The logistics of alternative practice settings: Nursing homes
The biggest obstacle in providing dental hygiene care in a nursing home is often something quite simple that you may not think about in your practice.
When I wrote last, I did not have a game plan for to get dental hygiene services into a nursing home. In my head it was working out seamlessly—simply find a dentist to work with me, walk into a nursing home, and offer my services. Easy peasy! So far it has not worked out that smoothly. I have run into some logistical snags along the way, as I should have anticipated, but each new question brings out several possible answers and about ten more questions. I needed to start somewhere, so I decided to determine the interest for hygiene services in local long-term care facilities.
I drafted letters stating my purpose and intent, highlighting the importance of oral care for the facilities’ aging population of residents, and touching on the importance of education for the staff. I also compiled a list of questions for the administrator about the facility: How many residents are there? Is there a space available to set up and provide services? Would the facility be able to provide any of the disposable items such as masks, gloves, gauze, etc? Who would obtain the permission from the residents and or families?
I needed to think about this endeavor from every possible angle. I needed to think about my license and how to protect that. I needed to think of the dentist and his license, his investments in me, and equipment. I needed to think about the facility and the potential questions or concerns that they may have, and to make sure that what is trying to be accomplished is within all of their guidelines and regulations as well. With my letters and questionnaires finished, I was ready.
There are six long-term care facilities and assisted living facilities in my community. Two of them are larger facilities with many residents; the other four are much smaller. I started with the largest facility thinking that with more residents, there would be more need. I gathered up my documents in my car, said a quick prayer, and walked through the front doors. I introduced myself to a small group of ladies that seemed to be waiting for me just inside the door. I indicated that I would like to speak to the facility administrator regarding bringing dental hygiene services into the facility. It seemed it was my lucky day—the person I was looking for was right there!
I could barely contain my excitement as I sat down in her office and began to share what I had envisioned for the residents of her facility. She barely looked at my letter of intent and asked when I could start. I was so happy that she was on board with the idea and was very interested in starting the process. The energy was a bit deflated when I had to tell her that I was still in the process of finding a dentist to join me. Together we talked through the questions that I had for her and we determined that the beauty salon, when not in use, could be a possible room for providing care. Stationary equipment would need to be minimal and could be moved into a corner when not in use. There may be a little bit of storage area for a few things, but other than that I would need to transport everything that I would need for the day. This first meeting really encouraged me knowing that others were understanding the importance of these services for this population and were very interested in starting the process.
I then moved on to the second largest facility and had a very similar discussion with the administrator there. She was very understanding and interested as well. She had a few different considerations and questions than the first facility, but I felt that I could still accomplish the what was needed here as well.
My third stop was a much smaller assisted-living facility. The administrator was interested in what I was trying to accomplish but could not answer many questions that I had, as this was a privately owned facility. The other consideration with this smaller facility was that many of the residents were still very independent and were able to get themselves out into the community and to their dental practice regularly. At the last few facilities that I visited that day, I was only able to leave my letter of introduction and intent to be passed on to the administration. I have since reached out to those last few facilities and have not heard back any interest.
I noticed quickly that the common concern was where these services would be taking place. These facilities simply did not have an extra room available. The larger facilities have beauty salons that are not in use every day, so that left one possibility. There is also the consideration that some of the residents that would maybe feel more comfortable staying in their room for the services. Both of those options bring up the need for different equipment, one being more stationary and the other being very portable.
I felt encouraged as I ended my day visiting these facilities and discussing my hopes. I found that it was a very productive experience as it provided another viewpoint of how this process would play out. I headed home encouraged by the interest that the administrators displayed. There is a great need for these services here in my own community and I am excited that others see it and believe that it is important as well. So, I go back to the growing lists of questions and considerations, another piece of the logistic puzzle to put in place.
Previous columns by Amy Ericks
Amy Ericks, RDH, BSDH, is currently transitioning offices and preparing to pursue a dream. She graduated from the University of Wyoming in 2010 with an Associate of Applied Science in dental hygiene. Five years of experience, two houses, one more child, and several internet classes later, she graduated with a Bachelor of Science in dental hygiene. She is excited to share her journey.
Editor's note: This article first appeared in RDH eVillage. Click here to subscribe.