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The Affordable Care Act substantially expands oral health care coverage for children. The ADA estimates that it will reduce by 55 percent the number of children without dental coverage.
But the ACA did little to expand dental coverage to underserved adults, which includes a large population of elderly people. Today there are approximately 1.3 million nursing home residents in America and they face the greatest barriers to accessing dental care of any population group. As people live longer and retain more natural teeth, the complexity of their treatment increases. As a particularly vulnerable population, senior citizens in institutional settings often need an extraordinary amount of dental health monitoring and treatment. A growing percentage of these adults are unable to fully care for themselves.
Delivering care to nursing home residents is one of the initiatives in the Action for Dental Health: Dentists Making a Difference (ADH) campaign. There are a number of ways to connect institutionalized seniors with dentists. Because often the problem is one of logistics, the ADA and its constituent societies are expanding existing programs that work in bringing needed oral health care to senior citizens living in institutional settings.
Last month the ADA hosted a long-term care conference in Washington, D.C., at which representatives from eight states met to discuss the formation or expansion of programs to provide oral health care for the elderly in their respective states. The conference provided attendees with an opportunity to network with other state dental association officials and to use the ADA as a clearinghouse for ideas that work. The ADA has incorporated information on existing programs in the states into materials for use by dental associations that wish to launch their own long-term care initiatives.
"There aren't a lot of funds available for dental care and this is true throughout the country,” said conference participant Dr. Frank Iuorno, a practicing orthodontist in Virginia and a member of the Virginia Dental Association's Long Term Care Task Force. "Our task force is working on a lot of things, like adapting the Give Kids A Smile model in Richmond and calling it Give Elders A Smile. The challenge for us isn't buy-in from the dentists—a lot of them already deliver care to seniors. The challenge is to get preventive care to this population.”
According to Dr. Iuorno, VDA is attempting to show private and government officials in the state that creating, licensing and establishing a workforce position that will essentially serve as a case manager for institutionalized seniors. "We want to start a program to go into nursing homes in the state, have a full-time presence in homes to monitor dental needs,” he said. "This person would identify patients who need more treatment, get them screened and get them care. The treatment would be provided free of charge, but the point would be to show how identifying these patients and emphasizing prevention is cheaper than emergent care. We need to heighten awareness. We have to educate patients and caregivers that this is important for overall health.
"Ultimately the success of any nursing home program is going to rely on funds coming from outside government,” Dr. Iuorno said. "Frankly, this is just not a priority for governments.”
The Action for Dental goal for long-term care: at least 10 state dental associations committed to implementing long-term programs by 2015, with 1,000 dentists trained to provide that care by 2020. That training includes educating dentists and caregivers about incurred medical expense (IME) billing, which helps long-term care residents get dental treatment and allows dental practices to get reimbursed for services.