1 DENTAL CARE FOR SENIORS

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1 1 DENTAL CARE FOR SENIORS The Health and Emergency Medical Services Committee recommends the adoption of the recommendation contained in the following report, August 14, 2006, from the Commissioner of Community Services, Housing and Health Services: 1. RECOMMENDATIONS It is recommended that this report be received for information only. 2. PURPOSE This report provides information on the dental health of seniors and on the dental needs of seniors in York Region and Ontario. 3. BACKGROUND At the April 6, 2006 meeting of Health and Emergency Medical Services Committee, staff were requested to bring forward a report regarding dental care for seniors living at home. 3.1 Importance of Oral Health Oral care is an important component of overall health and wellness. To reflect this, in 2004 Health Canada created the Office of the Chief Dental Officer for Canada to raise awareness about oral health and to incorporate oral health issues in a wider health agenda. With the Federal, Provincial and Territorial Dental Directors Working Group, the Chief Dental Officer is working on a COHS that will: Establish a baseline of the current status of oral health in Canadians. Establish goals to work toward for the year Develop strategies to help accomplish the goals. Develop a system of measurement and monitoring of progress towards these goals. While oral health is acknowledged as important, it has been a neglected part of the health care system. 3.2 History of Dental Programs for Seniors in Ontario Expert Committee Recommendations Two expert panels in Ontario have called for dental programs for seniors to be delivered by public health units. The first one, the Ontario Advisory Council on Senior Citizens, pointed out in 1980 that six out of ten seniors living in the community required dental

2 care and that the needs of those in collective living centres were even higher. The council recommended that public health units conduct dental health promotion programs, screening and referral, and follow-up activities for seniors. In 1989, the Ontario Minister of Health s Advisory Committee found a high level of unmet dental needs among seniors: many could not afford care, and those in institutions and those who were homebound had the least access to care. The advisory committee recommended a provincial dental plan for seniors, including a community-based health promotion program provided by public health units and a targeted dental treatment program provided by dentists and denturists. Neither committee s recommendations were implemented Mandatory Health Program and Services Guidelines (MHPSG) In 1982, when the MHPSG were being revised, the draft guidelines contained a universal preventive dental program for seniors. When the final draft was released, it included services for residents of collective living centres only. In the revised 1997 MHPSG, preventive dental services for seniors were completely removed. With preventive dental services for seniors no longer being mandated, many Ontario public health units have lost their capacity to provide community-based oral health promotion programs for seniors. 3.3 Municipally Funded Programs A few municipalities in Ontario offer basic or emergency dental care for low income seniors. These programs are 100% municipally funded. The City of Toronto offers dental treatment for low income seniors through community-based clinics. Halton Region has a program called Dental Care Counts. Seniors are eligible if they are over 65 years of age and have both dental and financial needs. Treatment is provided by private practice dentists either in their office or in a long-term care facility. The City of Ottawa provides dental treatment and the Community Denture Program for low income seniors. Seniors must first qualify for the program through the social services department based on financial criteria. If approved, they are referred to the city s dental clinics. The level of service for treatment is emergency care only (fillings and extractions) and the denture program is limited York Region Preventive Dental Program in Long Term Care Facilities This program, which is currently offered in 27 York Region long term care facilities, includes dental screening (visual assessment only), denture cleaning and identification, and in-services for caregivers on geriatric oral health, but not treatment. It began in the mid-nineties, when the Healthy Elderly Program was part of the MHPSG. This program was removed from the revised 1997 MHPSG; however, York Region continues to offer the program based on local need. In the spring of 2006, this program was extended to seniors in 27 retirement homes.

3 4. ANALYSIS AND OPTIONS 4.1 Seniors Oral Health Status In comparison with other population groups, seniors have less access to dental care and poorer oral health status. Oral disease and dysfunction can cause significant quality of life impacts on seniors, including: Loss of ability to chew. Difficulty swallowing. Difficulty eating nutritious foods. Disturbed sleep. Problems speaking. Reluctance to engage in social interaction. Oro-facial pain on a frequent basis. (Journal of the Canadian Dental Association, 2005) Links have also been found between periodontal disease and diabetes, which is more prevalent in older adults Risk Factors Seniors are also more prone to certain risk factors for oral health problems. These include conditions such as dry mouth syndrome from medications; physiological or pathological changes; systemic diseases such as diabetes and vitamin deficiencies; chronic conditions such as arthritis; and cognitive impairment, which make effective daily oral care difficult Prevalence of Seniors Oral Health Problems In 2005, there were 90,388 people aged 65 years and over in York Region (Statistics Canada Annual Demographic Statistics 2005). While there is very little information on the oral health of seniors in York Region, data from the Ontario Study of Oral Health of Older Adults 1991 indicate that approximately 45 56% of seniors in Ontario who still have some natural teeth would require restorative treatment (i.e. repair or rebuilding of teeth), and that 44 48% would require prosthetic treatment (i.e. replacement of missing teeth). Seniors also report negative oral health consequences from dental conditions, such as chewing problems (38 45%) and oro-facial pain within the last four weeks (38-41%). (Due to the fact that clinical treatment needs are found to increase as seniors age, the percentages given range: the lower percentages represent those and the higher percentages represent those 75 years of age and above.) Utilization of Dental Services by Seniors While use of health care services based on physician visits increases for individuals over the age of 65, visits to dentists decrease markedly. According to the Canadian Community Health Survey (2003), 89.7% of seniors over the age of 65 in York Region reported visiting a physician in the last year, but only 62.0% reported visiting a dentist. Yet, dental disease in seniors is high relative to the rest of the population.

4 4.2 Gaps in Seniors Access to Care Seniors, particularly low income seniors, face many barriers to accessing care. The obstacle most often cited by seniors is financial need. Many live in relative poverty, existing on small pensions. For these seniors, accessing essential or even emergency dental treatment is financially prohibitive. Other barriers to care include lack of mobility, lack of transportation and being isolated Third Party Coverage for Dental Care In Canada, most dental care is linked to ability to pay. Data from the Canadian Community Health Survey (2003) indicate that only 28.9% of seniors over the age of 65 in York Region have insurance to cover dental expenses. For many seniors, particularly if they are low income, lack of dental coverage is cited as the greatest barrier to care. In a report on oral health by the National Advisory Council on Aging (2005), it is stated that even with insurance, many seniors visit the dentist only when they have a problem; they cannot afford regular visits or preventive care Publicly Funded Dental Programs Publicly funded programs are often created based on the idea of return on investment. Children s enrichment and health programs are a prime example: these pay off in improved development and other gains, which ultimately give a return back to society. York Region s Ontario Works Dental Program for Adults covers dental treatment based on need and results in participants having improved oral health and improved confidence when seeking employment. In Ontario, the following publicly funded programs are accessible to various eligible participants: Children in Need of Treatment (CINOT). Ontario Works adult dental programs (level of services may vary by municipality). Ontario Works Dental Program for Dependant Children. Ontario Disability Support Program (ODSP). Veterans Affairs. Non Insured Health Benefits (NIHB) for native peoples. Of these programs, seniors only have access to publicly funded dental care if they are veterans or aboriginal people. They may also qualify for ODSP supports if they are not eligible for Old Age Security and are in financial need. In Canada, only Alberta, the Yukon and Northwest Territories offer seniors dental care as part of their universal health care programs Social Assistance Prior to changes to Social Assistance legislation in 1997, discretionary municipal programs existed which allowed people to qualify exceptionally for certain benefits.

5 While these programs were not specific to seniors or dental care, they could in extraordinary circumstances provide a senior with assistance towards the cost of basic dental treatment. Under new legislation introduced in 1997, these discretionary programs, which occasionally supported seniors with the cost of dental treatment, were eliminated. 5. FINANCIAL IMPLICATIONS There are no financial implications as a result of this report. 6. LOCAL MUNICIPAL IMPACT York Region Health Services continues to provide a Preventive Dental Program to seniors in long term care facilities and retirement homes across York Region. A provincially funded dental treatment program, however, is not available for York Region seniors. 7. CONCLUSION The clinical needs of elderly are high and the need for organized oral healthcare for this population is clearly evident. The MHPSG is currently under revision. To this end, Health Services Department would support the reinstatement of a preventive dental program for seniors and the development of a dental treatment program for seniors in financial need, should it be funded 100% by the provincial government. The Senior Management Group has reviewed this report.