Understanding the Challenges of
Providing Oral Health in the
Long Term Care Setting
Maria Wellisch, RN, BBA, LNFA
V.P. of Corporate Education
at Morningside Ministries
Course Objectives
1. 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?
Certified
Nursing
Assistant
CNA Qualifications
Nurse 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-
Texas
Curriculum for
Nurse Aides in
Long Term Care
Facilities
(Third Edition 2000)
DEPARTMENT OF AGING AND DISABILITY SERVICES
REGULATORY
NURSE AIDE TRAINING PROGRAM
MAIL CODE E-420
PO 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 Hours
1. Communication and
interpersonal skills
2. Infection control
3. Safety and emergency
procedures including the
Heimlich maneuver
4. Promoting resident’s
independence
5. Respecting Residents rights
6. 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 Hours
7. Personal care skills,
including:
• Bathing
• Grooming,
including mouth
care
• Dressing
• Toileting
• Assisting with eating and
hydration
• Skin care
• Transfers, positioning, and
turning
16 Introductory Hours
8. 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:
• Understanding the
behavior of cognitively
impaired residents
• Techniques for addressing
the unique needs and
behaviors of an individual
with dementia (
Alzheimer’s disease and
others)
• Appropriate responses to
the behavior of cognitively
impaired resident
• Communicating with the
cognitively impaired
• Methods of reducing the
effects of cognitive
impairments
16 Introductory Hours
10. 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 Hours
11. 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 Educationnot mandated for oral care
Barrier 4
Oversight by Registered Nurses
Barrier 5
6. 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 longterm 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 Medicaidcertified long-term care facility.
MDS- Minimum Data Set
MDS 3.0 (Section L) Video
http://www.careplans.com/pages/video/i_active_diagnosis.aspx
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
Malnutrition
Dehydration
Brain abscesses
Valvular Heart Disease
Joint infections
Cardiovascular Disease
Pneumonia and Aspirational
Pneumonia
Poor 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
• Dental Hygienist
• Director of Nursing
• Dentist
• Charge Nurses
• Physician
• MDS Nurses
• Family members
• CNA
• Residents
• Dietician
• Social Worker
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