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I've brought it up with the nursing supervisor and she says that they will do so, but it never happens. My husband is quadriplegic and unable to hold a toothbrush. He is cognitive and can speak fine.
Absolutely! But the reality is that this bit of caregiving tends to get pushed to the side. I knew that I needed to be vigilant about my mother's dental care after I was told that bleeding gums were normal 🙄.
Dental care isn’t covered by Medicare except in rare situations. Most states Medicaid only cover dental care for kids within CHIP or ACA as it’s primarly preventative care via those big vans staffed by dental assistants & hygienists that go to community centers. Its overlooked imo as there no way to bill for the time to do this service.
For NH, those pink tipped sponge swab sticks with some sort of oral hygiene embedded in them is considered acceptable level of dental oversight.
To get more than this, he is going to need MD / medical directors orders in his chart for an CNA or aide to assist in daily brushing of teeth. It will need to have to be done tied into some sort of serious health risk, like heart disease. MD order has to be in his chart for anything to be done by staff, whether it’s an OTC cream at night or brushing teeth.
For anyone reading this, if it’s looking like your folks are going to go into a facility doing a spend down on dental care is well worth it. Really if they are still ok on their ADLs and have a dentist who will see them, please have them get work done ahead of ever entering a NH. My mom had a ton of work done, like implants and full bridging & gum work done years before. It will not be cheap $$$ but will be imo and experience one of the best things to have done with their $. They will be able to have a healthier more varied diet and can actually actively eat. One surprising takeaway at one of my mom’s NH care plan meetings from the RN charge nurse was on how my mom was great in going for meals and how well she ate and that the whole process of actively eating 3 meals a day - grab flatware, cut, fork, place in mouth, chew, swallow, drink, etc - helps keep them cognitive and keeps them socialized. If they have the funds, spending on dental now will pay off later on.
That is such a good point. Without proper dental care many seniors start to find it too hard to eat proper meals. Or are so embarrassed about their teeth they isolate. Being able to go to dining room, eat a full varied diet and maintain social function is so important. I watched a relative go through that, my cousins were too cheap to help her as they wanted to "save" for their inheritance.
as my dad had aspiration issues, the speech therapist at the SNF itself prescribed his mouth was to be swabbed out before and after meals, to help minimize risks of aspirating. Unless we were there to remind them of this, they rarely did. They should be brushing your husbands teeth. . This is not an issue of covered dental care per se, this is just basic health hygiene which they should be doing, and which you are paying for. I would talk to the DON. They do not need doctors orders to cause them to help him go to the bathroom. Nor do they need doctors orders for something as basic as brushing teeth.
Assisting resident's with brushing their teeth is ABSOLUTELY something the nursing aides are supposed to do! But, when one CNA is tasked with getting 10 - 15 people up, dressed, toileted, to the dining room, and then feeding the ones that can't feed themselves, within a couple of hours of their shift starting, it is one of the most overlooked hygiene issues also. If you have already spoken with the Director of Nursing and/or the social service person, I would file a grievance with the social services department. This way it is brought up at the care plan meetings and the facility will try to resolve the issue because they know that state surveyors review all of the grievances filed during their annual visits. Each time you notice his teeth aren't brushed, fill out another form. The administration knows that if state sees multiple grievances from the same person on the same issue, they will get a citation from the state. Unfortunately, this will cause them to take action faster than anything else.
It's worth remembering that most of us like to clean our teeth first thing, but it is actually better to do it after breakfast rather than before. Surely it would make the morning shift a little easier.
I’ve posted signs on the bathroom mirror and in his room telling them to brush his teeth every morning. I check every day for a wet toothbrush and ask him if his teeth were brush. He usually can tell me. If they are not I file a complaint. Because I’m there 6 days a week they usually do what I need.
One day in ICU along came the RN and a Occupational therapist to see how a managed my daily aides. They wanted me to brush my teeth and i told them they felt as though they were wearing sweaters and why were they not being cleaned. They said on admission a patient was asked if they could clean their teeth and if they said"yes" that was it. I went up one side and down the other and told them it should be in the plan of care for a seriously ill person. They both left in a hurry and another nurse arrived and got the job jone. I do not see this as part of dental treatment tome it comes under personal care so yes Dad's teeth should be getting brushed. Medicare does in fact cover dental cleaning at least once a hear and I think a few X-rays
I guess I take this personally, but to me it is about more than your husband's teeth. This is about his dignity. I get so angry when I think about this facility, who is getting paid to take care of your husband, and he is not given the dignity of having his teeth brushed.
I agree that a NH resident, or anyone in any care facility, should receive daily dental care. Do they get it? No. The staff probably set him up in the morning with a toothbrush and emesis basin, ask if the resident needs help, resident says no, and then off they go. I can almost guarantee the above happens. And if the staff do try it’s probably a once over cleaning and out they go again... This is definitely a problem but due to staffing it doesn’t get done.
As your husband is cognitive and has the power of speech, why doesn't he ask the aides to brush his teeth? If it's because he's reluctant to be "pushy," remind him that this is part of everybody's standard daily routine and there is nothing remotely unreasonable about asking for help with it.
I wonder... does he not like the idea of the aides doing it? It's a funny thing about dental care, how intimate it can feel.
Yes the aides, and nurses if needed, should be brushing your Husband’s teeth. Have a visit with the administrator and DON to let your concerns be known outside of the nursing staff.
Yes, if he is quadriplegic, someone needs to be brushing his teeth after every meal.
Someone must be feeding him - they need to be doing the oral hygiene after every meal. This needs to be reported on a higher level. If it were my LO, I would be calling the board of health and asking who I need to contact.
I kept my DH at home and getting him to brush his teeth or allow me to help was like pulling teeth, pardon the pun. But I kept asking and eventually we came to an agreement.
I agree with Countrymouse - why isn't your husband asking for the assistance? As a 24/7 caregiver, sometimes things were so hectic that I didn't always think of what needed doing and I bet the nursing staff/aides are running into a similar situation.
Remember, it's the squeaky wheel that gets the grease. Your husband and you need to speak up.
There should be an Ombudsman available to handle your concerns. Start here: https://ltcombudsman.org/about/about-ombudsman Usually just a suggestion to the Administrator that you would like to speak to an Ombudsman brings immediate action.
I don’t understand why some of you are assuming he’s not asking. And besides, he shouldn’t have to ask. This is common sense. If they do not continue to assist your husband after you exhaust the normal avenues of trying to accomplish this, find another facility.
Record. Take photos of him smiling, show debris I teeth. Report NH to Medicare & Medicaid, and consider hiring a Nursing Home Abuse Attorney with a strong track record. It may require only one letter from him.
This is a big deal, endocarditis ( infection causing sack around heart to be inflamed) other serious infection affecting kidneys and causing death can be direct result of poor dental care.
You have informed the facility. Record how and when, as best you recall. Use "on or about" .
If this is happening with your LO, it is happening with others! Doing this can save you LO and others from unnecessary misery and even death!
When my mother was in the SNF, she wouldn’t let anyone but me take out her denture, clean it & put it back into her mouth. & the only day I missed going there, she would not let anyone touch them. She figured they would either break them or maybe sell them to some other patient!?! I wish she wasn’t so difficult, but that’s the story. Most patients there had missing teeth or if they had dentures, they take them out...put them on the food tray & they take the tray away with the dentures on them! Since my mother is home, I’ve taken her to dentist...she’s had a few extractions of teeth that broke off ....& I soak her upper denture every night. I’ve just decided not to go ahead with bottom dentures for her since I believe it would be too stressful for her & she probably would not let me clean the 2 implants necessary to hold the denture... implants would involve drilling into jaw...& trips back & forth to dentist & it takes 3 months for implants to grow into jaw...at 91 1/5 years old w dementia, I feel it’s too much for her to go through...even with dental insurance....I would not hesitate to pay this for her...but the anesthesia also & drilling etc just too much for her...I believe.
SLR, a ? for you..... For both my mom & mil NH stays, physician orders HAD TO come from the MD who was the medical director of the NH. RXs or orders from an outside pharmacy or MDs - unless it was a unique situation - was not allowed. “Unique” like RX or TX post surgery/post hospitalization related & time limited. The policy was that anything related to residents health care had to come from the MD medical director of the facility & who consulted with the DON as to staffing needs.
Your an RN at a NH, right? Will the facility you’re at allow for a NH resident to have their various old MDs - like their old internal medicine doc, ophthalmologist, ENT guys, etc. - to place orders for care, & let family bring in outside filled RXs from those old MDs? And your NH is it only Medicare/private pay or is it MediCARE/Medicaid?
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Most states Medicaid only cover dental care for kids within CHIP or ACA as it’s primarly preventative care via those big vans staffed by dental assistants & hygienists that go to community centers.
Its overlooked imo as there no way to bill for the time to do this service.
For NH, those pink tipped sponge swab sticks with some sort of oral hygiene embedded in them is considered acceptable level of dental oversight.
To get more than this, he is going to need MD / medical directors orders in his chart for an CNA or aide to assist in daily brushing of teeth. It will need to have to be done tied into some sort of serious health risk, like heart disease. MD order has to be in his chart for anything to be done by staff, whether it’s an OTC cream at night or brushing teeth.
For anyone reading this, if it’s looking like your folks are going to go into a facility doing a spend down on dental care is well worth it. Really if they are still ok on their ADLs and have a dentist who will see them, please have them get work done ahead of ever entering a NH. My mom had a ton of work done, like implants and full bridging & gum work done years before. It will not be cheap $$$ but will be imo and experience one of the best things to have done with their $. They will be able to have a healthier more varied diet and can actually actively eat. One surprising takeaway at one of my mom’s NH care plan meetings from the RN charge nurse was on how my mom was great in going for meals and how well she ate and that the whole process of actively eating 3 meals a day - grab flatware, cut, fork, place in mouth, chew, swallow, drink, etc - helps keep them cognitive and keeps them socialized. If they have the funds, spending on dental now will pay off later on.
to find it too hard to eat proper meals. Or are so embarrassed about their
teeth they isolate. Being able to go to dining room, eat a full varied diet
and maintain social function is so important. I watched a relative go through that, my cousins were too cheap to help her as they wanted to "save" for
their inheritance.
I do not see this as part of dental treatment tome it comes under personal care so yes Dad's teeth should be getting brushed.
Medicare does in fact cover dental cleaning at least once a hear and I think a few X-rays
The staff probably set him up in the morning with a toothbrush and emesis basin, ask if the resident needs help, resident says no, and then off they go.
I can almost guarantee the above happens. And if the staff do try it’s probably a once over cleaning and out they go again...
This is definitely a problem but due to staffing it doesn’t get done.
I wonder... does he not like the idea of the aides doing it? It's a funny thing about dental care, how intimate it can feel.
Someone must be feeding him - they need to be doing the oral hygiene after every meal. This needs to be reported on a higher level. If it were my LO, I would be calling the board of health and asking who I need to contact.
I kept my DH at home and getting him to brush his teeth or allow me to help was like pulling teeth, pardon the pun. But I kept asking and eventually we came to an agreement.
I agree with Countrymouse - why isn't your husband asking for the assistance? As a 24/7 caregiver, sometimes things were so hectic that I didn't always think of what needed doing and I bet the nursing staff/aides are running into a similar situation.
Remember, it's the squeaky wheel that gets the grease. Your husband and you need to speak up.
https://ltcombudsman.org/about/about-ombudsman
Usually just a suggestion to the Administrator that you would like to speak to an Ombudsman brings immediate action.
This is a big deal, endocarditis ( infection causing sack around heart to be inflamed) other serious infection affecting kidneys and causing death can be direct result of poor dental care.
You have informed the facility. Record how and when, as best you recall. Use "on or about" .
If this is happening with your LO, it is happening with others! Doing this can save you LO and others from unnecessary misery and even death!
Your an RN at a NH, right? Will the facility you’re at allow for a NH resident to have their various old MDs - like their old internal medicine doc, ophthalmologist, ENT guys, etc. - to place orders for care, & let family bring in outside filled RXs from those old MDs? And your NH is it only Medicare/private pay or is it MediCARE/Medicaid?
Oral care should be a part of daily care of each resident! When I was a professional Ombudsman this topic came up often.