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Action for Dental Health

Vermont Nursing Home Launches Long-Term Care Dental Pilot Project

August 25, 2014

A non-profit nursing home in Vermont has created a pilot project to provide comprehensive dental treatment to its residents that it hopes will spread to other long-term care facilities throughout the state.

The Manor, a private, non-profit long-term care facility in Morrisville, partnered with the Vermont Department of Health and Community Health Services of Lamoille Valley, a Federally Qualified Health Center, to address the oral health needs of the nursing home’s residents.

“When we first began this project, we had to conduct an assessment on the residents because there really is no national assessment out there for nursing homes,” said Linda Greaves, a public health dental hygienist with the state department of health. “We looked at it and knew we had to start a collaborative because less than 46 percent of the residents don’t have their teeth. So that’s a high percentage of people who still do have their teeth.”

Nearly 95 percent of residents had some form of gum disease, she noted.

The program started in June following nearly 18 months of development, according to Lynn Smith, executive director and administrator of The Manor. Initially, dental hygienists trained the staff about how to take care of the teeth of residents who can no longer brush and floss.

“After the training, we recognized that there were even greater challenges to accessing care that we had to address,” said Krystina Laychak, nursing services director at The Manor. “Some of our residents need specialized lifting equipment because they’re not mobile enough to get in to a chair. Others have cognitive issues that make it difficult for them to leave the facility.”

The nursing home’s administration purchased portable dental equipment, and received a grant to pay for a device that sterilizes dental tools. The Manor also partnered with state and local dental agencies to help seniors with complex health problems receive dental treatment from the right providers.

“We realized we were only scratching the surface initially, because some of our residents still had dirty teeth or infections in their mouths,” said Ms. Laychak.

Dental hygienists from the state department of health and the local FQHC were brought in to evaluate the residents’ dental needs. 

Sandy Beynnon, who serves as clinical supervisor and a dental hygienist for the FQHC, spends one day each week at The Manor and sees about five to eight patients per visit.

“It’s not like a typical schedule that you have in a dental office,” she said. “You have to allot time for movement because many patients have mobility issues, and you have to spend a little extra time to get to know them so they feel comfortable. It’s like taking care of a family member.”

The Manor is tracking its residents’ levels of gum disease as well as their hemoglobin levels in diabetic patients, said Ms. Greaves. 

Recent research suggests there is a connection between gum disease and diabetes. Because of lowered resistance and a longer healing process, gum disease appears to be more frequent and more severe among those with diabetes. It also appears that treating gum disease in people with diabetes can help improve blood sugar control.

The next step, says Ms. Greaves, is to bring in a dentist from the FQHC to evaluate patient needs. Some patients will be sent to the FQHC for treatment, while those with severe physical or cognitive impairments likely will be treated at The Manor.

“We do believe so much in this program that we’re also doing outreach with the state of Vermont to expand this model throughout the state,” said Ms. Greaves. “We’re partnering with state agencies to build momentum and spread the knowledge by providing presentations that showcase how our program works.”