Oral Health Program for

Long Term Care ResidentsPresentation to Saskatchewan Oral Health Coalition

November 4th, 2013Audrey Harder, Speech Language Pathologist

Ashley White, Dental Health Educator

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The Importance of Daily Oral Care

• The purpose of oral hygiene is to prevent the buildup of plaque, the sticky film of bacteria and food that forms on the teeth.

• The mouth is an important part of your body that enables you to eat, talk and breathe. Cleaning your mouth daily improves oral health and overall health.

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• Access to proper oral health care is more profound for seniors residing within a long-term care facility.

• According to the Surgeon General’s report, “nursing homes and other long-term care facilities have limited capacity to deliver needed oral health services to their residents, most of who are at increased risk for oral diseases.”

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Survey in LTC facilities - 2009• Done to identify the current state of oral care

across 13 long term care facilities– 71.2% of residents were dependent for oral care

across the facilities– 13.2% required set-up help only – No facility indicated that regular dental checkups and

cleanings were done– 4 different policies were identified regionally, none

had been recently updated

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Results:1. Those with natural teeth: 94.4% of facilities fell in

the fair oral care category, 5.6% in the incomplete oral care category.

2. Dentures: 88.9% of facilities fell in the incomplete oral care category, 11.1% in the fair oral care category. Typically, individuals with dentures did not have their mouths cleaned, only their dentures.

3. No teeth (edentulous): 100% of facilities fell in the incomplete oral care category.

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What is a caregiver?• What constitutes as a caregiver? • Is it the person who provides direct patient

care?• Is it the person who supervises those who

are providing direct care?• Is the decision makers? • Facility manager? VP’s? CEO? Board

members?

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Goal of the Program:• Improved oral health for residents of the long

term care facilities across the health region consisting of oral assessments, individualized daily oral care plans, regular dental check ups and cleaning, and referral if necessary.

• A regional or PROVINCIAL standardized program and policy.

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Current status of project:

• Cut Knife, Edam and St. Walburg – initial assessment and first 6 month follow-up screening completed,

they are continuing to screen each resident every 6 months• Dr. Cooke – initial staff training was completed• Jubilee Home – questionnaire phase • Simplified staff education component by putting training module on

line, along with all staff quizzes on survey monkey.• Presented status of LTC project to PNHR Board Members. Made

recommendations, none of which were followed up with.• Met with our managers to discuss frustration, program at stand still.• Discussed RPIW at our championship site in Cut Knife. This did

not occur.

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Current status of project:

• Developed several policies for use in LTC. These were not approved at the manager level.

• Met with rural clinical nurse educator for ideas/suggestions on how to move forward. Developed 5 oral care audit questions for her to use in facilities to evaluate how oral care is being delivered to residents by staff – specifically SCA’s. These have yet been put into use.

• Contacted SHR for permission to use their LTC program model.• Meet with Cut Knife facility manager to discuss implementation of

new program next week.

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Project Barriers:• Staff turnover • Scheduling conflicts • Staff buy-in• Oral care not a priority• Lack of oral care equipment• Transportation to dental offices for follow up care• No outside contract dental services or space available to

provide dental care in the facilities• No PNHR ltc facilities have built in dental suites • Finding a dental office that treats residents with

dementia or residents in wheelchairs

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Conclusion

• Our goal has been to provide quality individualized geriatric oral care to all LTC residents.

• Where do we go from here? How can we improve access to oral care? What can we do better?

• How can we improve the current oral care regime in facilities?

• How can we get LTC staff and facilities to recognize the importance of oral health in relation to overall well-being.

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Questions??

Thank you for your attention.

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