Janetta Asked July 2012

What is obligation of nursing home to provide dental care?

Follow
Share

My 91-year old mother lives all the way across the country and I do not get to visit her but once every year or two. My two brothers live nearby and visit her and are supposed to look after her but they have health issues and are becoming incapable.

I just visited mother this week for the first time in two years. She has severe dementia. I arranged for a dental exam with a local dentist and the nursing home transported her. Things are horrible - she needs several extractions, three root canals and several fillings. The dentist said that he was sure the nursing home was not brushing her teeth at all and indicated he knows this is a problem with the home.

What is the obligation of the nursing home to see that mother's teeth are brushed after every meal by one of the nurses?

Second question, the dentist says he can do all the work in his office in six phases over six weeks ($9000) and that mother is a good, cooperative patient.

The other option is to have an oral surgeon do all the work in one day in a hospital setting (much more expensive I assume?). Any advice on which option to choose? Mother has enough assets to self-pay all her expected expenses for about two more years then the plan is to rely on Medicaid.

I think with the help of the case worker I can manage this all remotely when I return home and basically leave the sons out of it. I already pay all the bills and do all the correspondence.

Is this common for a nursing home to completely overlook the oral health of their dementia patients and let their teeth rot away? I feel like consulting with a lawyer. Tears.

One tricky thing I should add. The nursing home considers the hall Mother is on as assisted living even though they have registered nurse care on the hall. Maybe this lowers the obligation to provide dental care?

This question has been closed for answers. Ask a New Question.
12

Answers

Show:
imissivy Jul 2013
The nursing home in Texas says that should we have a hurricane mom is my responsibility. she is 94, can't walk, legally blind, and dead weight if you try to move her. I am in my 70's and not able to lift her or care for her. There is no one to help me. ( Oh ,she has the beginnings of dementia ) How do I deal with this?
Helpful Answer (0)
Report

maryhord Aug 2012
I've worked several years as a part-time counselor in various nursing homes and I've seen the staff soak the dentures but never seen them encourage someone to brush their teeth. The majority of the residents had dentures, however.
I would suggest that you speak with the director of nursing about your concerns. I would also suggest, if possible, to keep dental insurance on her, because Medicaid is limited in the dental services they cover.
Hope your mother has a good outcome with her dental work.
Helpful Answer (0)
Report

Kimbee Jul 2012
Janetta, I am so sorry to hear the DDS n staff were not sensitive to you. Do they understand you live far from mom? If not, pls make sure they know n let them know u feel bad for the condition you discovered. However, don't let them shame you into feeling worse than u already do; that is just counter-productive. Where does mom live? Any possibility you could engage a student of nursing, dental hygiene, or social work to visit weekly and check on her oral care? Perhaps that could be a project basis for a student, or maybe a part time job? My mom has mid stage dementia and has much to offer, but we are having trouble finding anywhere that will let her volunteer, even tho I would partner w her (retired SW) n could assure / monitor / support proper interaction. Where does ur mom live? Lots of people use geriatric care mgr service to help w long distance care. Fairly pricey, but may b a place to start. They may know a perfect referral fo just such a person who could do regular checking on mom's oral care. stay connected to this site, lots of support here for a very tough role we r all dealing with. Kimbee
Helpful Answer (2)
Report

Janetta Jul 2012
To everyone that is replying thank you so much. I feel so alone and you are helping by continuing to reply.

Regarding Kimbee's post, the dentist wrote an order to have mother's teeth brushed after each meal. It is now on her record and the NH started with it before I left. Time will tell if they are consistent with it. I have some doubts because they are not doing it for the other patients on her hall.

After all her work is done, at the dentist's suggestion, I will arrange for a checkup with the dentist every two months. Among other things he will be able to put pressure on the NH to do the brushing consistently if they fall short. The dentist is also trying to partner with the NH to establish oral care including a chair in the facility and training for the CNAs.

I must be open and say I feel traumatized by what I saw in mother's mouth at the dentist's office. The dentist and the staff made me feel guilty and fully responsible for her condition - they were unpleasant to me but caring for my mother. I am losing sleep over this and now I am back at home a long way off and unable to personally check on my mother.

Thank you again.
Helpful Answer (0)
Report

Kimbee Jul 2012
Could u ask the dentist if any of the facilities in the area do a good or better than avg job w oral hygiene? I would think that would be an excellent indicator of overall care quality. I have read this is a pretty widespread problem and there are studies being conducted evaluating protocols to improve dental health in dementia pt's. In NH's. Also, as there is a correlation b/w oral disease and heart disease, it is believed one exists b/w dementia and oral disease. I like the idea of the prescription oral rinse, but would she remember to use it any better than tooth paste? My mom, mid stage dementia, needs continual prompts to complete ADL's. I too think AL level of care may be too low for your mom. Perhaps the DDS could write a formal order/RX for the specific care and time frames he recommends ( not just brush two tomes daily) more like provide prompt and assistance to brush all teeth successfully x times per day or rinse w XYZ product for 90 seconds two times each day or status post every meal) it seems this should / could be incorporated into care plan. If you spread out the remedial work, the dentist could provide feedback if care plan is being followed, or no apparent change. Good luck- mom's lucky to have such a good advocate in you.
Helpful Answer (1)
Report

igloo572 Jul 2012
Janetta - I feel for you and your mom. Dental care is iffy whether it's AL or NH.
My mom is in a NH and before she went in, had several thousand dollars of work done over about 10 months. Endodontics, replacement of some vintage bridges, etc. I think she could have done it in about 4 mos but scheduled it when I could take her and stay for follow-up.The gum scraping was brutal. I'd go with the series of work and agree with Jeannie on the worry on getting it done in 1 fell swoop with anthesthia issues.

Ask the dentist about GEL KAM. This is what my mom uses. It comes in a regular toothpaste tube that she can use BUT also come in a rinse. It is made by Colgate and is prescription only and takes a bit of getting used to (the cinnamon flavor is tart). When mom was in IL, she did the toothpaste. Now that she is in NH (Lewy body dementia), they do the rinse daily. It's kinda strong stuff but does work. You know you're lucky to find a dentist who will have a 91 yr old as a patient, most won't.

If you have time, speak with the social worker at the AL regarding your mom's suitability to stay in AL. It may be time for a higher level of care and perhaps another facility. The social worker really can be lots of help as they know just so much about what to expect and and not focused about the financial aspect.
Helpful Answer (4)
Report

jeannegibbs Jul 2012
Actually, you did say that about dementia and I misread it when I went back the second time. Sorry.

Most people with severe dementia would need more care than "assisted living." It sound like Mom is in a tiered care facility where it will be pretty easy to move her to a different level of care. Do you think a talk with the director is in order, along with a request for a copy of the contract they are operating under?

My husband has dementia, moderate stage. If surgery of any kind were recommended for him, I would first discuss it with the behavioral neurologist who manages his dementia care, and probably also with his PCP.

Best of luck to you!
Helpful Answer (0)
Report

Janetta Jul 2012
Yes, sorry I forgot to say that mother's dementia has progressed to the severe level.
Helpful Answer (0)
Report

jeannegibbs Jul 2012
By "becoming incapable" do you by any chance mean Mom is developing dementia? Surgery of any kind, including oral surgery, can have a significant adverse affect on dementia. That doesn't mean the surgery should always be avoided, but if dementia is involved, I suggest finding out exactly what anesthetics will be used and discussing it with the specialist who manages dementia care. If there are ways to minimze risk, you can take that into consideration in deciding which way to take care of the dental work.

Your mother is fortunate to have you to advocate for her.
Helpful Answer (1)
Report

jeannegibbs Jul 2012
I could be wrong, but I don't think brushing the resident's teeth is a standard service of assisted living facilities, if there is such a thing as "standard service."
Helpful Answer (2)
Report

This question has been closed for answers. Ask a New Question.

Related
Articles

Related
Questions