Oral health care protocols and practices in New Zealand rest homes and long term care facilities

Abstract

Introduction: New Zealand's population is aging. Research in New Zealand (NZ) has reported that older people are retaining their natural teeth for longer than before. Approximately 7% of New Zealand's older adults reside within Rest Homes (RH) and Long Term Care (LTC) facilities. They depend on nurses and care-aides for assistance with multiple activities of daily living (ADL); this includes oral care. If older adults are retaining their teeth for longer it is imperative that they have access to adequate daily oral care, as poor oral health can lead to dental neglect resulting in crippling pain and loss of quality of life.

Aim: The purpose of this study was to identify whether RH/LTC facilities within NZ have written oral health care (OHC) plans and policies for the maintenance of the oral health of their residents and to document the level of OHC understanding of the LTC staff.

Methods: A two-part survey was designed and sent to 425 randomly selected LTC facilities in NZ. Part one recorded the number of residents, staff and location of the facilities. It then examined whether or not the facility had written OHC policies, if they were drafted with the assistance of a dental professional and whether or not the staff had problems with adhering to the policies. Part two investigated the core level of oral health knowledge of staff, and their personal dental habits and oral hygiene practises.

Results: Written policies for oral care were in place in 35.9% of (n=139) facilities. Of those with policies, 15.4% had a dental professional assist in drafting it (5.5% overall). Only 14.0% of facilities had ever had a dental professional in to give a demonstration in oral care, and 90.2% of facilities felt that a demonstration in oral care would be beneficial. Most facility management teams were satisfied with the way in which they dealt with basic oral care for their residents, and the way in which they manage dental emergencies (85.1 % and 82.2% respectively). Baseline oral examinations were a low priority for facilities; only one in nine reported to provide them for residents on entry. The staffs level of oral health knowledge appeared to be adequate. With regards to daily oral hygiene habits: 88.6% reported brushing twice daily or greater, 59.2% flossed on a regular basis and 34.6% used mouthwash regularly. Where dental visiting was concerned, 63. 7% reported a regular dental attendance pattern.

Conclusion: Ultimately the findings expressed a low level of policy in place to protect the oral health of older people residing in L TC facilities. There is lack of initiative by facilities to provide baseline oral examinations to document poor levels of oral health in residents on admission. Staff personal practices appeared to be positive and conform to evidence based recommendations. Many facilities identified that there was a need for improvement but due to lack of financial incentive and time constraints, were generally satisfied with the level of care they were able to provide for their residents.