Understanding the Challenges of Providing Oral Health in the Long Term Care Setting

Maria Wellisch, RN, BBA, LNFAV.P. of Corporate Education

at Morningside Ministries

Course Objectives1. Identify five (5) significant challenges found in the long

term care setting that affect providing resident’s with basic oral hygiene and dental care

2. Discuss the systemic health consequences most commonly seen in residential care that can directly attributed to poor oral health

3. Describe the interdisciplinary interventions that will have the greatest impact on improving oral health needs of the elderly and disabled in nursing care settings

Who Provides Primary Daily Dental Care for

Residents in Long Term Care and Assisted

Living?

CertifiedNursingAssistant

CNA QualificationsNurse Aide Registry for State of Texas , FAQ

Q: Do I have to have high school diploma or GED to become a certified nurse aide?

A: Neither the federal regulation nor state rule imposes a minimum education requirement for nurse aides.

Respecting CNA’s

Barriers to Good Oral Care

• 1. Education- TexasCurriculum forNurse Aides in

Long Term CareFacilities

(Third Edition 2000)

DEPARTMENT OF AGING AND DISABILITY SERVICESREGULATORY

NURSE AIDE TRAINING PROGRAMMAIL CODE E-420PO BOX 149030

AUSTIN TX 78714-9030(512) 438-2017

How Many Hours of Training Required for a CNA?

• 300

• 500

• 600

• 1500

Nurse Aide Training and Competency Evaluation Program Requirements

• Rule 94.3 (7) (h) Each NATCEP must teach a minimum of 75 clock hours of training

• (1) 51 clock hours of classroom training defined as classroom and skills training that does not involve direct care of residents by trainees; and

• (2) 24 hours of clinical training defined as hands-on care of residents in a nursing facility

CNA Video

16 Introductory Hours1. Communication and

interpersonal skills2. Infection control3. Safety and emergency

procedures including the Heimlich maneuver

4. Promoting resident’s independence

5. Respecting Residents rights6. Basic nursing skills including

• Taking and recording vital signs

• Measuring and recording height and weight

• Caring for the residents environment

• Recognizing abnormal changes in body functioning and the importance of reporting such changes to a supervisor

• Caring the resident when death in imminent

16 Introductory Hours7. Personal care skills,

including:

• Bathing

• Grooming, including mouth care

• Dressing

• Toileting

• Assisting with eating and hydration

• Skin care

• Transfers, positioning, and turning

16 Introductory Hours8. Mental Health

• Modifying aide’s behavior in response to resident’s behavior

• Awareness of developmental tasks associated with the aging process

• All the resident to make personal choices, providing and reinforcing other behaviors consistent with the resident’s dignity

• Using the resident’s family as a source of emotional support

16 Introductory Hours• 9. Care of the cognitively

impaired residents including:

• Techniques for addressing the unique needs and behaviors of an individual with dementia ( Alzheimer’s disease and others)

• Communicating with the cognitively impaired

• Understanding the behavior of cognitively impaired residents

• Appropriate responses to the behavior of cognitively impaired resident

• Methods of reducing the effects of cognitive impairments

16 Introductory Hours10. Basic restorative services,

including:

• Training the resident in self care in self care according to the resident’s available

• Use of assistive devices in transferring , ambulation, eating and dressing

• Maintenance of range of motion

• Proper turning and positioning in bed and chair

• Bowel and bladder training

• Care and use of prosthetic and orthotic devices

16 Introductory Hours11. Resident rights, including:• Providing privacy and

maintenance of confidentiality• Promoting the resident’s right

to make personal choices to accommodate their needs

• Giving assistance in resolving grievances and disputes

• Avoiding the need for restraints in accordance with current professional standards

• providing needed assistance in getting to and participating in resident, family, group, and other activities

• Maintaining care and security of the resident’s personal possessions

• Promoting the resident’s right to be free from abuse, mistreatment, and neglect and the need to report any instances of such treatment appropriate facility staff

WHEW……………. (Grooming, including mouth care)

Barriers to Good Oral Care:

Barrier 1

Inadequate training for primary provider of dental hygiene

Barrier 2

Resident ability and compliance with care

Barrier 3

Continuing Education-not mandated for oral care

Barrier 4

Oversight by Registered Nurses

Barrier 56. Consultants in Long Term

Care• Social Workers• Dieticians• Pharmacists• Medical Records

Where are the Dentists and Dental Hygienists????

Other considerations

• Surveyors• Reimbursement• Poly pharmacy• Transportation• Ageism• Fear• Lack of Geriatric Training

What Is An MDS

• The Centers for Medicare and Medicaid Services' (CMS) tool for facilitating care management in nursing homes is called the Minimum Data Set (MDS), a core set of screening and assessment elements that is part of a Resident Assessment Instrument (RAI). The RAI provides a comprehensive and standardized assessment of each long-term care facility resident's functional capabilities and helps staff to identify health problems. This assessment is performed on every resident in a Medicare and/or Medicaid-certified long-term care facility.

MDS- Minimum Data Set

http://www.careplans.com/pages/video/i_active_diagnosis.aspx

MDS 3.0 (Section L) Video

http://www.youtube.com/watch?v=yuFkhU3MXz4

Discuss the systemic health consequences most

commonly seen in residential care that can be directly attributed to poor

oral health

MalnutritionDehydrationBrain abscessesValvular Heart DiseaseJoint infections Cardiovascular DiseasePneumonia and Aspirational PneumoniaPoor Glycemic Control- Type I and II Diabetes

3. Describe the interdisciplinary interventions that will have the

greatest impact on improving oral health needs of the elderly and

disabled in nursing care settings

Who Comprises the Interdisciplinary Team?

• Administrator

• Director of Nursing

• Charge Nurses

• MDS Nurses

• CNA

• Dietician

• Social Worker

• Dental Hygienist

• Dentist

• Physician

• Family members

• Residents

What Can This Team DO?

• Be an advocate for the residents

• Improve education in each facility, including orientation, continuing education and competency training

• Seek legislative changes for training requirements for front line staff

• Seek funding to support improved dental access and care

Work With State and National Organizations Serving the Aging

• Present at national conventions

• Put training …good training on the web

• Emphasize cost savings when good oral care is provided

• Become part of your communities Area Agencies on Aging

• Meet with architects who design assisted living and long term care facilities

Final Thoughts