It’s hard to eat when your teeth hurt or are missing, and that’s a big concern for Indiana AAAs. Last year, AAAs served more than 2.1 million meals to 25,422 older adults and persons with disabilities. It doesn’t do a AAA any good to serve a meal that someone can’t properly eat, and the resulting malnutrition can have serious consequences.
Infections resulting from poor oral health may lead to increased hospital use and comorbidities such as heart disease, stroke, respiratory disease and diabetes. It’s a real problem, as this story from a case manager at Area Five Agency on Aging and Community Services exemplifies. An elderly client, blind due to insulin dependent diabetes, was unable to eat 50% of the contents of the meals he received. His teeth were rotten up into the gums, broken off in other places, and sensitive to hot and cold. It was painful to chew and his mouth always hurt. The case manager was able to get his teeth pulled and have him fitted for dentures. He is no longer in pain and now eats what he wants, which is important for an insulin dependent diabetic.
While this client had a successful outcome, the oral health safety net in Indiana has holes. Indiana Medicaid may not cover all the services an adult needs, and traditional Medicare offers few benefits unrelated to care involving other diseases. Further, even if one has the resources to cover the cost of services, provider shortages can make accessing a dentist challenging, especially in rural areas.
Consumers also lack oral health literacy. Many believe that tooth loss is a normal part of aging. But it is not, and there is something we can do about it.
Connecting people to dental services is a first step. There are Federally Qualified Health Centers that offer dental services, although they are not available in every part of the state. The Indiana Dental Lifeline Network is a donation program for older adults and adults with disabilities, but there are waiting periods in some counties because of provider shortages.
Advocacy is also important. Medicaid rates for dental services must be sufficient to ensure a robust network of providers, and covered services in Medicaid and Medicare can also be expanded beyond their current limits.
The federal government’s Administration for Community Living, whose mission is to maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers, recently published a policy brief about options for connecting more adults to dental care. They encourage states to:
- Encourage primary care health practices to screen older adults and adults with disabilities for oral health problems and refer them to dentists and other dental practitioners.
- Encourage hospitals to develop formal referral relationships with safety net dental providers.
- Extend oral health through the use of “dental therapists,” whose scope of practice varies but generally includes preventive and “simple” restorative services like filling cavities and extraction of primary teeth.
- Use a “virtual dental home” that ensures dental hygienists have dentists who can remotely supervise their work.
IAAAA has previously advocated at the Indiana statehouse on adult oral health. Our collective voices can ensure that policy makers remember that oral health is an important component of overall physical health, and dental services are a critical part of our overall healthcare system.