the ohs journey - oral health of seniors annual general meeting
TRANSCRIPT
The OHS Journey – Year 1
Where we’ve been
TeamFG’s
MeetLit.
Submit
OHS
• By 2041, the senior population will be 23% (1995 only 12%) - 80,000,000 more teeth to care for!
• Literature indicates many barriers to care:– Financial, access, attitudes & beliefs, institutional,
education, physiological
• Oral health is marginalized from publicly funded health care
• Oral health impacts overall health and quality of life
Serving Seniors: Challenges for Oral Health
Purpose
To determine the key components of a health services model, based on continuity of care, which will help improve access to
oral health services for seniors.
What’s needed?
• A collaborative, integrated team approach
• Data
• Increased awareness of the issue
• Links to other research and initiatives
Nova Scotia: Our Project’s Playground
• High proportion of seniors: 128,333 seniors (65+) in NS; 13.6% of total population
• Many seniors living in rural communities, at home and with poor socio-economic conditions
• Currently, outside of our project, there is no information on the oral health services, barriers and facilitators
• No publicly funded dental services for seniors
Objectives – Year 1 (Data Collection/Planning)
Develop a survey for seniors and DCPDevelop 4 focus group guidesDevelop a research logic framework for the Best
Practices Identify resources and experts to consultDevelop a recruitment strategy and materialsBegin organizing the ForumDevelop a communication plan
MAWG
BPWG
RFCWG
Objectives – Year 2 (Analysis/Model Dev./ Dissem.)
Synthesize, design and prepare a final report and executive summary for the Focus Group findings and Best Practices Scan
Design Forum process, recruitment strategy, funding, and develop materials/presentations
Host Forum Assist with the development of proposals for future
projects/initiatives Develop a oral health services model for Nova Scotia Disseminate project findings
Research
Forum Planning
Team
Products/Wins Intersectoral team, 20+ working group meetingsA comprehensive evaluation frameworkCommunication Plan - 30 opportunitiesFacilitator training workshopRecruitment process and materials2 surveys and 4 focus groups guidesSurvey and Focus Groups findingsFramework for Best Practices ScanOver 266 literature referencesDetailed tracking of project progress
It takes a village to build a model
Insurance
Education
Dentistry societies
LTC facilities
Seniors
Researchers
Government
Researchers
Celebrating our Work
Today’s Agenda9:30am Welcome & Project Update (Mary & Liz)
10:00am Seniors’ Oral Health Services Evaluation: An Overview & Discussion of the Findings (Pam & Liz)
12:00pm Lunch
12:45pm Best Practices Scan: An Overview of Preliminary Findings (Pam)
2:30pm Building a Model: A Discussion to Plan Year 2 (Renée)
3:15pm Closing Remarks (Mary)
Please take a few minutes to complete the evaluation – thank you!
Challenge Today
• To receive an update of the OHS project’s Year 1 activities
• To share and discuss the research results we have to date
• Prepare recommendations and a plan for Year 2 activities including the Forum and model development
Research ObjectivesGoal: To determine the key components of a health services model, based on continuity of care, which will
improve the oral health status of seniors?
1) Seniors’ Oral Health Services Evaluation• Survey, Focus Group Sessions, Key Informant Interviews
2) Best Practices Scan• Review of literature, program scan, policy scan, professional
training scan, insurance scan, promotion & prevention scan
3) Oral Health Policy Forum• Review OHS project findings, develop strategies, clarify
sector roles
Seniors’ Oral Health Services Evaluation
Seniors’ Oral Health Services Evaluation
Senior Focus Groups
Northwoodcare Inc. - Halifax
Canso
Dartmouth
Margaree Forks
Saulnierville
Bridgetown
Bear River First Nations
7 focus groups Average # attending: 10 Range: 2-15
Dentists, Dental Hygienists and NursesFocus Groups
Sydney
Kentville
Yarmouth
Halifax
Truro
Antigonish
6 concurrent focus group sessions (18 in total)
Average # attending: DDS & DH = 7 Nurses = 4
Range: DDS & DH = 6-9 Nurses = 2-5
Survey FindingsSurvey Findings
Profile of the Senior Participants• 67 senior participants• Most:
– Female– Living 21+ years in their community– Perceived oral health and general health to be good– Partial or full dentures, only 73% had all their own teeth
• All but 3 of the seniors were able to care for their own teeth and/or dentures
• Slightly over half of the seniors visited a dentist, dental hygienist, or denturist in the last year
• Only 68% of the seniors have private dental insurance
Profile of Dentist and Dental Hygienist Participants
• 41 dentists and 44 dental hygienists participants• Most:
– 41+ years of age– 11+ years in practice
• 19 DDS and 22 DH had some form of geriatric training - either as a component of their degree or CE courses
• Seniors comprised less than 30% of their patient base• Like the seniors, most of the care providers perceived their senior patients’ oral health and
general health to be good• All but 10% indicated that their dental offices were wheelchair accessible• 26 DDS and 9 DH provide dental services to seniors outside of the traditional dental office:
– 16 DDS and 5 DH in nursing homes– 7 DDS in the hospital– 4 DDS and 2 DH serve homebound seniors
Focus Group FindingsFocus Group Findings
Profile of Nurse Participants• 21 nurses participated in the focus
groups• There were both general nurses
and nurse supervisors and working in homecare, long-term care and hospitals.
• Majority indicated no existing dental care policies or procedures in work place.
• No formal or informal geriatric dental care training either during nursing training or through their place of employment
Question #1: What are the existing dental services for seniors?
Type of Service Dentists Dental Hygienists
Nurses Seniors
Dental Office Dentist/Dental Hygienist Specialist/Hospital Nursing Homes MD
Note: Lack of services in rural areas
Key Findings - Services
Key Findings - Barriers
Question #2: What hinders seniors from accessing dental care (the barriers)?
– Financial (Rural)
– Lack of continuity –LTCF
– Attitudes Beliefs, & Practices (Rural/Communication)
Key Findings - Enablers
Question #3: What helps seniors access dental care (the enablers)?
– Supportive Measures
– Transportation
– Education/Awareness
– Initiatives Outside N.S.
Key Findings - Ideas
Question #4:What do you feel is needed to create a system of oral health care for seniors living in Nova
Scotia?
– Universal dental coverage
– Mobile clinics/equipment
– Policies/standards
– Geriatric education/awareness
– Dental Coordinator
Think Big and Dream Big!
The following is an example of storytelling
An Overview of the Seniors’ Oral Health Services Evaluation
Welcome to Smileyville
Introduction
Gotta Research
Played by: Pam Magee
Our Representative
s
Shirley A. Senior
Played by: Liz Tait
Dr. Phil Yourtooth
Played by: Steve Creaser
Unida Scale
Played by: Jennifer Le
Ima Caregiver
Played by: Crystal Holly
Profile of the Senior Participants
• 67 senior participants, 7 focus groups
• Most:
– Female
– Living 21+ years in their community
– Perceived oral health and general health to be good
– Partial or full dentures, only 73% had all their own teeth
• All but 3 of the seniors were able to care for their own teeth and/or dentures
• Slightly over half of the seniors visited a dentist, dental hygienist, or denturist in the last year
• Only 68% of the seniors have private dental insurance Shirley A. Senior (Liz
Tait) will be travelling to Smileyville to speak on
behalf of the senior patricipants-
Profile of DDS and DH Participants
Dr. Phil Yourtooth (Steve Creaser) and Ms.Unida
Scale (Jen Le) will be travelling to Smileyville to
speak on behalf of the participants of
their sector
• 41 DDS and 44 DH participants• Most: - 41+ years of age
- 11+ years in practice• 19 DDS and 22 DH - some form of geriatric
training (component of degree or CE courses)
• Seniors comprised < 30% of patient base• Most care providers perceived senior oral
health and general health as good• All but 10% indicated that their dental
offices were wheelchair accessible• 26 DDS and 9 DH provide services to
seniors outside dental office:– 16 DDS and 5 DH in nursing homes– 7 DDS in the hospital– 4 DDS and 2 DH serve homebound
Profile of Nurse Participants• 21 nurse participants in the
focus groups, 6 focus groups• Nurse supervisors and general
nurses; working in homecare, long-term care and hospitals.
• Majority indicated no existing dental care policies or proceduresin work place
• No formal or informal geriatric dental care training either during nursing training or through their place of employment
Ms. Ima Caregiver (Crystal Holly) will be
travelling to Smileyville to speak on behalf of the
nurse patricipants
The Round Table Begins…
Question 1.
What are the existing dental services for seniors?
Key Point Recap – Question #1
Type of Service Dentists Dental Hygienists
Nurses Seniors
Dental Office Dentist/Dental Hygienist Specialist/Hospital Nursing Homes MD
Note: Lack of services in rural areas
Question 2.
What hinders seniors from accessing dental care (the
barriers)?
Key Point Recap – Question #2
– Financial (Rural)
– Lack of continuity –LTCF
– Attitudes Beliefs, & Practices (Rural/Communication)
Question 3.
What helps seniors access dental care (the enablers)?
Key Point Recap – Question #3
– Supportive Measures
– Transportation
– Education/Awareness
– Initiatives Outside N.S.
Question 4.
What do you feel is needed to create a system of oral health care for seniors living in Nova Scotia?
Key Point Recap – Question #4
– Universal dental coverage
– Mobile clinics/equipment
– Policies/standards
– Geriatric education/awareness
– Dental Coordinator
Discussion Questions
1) What key findings or issues stand out? What are the highlights?
2) Do you feel that story-telling would be a useful tool for dissemination of these findings at the Forum? Ideas for improvement?
Recap of Focus Group Findings
• Services: All / rural • Barriers: Financial, LTC facilities, attitudes,
beliefs and practices• Enablers: Supportive measures,
transportation, education / awareness• Think Big: Universal dental coverage,
mobile units / equipment, policies / standards, geriatric education / awareness, dental coordinator
Best Practices ScanBest Practices Scan
Literature Review
Prevention & Promotion
Scan
Program Scan
Policy Scan
Professional Training
ScanInsurance
Scan
BP ScanBP Scan
Best Practices Analysis
Scan of barriers and facilitators in oral health services for seniors’. Critical analysis of experiences and lessons learned
in Canada and elsewhere.
Objectives:Conduct a review of the literature relating to the Oral Health Care of Seniors’.
Conduct a scan for programs & services at 3 levels:
• Seniors’ dental programs
• Geriatric dental training programs
• Seniors’ oral health promotion/prevention services
Conduct a scan of existing policies that address seniors’ access to oral health care:
• gov’t, insurance
• national, international
Progress:Comprehensive search of existing literature completed
Oral Health Policy Scan –initial stages of search, on-going
•Seniors’ oral health program scan: completed
• Geriatric dental training scan: completed
• Promotion / prevention scan on-going
Next Steps:
Literature ReviewLiterature Review
Key Findings• 266 articles that address seniors’ oral health issues:
– Disparities in Oral Health Care and Access– Seniors’ Oral Health Status– Oral Health and Quality of Life– Oral Health and Medical Status– Oral Health and Nutrition– Barriers to Accessing Oral Health Care
• Seniors’ Barriers • Care Providers’ Barriers • System Barriers
– Long-term Care Facilities and Oral Health– Oral Health Prevention/Promotion– Geriatric Oral Health Education/Training– Policy and Seniors’ Oral Health– Recommendations and Future Directions
Attitudes, beliefs and practices
Policy ScanPolicy Scan
What is a Policy?
A policy is “a broad direction or course of action that has been endorsed by a body with authority to both implement it and resource it.”
HEAL Policy and Initiatives Scan, 2003
Types of Policies
• Care/Access- Those which state the level of care one must receive, and also the level of access to which one is entitled
• Coverage- The policies which outline the coverage of dental care and treatment to which individuals are entitled
• Advocacy- The policies of authoritative bodies which advocate for better or changed Oral Health Policies
Profile of Policies (total = 18)Canada: 73 Coverage4 Care/Access
US: 42 Advocacy2 Care/Access
International: 71 Advocacy6 Coverage
Canadian Policies (total = 7)
Federal: 22 Coverage
Ontario: 22 Care/ Access
BC: 11 Care/ Access
Yukon: 11 Coverage
NWT/ Nunavut: 11 Coverage
Policy- Canada
Policy Level Addressing
Veterans Health Care Regulation Federal Coverage
Non Insured Health Benefits Federal Coverage
Community Care Facility Act Provincial Care/Access
Extended Health Benefits for Seniors Provincial Coverage
Ontario Nursing Homes Act Provincial Care/Access
Long Term Care Facility Oral and Dental Care Program (Halton)
Regional Care/Access
Health Care Insurance Plan Act Provincial Care/Access
Policy- InternationalPolicy Location Level Addressing
Policy of Gov't of Australia Australia Federal Coverage
Securite sociale & couverture maladie universelle
France Federal Coverage
Social Security Germany Federal Coverage
Irish Legislation Ireland Federal Coverage
Medicare and Medicaid: State operations manual
US Federal Care/Access
North Carolina Senior Tar Heel Legislature
US State Advocacy
Policy of American Public Health Association
US Federal Advocacy
United States Medicaid and Medicare US Federal Care/Access
Key Findings
• Policies can be classified as governing care/access, coverage or advocacy
• There are relatively few policies directly mandating the Oral Health of Seniors
• There is also a lack of research or assessments of the few existing policies
Program ScanProgram Scan
What is a Program?
• Division of programs (better and promising)
Profile of Programs (total = 58)Canada: 32
US: 18
International: 8
How did we select ‘Better Programs’
Based upon:
1. Theoretical and best practices literature findings from:– health prevention/promotion literature
– community development and capacity building literature
2. Discussions with senior oral health program directors (e.g. Apple Tree, Baycrest Geriatric Dental Program and Golden Care)
Key Indicators
Sustainability
Public/Private Partnerships
Duration
FundingOH initiatives
Geriatric EducationExpansionAwareness
On-going evaluationAwareness
DeliveryLocation
TransportationOpen to seniors
Accessibility
Literature and Program findings used to help determine ‘better seniors’ oral health programs’ using accessibility and sustainability as the assessment markers
Key findings
• Halton Dental Program (Ontario)
• Golden Care Dental Services (Ontario)
• Baycrest Centre for Geriatric Care (Ontario)
• Apple Tree Dental (US)
• Geriatric Dental Clinic, Yad Sarah (Isreal)
Insurance ScanInsurance Scan
What is a Dental Insurance Plan?
• An agreement that guarantees the financial coverage of costs (partial or full) incurred as a result of receiving dental treatment
• Two kinds: – Private– Public
Private Insurance
Company
Dental Packages for Seniors Evaluation
Individual Group Program Needs Assess.
Liberty N/A
Green Shield Canada
(none offered in NS) No
Standard Life N/A
Imperial N/A
Sun Life N/A
Maritime Life No No No
Great West Life (retiree packages) No No
Manulife No No
Canada Life Not willing to participate
Atlantic Blue Cross No
Public InsurancePlan Coverage Population
NWT Extended Benefits Dental Plan Comprehensive
$1000 max
All seniors 60 and over
Yukon Comprehensive
$1400 2 years max
All seniors 65+
Veteran Affairs Dental Plan Comprehensive
$600 max
All veterans 60 and older
NIHB Dental Plan Comprehensive All Status First Nations & Metis
Denmark Public Health Dental Plan Comprehensive All residents
Finland Public Health Dental Plan Comprehensive
70% Coverage
All residents
Norway Public Health Dental Plan Comprehensive Seniors (homebound and LTC) and children
Sweden National Dental Plan Comprehensive Seniors (homebound and LTC), partial for others
Germany National Dental Plan Partial coverage All residents
Key Findings
• Private: If seniors come forward and ask for private insurance – the insurance companies will develop a dental plan
• Public: Not good enough just to have a system in place (e.g. NFLD children’s)
• Explore why not working: attitude and beliefs of seniors, caregivers perception of need, dental community not raising awareness about the system
Prevention & Promotion Scan
Prevention & Promotion Scan
Prevention and Promotion Scan:
• This scan is ongoing
• The three components of this scan are:• Basic Informational Resources
• Educational Tools – Workshops
– Tool Kits
– Other educational aids
• Assessment tools developed
Professional Training Scan
(DDS and DH)
Professional Training Scan
(DDS and DH)
DDS and DH Programs in North America
DH Programs (US)
Diploma = 115
Degree = 60
DH Programs (Cdn)
Diploma = 20 (1 private)
Degree = 4 (2 pending)
DDS Programs (US)
Undergraduate = 53
DDS Programs (Cdn)
Undergraduate = 10
Key Findings DDS Programs
Geriatric dental education is not universal in Canadian and US schools
Need to develop universal geriatric educational standards Curriculums not changing to meet the needs of the
population; no major changes over the last decade Major barrier to inclusion/expansion of geriatric didactic
and clinical components in curriculum, over crowded curriculum
Lack of faculty members with an interest in or training in geriatrics
Geriatric Component in DDS Undergraduate Programs
Canada N=10
US N=53
Didactic 1. Requires some geriatric component in curriculum 10 53 2. Specific course or series of courses in geriatric dentistry
2 44
Clinical 1. Integrated as part of clinical training 8 25 2. Specified/defined component of clinical training
2 28
Comprehensive Geriatric Training Geriatric training/residency program 2 9
Key Lessons: Iowa University Geriatric Dental Program
Geriatrics: multidisciplinary should be integrated into clinical departments
Seniors require specific OH treatment Senior faculty member as director of geriatric courses Students should only provide care when equipped with the
knowledge and skills Students need to gain clinical experience working with
seniors Faculty need CE in geriatric dental care
Key Findings DH Programs
Lack of standardized geriatric accreditation standards
Differences between geriatric components offered in Diploma and Degree programs
Lack of faculty trained in geriatric dentistry
Overcrowded curriculum cited as the key barrier to the growth of geriatric curriculum within programs
No major changes in geriatric components in curriculum over last decade
Geriatric component in DH curriculum
Curriculum requires: Canada and USA
N = 210
Geriatric Component 187
Clinical Component 113
Specific Course 40
Average time allotted for geriatric didactic and clinical components
in dental hygiene programs
DiplomaPrograms
Degree Programs
Time devoted to geriatric didacticcomponents:
Average:Range:
10 hrs1 to 45 hrs
Time devoted to geriatric clinicalComponents:
Average:Range:
22 hrs0 to 130 hrs
Comparison: Geriatric didactic components 9 hrs 13 hrsComparison: Geriatric clinical components 26 hrs 11 hrs
Time Allotted to Geriatric Clinical Components: Dental
Hygiene Programs
DiplomaPrograms
DegreePrograms
1. Long-term care 16 hrs 6 hrs2. Acute care 3 hrs 1 hr3. Oral Examinations 5 hrs 5 hrs4. Education for care givers 4 hrs 4 hrs5. Average amount of time spent providing geriatricoral health care 29 hrs 17 hrs
Key Findings DDS and DH Programs
Similar barriers identified to lack of enhancement of geriatric dentistry components in curriculum
Overcrowded curriculum
Lack of faculty trained in geriatric
Financial considerations
Lack of standardized accreditation standards
No major changes in geriatric components offered over last ten years
Lack of standardized accreditation assessment
tool
Lack of a continuum of oral health care from one setting to another (independent living, homecare, long-term care, hospital)
Lack of care providers
Lack of insurance coverage
Lack geriatric education/awa
reness
Lack of standardized
geriatric accreditation
standards
Lack of seniors’ oral
health delivery
programs
Lack of policies/standards
Lack of availability of
services (transportation,
facilities, equipment)
Lack of communication between health
sectors
Lack of training for
care providers
Building a Model
Education
Services
Policy
Funding
TrainingResearch
?
Public Private
Discussion Questions
1) How can these findings be used in the development of a model?
2) What is necessary to build the model:a) During the Forum
b) After the Forum
3) Do we need new team members to help with strategic planning and model development?
Closing Remarks - Workplan
Synthesize, design and prepare a final report and executive summary for the Focus Group findings
Synthesize, design and prepare a final report and executive summary for the Best Practices Scan
Design Forum process, recruitment strategy, funding, develop materials/presentations
Host Forum Assist with the development of proposals for future
projects/initiatives Develop a oral health services model for Nova Scotia Disseminate project findings
Research
Best Practi
ces
Forum Planning
Team