HHS says to SNF: Improve dental care or pay the price

How to tackle the challenge of oral hygiene

Over the past few decades, nursing homes have cultivated a poor reputation in the oral health department. Since The New York Times called the problem an ‘epidemic’ back in 2013, experts say the situation hasn’t improved much.

With more studies linking dental neglect to pneumonia (a leading cause of death in nursing home residents), it’s about time providers start taking things seriously. In fact, oral health assessment should be a key part of patient intake and ongoing examination.

 

Tooth be told

Just this month, the Department of Health and Human Services (HHS), in participation with CMS, fined a West Virginia facility in excess of a million dollars. The suit stems from an incident back in 2014, in which caregivers failed to provide an extraction for a 62-year-old resident suffering serious tooth decay.

According to testimony of facility surveyors, their failure to act resulted in a number of avoidable infections, contributing to the man’s health decline. As soon as he had the procedure, the resident made a swiſt recovery. Judge Stephanie Thacker agreed with HHS, upholding the fine during a recent appeals hearing.

Let this headline be a lesson for LTC facilities everywhere. While other hygienic tasks like hourly repositioning, feeding, bathing, and restroom trips tend to trump dental care, conquering this deficiency doesn’t have to be difficult.

Start with a “system-wide approach” to oral health, says Nidhi K. Gulati, MD and CMD: “The main objectives of such an approach are to increase resident participation in oral care and enhance interdisciplinary oral hygiene involvement—all while optimizing the overall health and quality of life of residents.”

Dr. Gulati’s dental training toolkit for long-term care staff includes the following:

• An interactive PowerPoint presentation with brushing and other strategies
• Periodic hands-on training for nursing staff and certified nursing assistants
• A staff questionnaire identifying their general knowledge and attitudes

By starting with these subtle additions, your facility can make small steps toward improving its greater oral healthcare program. Residents should also be assessed for their individual needs including issues with prostheses, mastication, periodontal disease, salivation, pain, dysphagia and more.