Preventing Lawsuits with Dental Care
Skilled nursing facilities face a number of hurdles in caring for the elderly, not the least of which is the inability to spend a sufficient amount of time providing oral care for residents unable to brush their teeth or maintain their dentures. Numerous articles
have been published criticizing the lack of funding for dental care in nursing homes.
When a resident is a Medicaid recipient the federal nursing home benefit only covers emergency dental care (although some state plans require routine dental care coverage). What constitutes an "emergency" in terms of a dental visit is difficult to define. Perhaps more importantly, with attention to pressure sores, nutrition, weight management and the routine medical needs of complex patients, oral care may not be a routine issue checked by nursing staff.
One of the things that routinely saves skilled nursing facilities from liability for pressure sores is the routine documentation of skin condition, and the pressure sore risk assessment forms maintained by facilities.
For patients unable to do their own oral care, routine documentation on a weekly basis of some form of oral care is probably a must. If a dental or oral care issue gets to the point of it being an emergency then the facility may already have lost the lawsuit that is likely to be coming.
The problem, of course, is that most state plans do not pay for routine dentistry, and dentists who have billed Medicaid for routine examinations and oral care tend to either have their claims go unpaid, or in some cases, wind up paying back large amounts of money to the government under the False Claims Act.
Dental care is an issue that should be raised at the national level because patients who can't chew can't maintain their weight, and any rational nutrition plan should call for patients to be screened for dental problems. Yet, once identified, if the patient is limited to the $35 per month allowed by Medicare, the resident likely has no way to pay for the care other than to request that family members pay. For more than half of the residents in nursing homes, this is simply not an option.
One solution may be community service agencies. The Samaritan Center in Jefferson City, MO, has volunteer dentists and staff who treat homeless and impoverished clients in their Dental Care program. If expanded to include nursing home patients, such a program might be a good adjunct to routine documentation of oral health.