My 91-year old mother lives all the way across the country and I do not get to visit her but once every year or two. My two brothers live nearby and visit her and are supposed to look after her but they have health issues and are becoming incapable.
I just visited mother this week for the first time in two years. She has severe dementia. I arranged for a dental exam with a local dentist and the nursing home transported her. Things are horrible - she needs several extractions, three root canals and several fillings. The dentist said that he was sure the nursing home was not brushing her teeth at all and indicated he knows this is a problem with the home.
What is the obligation of the nursing home to see that mother's teeth are brushed after every meal by one of the nurses?
Second question, the dentist says he can do all the work in his office in six phases over six weeks ($9000) and that mother is a good, cooperative patient.
The other option is to have an oral surgeon do all the work in one day in a hospital setting (much more expensive I assume?). Any advice on which option to choose? Mother has enough assets to self-pay all her expected expenses for about two more years then the plan is to rely on Medicaid.
I think with the help of the case worker I can manage this all remotely when I return home and basically leave the sons out of it. I already pay all the bills and do all the correspondence.
Is this common for a nursing home to completely overlook the oral health of their dementia patients and let their teeth rot away? I feel like consulting with a lawyer. Tears.
One tricky thing I should add. The nursing home considers the hall Mother is on as assisted living even though they have registered nurse care on the hall. Maybe this lowers the obligation to provide dental care?
Your mother is fortunate to have you to advocate for her.
Most people with severe dementia would need more care than "assisted living." It sound like Mom is in a tiered care facility where it will be pretty easy to move her to a different level of care. Do you think a talk with the director is in order, along with a request for a copy of the contract they are operating under?
My husband has dementia, moderate stage. If surgery of any kind were recommended for him, I would first discuss it with the behavioral neurologist who manages his dementia care, and probably also with his PCP.
Best of luck to you!
My mom is in a NH and before she went in, had several thousand dollars of work done over about 10 months. Endodontics, replacement of some vintage bridges, etc. I think she could have done it in about 4 mos but scheduled it when I could take her and stay for follow-up.The gum scraping was brutal. I'd go with the series of work and agree with Jeannie on the worry on getting it done in 1 fell swoop with anthesthia issues.
Ask the dentist about GEL KAM. This is what my mom uses. It comes in a regular toothpaste tube that she can use BUT also come in a rinse. It is made by Colgate and is prescription only and takes a bit of getting used to (the cinnamon flavor is tart). When mom was in IL, she did the toothpaste. Now that she is in NH (Lewy body dementia), they do the rinse daily. It's kinda strong stuff but does work. You know you're lucky to find a dentist who will have a 91 yr old as a patient, most won't.
If you have time, speak with the social worker at the AL regarding your mom's suitability to stay in AL. It may be time for a higher level of care and perhaps another facility. The social worker really can be lots of help as they know just so much about what to expect and and not focused about the financial aspect.
Regarding Kimbee's post, the dentist wrote an order to have mother's teeth brushed after each meal. It is now on her record and the NH started with it before I left. Time will tell if they are consistent with it. I have some doubts because they are not doing it for the other patients on her hall.
After all her work is done, at the dentist's suggestion, I will arrange for a checkup with the dentist every two months. Among other things he will be able to put pressure on the NH to do the brushing consistently if they fall short. The dentist is also trying to partner with the NH to establish oral care including a chair in the facility and training for the CNAs.
I must be open and say I feel traumatized by what I saw in mother's mouth at the dentist's office. The dentist and the staff made me feel guilty and fully responsible for her condition - they were unpleasant to me but caring for my mother. I am losing sleep over this and now I am back at home a long way off and unable to personally check on my mother.
Thank you again.
I would suggest that you speak with the director of nursing about your concerns. I would also suggest, if possible, to keep dental insurance on her, because Medicaid is limited in the dental services they cover.
Hope your mother has a good outcome with her dental work.