TOTALLY GEEKED!

This is going to be a HUGE issue. Dentists are very set in their ways and I doubt they will start doing nursing home visits, unless it would pay very well, which it won't. So, I think we are going to have a lot of elderly people suffering with abcessed, painful, swollen teeth or teeth with cavities, etc and just simply be neglected.

Makes sense to me.

jlbear71 wrote:

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Here is the major part of the problem tho. Medicare doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you're in a hospital. Supplemental insurance usually does not cover it either.

So, unless you are willing to pay out of pocket, you are out of luck.

Even with using students/interns, most of the equipment they are using is not portable.

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 Then do that.  MILLIONS of people do it every year. 

 

Good grief.  Everyone seems to expect to get everything for free. 

Here in Texas it is illegal to practice dentistry without being registered and insured for the premises that you are practicing on.
We have had many patients who have had to go to nursing homes. While my dad would love to go to them when they can no longer come to us, it is illegal for him to do so.
Also, as was mentioned, you can't exactly cart around air driven dental drills and suction and x ray machines.

I wonder if retirement communities and nursing homes should look into investing in on site dental and medical offices.

Tangerine wrote:

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Here in Texas it is illegal to practice dentistry without being registered and insured for the premises that you are practicing on.
We have had many patients who have had to go to nursing homes. While my dad would love to go to them when they can no longer come to us, it is illegal for him to do so.
Also, as was mentioned, you can't exactly cart around air driven dental drills and suction and x ray machines.

I wonder if retirement communities and nursing homes should look into investing in on site dental and medical offices.

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But this should be no different than taking them to a clinic or hospital when they are sick.  MOST health care is not done on site.

They don't have gall bladder surgery in the nursing home.   

Nobody Just Nobody wrote:

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huskerbb wrote:

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Nobody Just Nobody wrote:

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But some people don't plan well for the future and have no money to rely on to pay for this stuff. You can ask your kids to pay for it but a lot of them have families of their own now and bills they need to pay. Dental work is NOT cheap.

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That's their problem.  Don't know what to tell you.  You can't expect to get everything for free.  Likely the government is already shelling out thousands per month for their stay in the nursing home and their other health care.   

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 I didn't say it wasn't their problem.  I'm just explaining why it might be the way it is.  Don't get your panties in a wad.

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Oh, I know the "why". I'm just saying that the fact is if they don't have the money--then they may not get the dental care they need and they shouldn't expect to get it for free.   

Nobody Just Nobody wrote:

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Tangerine wrote:

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Here in Texas it is illegal to practice dentistry without being registered and insured for the premises that you are practicing on.
We have had many patients who have had to go to nursing homes. While my dad would love to go to them when they can no longer come to us, it is illegal for him to do so.
Also, as was mentioned, you can't exactly cart around air driven dental drills and suction and x ray machines.

I wonder if retirement communities and nursing homes should look into investing in on site dental and medical offices.

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 I spent the majority of my career working in TX nursing homes.  I knew I had never seen a dentist in one!  Most of the time when a patient needed dental care their family came and got them and took them.  The nursing home doesn't like taking them because it requires one person to drive the van and then a licensed staff member to sit with the patient while they are there.  So that is two paid employees for one person to get dental care.  It adds up fast.

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Yup.  Families need to take responsibility here.  I realize that some don't--and that's a shame, but not every problem has a solution.   

jlbear71 wrote:

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huskerbb wrote:

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Nobody Just Nobody wrote:

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But some people don't plan well for the future and have no money to rely on to pay for this stuff. You can ask your kids to pay for it but a lot of them have families of their own now and bills they need to pay. Dental work is NOT cheap.

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That's their problem.  Don't know what to tell you.  You can't expect to get everything for free.  Likely the government is already shelling out thousands per month for their stay in the nursing home and their other health care.   

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And some people have no more assets because they were sold to pay for the care they have already received, government requirements.  Usually there is very little or nothing left for the family to pay with.  Many families are already paying for extra necessities like clothing for their loved ones.  And then there are those who don't have anyone.

While the VA does offer a dental plan, it is voluntary and you must purchase it.

Hate to say this, but the elderly are treated very poorly in this county, especially compared to many other countries.

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 They SHOULD have to pay for the care they receive!!!!  DUH!!!!!  That's what their assets, if any, are for--to pay for their expenses in their old age. 

 

It's NOT the government's responsibility to pay your bills.

 

As to your last statement--that is just looney.  The fact is that the government, the taxpayers--ME--will and do pay for those who can't pay themselves, even if they were stupid and didn't plan well. 

There are reasons why dentists don't do nursing home visits.

One is that the federal DEA prohibits prescribing, dispensing or administering drugs at a location other than the one printed on the dentist's DEA certificate (which is usually his office address).

Another one is the obvious problem of many of their instruments and machines not being portable.

I think the best solution is for family to take ambulatory nursing home patients outside to their own dentist, and self-pay.

If you get into the nursing homes routinely providing dental services on-site, that will surely drive up the cost of nursing homes - which is not a good thing.

Nursing homes in my area are running $13,000 per month already.

As for the non-ambulatory nursing home patients, I don't know. Maybe nursing homes could start contracting with dentists to come a few days a month for routine check-ups for non-ambulatory patients that would not include any drug dispensing or prescribing, and the patient's family could self-pay for the visit. But then if they need drugs, they would have to go to a dentist's office for the follow-up care.

I know podiatrists that go into nursing homes to do toenail clipping, especially for diabetic patients. I wonder if that is a self-pay situation.

 

-- Edited by Blankie on Tuesday 2nd of June 2015 06:46:00 AM

I know what to do_sometimes wrote:

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You know what? I think we have uncovered a hole in elder care with laws restricting a simple solution This is one cause I would be willing to go to bat for.

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Yes, dentists are very resistant to anything to do with the big insurance companies.  I don't think they would get on board because they know they aren't going to get squat. 

First - nursing home staff should be ensuring dental hygiene just like any other kind of hygiene. As for pain and dental care, some of the pain becomes medical - not strictly "dental". If there is an abscess, there's likely and infection.

Wisdom teeth removal is covered by MEDICAL insurance, not dental insurance.

So, the first thing to do is determine whether was is causing the problem could be covered as medical.

Blankie wrote:

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Lady Gaga Snerd wrote:

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Blankie, there are also lots of people in homes that have no families. Don't assume everyone has some family that can come and assist them. Many of them don't.

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I'm not assuming anything. It's a complex problem, and there is probably no easy solution. If there was, you'd see it happening.

People have a lot of illusions that nursing homes are supposed to provide all medical care. That is a misconception. They provide skilled nursing care, which is very different from the medical/dental care that a physician or dentist provides.

Medical care by physicians and dentists is a lot more expensive.

I have heard of some nursing homes that do not even have an attending physician on-site 24/7. Some use just consulting physicians.

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 Most nursing homes do not have a physician on site 24/7.  My wife works in that industry and she's never even heard of that practice.

Lady Gaga Snerd wrote:

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Lawyerlady wrote:

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First - nursing home staff should be ensuring dental hygiene just like any other kind of hygiene. As for pain and dental care, some of the pain becomes medical - not strictly "dental". If there is an abscess, there's likely and infection.

Wisdom teeth removal is covered by MEDICAL insurance, not dental insurance.

So, the first thing to do is determine whether was is causing the problem could be covered as medical.

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  Maybe we should put in our POA, to have our kids make sure all of our teeth are extracted prior to going into the Home.

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Yes, and at the same time request that they put in a Foley catheter immediately, so you don't have to worry about being incontinent. 

I have never worked in a nursing home that had a physician there 24/7. They are on call 24/7 but usually only come to the nursing home one day month. You, general you, should be really freaking nice to your nursing home nurses. They really are the only thing between death and your doctor. Oh, and nursing home nurses are not dumb. In fact, we have to be really smart since we don't have a doctor looking over our shoulder 24/7. There is a huge misconception that nurses that work in nursing homes are dumb and can't get a job anywhere else.

Oh, and when the doctors come out? Yeah, they don't usually know much about the patients. It's amazing. I wish people knew what nursing homes were really like.

Back to the dental care - nursing homes will do what they are required to do, or they risk failing their DPH or Joint Commission survey. They are subject to federal and state regulations. Of course, regs will vary from state to state.

In Mass., the DPH requires the following of nursing homes for dental care (short version:complete dental examination annually and periodic dental inspection every 6 months).

 

150.006: Other Professional Services and Diagnostic Services

 

(A) Each patient or resident or (if he is not competent) his next of kin or sponsor shall have the right to

 

designate other licensed practitioners of their choice.

 

(B) Dental.

 

(1) All patients and residents shall be assisted to obtain proper dental care including prophylactic,

 

therapeutic and emergency dental services. Such services shall be rendered with the knowledge of

 

the attending physician or physician-physician assistant team or physician-nurse practitioner team.

 

A SNCFC shall ensure each patient has a complete dental examination annually and

 

periodic dental inspection every six months.

 

(2) All dental services shall be documented and recorded in the clinical record.

 

(3) A SNCFC shall appoint a consultant dentist with experience or training in developmental

 

disabilities who shall participate in the development of patient care policies related to dental health,

 

familiarize him/herself with the dental condition, needs and care of each patient, and as necessary,

 

participate in periodic staff conferences. A SNCFC shall retain the services of a dental hygienist to

 

work under the general supervision of the consultant dentist. The dental hygienist shall conduct

 

periodic inspections of patients or residents and develop dental disease prevention programs within

 

the facility.

 

 

 

 

 

 

-- Edited by Blankie on Wednesday 3rd of June 2015 06:47:56 AM