About the SeniorAdvisor.com 2014 In-Home Innovation Scholarship: We started the scholarship program to bring awareness of the unique benefits and challenges of in-home caregiving for seniors to younger generations. The questions posed by the scholarship encouraged our nation’s future caregivers to present solutions for improving home care in the United States. College-aged students were required to answer one of the three essay topics below and provide a short bio as part of their scholarship application. Read the winning essays here.

How can your major of study improve the lives of seniors receiving in-home care services?

Essay response by Debra Peterson

The United States Department of Health and Human Services reports that our elder population represents 12.9% of the population and this percentage will continue to rise as healthcare advances, better diet and education all raise life expectancy. As the medical community continues to embrace the concept of oral health as an integral part of systemic well-being, people realize that they can keep most or even all of their teeth if they have access to dental care and that a healthy mouth contributes exponentially to health and longevity.

Dental health has not been emphasized historically.  People in the early 1900’s had little incentive to care for teeth when only 47% of the population made it to age sixty. Many people still think that losing one’s teeth is part of the aging process but this attitude is unacceptable.  Neglecting oral health in the elderly is analogous to malpractice.  When a patient starts to lose their teeth the capacity to eat, self-esteem and health can all be impacted. Failing dentition and poor oral health can be sequela for other disease and infected oral tissue can initiate disease in other systems.  Contrary to popular belief, pulling all the teeth and fitting patients with dentures is often not a good solution and will create different negative issues. As health care providers, it is our duty to monitor and maintain the oral health of our elderly population and one of the biggest hurdles is providing care for home-bound seniors.

Some areas simply do not have enough dentists to treat a scattered population, let alone the home-bound. To remedy this access to care deficit, provisions are in place in many states that allow direct access hygienists the ability to initiate dental treatment based on the assessment of a patient’s needs without specific authorization of a dentist.  While these providers are able to treat certain conditions, there are still relatively few of them and the hurdles they must overcome to provide services can be prohibitive.  Dentistry has the ability to combine technology and midlevel providers in order to implement a streamlined system of care for folks who are unable to get to the traditional dental office.

Direct care hygienists are required to buy their own equipment, which can run 5k-10k, plus provide their own supplies.  This can directly affect the types of patients the hygienist treats because they need to be profitable to recoup costs.  Dentists should embrace these entrepreneurship instead of seeing them as competitors and set up regional centers that could lease or rent portable dental units to the hygienists with the understanding that a certain percentage of patients treated would be home-bound. By alleviating the high cost required to start a mobile treatment model, hygienists will have an increased capacity to treat home patients. Maintenance/repair support, sterilization services and bio-waste disposal could be handled by each regional center giving the providers more time for travel or patient based services.

Dental assistants are the unsung heroes of the dental profession.  While they may have less didactic education than their hygienist counterparts, they are often experts in taking radiographs and making patients feel cared for.  An experienced assistant can go out to patients’ homes and take radiographs with a hand held radiographic unit or take live video from special intraoral cameras. Media can be uploaded and transmitted immediately to an off-site dentist. This would keep costs down yet provide hands on service. Oral manifestation of disease can be identified and diagnosed by dentists several hundred miles away and treatment can be planned and/or rendered in a timely manner.  Dental assistants can also guide caretakers in proper oral hygiene and can assess the general living conditions of the in-home patient.  Any concerns or safety issues would be noted and forwarded to the proper agencies.  Follow up for these patients could be handled by the dentist/hygienist or be referred to a central receiving hub that would track patients and schedule appointments.

More needs to be done to reach home-bound patients.  By lessening the financial burden on hygienists, using assistants as the “eyes and ears” for remote dentists and dentists themselves supporting the mid-level provider model, the dental community will go far in meeting the needs of this population.  With improved oral health care, we can help these patients live longer and more comfortably into their senior years and as part of a multidisciplinary approach to medicine, the dental profession has much to offer going forward.


About Debra

Debra is planning on working at a FQHC or a hospital based program after graduation.

Senior Advisor's knowledgeable writers blog about senior care services, trends and more.

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