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Part 1 Oral Health Program

Needs Assessment
A. General Data
I. Description of Site:
Vidor Health and Rehab is an assisted living facility that is for
short-term or extended stay for the elderly and mentally compromised. It is
located at 470 Moore Dr. in Vidor, TX. This facility serves nearly 100
patients, ranging from 30-90 years old. An individual's stay at the facility is
funded by Medicare, Medicaid, private insurance, and hospice.
2. Description of Target Group:
Our target population is currently 97 patients that are elderly
with cognitive deficits or people with mentally disabilities. This includes
patients that are unable to perform everyday tasks (such as tooth brushing,
bathing, feeding) independently. There are currently more females than
males living in this facility. To be considered a patient here, certain criteria
need to be met. These include the need to have a skilled nurse on an
everyday basis. If they don't meet this criteria, there is the option to pay
privately and still be able to live at the facility. To be considered for
admission, the staff look at the patient's physician office visit notes (if
available), recent medical history and physical, financial information
(Medicare, managed care, private insurance), information about recent
hospitalization (if applicable), and Medical Power of Attorney. It is the policy
of this facility to admit and treat all residents without regard to race, color,
sex, national origin, handicap or age. A recommendation from a licensed
physician is required upon admission.
3. Description of Staff Population:

The staff of Vidor Health and Rehab consists of administration,


which includes Human Resources, Dietary, Assistant Director of Nursing,
Business Office Manager, Housekeeping, Social Worker, Activity Director,
MDS, and Admissions Coordinator. There are also Licensed Vocational
Nurses (LVN), Certified Nurse's Assistants (CNA), and a Registered Nurse
(RN). During the day and the evening, there are eight LVNs and CNAs on
duty. During the graveyard shift, there are three LVNs and seven CNAs.
The CNA's responsibilities are to assist the patient in changing clothes,
personal hygiene, and changing diapers if needed. The LVN's
responsibilities include administering medications and wound care. The RN
oversees the LVNs and CNAs. CNAs require a high school diploma and
certification. LVNs require to complete a one year degree through a
certified college. RNs require either an associate's degree or a bachelor's
degree in nursing through a certified college.
4. Description of Services Provided:
The Activities Director is in charge of coordinating all activities
for residents at Vidor Health and Rehab. Any resident physically able can
participate in activities. Events that residents participate in throughout the
year include BINGO, baking cookies, ice cream socials, casino trips, Mardi
Gras, Taste of Beaumont, and a meal of their choice once a month.
Generally, the usual daily routine consists of:
5:30-6:00 AM: Wake up
6:30 AM: Breakfast
10:00 AM: Snack
12:00 PM: Lunch
3:00 PM: Snack
5:00 PM: Dinner
8:00 PM: Snack

8:00-9:00 PM: Bedtime


An example of a daily schedule of activities is:
8:30 AM: Front Porch with Tommy
9:00 AM: Daily Chronicle
9:15 AM: Beauty shop
9:30 AM: Coffee and cookies
10:00 AM: The Price is Right
10:30 AM: Evelyn and Edna
11:15 AM: Appetizers
1:30 PM: Movie and popcorn
2:30 PM: Mardi Gras social
4:00 PM: Dominos
5. Other Pertinent Data
The level of water fluoridation provided at this facility is 0.69
ppm, which is slightly outside the optimum fluoride range. (2)
B. Information Related to Dental Health
1. Services Provided:
This facility provides basic dental services to the residents,
such as brushing teeth and denture care. Upon assessment of the dental
needs of the facility, it was concluded that most of the time these services
are not done due to being short-handed. The staff did not seem concerned
at all about flossing the patients' teeth. Each resident is provided a
toothbrush, mouth rinse, toothpaste, denture cups and cleaner. Many
patients do not like to use the dental supplies provided due to the quality, so
family members sometimes buy them more expensive oral health care aids.

Most new patients have their name stamped on the inside of their dentures,
but most of the time they are not taken out of their mouths regularly. The
facility does have a dentist that comes in about once every three months,
but in order to be seen the residents must have dental insurance or pay
privately. The dentist only assesses patients who have a need, including
pain, denture problems, etc. Residents who want to receive dental care
outside of what is provided at the facility are allowed to leave with a family
member to be taken to a local dental office. This facility has never had an
oral health program implemented in the past. The staff's knowledge about
dental health is dependent on their level of education, but most are
unaware about how oral health is related to overall health.
C. Dental Health Status:
1. Dental Caries:
According to the National Institute of Health and Craniofacial
Research, 93% of seniors 65 and older have had dental caries in their
permanent teeth. 18% of these seniors have left their decay untreated.
Seniors generally have an average of 9.24 decayed or missing permanent
teeth and 43.02 decayed and missing permanent surfaces. The percent of
seniors with decay, missing, or filled permanent teeth in seniors age 65-74
is 93.25%. For seniors age 75 years or more, the percentage is 92.70%.
Caucasian seniors and those with higher socioeconomic status and
education have had more decay. Those with lower incomes and less
education that are of black and Hispanic ethnicity have more untreated
decay. (3)
2. Periodontal Disease:
According to the National Institute of Health and Craniofacial
Research, 17.20% of seniors ago 65 and over have periodontal disease.

Smokers, black and Hispanic seniors, and those with lower socioeconomic
status are more likely to have periodontal disease. The percentage of
seniors with moderate or severe periodontitis is 10.58%. The percentage of
geriatric males with periodontal disease is 12.97%, and for geriatric females
the percentage is 8.56%. (4)
3. Oral Hygiene:
In long-term care facilities, oral hygiene receives very little
attention, and as the quality of oral hygiene decreases, there is more
potential for serious problems to occur. Staff members at nursing homes
should be educated on the importance of oral care so they will better
understand how important it is that the teeth and overall health of these
individuals are preserved for as long as possible (5). According to Lamster,
elderly are at a greater risk for experiencing difficulty while providing oral
care and are at a higher risk for developing oral infections that result in
systemic diseases. (6)
4. Utilization of Dental Services:
Geriatric patients in nursing homes generally exhibit more
limited choices in regard to access to dental care and payment for dental
services. Many dentists are reluctant to care for Medicaid patients, which
leads to more issues among nursing home patients and increases the level
of disparity present in rehabilitation facilities. (7)
Goal:
The goal of this program is to develop and provide an oral health
program for the staff of Vidor Health and Rehabilitation in order to benefit
the residents of the facility.

Objectives:
1. To increase the dental health knowledge of the staff members of
Vidor Health and Rehabilitation by 20%.
2. To establish a daily routine of proper oral hygiene for the staff
members of Vidor Health and Rehabilitation to carry out to the residents.
3. Develop a dental health resource list to provide to the staff
members and residents of Vidor Health and Rehab.
4. Establish a denture identification system for the residents of Vidor
Health and Rehab.
5. To establish an oral cancer screening routine for the nursing staff to
carry out to the residents.
Rationale (Review of the Literature):
This program is directed towards older adults in need of improved oral
health care and education along with the staff members at Vidor Health and
Rehabilitation. In contrast to the extensive national attention focused on
childrens oral health in recent years, Americas growing elderly population
has received relatively little attention and almost no public health or public
policy interventions. However, because the current elderly population have
had increased oral health education earlier in their lives, these seniors will
have a complete or near-complete dentition. (3) As the
incidence of edentulism (the absence or complete loss of teeth)
decreases, more elderly people are entering long term care
facilities with more teeth intact. Because elderly patients often
have decreased salivary function, they can quickly develop dental
decay and periodontal disease when the growth of the dental
biomass on their teeth goes unchecked. (4)

Periodontal disease is a very important topic to address with elderly


populations and nursing home staff members. Long-term studies
demonstrate that periodontal disease may increase the risk of
mental dysfunction associated with Alzheimers disease in healthy
individuals and in those who are mentally impaired. (4) Overall, the
prevalence of periodontal disease in elderly individuals has decreased from
the early 1970s until the latest (1999-2004) National Health and Nutrition
Examination Survey. In spite of this improvement, significant disparities
remain in some elderly population groups. (6)
Program Design:
A. Activities:
Session 1: Plaque and Periodontal Disease
-Target group is directed toward the Vidor Health and
Rehabilitation Staff.
-We will teach the staff the definition of plaque. What is plaque?
What causes plaque to form?
-We will discuss the progression of gingivitis as it relates to
plaque.
-We will discuss the progression of gingivitis to periodontitis.
-We will demonstrate the bass tooth brushing method on a
typodont.
-We will discuss how different supplies may be used to aid in
brushing for residents with poor dexterity.
-We will provide visual aids showing plaque, gingivitis, and
periodontitis.
-We will explain the effects of plaque left over a long period of
time and how it may harden to form calculus.
-We will provide toothbrushes and toothpaste for the residents.

Session 2: Proper denture care/Oral candidiasis


-Target group is directed toward the Vidor Health and
Rehabilitation Staff.
-We will discuss and demonstrate proper denture care
procedures.
-We will educate the staff about Oral Candidiasis.
-We will provide visual aids of Oral Candidiasis.
-We will discuss how denture care relates to Oral Candidiasis.
-We will provide the staff with denture brushes and cleaner for
each resident.
-We will help establish a daily routine for the staff to carry out to
the residents.
-We will help the staff establish and implement a denture
identification system for the residents and staff.
-We will provide a resource list for future oral care needs.
Session 3: Nutrition related to oral health
-Target group is directed toward the Vidor Health and
Rehabilitation Staff.
-We will educate the staff about cariogenic and non-cariogenic
foods.
-We will educate the staff about the caries process.
-We will discuss the five basic food groups and daily
requirements.
-We will help identify alternative healthy snacks for the
residents to eat in between meals.
-We will discuss the foods that neutralize harmful acids in the
oral cavity.
Session 4: Oral Cancer
-Target group is directed toward the Vidor Health and
Rehabilitation Staff.

-We will teach the staff about oral cancer and oral cancer
screening procedures.
-We will provide visual aids showing the effects of oral cancer.
-We will educate the staff about oral cancer and its prevalence
in the elderly.
-We will help establish an oral cancer screening routine.
-To evaluate the effectiveness of this oral health program, we
will have an end-of-program meeting with the Nursing Home
Facility Administrator to assure that the objectives were met
and carried out.
-We will have the Administrator provide feedback about the oral
health program on behalf of the staff of Vidor Health and
Rehab.
B. Constraints and Alternative Strategies
1. Due to the staff's every day routine and knowledge, the
audience may not pay attention or show interest in the lesson because they
do not think it is worth their time.
-Establish a routine that allows us to teach the staff
members in groups
-Develop rapport with the audience and encourage
participation to keep their interest.
2. Staff members may not be present at the oral health
program.
-Coordinate with the Activities Director to have the oral
health program implemented into their daily schedule.
-Post flyers in the break room weeks in advance to
remind staff members of the upcoming meetings.
C. Resources:

Personnel: Nursing staff (CNA, LVN, RN), Activities


Director
Supplies: Typodont and toothbrush for demonstration,
denture brush, denture solution, gloves, mask, safety
glasses, lab coat, tooth brushes and toothpaste for
residents, supplies for denture identification
system.
Visual aids: pamphlets provided by National Institute of
Dental and Cranio-facial Research for oral cancer,
poster board showing periodontal disease, patient
education flip books to show all different topics

D. Budget:
Toothbrushes: $19.00 (donated)
Toothpaste: $20.00 (donated)
Denture brushes: $78.00
Denture solution: $5.00 (donated)
Gloves: $5.00
Masks: $3.00
Non-alcoholic mouth rinse: $15.00 (donated)
E. Timetable:
Session 1: Week of March 21, 2016
Session 2: Week of March 28, 2016
Session 3: Week of April 4, 2016
Session 4: Week of April 11, 2016
Evaluation:
Formative Evaluation:

1. We will meet weekly with the Licensed Nursing Home Facility


Administrator to make sure that all needs were being met during the oral
health program presentation and that all educational topics were specified.
2. At the end of each session, we will verbally ask the staff
members questions pertaining to the information presented that day in
order to ensure the information presented was understood.
3. A weekly review for each group of the information which was
presented during the previous session will be conducted to promote optimal
understand and retention of information.
Summative Evaluation:
1. A pretest and posttest will be given to the staff members to
compare their knowledge of oral health from the first presentation to the last
presentation.
2. We will provide an evaluation to the program director at the
end of the oral health program in order to evaluate the success of the
program; allowing the director to give any positive and negative feedback
on the overall program design.
3. We will give a dental resource list to the staff for the residents
that will need emergency treatment.
4. Annual contact with the Licensed Nursing Home Facility
Administrator will be made to assess the rate of utilization for the oral health
program by the nursing staff.

References:
1. Personal Interview: Shawn Gallet, Licensed Nursing Home Facility
Administrator (LNFA)
2. https://nccd.cdc.gov/DOH_MWF/Default/WaterSystemDetails.aspx
3.
http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/Dent
alCariesSeniors65older.htm
4.
http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/GumDisease/Perio
dontaldiseaseSeniors65over.htm
5. http://www.annalsoflongtermcare.com/article/biggest-wound-oral-healthlong-term-care-residents
6. Lamster, I.B. (2004, December). "Oral health care services for older
adults: a looming crisis" New York State Dental Journal 14-23 (NYSDJ)
7. Jablonski, R.A., C.L., Grap, M.J. & Elswick, R.K. (2005, July). "The role
of bio behavioral, environmental, and social forces on oral health disparities
in frail and functionally dependent nursing home elders." Biological
Research for Nursing, 7 (1); 75-82.

Appendix:
Pre-test/Post-test for Nursing Staff at Vidor Health and Rehabilitation
1. How long does it take for plaque to form?
a. Immediately
b. 12 hours
c. 24 hours
2. Hardened plaque is called?
a. Material Alba
b. Linea Alba
c. Calculus
3. Plaque is a bacteria that can lead to bone destruction.
a. True
b. False
4. Which oral care aid is best for patients with limited dexterity?
a. Floss
b. Electric powered toothbrush
c. Regular toothbrush
5. Can plaque and calculus form on partials and dentures?

a. Yes
b. No
6. To clean a denture, you should use:
a. Regular tooth brush
b. Denture brush
c. End-tuft cleaner
7. It is acceptable for a patient to sleep with their partial in at night.
a. True
b. False
8. Oral candidiasis is a fungal infection that can grow in the mouth.
a. True
b. False
9. What color is Leukoplakia?
a. Red
b. White
c. Gray
10. What is a common cause of oral cancer?
a. Cigarette smoking
b. Chewing tobacco
c. Pipe smoking
d. All of the above
11. What color is Erythroplakia?
a. Red
b. White
c. Blue

12. Periodontitis is:


a. Reversible
b. Irreversible
13. Gingivitis is:
a. Reversible
b. Irreversible
14. Which of the following is the least cariogenic snack choice?
a. Peanut butter sandwich
b. String cheese
c. Banana
d. Chocolate chip cookies
Answer Key:
1. a
2. c
3. a
4. b
5. a
6. b
7. b
8. a
9. b
10. d
11. a
12. b
13. a
14. b
Program Plan Evaluation

1. Do you believe the groups involved benefitted form this program? yes
____ no _____
2. How did the groups benefit? Pleas identify the different groups and how
they benefited.
3. Will you continue this program as it was designed? yes _____ no ____
What improvements should be made so that the program could be
continued by your administration?
4. What were the strengths of the program?
5. What were the weaknesses of this program?
6. Other comments: