Long-Term Care Survey Alert

Nursing facilities aren't disputing that elderly nursing home residents should be getting regular dental checkups and emergency dental care. And facilities can easily arrange for Medicare and private pay residents to receive such care for an extra charge. Yet making sure Medicaid residents get the dental services they need is another story.

"Twenty-two states have no adult dental coverage under Medicaid and another third provide only limited access," Gregory Folse, dental consultant for the Louisiana Department of Health, tells Eli. "Louisiana, for example, only provides coverage for dentures. That means residents have no access to exams, x-rays, emergency dental treatment, treatment for abscesses and gum infections."

So a first step to providing dental care to Medicaid residents is to check exactly what your state covers. If your state plan does include dental services, the facility must refer patients to a Medicaid- approved dentist who bills Medicaid directly, says Linda Davis, a nursing home consultant with FR&R Healthcare Consulting in Deerfield, IL.

If there's no adult dental coverage, the facility should check with its local caseworker to see if the state will allow money for dental services to be deducted from the resident's Social Security check. Some states, such as Illinois, allow this arrangement, says Davis.

If the state offers no way to pay for dental care in nursing facilities, it's time to get creative. For example, your facility might consider teaming up with a local dentist who agrees to provide pro bono services.

To provide routine dental cleaning, assessments and referrals, facilities may be able to contract with a dental hygienist to come to the premises on a regular basis. Facilities should check their state practice act to see if dental hygienists can provide such care without a dentist being present on site. For example, Washington state allows dental hygienists to engage in unsupervised practice in nursing homes, provided the hygienist refers residents to a dentist or dental treatment and planning, according to the American Dental Hygienists' Association.

Another alternative is to form a relationship with a regional dental college that will agree to provide reduced cost services and educational programs. "Nursing homes can negotiate with dental schools to provide services to residents on a sliding fee scale, which is a very good mechanism to increase access to dental care for the elderly," says James L. Martin, professor and chair of the department of dental public health at Meharry Medical College School of Dentistry in Nashville, TN.

Some facilities are also hiring a dental director. "A dental director does in-house evaluations, helps with the minimum data set and regulatory issues, trains the facility staff and refers patients," says Folse. The dental director can be part-time or "shared" among several facilities and may also, in some cases, also provide actual dental care to residents who do not have their own dentist.