Dental Treatment and Demand for Services in a Veterans Administration Nursing Home Care Unit*

Abstract

Planning the provision of dental care in nursing homes requires evaluation of both dental needs and demand for services. Dental treatment needs have been documented for residents of longterm care facilities. This paper examines the actual dental care provided to institutionalized persons demanding care. Dental records of 144 patients at a Veterans Administration Nursing Home Care Unit (NHCU) were reviewed to evaluate needs and treatment demands. About 20 percent of the NHCU patients were currently receiving dental treatment; the remainder were on recall (closed cases). Of the total services needed, slightly over half were denture related services, about a quarter were oral surgical services, and 16 percent were operative procedures. Almost a third refused some or all of the proposed dental treatment; seven percent were unable to be examined or treated. No statistically significant difference was found between the age and the level of nursing home care needed for those receiving treatment and those refusing treatment. Once the backlog of need was met, this NHCU dental program consisted primarily of recall exams, and prosthetic and oral surgical treatment. The case mix and refusal rate may change, however, as future cohorts of elders retain more teeth and have experienced preventive dental services during their lifetimes.

A 5‐year follow‐up of older adults residing in long‐term care facilities: utilisation of a comprehensive dental programme

“…Denture-related care declined, but restorations and extractions were highly variable over the 5 years. Prosthodontic services (denture fabrication, repair and reline) were received by one-third or fewer residents, which is considerable less than previous reports 6,9,20 . The mean cost per resident for dental care, excluding examinations, was $449 in the first year increased to $521 in the second year, then declined to $319 by the end of the study.…”

“…Despite multiple attempts to contact the non‐responding family members by mail and phone, 40% did not respond, a considerable barrier to provide dental treatment for LTC residents. Almost a third of residents in an American Veterans Administration Nursing Home Care Unit also declined no‐cost care 20 .…”

Issues in Financing Dental Care for the Elderly

“…While the above studies have reported primarily on community-dwelling elders, individuals who reside in nursing homes also have been shown to have high levels of need for dental treatment (15). A study of caries prevalence among institutionalized veterans (16) reported that 68 percent of the decayed and/or filled root surfaces were in the decayed category, and the number of surfaces with active root caries peaked in the 55-64year-old agegroup (7.5 decayed surfaces), remained high in the oldest age group (5.3 decayed surfaces), and accounted for greater treatment needs than coronal caries.…”

A model for oral health care for elderly persons in nursing homes with an estimate of the resources needed

“…Oral health care for institutionalized elderly persons has so far, by and large, been limited to emergency care, and the oral health of elderly persons in nursing homes is far from satisfactory (1-4). However, the organization of more comprehensive oral health services for these elderly persons has become a matter of increasing interest in many countries (4)(5)(6)(7). In 1986 the Danish Parliament enacted a law making it possible to offer free dental services for physically or mentally handicapped persons, such as residents of nursing homes, who are not able to use the existing dental services.…”