Incorporating Oral Health in the CARE Tool Assessment

Overview
This project involved working collaboratively with Eastern Washington University (EWU) Dental Hygiene Program to develop and deliver an oral health training for case managers, registered nurses, and care transitions coaches. Case managers and lead staff from community partner organizations were also in attendance.

Presentation materials were created collaboratively with support from the EWU dental hygiene professor, dental hygiene students, and ALTCEW planning and case management staff. The presentation was a capstone research project for the EWU students who were in their final two quarters of the dental hygiene program.

Submitted byLynn Kimball and Jamie  McIntyre, Aging and Long Term Care of Eastern Washington  (ALTCEW, an Area Agency on Aging).

Project Objective
The goal of the project was to increase the knowledge, skills, and confidence of professional staff who work with older adults to address oral health during the assessment process and connect them to care when needed.

Approach
To accomplish the goal, ALTCEW oral health champion case managers worked collaboratively to develop a presentation that bridged the EWU dental hygiene student presentation to direct practice with the Washington State CARE tool and client interactions. The presentation titled Incorporating Oral Health in the CARE Tool Assessment Process provided screen shots of the CARE tool noting areas of risk that additional follow up or referrals may be warranted. (Please note the screen shots were produced using the CARE tool with a mock client, so the slides don’t include protected health information.)

The presentation also highlighted the unique dental needs of older adults, oral care for people who no longer have teeth, as well as a current list of local dental providers who accept Medicaid. At the conclusion of the presentation, ALTCEW staff summarized the presentation, reviewed the steps to address oral health in the CARE tool, discussed community resources, and distributed oral health kits for clients.

Successes and Challenges
The majority of training attendees rated the training as “very good” in terms of increasing their awareness of the dental health needs of older adults. They also reported increased knowledge of strategies to assess dental health and knowledge of community resources available to seniors. Case managers also reported using the Medicaid dental provider list frequently.

The main challenge identified is that due to the evidence based model utilized, the care transitions coaches are unable to deviate from the fidelity of the patient-directed nature of the intervention. Given that coaches are only seeing high-risk Medicare patients hospitalized with certain conditions, they are not sure patients will identify dental concerns as primary issues during coaching sessions. Coaches use the Oral Health Flags tool if individuals express oral health concerns.

Lessons Learned
In order to ensure that we were providing an effective training, prior to the event we spoke with staff to see what the current issues were when discussing oral heath with clients. This allowed us to tailor the presentation accordingly, particularly highlighting local resources and oral health needs for individuals who no longer have teeth.

Thanks to a generous donation from Washington Dental Service Foundation, ALTCEW was able to offer dental hygiene kits to a portion of the clients served through our services. This resource was accepted by most clients and was a good vehicle for discussing oral health needs. In addition to the kits, staff were able to provide clients with a list of local dental providers that accept Medicaid. The timing of this training worked well, as it occurred within a couple of months of the reinstatement of Medicaid dental services for clients in Washington State.

If other organizations are considering a training of a similar nature, it would be beneficial to seek field staff input at each stage of the process to ensure that there is staff buy-in. With the use of the oral health champion, in the case management department, staff has continual reminders from their peers about the importance of oral health care.

Materials