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November 2018

Statewide Group Working to Improve Oral Health for Older Adults in North Dakota

Dr. Nancy Hodur is the Center for Social Research Director at North Dakota State University. Nancy has over 25 years of professional experience in applied research, public policy, and outreach education. At the Center, Nancy and other staff evaluate a number of the North Dakota Department of Health’s Oral Health Programs. In this article, Nancy gives a brief overview and resources of one of these evaluated oral health programs that works towards improving oral health care for older adults living in long-term care facilities in North Dakota.

Good oral health is just as important later in life, as it is earlier in life. Oral health has a direct impact on overall health and poor oral hygiene impacts more than the mouth. Though there is not necessarily direct causality, evidence suggests that poor oral health and gum disease are linked with increased hospitalizations, readmissions, respiratory infections, diabetes, dementia, poor nutrition, pneumonia, chronic obstructive pulmonary disease, and behavioral change in older adults (Schroeder & Fix, 2018). The National Center for Health Statistics (2016) reports older adults (65 years and older) are less likely to have visited a dentist in the past year than any other age cohort. Data also indicates that within the older adult age group, those with basic or complex physical limitations are less likely to see a dentist compared to those with no physical disability.

In general older adults, especially those in long-term care facilities, often lack access to oral health care. According to the North Dakota Department of Health’s 2016 Basic Screening Survey, 34 percent of nursing home residents require dental care (Schroeder, 2018). And even though oral health screenings in long-term care facilities are mandated by federal law, 28 percent of North Dakota long-term care facilities surveyed in 2015 reported they did not conduct dental assessments upon admission (Schroeder & Bright, 2016).

To help address oral health care needs of older adults living in long-term care facilities, the North Dakota Oral Health Program applied for and received a grant from the DentaQuest Foundation. The DentaQuest Foundation’s mission is to promote optimal oral health through collaboration with partners with shared goals of access to oral health care for everyone.

The Oral Health Program began by organizing and formalizing an Older Adults Oral Health Program working group of stakeholders in 2017. The working group was made up of 15 individuals of various backgrounds including public health professionals, dental providers, and partnership organizations. One of the working group’s goals was to identify key objectives. Ultimately, the key objective of the working group was defined as “Increase the number of long-term care facilities adopting a policy or procedure for residents to receive a dental screening by a dental professional.”

In addition to identifying a clear objective to guide the working group’s long-term activities, the working group identified several other short-term goals and developed materials to help facilitate those goals. To encourage dental screenings in long-term care facilities, a 2-page oral health screening tool was developed as part of the Standardized Dental Screening for New Nursing Home Residents: A Promising Practice Guide. The screening tool meets federal and state regulations for nursing home care and includes measures recommended by national oral health programs.

Beginning in 2018, Bridging the Dental Gap, a 501(c)(3) non-profit community dental clinic in Bismarck, has been piloting the screening tool located within the Standardized Dental Screening for New Nursing Home Residents: A Promising Practice Guide . The screening takes 20 to 30 minutes. Residents and hygienists report the tool is easy to use and view the tool favorably. While there currently is no Medicaid reimbursement or funding mechanism for the screening, the development and piloting of the tool represent critical first steps towards achieving the working group’s long-term goal of increasing the number of long-term care facilities that have policies and procedures in place for oral health screenings.

Another goal of the working group was to educate and increase awareness to advance oral health care for older adults. In addition to A Promising Practice Guide, several factsheets were developed. The factsheets provide:

background information on the impact of oral health care on overall health,
a review of reimbursement policies for Medicare and Medicaid,
a review of federal regulations on required oral health care in long-term care facilities,
and basic information on daily care plans.

The North Dakota Oral Health Program public health hygienists also delivered the Smiles for Life training, a national oral health curriculum, at 10 long-term care facilities. The North Dakota public health hygienists will provide the training free of charge to long-term care facilities that request the training. The Smiles for Life training can also be used to fulfill continuing education requirements for some care providers at long-term care facilities.

Overall, funding from the DentaQuest Foundation provided support for a working group of stakeholders with shared goals to advance oral health care for older adults living in long-term care facilities. The development and piloting of a standardized screening tool, development and dissemination of fact sheets, and education and outreach by a public health hygienists are all tools that can raise awareness and ultimately improve oral health and access to oral health care for older adults in North Dakota.

The following materials were developed and distributed as part of the activities of the North Dakota Oral Health Program Older Adult Working Group:

“Dental Coverage for Nursing Home Residents”
- Fact sheet on Medicare and Medicaid oral health care reimbursement policies for nursing home residents.
“Dental Screenings and Daily Care for North Dakota Nursing Home Residents: A Promising Practice”
- Fact sheet on rationale for standardized dental screenings for long-term care residents using state-specific (North Dakota) data.
“Dental Screenings and Daily Care for Nursing Home Residents: A Promising Practice”
- Fact sheet on rationale for standardized dental screenings for long-term care residents using national data.
“Evaluation of Long Term Care Oral Health Program”
- Fact sheet highlighting the success of and barriers to mobile dental service for nursing home residents.
“Standardized Dental Screening for New Nursing Home Residents: A Promising Practice Guide”
- This guide provides a template for nursing home administrators and dental professionals to help ensure all nursing home residents, upon admission, have dental screenings done by dental professionals.

While much work remains to achieve the group’s long-term goal, the activities and materials developed by the North Dakota Oral Health Program working group represent critical first steps towards improving oral health care for older adults living in long-term care facilities in North Dakota. Unfortunately, given the lack of continued funding, future group activities are uncertain. To help ensure stakeholders remain engaged, the working group has continued to meet monthly via conference calls. A grant to support a pilot program for a dental hygienist to perform oral health screenings in long-term care facilities has been submitted by the University of North Dakota - Center for Rural Health and is awaiting notification of award.

For more information on North Dakota Oral Health Programs, please visit: https://oral.health.nd.gov/

The full program evaluation, titled Program Evaluation: North Dakota Department of Health Older Adults Oral Health Program, is available here: http://dentaquest.com/pdfs/impactreport.pdf/

References
National Center for Health Statistics. “Health, United States, 2016: With Chartbook on Long-Term Trends in Health”. Hyattsville, MD. 2017.

Schroeder, S. 2018. “Dental Screenings and Daily Care for North Dakota Nursing Home Residents: A Promising Practice”. Center for Rural Health, University of North Dakota, Grand Forks.

Schroeder, S. & Bright, P. 2016. “Oral Health Services and Barriers to Care in North Dakota Long Term Care Facilities: Chartbook”. Center for Rural Health, University of North Dakota, Grand Forks.

Schroeder, S. & Fix, N. 2018. “Standardized Dental Screening for New Nursing Home Residents: A Promising Practice Guide”. Center for Rural Health, University of North Dakota, Grand Forks