Residential Unit Questionnaire National Programme for Dental Epidemiology - Lot 1 study designed in consultation with the Lot 1 Health Board User Group Background Pilot Study 2 pilot studies in Dundrum and Kerry highlighted problem areas for clinical examination of elderly residents difficult to obtain informed consent difficult to validate medical history sample biased towards very active residents or residents with dental problems Postal Survey : No Clinical Exam To assess at residential unit level the mouth care needs of elderly residents in long-term care in Ireland current oral health care practices current level of service provision barriers to care Aims To communicate findings to decision makers All residential centres for the elderly under the direct care of the Health Boards
Excluding psycho- geriatric units Coverage Sample = 177 units A survey questionnaire was posted to all residential units on the validated database and completed by a senior staff member. Method Response Rate = 73% Questionnaire returned 129 units Questionnaire not returned 48 units Sample = 177 units Under Direct Care of HBs 124 centres
5692 residents Questionnaire Results Size of Units Unit size 11-20 15 12.1% 249 4.4% 21-50 87 70.2% 2892 50.8% 51-100 11 8.8% 819 14.4% 101-200 11 8.8% 1732 30.4% Total 124 100% 5692 100% Centres Residents Residents Profile 40.0% 60.0% 43.4% 56.6% In Residential Care General Population (CSO 2002) Gender Balance (aged 65 and over) Male Female Residents Profile 138 109 463 432 944 1353 533 1126 <65 years 65-74 years 75-84 years 85+ years 45% Age Distribution Male Female elderly in residential care of HBs as percentage of general population : 0.4% 1.5% 4.0% 65-74 years 75-84 years 85+ years 4% of the population aged 85 years and over are in residential care of the HBs! Residents Profile 42% of residents are able to read Large Print Residents Profile 14% of residents are able-bodied (i.e. able to climb stairs) Residents Profile 60% fully dependent 22% semi-independent 18% independent Staff Training 82 centres 42 centres Yes = 66% No = 34% Staff Training If YES: when was training provided? No. Centres % Centres No. Centres % Centres During basic training 74 90% 12 15% Special post graduate course 5 6% 2 2% Course provided since starting to work with elderly 10 12% 13 16% Other 7 9% 8 10% Nurse Care Assistant Staff Training Do you see a need for training in this area? Staff Training 3 centres 11 centres 110 centres Yes = 89% No = 9% No Answer How do oral health/dental problems/denture problems come to light generally? 77% nursing/care staff observation 15% resident/family member reported problem to staff 8% no answer Do you know the entitlements of older people in relation to dental care? 59% Yes 13% No 26% Not sure 2% No answer 15% of centres have ever had an oral health needs assessment carried out in their unit Only 42% of centres include a dental/mouth check up in their admission process Only 14% of centres have regular dental treatment or check-ups of their residents Only How do we prioritise the oral health care of the elderly? 1 centre (1%) 14 centres (12%) 102 centres (87%) Health Board Dental Service Private Dental Practitioner Family would arrange If residents required routine dental treatment n=117 2 centres (2%) 12 centres (10%) 18 centres (15%) 87 centres (73%) Health Board Dental Service Private Dental Practitioner Medical Practitioner/Family would arrange Don't know/Not sure If residents required emergency dental treatment n=119 dentist? oral health promoter, hygienist or dental nurse? 44% 6% Domicillary Care Has your unit ever been visited by a Ummyes Is it difficult to get a dentist to visit the unit ? 52% Yes 43% No 6% No reply When a dentist does visit who does he/she see? 55% replied dentist only see residents in pain/problem 6% replied dentist sees all residents at least every 2 years 36% replied dentist never visits 4% did not reply How far to the nearest accessible dentist ? 33% no reply 37% within 1 mile 52% with 3 miles 58% within 5 miles 64% within 10 miles How are residents transported to the dentist? 41% taxi 29% ambulance 28% family 23% unit minibus 13% walk to dental surgery
35% residents are treated in unit 3% residents dont ever go to dentist
Medical Card Is there a policy in your CCA/Health Authority for eligible elderly clients in residential care under the direct care of the Health Boards not to hold their own medical cards? All persons aged 70 years and over are entitled to a Medical Card.
Did not reply 43% Replied 57% 11 - YES, our residents do not hold their own medical card because HB providesCustom & practice 5 - NO, our residents can hold their own medical card 1 - Policy is under review How many of your residents hold their own medical card? On average, 43% of the elderly in long-term residential care hold their own medical cards Medical Card All persons aged 70 years and over are entitled to a Medical Card. 57% of elderly in care do not hold their own medical cards Medical Card All persons aged 70 years and over are entitled to a Medical Card. Can they avail of the DTSS? OPINIONS Oral health services required: 80% provision of dentures/extractions 80% denture repairs 59% oral hygiene instruction 58% scaling & cleaning 49% emergency treatment 44% treatment for mouth ulceration 21% fillings #1 need Barriers staff encounter in providing daily mouth care: 40% patient cooperation 31% inadequate training / awareness of importance of daily mouth care 29% staff shortages/time pressure of normal routines Difficulties in providing access to dental treatment: 41% availability/access to services (particularly for routine care) 24% arranging transport/escorts 13% mobility/cooperation of patients Issues Responsiblitity for oral health care of residents in units under the direct care of the HSEs Oral health care training for nurses and care assistants, with emphasis on care of the elderly with high dependency Availability and accessibility of dental services, particularly for routine treatment Domicillary Care for elderly with disabilities