Elder Smiles

State: KS Type: Model Practice Year: 2010

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In the 2000 report, Oral Health in America, the Surgeon General recognized the connection between oral health and general health. Dental pain can cause a deterioration of nutritional status and consequent weight loss. Scientific research shows an association between chronic oral infection and diabetes, heart and lung disease, stroke, osteoporosis, blood infections, and more. Additionally, research has shown a connection between oral health and mental health. Enhanced oral health has been shown to increase self esteem and decrease self-imposed isolation of seniors living in long-term care facilities. It is well known that the population of Americans 65 years of age and older is growing in number, and the number of frail elders with complicated medical conditions is also increasing.

The goal of Elder Smiles is to improve the oral health of seniors living in long-term care facilities. The objectives include:
-Provide preventative oral health care to the targeted population.
-Provide referrals for restorative care to target population as needed. Restorative care includes fillings, root canals, fixing of broken teeth, untreated cavities, and treatment of gingivitis.
-Provide dental homes to targeted population. For those seniors without a dentist, a dental home will be established in the community or with the volunteer dentist(s) that serve the facility.

This program offers an opportunity for seniors in long-term care facilities to address their dental needs in a convenient setting at a reasonable cost. Elder Smiles intends to be able to offer this service in as many long-term care facilities in Johnson County, KS as are interested in participating. Elder Smiles started with two long-term care facilities, and has grown steadily to 19 facilities enrolled, with 17 facilities currently active. Marketing of the program to facilities as well as word of mouth promotion has made Elder Smiles an in-demand service. Since July of 2008, Elder Smiles has accomplished 516 visits to residents in long-term care facilities. Elderly residents in long-term care now have increased access to dental hygiene services that have resulted in lower rates of new oral disease and tooth loss. The portable oral health clinic also provides flexibility and convenience. Patients experience less pain related to dental problems and are referred for dental work before infections or other problems escalate. The anticipated long term result is that they will maintain or improve their nutritional status and avoid weight loss which translates to better overall health and decreased healthcare expenses. The resident’s mental health is also expected to improve based on oral health research.

Outcomes are measured through various dental statistics maintained by the program including patient visits, existence of a family dentist, and numbers of referrals made. These measures will show that over time, on-site access to dental services for the elderly in long-term care facilities will result in improved oral health and general well being. To date the following services have been provided: Prophylaxis – 444 Oral Hygiene Instruction – 247 Fluoride Varnish – 305 Nutritional Counseling – 144 Full Mouth Debridement – 2 Oral Evaluation (dentures) – 13 Referrals - 57

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Johnson County Department of Health & Environment
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Elder Smiles
In the 2000 report, Oral Health in America, the Surgeon General recognized the connection between oral health and general health. Dental pain can cause a deterioration of nutritional status and consequent weight loss. Scientific research shows an association between chronic oral infection and diabetes, heart and lung disease, stroke, osteoporosis, blood infections, and more. Additionally, research has shown a connection between oral health and mental health. Enhanced oral health has been shown to increase self esteem and decrease self-imposed isolation of seniors living in long-term care facilities. It is well known that the population of Americans 65 years of age and older is growing in number, and the number of frail elders with complicated medical conditions is also increasing. The goal of Elder Smiles is to improve the oral health of seniors living in long-term care facilities. The objectives include:-Provide preventative oral health care to the targeted population. -Provide referrals for restorative care to target population as needed. Restorative care includes fillings, root canals, fixing of broken teeth, untreated cavities, and treatment of gingivitis.-Provide dental homes to targeted population. For those seniors without a dentist, a dental home will be established in the community or with the volunteer dentist(s) that serve the facility. This program offers an opportunity for seniors in long-term care facilities to address their dental needs in a convenient setting at a reasonable cost. Elder Smiles intends to be able to offer this service in as many long-term care facilities in Johnson County, KS as are interested in participating. Elder Smiles started with two long-term care facilities, and has grown steadily to 19 facilities enrolled, with 17 facilities currently active. Marketing of the program to facilities as well as word of mouth promotion has made Elder Smiles an in-demand service. Since July of 2008, Elder Smiles has accomplished 516 visits to residents in long-term care facilities. Elderly residents in long-term care now have increased access to dental hygiene services that have resulted in lower rates of new oral disease and tooth loss. The portable oral health clinic also provides flexibility and convenience. Patients experience less pain related to dental problems and are referred for dental work before infections or other problems escalate. The anticipated long term result is that they will maintain or improve their nutritional status and avoid weight loss which translates to better overall health and decreased healthcare expenses. The resident’s mental health is also expected to improve based on oral health research. Outcomes are measured through various dental statistics maintained by the program including patient visits, existence of a family dentist, and numbers of referrals made. These measures will show that over time, on-site access to dental services for the elderly in long-term care facilities will result in improved oral health and general well being. To date the following services have been provided: Prophylaxis – 444 Oral Hygiene Instruction – 247 Fluoride Varnish – 305 Nutritional Counseling – 144 Full Mouth Debridement – 2 Oral Evaluation (dentures) – 13 Referrals - 57
In the 2000 report, Oral Health in America, the Surgeon General recognized the connection between oral health and general health. Dental pain can cause a deterioration of nutritional status and consequent weight loss. Scientific research shows an association between chronic oral infection and diabetes, heart and lung disease, stroke, osteoporosis, blood infections, and more. Additionally, research has shown a connection between oral health and mental health. Enhanced oral health has been shown to increase self esteem and decrease self-imposed isolation of seniors living in long-term care facilities. It is well known that the population of Americans 65 years of age and older is growing in number, and the number of frail elders with complicated medical conditions is also increasing.The idea for Elder Smiles was born in 2004–2005 when the Johnson County Health Department’s Adult/Childcare Facilities Division Director attended a meeting where a similar program was described. After some discussion, JCHD’s Health Director consented to initiating the program as long as start-up costs were covered by grant funding. Program planning and design specific to Johnson County began shortly thereafter. One of the first tasks was to convene an Advisory Board. The Board included representatives from Oral Health Kansas, the University of Missouri, Kansas City School of Dentistry, local ECPII hygienists and dentists, the Kansas Department of Health and Environment Office of Oral Health’s Director, the Past President of the Kansas Dental Association and a local long-term care facility administrator. The Advisory Board met initially to identify equipment and supplies needed and discuss program design. Currently, its function is to provide group feedback on services and guidance for the overall program. The Elder Smiles Advisory Board meets on a quarterly basis. In order to determine the need for on-site dental services, JCHD conducted a survey of all adult care facilities in the County. Forty-seven facilities responded. Eleven facilities, accounting for 40% of the total adult care beds in Johnson County, stated they were very interested in bringing on-site oral health services to their residents. Approximately half of the facilities stated they accept Medicaid clients. Within the facilities accepting Medicaid, an average of 49% of their total population were Medicaid recipients. The survey also showed that only one percent of the respondents reported having dental insurance.Elder Smiles is designed to provide on-site teeth cleanings and oral health exams twice a year to residents in long-term care facilities by an Extended Care Permit II (ECPII) hygienist. Each resident also receives an annual fluoride varnish. The fluoride varnish is beneficial since good daily brushing is often difficult for the elderly. The hygienist can take digital x-rays annually and as needed. The hygienists’ sponsoring dentist reviews all patient records and x-rays monthly. The ECPII hygienist makes appropriate referrals to the dentist who is providing care to the resident for infections, cavities, and extractions. X-rays and other documentation are mailed to the patient’s dentist providing valuable information and keeping him/her directly involved with the resident’s dental care. If the resident does not have a dentist, the program helps the resident find a dental home. If no private dentist is identified that is acceptable to the resident, the Elder Smiles program and the volunteer dentists of the program become the resident’s dental home. The idea for Elder Smiles was born in 2004–2005 when the Johnson County Health Department’s Adult/Childcare Facilities Division Director attended a meeting where a similar program was described. The program, "Wee Smiles" a one facility, one hygienist model originated in Whitewater, KS. JCHD took this model and adapted it to be a multi-facility, on-site oral healthcare model. After some discussion and a review
Agency Community RolesThe Johnson County Health Department developed, implemented, oversees and staffs the Elder Smiles program. The idea for Elder Smiles was born in 2004–2005 when the Johnson County Health Department’s Adult/Childcare Facilities Division Director attended a meeting where a similar program was described. After some discussion, JCHD’s Health Director consented to initiating the program as long as start-up costs were covered by grant funding. Program planning and design specific to Johnson County began shortly thereafter. One of the first tasks was to convene an Advisory Board. The Board included representatives from Oral Health Kansas, the University of Missouri, Kansas City School of Dentistry, local ECPII hygienists and dentists, the Kansas Department of Health and Environment Office of Oral Health’s Director, the Past President of the Kansas Dental Association and a local long-term care facility administrator. Also, Dan March, Executive Director of "Wee Smiles" served as a consultant to the Board. This Board was convened at the beginning of the program planning to glean as much expertise as possible for this new endeavor. The Board remains committed to assist with implementation as needed. The Advisory Board's role is to oversee the operations of the program and give advice and counsel on how to maintain/grow the program. Costs and ExpendituresApproximately $46,000 was spent on examination equipment, 12 sets of instruments and consumable supplies needed for teeth cleanings and exams for the first year. $9,240 was spent for EagleSoft Practice Management Software as well as installation, training and support. $1,488 was spent on climate controlled storage for supplies for a one year period. Each Extended Care Permit II Hygienist is paid $32 and her sponsoring dentist paid $7 per patient visit. JCHD Program staff are responsible for the day to day management of the program and their salaries/benefits ($18,200) are paid by the Johnson County Health Department. Initial funding source was the REACH Healthcare Foundation, currently the program is self-sustaining from fees paid by Medicaid (where allowable) and self-pay by the person receiving the services, or their family. The cost of a routine dental cleaning is $50. ImplementationThe Elder Smiles Advisory Board meets regularly to discuss and review the successes and challenges of the program. Strong oversight and implementation of the program is provided by the Johnson County Health Department's Adult/Childcare Facilities Division. Registered Dental Hygienists with an Extended Care Permit II, sponsoring dentists and volunteer dentists are recruited on an as needed basis to offer the services of Elder Smiles that include routine teeth cleaning, fluoride varnish, x-rays and referrals. Long-term care facilities were initially recruited to participate but now word of mouth advertising brings additional clients. Initially, the whole project depended upon grant funding. Once that was established and supplies could be purchased, Elder Smiles was implemented in a short amount of time, aapproximately 6 months. The Advisory Board is an on-going commitment, with quarterly meetings and additional meetings as needed. The Extended Care Permit II Hygienists and dentists were initially recruited through the community partners and it is anticipated that, future needs will be met through that method. Visit are scheduled one or more weeks in advance with on-site visits occurring weekly, usually on Fridays. Facility recruitment will happen as additional ECPII staff become available.
The goal of Elder Smiles is to improve the oral health of seniors living in long-term care facilities and establish a dental home for those seniors in need of one.Provide preventative oral health care to the targeted population.Number of facilities offering the program in the first year: two Number of client visits in the first year: 100 Number of facilities offering the program in the second year: 10 Number of client visits in the second year: 400 Number of facilities offering the program in the third year: 19 Number of client visits in the third year: 800 decreased # of emergency dental visits decreased Number of fewer cavities decreased incidence of tooth calculus/plaque/tartar Number of seniors without a dental home Number of seniors using Elder Smiles as their dental home Data collected includes: Number of facilities, number of client visits, number of referrals, number of cavities, number of incidence of tooth calculus/plaque/tartar, decreased number of emergency dental visits, number of seniors without a dental home, number of seniors using Elder Smiles as their dental home. Outcome data was collected by Elder Smiles hygienist, program aide and long-term care facility staff. Data is also collected from an annual survey conducted at each long-term care facility participating. The survey is sent to family members/resident and facility administration.Data is collected at every visit, compiled on a monthly basis and a annual report is written. Health Department staff receives and compiles data. Lessons learned: original source data was inadequate so it was modified to use additional sources to obtain data points, original data collection method not appropriate for all facilities, so the method was changed to accommodate facility requirements, original estimate of supplies needed for each visit far exceeded the actual need, so the type of supplies needed were identified and only those were taken. Elder Smiles started with two long-term care facilities, and has grown steadily to 19 facilities enrolled, with 17 facilities currently active. Elder Smiles has accomplished 619 visits to 348 residents in long-term care facilities. Approximately 80% of the Elder Smiles clients do not have a private dentist, so as a result Elder Smiles has become their dental home. The outcome of the objective was what was intended and planned for to occur. This successful outcome continues to be the long term plan for the program.
Elder Smiles has become a popular, in-demand service. The Advisory Board, the program ECPII hygienists and dentists, Johnson County Health Department and the long-term care facilities involved in the program are dedicated to making it work. Elderly residents now have increased access to dental hygiene services that have resulted in lower rates of new oral disease and tooth loss. The portable oral health clinic also provides flexibility and convenience. Patients experience less pain related to dental problems and are referred for dental work before infections or other problems escalate. A dental home is established for clients who did not have one. It is a win-win program for everyone involved. Elder Smiles is structured to be self-supporting through fees for service. This is possible because a grant covered the initial start up costs for equipment and supplies. Operating revenue covers the hygienist’s and sponsoring dentist’s salaries and consumable dental supplies. The fee ($50) for an Elder Smiles visit can be private pay or charged against the client’s Medicaid personal allowance. As stated above, all partners are committed to sustaining this practice for the long run. Some of the long-term care facilities are unable to participate due to a change in funding status with the Medicaid Home and Community Based Waivers that have been cut in Kansas as of January 1, 2010. An increase in private pay clients are needed to balance this loss of funding. It is anticipated that Elder Smiles will be able to replace the loss with private pay clients currently waiting to receive services.
 
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