Building Community Partnership for High-Risk Seniors

Seattle/King Country Aging and Disability Services submitted this example of how they were able to provide a holistic plan to integrate oral health and community services for the agency’s long-term care clients and those clients enrolled in the King County Care Partners Program. By working collaboratively with community partners, they were able to address oral hygiene issues.

Submitted by: Mary Pat O’Leary, RN, Aging and Disability Services (ADS) 

1173101521. What was the need or challenge that you were addressing?

Long term care clients and clients enrolled in the King County Care Partners Program have a tremendous need for oral hygiene and dental care. In the King County Care Partners Program, many clients have not had access to dental care for years. Due to drugs, alcohol use, and history of homelessness, clients’ oral health is frequently neglected. Dental abscesses are quite common and in those clients with heart disease, diligence is needed to ensure that the client understands that oral hygiene is equally as important as taking a cardiac medication.

One such need/challenge was a client who had serious oral hygiene issues, including several dental caries. He needed multiple teeth extracted, he lacked the basic understanding of how to access dental care, he did not have anyone to stay with him after a planned multiple teeth extraction procedure, and he needed coaching and help to take his medications, including a prescribed antibiotic.

2. What program or service did you provide?

Our agency provided a holistic plan to integrate oral health and community services.

ADS identified for a dentist who accepted Medicaid reimbursement, the RN Care Manger collaborated with the dentist who agreed to examine the person, and a plan was put into place to address the multiple dental caries, including scheduling a fairly lengthy teeth extraction appointment.

In order to support the client in this process, the RN accompanied the client to the appointment. Other services included having the RN coordinate to ensure the antibiotic medication was available post extraction and having a caregiver available for at least 24 hours after the procedure to ensure that the client followed the post extraction instructions. We had oral hygiene supplies available, including a toothbrush, toothpaste, floss, and mouth wash. It was important for the client to have access to these supplies to help keep any remaining teeth healthy.

3. How did you or others in the community benefit? What was the impact?

The community benefits by coordinated plans of care that address high risk/high cost clients who have multiple needs, including those needs related to oral health. Should the client have needed a visit to the emergency department or a hospital post extraction, this could have potentially cost thousands of dollars. The community benefits not only from a cost savings perspective but from the fact that it is investing and improving the overall quality of life by improved oral health.

Our program’s education and teaching efforts focus on oral hygiene and outcomes of improved oral health; less oral infections, improved overall physical health, improved self-confidence, self-esteem, and personal dignity. Nutritional intake is impacted when individuals have oral hygiene problems that are not addressed. Providing this necessary service makes a difference in every aspect of a client’s life.

4. Please share anything else about this success that is important part of the story.

Working collaboratively with community partners is key in addressing oral hygiene issues. Having a person work along-side a client who needs oral health education, dental exams, and restorative dental work is very important. Clients/patients need a “coach”, particularly those clients/patients who do not know about the importance of oral health. At-risk clients benefit greatly from having someone willing to help them understand the importance of oral hygiene through handouts, pictures, etc. that are culturally and linguistically appropriate. Having the necessary equipment; toothbrush/toothpaste, floss, etc. is equally as important.

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