ada nccc presentation dolan

National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults

and Persons with Disabilities

National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and

Persons with Disabilities

National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults


Professional Education to Meet the Oral Health Needs of

Older Adults andPersons with Disabilities

Teresa A. Dolan, DDS, MPHProfessor and Dean

[email protected]

PresenterPresentation NotesThank you for the opportunity to participate in todays program.

PresenterPresentation NotesPersonal Perspective

DentistCompleted a 2 year general dentistry residency programWork with Saul KamenRWJ Fellowship/MPH2 year Geriatric Dentistry FellowshipMore than 20 years in dental education faculty, program director, nursing home dentist/consultant, researcher, associate dean for education, dean

Who are special needs or vulnerable patients? The demographic imperative for a well prepared

dental workforce. Historical perspective: geriatric and special needs

dental education Calls to action Should special care dentistry become a dental

specialty recognized by the ADA? Expanding dental educational opportunities Creating new models of care delivery, with

embedded educational opportunities

Professional Education

Who are special needs or vulnerable patients?

The demographic imperative for a well prepared dental workforce.

Historical perspective: geriatric and special needs dental education

Calls to action Should special care dentistry become a dental




Todays Images of Aging

Using a functional needs-based framework, special needs can be defined as:

Populations whose members may have additional needs. including but not limited to: maintaining independence, communication, transportation, supervision and medical care

may include those who have disabilities; who live in institutionalized settings; who are elderly, who are children; who are from diverse cultures; who have limited English proficiency or are non-English speaking; or who have limited transportation options.

http://www.fema.gov/emergency/nrf/glossary.htm#S

PresenterPresentation NotesMany definitions

Variability among the group being described

Vulnerable Elders

Vulnerable Elderly Patients are patients over age 65 who have any or all of the following: limited mobility, limited resources, or complex health status.

Source: 2007 Oral Health Care of Vulnerable Elderly Patients Survey, ADA Survey Center

Who are special needs or vulnerable patients?

The demographic imperative for a well prepared dental workforce






41.3 million people or 15.1 percent of civilian non-institutionalized population 5+ years have one or more disabilities(Census Bureau, American Community Survey, 2008)

54 million children and adults have one more disabilities(National Organization on Disability)

1.6 million people live in nursing homes (CDC)

US Population Estimates

PresenterPresentation NotesWhy is this important?

People with disabilities :are much more likely to be living in povertyare much more likely to report not getting needed medical care.are more likely to experience difficulties with transportation

All these factors contribute to challenges accessing dental services

Question: How do we plan and implement appropriate health professions curriculum to meet the needs of this diverse and challenging patient populations?

Who are special needs or vulnerable patients? The demographic imperative for a well prepared

dental workforce.






Year Agency Activity1960s Federal agencies funded university-affiliated programs in most

states to train professionals in the care of disabled patients Mid 1970s Robert Wood

Johnson Foundation

Funded training programs and curriculum development for special needs dentistry in 11 of the existing 52 dental schools

1981+ Univ. MN First university-based MS program in geriatric dentistry

1982+ VA Fellowship Training Programs in Geriatric Dentistry

1986 NIDR, NIH, VA Research Agenda on Oral Health in the Elderly

1988 NIDR NIDR Research and Action Program to improve the Oral Health of Older American and Older Adults at High Risk

1987 AADS, AoA Geriatric Dentistry Curriculum Project

1988+ HRSA Fellowship Training Programs in Geriatric Medicine & Dentistry

1989 AADS (ADEA) Curriculum Guidelines in Geriatric Dentistry

1994 AADS (ADEA) Section on Gerontology and Geriatrics Education was established

1996 BHPr, HRSA Geriatric Education Futures Project - White Papers, etc.

Special Needs and Geriatric Professional Education Milestones

Changes in Geriatric Dentistry Curriculum

1974 1979 1985 1998

% % % %

Taught at all 58 100 100 100

As a required course 0 78 67 88

As a specific course 0 12 58 83

As lectures in a course 44 69 85 44

Integrated in curriculum 30 39

Other 5 0 14

Ettinger RL, Watkins C, Cohen H. Reflections on changes in Geriatric Dentistry. J Dent Educ 64(10):715-22. 2000.

PresenterPresentation NotesHave we set the dental education curricular bar too low?Ettingers recent review of the dental educational literature concluded there are significant barriers to teaching geriatric and special needs dentistry, and these have remained the same since Moshman et al. identified them in 1985. Ettinger categorized these barriers as: inadequate curriculum time, including lack of time in the clinical curriculum for new disciplines, an overcrowded overall curriculum and competition among clinical disciplines for curricular time; inadequate funding, including lack of resources to support geriatric and special needs clinics and lack of full-time faculty to teach in these clinics; and lack of trained faculty as teachers for the didactic and clinical courses.

Ettinger RL. Meeting oral health needs to promote the well-being of the geriatric population: Educational research issues. J Dent Educ 2010; 74(1): 29-35.Moshman J, Warren GB, Blanford DH, Aumack L. Geriatric dentistry in the predoctoral curriculum. J Dent Educ 1985; 49(10):689-95.

Dental Accreditation Standards

Predoctoral Dentistry Standard 2-22: Graduates must be competent in providing oral

health care within the scope of general dentistry to patients in all stages of life.

Standard 2-24: Graduates must be competent in assessing the treatment needs of patients with special needs.

Definition: Special needs patientsThose patients whose medical, physical, psychological, cognitive or social

situations make it necessary to modify normal dental routines consider a wide range of assessment and care options in order to provide dental treatment for that individual. These individuals include, but are not limited to, people with developmental disabilities, cognitive impairment, complex medical problems, and significant physical limitations, and the vulnerable elderly.

PresenterPresentation NotesAlthough not extensively studied, there is evidence that student characteristics, community-based dental education, and the contextual learning environment predict plans to care for underserved populations upon graduation.

Dental admissions processes and subsequent curricular experiences are critical to developing the next generation of dentists willing and able to treat underserved patients including special needs and vulnerable elders.

Davidson PL, Carreon DC, Baumeister SE, Nakazono TT, Gutierrez JJ, Afifi AA, Andersen RM. Influence of contextual environment and community-based dental education on practice plans of graduating seniors. J Dent Educ. 2007;71(3):403-18.

Dental Accreditation Standards

Dental Hygiene Standard 2-16, Graduates must be competent in

providing dental hygiene care for the child, adolescent, adult and geriatric patient. Graduates must be competent in assessing the treatment needs of patients with special needs.

Intent Statement: The program must have an adequate patient pool to provide a wide scope of patient experiences that include patients whose medical, physical, psychological, or social situations may make it necessary to modify procedures in order to provide dental hygiene treatment for that individual.

PresenterPresentation NotesHowever, like the predoctoral dental education standards, these standards do not require students to achieve competency in the delivery of care in nontraditional settings such as using mobile equipment or in providing care in long term care facilities.

Probably more importantly, very few dental and dental hygiene programs provide substantial education and clinical experiences in team delivery of dental care, defined as either working effectively within the dental care delivery team or working effectively with other health professions team members.

Multidisciplinary training and care delivery is especially important when delivering care to special needs populations.

Dental Residency Programs

Why do students apply? Need more experience with special and/ or

medically compromised patients

Graduates were more likely to: serve on the staff of a nursing home or hospital

report that they treated geriatric/medically compromised patients in their offices

Atchison, KA, Mito, RS, Rosenberg, DJ, Lefever, KH, Lin, S, Engelhardt, R. PGD Training and its Impact on General Dentist Practice Patterns J Dent Educ, 66(12):1348-1357, 2002.

Federally-funded training programs in geriatric medicine and dentistry

Sources: (1) Pyle MA, Stoller EP. Oral health disparities among the elderly: interdisciplinary challenges for the future. J Dent Educ 67:1327-36, 2003. (2) http://www.hrsa.gov/about/budgetjustification09/geriatic.htm

Funding Year No. Programs Funded

No. Fellows Trained

1988 23 1151991 16 741994 9 1352000 5 -2001 2 -2002 2 -2004 11 662005 11 662006 0 02007 11 332008 11 66

PresenterPresentation NotesGuidelines for a Faculty Training Program in Geriatric Dentistry were developed by an ad hoc committee of the American Society for Geriatric Dentistry and revised in 1993. However, to date, fewer than 200 geriatric dentist academicians have been trained through these and similar initiatives. Funding for these programs declined in the 1990s . The current number of residency or fellowship training programs for special needs dentistry including geriatric dentistry is inadequate to meet our current and future needs.

Other dental workforce issues

Faculty pipeline national shortage of dental faculty

Large increase in the number of students applying to dental school; First-year dental school enrollment relatively flat

The dental profession is aging

Dentist-to-population ratio started declining around 1995 and has continued to decrease

Lack of diversity in the dental workforce

Current economics of dental practice not conducive to expanding access to special needs populations

Who are special needs or vulnerable patients? The demographic imperative for a well prepared dental

workforce. Historical perspective: geriatric and special needs dental

education

Calls to action

Should special care dentistry become a dental specialty recognized by the ADA?

Expanding dental educational opportunities Creating new models of care delivery, with embedded

educational opportunities


Calls to Action

May 2002The Silent Epidemic March 2003

Guiding principles:

Access to basic oral health care is a human right.

The oral health care delivery system must serve the common good.

The oral health needs of vulnerable populations have a unique priority.

A diverse and culturally competent workforces is necessary to meet the oral health needs of the nation.

March 2003

A State of Decay

There are significant structural problems in our oral health care system, and the problems are getting worse due to demographic trends, workforce trends, public health infrastructure inadequacies, and the increasing number of children, adults, elderly and special populations not covered by Medicare or Medicaid.

Overall grade D

Copyright 2003 Oral Health America

PresenterPresentation NotesAt the time of the survey, most states provided emergency services through their dental Medicaid program, but only 10 states provided full or comprehensive dental benefits to Medicaid-eligible adults.

Six states offered no adult dental Medicaid benefits. In addition, state Medicaid programs reimbursed dentists for basic services at rates below customary fees, and many states required pre-authorization for dental procedures and other administrative barriers to providing care.

The Elders Oral Health Summit (2004):Plan of Action

To change perceptions: Oral health matters for health and quality of life

To overcome barriers and replicate effective programs

To build the science base and accelerate the science transfer

To increase workforce diversity, capacity, and flexibility

To increase collaborations with extant aging networks

JA Jones, C Wehler. J Dent Educ 69(9):957-960, 2005

PresenterPresentation NotesIn 2004, the Elders Oral Health Summit critically examined determinants of elders access to dental care and oral health in the U.S., and compared financing and other options for improving oral health outcomes in elders. The proceedings and research agenda are helpful in targeting strategies for action.

The Summits Plan of Action included five main topic areas, including an objective to increase workforce diversity, capacity, and flexibility.

Jones JA, Niessen CL, Rupp RL. Preface to the Elders Oral Health Summit. J Dent Educ 2005; 69(9):956.

2005 White House Conferenceon Aging

Resolution: Attract and retain new health care providers with advanced training in geriatric medicine, mental health, social work, nursing, dentistry, allied health professional and direct care workers by establishing geriatrics as an underserved profession and by supporting expanded training opportunities, and financial incentives including loan forgiveness, benefits and appropriate reimbursement.

Source: http://www.whcoa.gov/

ADA Task Force on Elder Care

2004 ADA House of Delegates adopted Resolution 74H requesting appointment of a two-year task force to explore challenges in rendering comprehensive dental care to our aging populations; and that special attention be given to identifying varying needs based on the variety of resident situations.

Report included goals related to: Education, Advocacy, Research

Predecessor to the National Elder Care Advisory Committee

ADA Task Force on Elder CareRecommendations

Education Goal: Increase the understanding of how good oral health enhances quality of life in vulnerable elders.

Objective 2. Educate health care workers, including dentists, about vulnerable elders oral health needs and care delivery issues through provision of six new initiatives within three years. Expand AEGD programs in geriatric dentistry

Implement CE for certified nursing assistance in oral health and daily mouth care of vulnerable elderly

Create a web-based clearinghouse of programs, practice resources and CE related to providing oral health care to vulnerable elderly

What about dental specialty and fellowship

programs?

PresenterPresentation Notes A 1987 workforce report from the National Institute on Aging estimated that at least 6,000 dentists with substantial training in geriatric dentistry would be needed by 2000; and 2,000 more needed by 2010. We are obviously far behind in meeting these workforce goals.

ADEA Advisory Committee for theDevelopment of a Core Curriculum for

the Older AdultSupported by: GlaxoSmithKline

Goal: Develop the Oral Health for Independent OlderAdults, ADEA/GSK Pre-doctoral Curriculum Resource Guide.

Targets educational resource materials for pre-doctoral education that is geared toward the independent older adult.

Dr. Marsha Pyle, Committee ChairDr. Douglas BerkeyDr. Diane Ede-NicholsDr. Ronald EttingerDr. Raul GarciaMs. Karen Hart, ADA CDELDr. Todd WatkinsDr. Janet Yellowitz

Recommendations:

Enhance the geriatric competence of the entire workforce.

Increase the recruitment and retention of geriatric specialists and caregivers.

Improve the way care is delivered.Address health care needs comprehensively, efficiently, using new technologies

IOM, 2008

PresenterPresentation NotesIn June 2008, The American Geriatrics Society convened a meeting of 21 organizations representing healthcare professionals who care for older adults,

in order to advance the Institute of Medicine Retooling for an Aging America report and enhance our capacity to better meet the health needs of older Americans.

Workgroup members representing ten health disciplines developed the Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree.

The Impact of the Aging Population on the Health Workforce in the United States

(March 2006)

Many health professions including dentistry do not offer formal credentials focused on the needs of the elderly

A majority of health care professionals in most setting deal with substantial numbers of elderly people whether or not they are specialists

Prepared by: Center for Health Workforce Studies, School of Pubic Health, University of Albany, HRSA Grant U79HP00001.

PresenterPresentation NotesDentistry is not alone. We need additional curriculum time in all health professions programs.



education Calls to action

Should special care dentistry become a dental specialty recognized by the ADA?

Expanding dental educational opportunities Creating new models of care delivery, with embedded

educational opportunities


In the United Kingdom, Special Care Dentistry was added to the existing 12 specialist lists.

The General Dental Council defined Special Care Dentistry as being:

concerned enabling the delivery of oral care for people with an impairment or disability, where this terminology is defined in the broadest of terms. Thus, Special Care Dentistry is concerned with the improvement of oral health of individuals and groups in society, who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these factors.

Special Care Dentistry

that branch of dentistry that provides oral care services for people with physical, medical, developmental, or cognitive conditions which limit their ability to receive routine dental care.

Source: http://www.scdaonline.org/

Specialty Status

Pros Recognized dental specialties attract trainees,

prestige, and typically higher reimbursement commensurate with the additional expertise/training

Assist in recruitment of dental faculty?

Cons Further segmentation of dental care? Increased cost of care?



education Calls to action Should special care dentistry become a dental specialty

recognized by the ADA?

Expanding dental educational opportunities

Creating new models of care delivery, with embedded educational opportunities


Leadership and Funding: HRSA Oral Health Initiative 2010 Engage foundations, other funding sources Maintain GME funding for dental residency training

Curriculum and Commitment: Build on previous work in the 1970s-90s Expand geriatric and special care curriculum in all health

disciplines Enhance interdisciplinary health professions education Use distance learning and non-traditional delivery to

expand learning opportunities

Expanding dental educational opportunities

National Academy of Sciences Study Will Recommend Improvements to U.S.

System of Oral Health Care

Wednesday, October 08, 2009

HRSA recently awarded the National Academy of Sciences contracts worth $2.4 million to conduct a wide-ranging study of oral health care in the United States and suggest ways it could be improved.

Working with the National Academy of Sciences, the Institute of Medicines (IOM) Board on Children, Youth and Families and the Board on Health Care Services will establish two 15-member committees of experts in oral health and other health-related services to:

examine the oral health system of care in the U.S. as it currently exists;

explore its strengths, weaknesses and future challenges; describe a desired vision for the oral health care system; and recommend strategies to achieve that vision.

PresenterPresentation NotesHope on the horizon.

The Department of Health and Human Services (HHS), recently announced the Oral Health Initiative 2010

One component of this initiative is a recent contract with the National Academy of Sciences/Institute of Medicine to conduct a wide-ranging study of oral health care in the United States and to suggest ways it could be improved. The study will assess the current oral healthcare system, examine preventive oral care interventions, their use and promotion, explore ways of improving health literacy for oral health, and review elements of a potential DHHS oral health initiative.

Other components of the HHS Oral Health Initiative 2010 include the Indian Health Service Early Childhood Caries Initiative, and collaborative efforts with other federal agencies to enhance clinical and translational science, cultural competency research and practice, and womens health across the lifespan.

+ support for training programs in geriatrics, pediatric dentistry, public health



education Calls to action Should special care dentistry become a dental specialty

recognized by the ADA? Expanding dental educational opportunities

Creating new models of care delivery, with embedded educational opportunities


PresenterPresentation NotesNew developments:

New members of the dental care delivery team

Creating Regional Centers of Excellence for special needs patients

FQHCs recognizing adults with special needs as underserved and a priority patient population for dental care

Need to educate students within these models of care delivery so that they have a sense of possibilities for their own practice

Train and engage new members of the dental care delivery team

Create Regional Centers of Excellence for special needs patients

FQHCs recognize adults with special needs as underserved and a priority population for dental care

Educate students within a viable model of care delivery so that they have a sense of possibilities for their own practice

New models of care delivery, with embedded educational opportunities

PresenterPresentation NotesNew developments:

New members of the dental care delivery team

Creating Regional Centers of Excellence for special needs patients

FQHCs recognizing adults with special needs as underserved and a priority patient population for dental care

Need to educate students within these models of care delivery so that they have a sense of possibilities for their own practice

Professional Education to Meet the Oral Health Needs of Older Adults


Review Who are special needs or vulnerable patients? The demographic imperative for a well prepared

dental workforce. Historical perspective: geriatric and special needs

dental education Calls to action Should special care dentistry become a dental



Thank you!

People with disabilities are much more likely to be living in poverty.

Q1420 Which of the following income categories best describes your total 2009 household income?

Source: Kessler Foundation, Survey of Americans with Disabilities - July 26, 2010http://www.2010disabilitysurveys.org/presentation.html

People with disabilities are much more likely to report not getting needed medical care.

Harris Interactive

Q1100 In the past 12 months, was there a time when you needed medical care but did not get it, or not?


People with disabilities are more likely to experience difficulties with transportation

Q805 Is inadequate transportation a major problem, a minor problem, or not a problem for you?


National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and Persons with DisabilitiesSlide Number 2Slide Number 3Slide Number 4Professional EducationProfessional EducationSlide Number 7Using a functional needs-based framework, special needs can be defined as:Vulnerable EldersProfessional EducationSlide Number 11Slide Number 12US Population EstimatesProfessional EducationSlide Number 15Changes in Geriatric Dentistry CurriculumDental Accreditation StandardsDental Accreditation StandardsDental Residency ProgramsFederally-funded training programs in geriatric medicine and dentistryOther dental workforce issuesProfessional EducationCalls to ActionA State of DecayThe Elders Oral Health Summit (2004):Plan of Action2005 White House Conferenceon AgingADA Task Force on Elder CareADA Task Force on Elder CareRecommendationsWhat about dental specialty and fellowship programs?ADEA Advisory Committee for theDevelopment of a Core Curriculum for the Older AdultSupported by: GlaxoSmithKline Goal: Develop the Oral Health for Independent OlderAdults, ADEA/GSK Pre-doctoral Curriculum Resource Guide.Recommendations:The Impact of the Aging Population on the Health Workforce in the United States (March 2006)Professional EducationIn the United Kingdom, Special Care Dentistry was added to the existing 12 specialist lists. Special Care DentistrySpecialty StatusProfessional EducationProfessional EducationExpanding dental educational opportunitiesNational Academy of Sciences Study Will Recommend Improvements to U.S. System of Oral Health CareProfessional EducationNew models of care delivery, with embedded educational opportunitiesSlide Number 43Slide Number 44People with disabilities are much more likely to be living in poverty. People with disabilities are much more likely to report not getting needed medical care. People with disabilities are more likely to experience difficulties with transportation

ada nccc presentation dolan

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