><span style=\"font-weight: 400;\">basic Medicare<\/span><\/a><span style=\"font-weight: 400;\"> plans do not include dental coverage.<\/span><\/p><p><span style=\"font-weight: 400;\">It\u2019s an <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/benefits\/dental\/index.html\"><span style=\"font-weight: 400;\">optional benefit under Medicaid<\/span><\/a><span style=\"font-weight: 400;\">, and each state determines the extent of coverage. Some states cover all <\/span><a href=\"https:\/\/www.chcs.org\/media\/Adult-Oral-Health-Fact-Sheet_011618.pdf\"><span style=\"font-weight: 400;\">13 dental services<\/span><\/a><span style=\"font-weight: 400;\"> recommended for adults \u2014 Oklahoma <\/span><a href=\"http:\/\/www.okhca.org\/xPolicySection.aspx?id=6500&number=317:30-5-696.&title=Coverage%20by%20category\"><span style=\"font-weight: 400;\">only covers four<\/span><\/a><span style=\"font-weight: 400;\"> emergency dental services, like teeth extraction. Oklahoma could choose to expand its Medicaid dental coverage to include more services for adults, just like it does for <\/span><a href=\"http:\/\/www.okhca.org\/individuals.aspx?id=516\"><span style=\"font-weight: 400;\">children<\/span><\/a><span style=\"font-weight: 400;\">. About three out of every four nursing home patients use Medicaid.<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cBut then there&#8217;s also challenges with looking for a provider that\u2019s willing to accept the amount that Medicaid might pay for that emergency dental care, so I think there are significant challenges,\u201d said <\/span><a href=\"http:\/\/theconsumervoice.org\/about\/our-staff\/lori-smetanka\"><span style=\"font-weight: 400;\">Lori Smetanka<\/span><\/a><span style=\"font-weight: 400;\">, executive director at <\/span><a href=\"http:\/\/theconsumervoice.org\/\"><span style=\"font-weight: 400;\">The National Consumer Voice for Quality Long-Term Care<\/span><\/a><span style=\"font-weight: 400;\">, an Washington, D.C.-based advocacy group.<\/span><\/p><p><span style=\"font-weight: 400;\">Oklahoma nursing home residents are <\/span><a href=\"http:\/\/theconsumervoice.org\/uploads\/files\/issues\/Revised_Interpretive_Guidelines_with_Clickable_TOC.pdf\"><span style=\"font-weight: 400;\">not entitled to an annual routine dental cleaning<\/span><\/a><span style=\"font-weight: 400;\">. If the resident requests a cleaning or if the nursing home does a health assessment and determines the resident needs a dental service, then the nursing home has to arrange for it.<\/span><\/p><p><span style=\"font-weight: 400;\">Smetanka said nursing homes are required by law to help residents apply for reimbursement for <\/span><a href=\"https:\/\/www.ada.org\/en\/member-center\/member-benefits\/practice-resources\/paying-for-dental-care-a-how-to-guide-incurred-med\/incurred-medical-expenses-suggested-steps-for-residents-and-their-representatives\"><span style=\"font-weight: 400;\">unaffordable dental bills<\/span><\/a><span style=\"font-weight: 400;\">, but it doesn\u2019t often happen. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cThere is some data available through the nursing home compare system and the <\/span><a href=\"https:\/\/qcor.cms.gov\/main.jsp\"><span style=\"font-weight: 400;\">deficiency reports<\/span><\/a><span style=\"font-weight: 400;\">,\u201d she said. \u201cOkay, there\u2019s that data, but then there\u2019s what\u2019s actually happening on the ground.\u201d<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Overworked staff, un-checked teeth<\/span><\/h3><p><span style=\"font-weight: 400;\">Vivian Roberts has been a certified nursing assistant since 1993 but has only worked at the \u00a0Meeker nursing home for a few days. She didn\u2019t know that plaque is made up of bacteria until Mitchell\u2019s presentation and says she wasn\u2019t taught about oral health in her CNA program.<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cWe get in such a hurry sometimes, that we worry about how they look and that they get fed and clean,\u201d she said. \u201cWe really don\u2019t take that time to say, \u2018can I see your mouth\u2019 you know, \u2018can I see if you rinsed today,\u2019 to check that out. <\/span><\/p>\n<div id=\"attachment_30953\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-30953 size-large\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home004_HR-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home004_HR-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home004_HR-672x448.jpg 672w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home004_HR-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home004_HR-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home004_HR-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home004_HR-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/11\/20181109-meeker-nursing-home004_HR-1620x1080.jpg 1620w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Kateleigh Mills \/ KOSU<\/p>\n<p class=\"wp-caption-text\">Vivian Roberts has been a certified nursing assistant since 1993. She says she wasn&#8217;t taught about oral health care in her program.<\/p>\n<\/div><p><span style=\"font-weight: 400;\">The program teaches nursing home staff <\/span><a href=\"https:\/\/www.tmf.org\/Health-Care-Providers\/Nursing-Homes\/Oklahoma-Nursing-Home-Oral-Care-Project\"><span style=\"font-weight: 400;\">strategies<\/span><\/a><span style=\"font-weight: 400;\"> on dealing with dementia or Alzheimer&#8217;s patients who clench their mouths \u2014 or even try to hit aides. Roberts said that will help. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cI can\u2019t make them do something that they not willing to do, or they don\u2019t understand [they need] to do,\u201d she said. \u201cIt\u2019s not that I don\u2019t want to take care, it\u2019s sometimes they just won\u2019t let you.\u201d<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Who looks in Grandma\u2019s mouth?<\/span><\/h3><p><span style=\"font-weight: 400;\">National statistics on nursing home oral health are spotty, so it\u2019s hard to know how <\/span><a href=\"https:\/\/www.ada.org\/en\/science-research\/health-policy-institute\/oral-health-and-well-being\/Oklahoma-facts\"><span style=\"font-weight: 400;\">Oklahoma <\/span><\/a><span style=\"font-weight: 400;\">compares to other states. The state department of health licenses nursing homes and does surprise inspections, as well as responding to <\/span><a href=\"https:\/\/www.ok.gov\/health\/Protective_Health\/Long_Term_Care_Service\/\"><span style=\"font-weight: 400;\">complaints submitted<\/span><\/a><span style=\"font-weight: 400;\"> by the public. To date, the state health department has cited three nursing homes for dental violations in 2018. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cThis one has to do with dentures; we found that two that had broken dentures,\u201d said Debra Zamarripa, the survey manager in the state health agency\u2019s <\/span><span style=\"font-weight: 400;\">Protective Health Services, <\/span><a href=\"https:\/\/www.ok.gov\/health\/Protective_Health\/Long_Term_Care_Service\/\"><span style=\"font-weight: 400;\">Long Term Care division<\/span><\/a><span style=\"font-weight: 400;\">,<\/span><span style=\"font-weight: 400;\"> reading notes from one of the inspections.<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cIn the care plan, they didn\u2019t even document that the resident had broken dentures, there were no interventions or plans to fix the dentures, they had done nothing.\u201d<\/span><\/p><p><span style=\"font-weight: 400;\">After a nursing home is cited and possibly fined, staff must submit a plan to fix the problem. State health authorities then check up to see if the fixes were made. The agency often finds that a physician has issued medical orders for a resident to get certain dental services, but it hasn\u2019t been arranged by the nursing home.<\/span><\/p><p><span style=\"font-weight: 400;\">Shelley Mitchell, the dental hygienist, wraps up her presentation at the Meeker nursing home. Across the game room, <\/span><span style=\"font-weight: 400;\">a lone man in a wheelchair plays both sides of an oversized checkers game. He looks up when she asks the staff a question.<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cI mean, just be real honest with me, are you guys doing any kind of oral health screenings or looking in your resident\u2019s mouths?\u201d<\/span><\/p><p><span style=\"font-weight: 400;\">The nursing home workers shake their heads: No, they don\u2019t.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&#8220;What I\u2019m seeing on paper and what I\u2019m seeing in the mouths, it\u2019s two different things.\u201d<\/p>\n","protected":false},"author":199,"featured_media":30945,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[23],"tags":[986,208,985],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30944"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/users\/199"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/comments?post=30944"}],"version-history":[{"count":10,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30944\/revisions"}],"predecessor-version":[{"id":30999,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30944\/revisions\/30999"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media\/30945"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media?parent=30944"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/categories?post=30944"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/tags?post=30944"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}