Understanding the Challenges of Providing Oral Health in the Long Term Care SettingMaria Wellisch, RN, BBA, LNFAV.P. of Corporate Educationat Morningside Ministries

Course ObjectivesIdentify five (5) significant challenges found in the long term care setting that affect providing residents with basic oral hygiene and dental careDiscuss the systemic health consequences most commonly seen in residential care that can directly attributed to poor oral healthDescribe 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?

CertifiedNursingAssistant

CNA QualificationsNurse 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 CNAs

Barriers to Good Oral Care

1. Education-

TexasCurriculum forNurse Aides inLong Term CareFacilities(Third Edition 2000)DEPARTMENT OF AGING AND DISABILITY SERVICESREGULATORYNURSE AIDE TRAINING PROGRAMMAIL CODE E-420PO BOX 149030AUSTIN TX 78714-9030(512) 438-2017

How Many Hours of Training Required for a CNA?3005006001500

Nurse Aide Training and Competency Evaluation Program RequirementsRule 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 Hours1. Communication and interpersonal skills2. Infection control3. Safety and emergency procedures including the Heimlich maneuver4. Promoting residents independence5. Respecting Residents rights6. Basic nursing skills including

Taking and recording vital signsMeasuring and recording height and weightCaring for the residents environmentRecognizing abnormal changes in body functioning and the importance of reporting such changes to a supervisorCaring the resident when death in imminent

16 Introductory Hours7. Personal care skills, including:BathingGrooming, including mouth careDressing

ToiletingAssisting with eating and hydrationSkin careTransfers, positioning, and turning

16 Introductory Hours8. Mental HealthModifying aides behavior in response to residents behaviorAwareness of developmental tasks associated with the aging processAll the resident to make personal choices, providing and reinforcing other behaviors consistent with the residents dignityUsing the residents family as a source of emotional support

16 Introductory Hours9. Care of the cognitively impaired residents including:Techniques for addressing the unique needs and behaviors of an individual with dementia ( Alzheimers disease and others)Communicating with the cognitively impaired

Understanding the behavior of cognitively impaired residentsAppropriate responses to the behavior of cognitively impaired residentMethods of reducing the effects of cognitive impairments

16 Introductory Hours10. Basic restorative services, including:Training the resident in self care in self care according to the residents availableUse of assistive devices in transferring , ambulation, eating and dressingMaintenance of range of motion

Proper turning and positioning in bed and chairBowel and bladder trainingCare and use of prosthetic and orthotic devices

16 Introductory Hours11. Resident rights, including:Providing privacy and maintenance of confidentialityPromoting the residents right to make personal choices to accommodate their needsGiving assistance in resolving grievances and disputesAvoiding the need for restraints in accordance with current professional standardsproviding needed assistance in getting to and participating in resident, family, group, and other activitiesMaintaining care and security of the residents personal possessionsPromoting the residents 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 1Inadequate training for primary provider of dental hygiene

Barrier 2Resident ability and compliance with care

Barrier 3Continuing Education-not mandated for oral care

Barrier 4Oversight by Registered Nurses

Barrier 5Consultants in Long Term CareSocial WorkersDieticiansPharmacistsMedical Records

Where are the Dentists and Dental Hygienists????

Other considerationsSurveyorsReimbursementPoly pharmacyTransportationAgeismFearLack of Geriatric Training

What Is An MDSThe 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 long-term 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 Medicaid-certified long-term care facility.

MDS- Minimum Data Set

http://www.careplans.com/pages/video/i_active_diagnosis.aspxMDS 3.0 (Section L) Video

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

MalnutritionDehydrationBrain abscessesValvular Heart DiseaseJoint infections Cardiovascular DiseasePneumonia and Aspirational PneumoniaPoor 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?AdministratorDirector of NursingCharge NursesMDS NursesCNADieticianSocial WorkerDental HygienistDentistPhysicianFamily membersResidents

What Can This Team DO?

Be an advocate for the residentsImprove education in each facility, including orientation, continuing education and competency trainingSeek legislative changes for training requirements for front line staffSeek funding to support improved dental access and care

Work With State and National Organizations Serving the AgingPresent at national conventionsPut training good training on the webEmphasize cost savings when good oral care is providedBecome part of your communities Area Agencies on Aging Meet with architects who design assisted living and long term care facilities

Final Thoughts

*Photo of CNA*Photo of the Texas Curriculum for Nurse Aides in Long term Care Facilities*Photo of somebody exhausted*Photo of dementia residentThe 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 long-term 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 Medicaid-certified long-term care facility.