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Better Oral Health in Long Term Care
- 1. Better Oral Health in Long Term Care: Best Practice Standards in Saskatchewan Susan Anholt Executive Director/Registrar, Saskatchewan Dental Assistants’ Association
- 2. Better Oral Health in Long Term Care: Best Practice Standards in Saskatchewan
- 5. SOHP • College of Dental Surgeons of Saskatchewan • Saskatchewan Dental Therapists Association • Saskatchewan Dental Hygienists’ Association • Saskatchewan Dental Assistants’ Association • Manager, Oral Health Program, Saskatoon Health Region • Dean, College of Dentistry
- 6. Collaboration • We set out to build a ‘Saskatchewan made’ Long Term Care Strategy • Our strategy would be based on the ‘best practices’ • Present our strategy to the Saskatoon Oral Health Coalition Health Region personnel Saskatchewan Health
- 7. Collaboration: • Goals • “Best Practices” • Funding for the development of the manuals • Manual Review
- 8. Three Modules Facilitator trainer (OHP) Nurse education/nurse clinical Front line staff
- 11. Front Line Staff
- 12. * Assessment * Care Plan * Daily Hygiene * Treatment
- 15. SOHP Goal #1 The Saskatchewan Government, Ministry of Health, endorse the Saskatchewan Seniors Oral Health and Long Term Care (LTC) Strategy developed by the Saskatchewan Oral Health Professions collaboratively with the Saskatchewan Oral Health Coalition and Seniors Health and Continuing Care in the Saskatoon Health Region.
- 16. SOHP Goal #2 An Oral Health Coordinator (OHC), who is a registered and licensed oral health professional, should be employed in each health region to facilitate the delivery of initial oral assessments, dental examinations and treatment, daily oral hygiene for residents and oral health education. The Oral Health Coordinator will work collaboratively with the long term care, multi- disciplinary team to improve the oral and overall health of residents.
- 17. SOHP Goal #3 Upon entry into a LTC home, an initial oral assessment must be completed by a registered and licensed oral health professional, through the general and medical consent provided by the LTC home. 3.1 Oral assessments should be routinely performed every 6 months thereafter, by an oral health professional or a health care professional trained in oral health assessments. 3.2 Non-oral health professionals performing oral health assessments or care will receive appropriate training developed by the Saskatchewan Oral Health Professions. 3.3 Training will be provided by oral health professionals.
- 18. SOHP Goal #4 Initial oral assessments would include: 4.1 Personal client record, including consent for dental examination 4.2 Review of medical and dental history 4.3 Complete examination of the oral cavity, which includes: 4.3.1 Assessment of hard and soft tissues 4.3.2 Assessment of oral hygiene care 4.3.3 Oral cancer screening 4.3.4 Denture assessment Note: Implementation of a Saskatchewan electronic health record should include an oral health record.
- 19. SOHP Goal #5 Oral Health Care Policies and Procedures for LTC and Personal Care Homes* are standardized and implemented based on best practice for optimal oral and overall health for residents in LTC in Saskatchewan. Policies should ensure that every long term care resident has the right and access to the following oral health care services: • 5.1 An individualized oral health care plan • 5.2 Basic oral hygiene supplies • 5.3 Daily oral hygiene • 5.3 Access to professional oral health services • 5.4 Oral health record included within the health record • 5.5 Dental recommendations/orders are followed *Note: As per Section 23 of the current Personal Care Home Regulation, each resident receive a dental examination, as necessary.
- 20. SOHP Goal #6 Treatment needs based on the dental examination, may be provided by dentists, denturists, dental hygienists, dental therapists and/or dental assistants. Residents may access dental services through their personal oral health professional or through dental services as available through the long term care home. Dental examinations require: 6.1 Consent for dental examination 6.2 Treatment plan and progress notes 6.3 Estimate and consent for financial responsibility 6.4 Consent for treatment
- 21. SOHP Goal #7 The Saskatchewan Seniors Oral Health and Long Term Care Strategy is incorporated into post-secondary educational health training programs, orientation, and continuing professional development (i.e. for physicians, nurses, care aides, etc.).
- 22. SOHP Goal #8 The standard for new LTC homes includes provision for a treatment room suitable for a variety of health professionals including access to portable dental equipment to facilitate dental treatment.
- 23. SOHP Goal #9 The Saskatchewan government establish a safety net program to increase access to oral health services for low income seniors (similar to Ministry of Health Supplementary Health/Family Health Benefits or Alberta’s Dental Assistance for Seniors Program through which low income seniors are eligible for up to $5000 every 5 years for those aged 65 and older).
- 24. SOHP Goal #10 Surveillance, evaluation and continuous quality improvement be performed on an ongoing basis to demonstrate improved health and oral health status outcomes.
- 25. Project Status Update: • Resources made available to every health region (Modules) All OHP in all health regions in SK were orientated to modules in June • LTC Presentation at SOHP Conference – Sept, 2015 • Resources made available to every long term care home in SK (SOHP) • Endorsed by government
- 26. Together, making a difference
Notas do Editor
- Hi – I am Susan Anholt. I am the Executive Director / Registrar of the Saskatchewan Dental Assistants Association.
- My role is to introduce you to our strategy for Better Oral Health in Long Term Care Strategy. I will also provide an overview of the work that has brought us to this point.
- There was a time when a bad day at the nursing home occurred when all the dentures were collected for cleaning… At that point, I seriously doubt that anybody was smiling! And that my friends is the true story of why we label dentures….
- Dentistry has done a great job of achieving our goal of ‘retaining our teeth for a lifetime’. But what happens when the person can no longer care for themselves. I have talked to many, many dental assistants horrified by the lack of oral care that their parents have experienced in long term care. And yes, they end up providing that daily care themselves. We have created our own perfect storm. * Have you ever been part of a conversation that ended ‘somebody should do something’? We had that conversation, and yes… the somebody was us. As a first step, the Saskatoon Health Region called a meeting and everybody came! Yes, a Saskatoon coalition was formed and many oral care issues were identified. At a strategy session in May, 2011, oral care in long term care was identify as a significant issue. In October 2011… each association made a presentation on our individual initiatives in LTC. It was an eye-opener to say the least! We were all doing a different version of the same thing and it was past time to collaborate. This was the event of unusual magnitude.
- Yes, we are a team… Dentists, therapists, hygienists and assistants - all onboard, with the Saskatoon Health Region and the College of Dentistry.
- In January, 2012 we set out to collaborate on a strategy for oral care in long term care in Saskatchewan. agreed to develop a Saskatchewan made Long Term Care Strategy. The committee recognized that the majority of the current aging population have retained their teeth and many have sophisticated dentistry. Several committee members expressed the concern that this societal shift from dentures has created a need for oral health professionals and although nurses and care aides can meet the oral needs of most residents there will be residents with oral needs are beyond the capacity of care aides or exceed the time available to nursing staff.
- We set goals and agreed that our plan should consider geography and the availability of professionals. We agreed that awareness is the key to success and staff need to be trained to recognize a problem by “lifting the lip” and understand the connection between the mouth and general health. We reviewed a myriad of documents to identify the “best practices” in LTC from around the world; to that end we acquired access to the Australian model with permission to amend it to reflect our model for care; We secured funding from the Saskatchewan Oral Health Profession Conference fund to contract the development of the manuals for use by long term care staff; We contracted a Masters in Public Health to review and develop the materials based on our Saskatchewan priorities and experience.
- The strategy has three modules. An overall facilitator who is an oral health professional trains the clinical nurse who then trains the front line staff, the personal care aide.
- The strategy is based on assessment, the development of an individualized care plan, daily oral hygiene and treatment based on requirements
- This is the Oral Health Care Plan Chart
- This is a quick look at the Assessment tool. The entire oral cavity is assessed bu the categories of – Health – Changes – Unhealthy and Dental Referral.
- Goal 1: That the Saskatchewan Government, Ministry of Health endorse the Saskatchewan Seniors Oral Health and Long Term Care Strategy collaboratively developed by the Saskatchewan Oral Health Professions with stakeholders.
- Goal 2: That an Oral Health Coordinator (OHC)(s), who is a licensed oral health professional, should be employed in each health region to facilitate the delivery of initial oral assessments, dental examinations and treatment, daily oral hygiene for residents and oral health education. The Oral Health Coordinator will work collaboratively with the long term care, multi-disciplinary team to improve the oral and overall health of residents.
- Goal 3: So, lets look, let’s continue to look, let’s ensure that qualified people to train people to provide proper care.
- Goal 4: This is what the initial oral assessment would require…. Creating a record, consent, medical and dental history… in other words, a comprehensive review. It would include a complete examination and assessment. All of this should become part of the Electronic Health Record.
- Goal 5: Oral care needs to be legislated – they need to be standardized. The legislation must to be based on best practice to strive for optimal oral and overall health for the people of Saskatchewan. Policies should ensure that every senior and long term care resident has the right and access to oral health care services: 2.1 An individualized oral health care plan 2.2 Basic oral hygiene supplies 2.3 Daily oral hygiene 2.3 Professional dental services 2.4 Oral health record included within the resident’s health record 2.5 Dental recommendations/orders are followed And yes, the Personal Care Home Regulation currently requires that each resident receive a dental examination as necessary. That initial oral assessments may trigger a referral to a dentist for a full dental examination to include: 5.1 Personal client record, including consent for dental examination 5.2 Review of medical and dental history 5.3 Complete examination of the oral cavity, to include: 5.3.1 Assessment of hard and soft tissues 5.3.2 Assessment of oral hygiene care 5.3.3 Oral cancer screening 5.3.4 Denture Assessment 5.4 Treatment plan/progress notes 5.5 Estimate/Consent for financial responsibility 5.6 Consent for treatment
- Goal #6: This is a team event! Treatment needs based on the dental examination, may be provided by dentists, denturists, dental hygienists, dental therapists and/or dental assistants. Residents may access dental services through their personal oral health professional or through dental services as available through the long term care home.
- Goal 7: That the Saskatchewan Seniors Oral Health and Long Term Care Strategy is incorporated into our post-secondary education health related programs. It needs to be incorporated into staff orientation, and continuing professional development events for physicians, nurses, and care aides.
- Goal 8: That the standard for the construction of new long term care homes includes provision for a treatment room suitable for a variety of health professionals including access to portable dental equipment to facilitate dental treatment. So there is a actual place to work. A clean place to work. Marvelous concept!
- Goal 9: Here we are suggesting that the Saskatchewan Government find some funding for oral care for low income seniors. There is an example in the Ministry of Health Supplementary Health/Family Health Benefits or Alberta’s Dental Assistance for Seniors Program through which low income seniors are eligible for up to $5000 every 5 years for those aged 65 and older. And since Saskatchewan is the new Alberta, perhaps it is time to get with the full program!
- Goal 10: Surveillance, simply put, we need to ensure that we are accomplishing our goals on an ongoing basis.
- Where are we at today…. The resources have been made available to all of the dental public health staff in health regions in June 2015 and they can start using. After this conference the resources will also be on the SOHC website and if the SDAA/SDHA/SDTA want to also put them on their websites they can. Ashley White, SDT will have a concurrent session for anyone who wants to have an orientation to the ‘Better Oral Health in LTC modules’. The resources have not yet been endorsed by the Ministry of Health but we will be meeting with them in the future in order to update them and share the LTC Strategy and training resources.
- I believe that together, we will make a difference!