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Understanding the Challenges of Providing Oral Health in the Long Term Care Setting. Maria Wellisch, RN, BBA, LNFA V.P. of Corporate Education at Morningside Ministries. Course Objectives.
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Understanding the Challenges of Providing Oral Health in the Long Term Care Setting Maria Wellisch, RN, BBA, LNFA V.P. of Corporate Education at Morningside Ministries
Course Objectives • Identify five (5) significant challenges found in the long term care setting that affect providing resident’s with basic oral hygiene and dental care • Discuss the systemic health consequences most commonly seen in residential care that can directly attributed to poor oral health • 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 Provides Primary Daily Dental Care for Residents in Long Term Care and Assisted Living?
Certified Nursing Assistant
CNA Qualifications Nurse 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.
Barriers to Good Oral Care • 1. Education- Texas Curriculum for Nurse Aides in Long Term Care Facilities (Third Edition 2000) DEPARTMENT OF AGING AND DISABILITY SERVICES REGULATORY NURSE AIDE TRAINING PROGRAM MAIL CODE E-420 PO BOX 149030 AUSTIN TX 78714-9030 (512) 438-2017
How Many Hours of Training Required for a CNA? • 300 • 500 • 600 • 1500
Nurse Aide Training and Competency Evaluation Program Requirements • Rule 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
1. Communication and interpersonal skills 2. Infection control 3. Safety and emergency procedures including the Heimlich maneuver 4. Promoting resident’s independence 5. Respecting Residents rights 6. Basic nursing skills including Taking and recording vital signs Measuring and recording height and weight Caring for the residents environment Recognizing abnormal changes in body functioning and the importance of reporting such changes to a supervisor Caring the resident when death in imminent 16 Introductory Hours
7. Personal care skills, including: Bathing Grooming, including mouth care Dressing Toileting Assisting with eating and hydration Skin care Transfers, positioning, and turning 16 Introductory Hours
16 Introductory Hours 8. Mental Health • Modifying aide’s behavior in response to resident’s behavior • Awareness of developmental tasks associated with the aging process • All the resident to make personal choices, providing and reinforcing other behaviors consistent with the resident’s dignity • Using the resident’s family as a source of emotional support
9. Care of the cognitively impaired residents including: Techniques for addressing the unique needs and behaviors of an individual with dementia ( Alzheimer’s disease and others) Communicating with the cognitively impaired Understanding the behavior of cognitively impaired residents Appropriate responses to the behavior of cognitively impaired resident Methods of reducing the effects of cognitive impairments 16 Introductory Hours
10. Basic restorative services, including: Training the resident in self care in self care according to the resident’s available Use of assistive devices in transferring , ambulation, eating and dressing Maintenance of range of motion Proper turning and positioning in bed and chair Bowel and bladder training Care and use of prosthetic and orthotic devices 16 Introductory Hours
11. Resident rights, including: Providing privacy and maintenance of confidentiality Promoting the resident’s right to make personal choices to accommodate their needs Giving assistance in resolving grievances and disputes Avoiding the need for restraints in accordance with current professional standards providing needed assistance in getting to and participating in resident, family, group, and other activities Maintaining care and security of the resident’s personal possessions Promoting the resident’s right to be free from abuse, mistreatment, and neglect and the need to report any instances of such treatment appropriate facility staff 16 Introductory Hours
WHEW……………. (Grooming, including mouth care) Barriers to Good Oral Care:
Barrier 1 Inadequate training for primary provider of dental hygiene
Barrier 2 Resident ability and compliance with care
Barrier 3 Continuing Education- not mandated for oral care
Barrier 4 Oversight by Registered Nurses
Barrier 5 • Consultants in Long Term Care • Social Workers • Dieticians • Pharmacists • Medical Records Where are the Dentists and Dental Hygienists????
Other considerations • Surveyors • Reimbursement • Poly pharmacy • Transportation • Ageism • Fear • Lack of Geriatric Training
What Is An MDS • The 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 3.0 (Section L) Video http://www.careplans.com/pages/video/i_active_diagnosis.aspx
Discuss the systemic health consequences most commonly seen in residential care that can be directly attributed to poor oral health
Malnutrition • Dehydration • Brain abscesses • Valvular Heart Disease • Joint infections • Cardiovascular Disease • Pneumonia and Aspirational Pneumonia • Poor 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
Administrator Director of Nursing Charge Nurses MDS Nurses CNA Dietician Social Worker Dental Hygienist Dentist Physician Family members Residents Who Comprises the Interdisciplinary Team?
What Can This Team DO? • Be an advocate for the residents • Improve education in each facility, including orientation, continuing education and competency training • Seek legislative changes for training requirements for front line staff • Seek funding to support improved dental access and care
Work With State and National Organizations Serving the Aging • Present at national conventions • Put training …good training on the web • Emphasize cost savings when good oral care is provided • Become part of your communities Area Agencies on Aging • Meet with architects who design assisted living and long term care facilities
