If your father lived in a nursing facility, wouldn’t you expect someone to assist him with brushing his teeth? Here’s what I discovered with my Dad, and then I need your advice.
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My father sees his dentist three times a year. During his last appointment, we discovered he had ELEVEN cavities that will cost a total of $3,400 to fill. How could that happen if he is brushing his teeth daily? I visit Dad twice a month and often notice his teeth are not clean. I’ve dismissed it assuming the aides would help him brush before bedtime.
Two days after hearing from the dentist, I called the head nurse at the home. I informed her of Dad’s eleven cavities and asked if Dad was receiving dental hygiene. I received a polite, “I’m sorry to hear that.” Not the resounding, “Yes, every resident in our care gets help with their dental hygiene,” that I was hoping for. Her response made me wonder if the staff might drop the issue if I didn’t continue to pursue the issue.
The following day I decided to join Dad for supper to see if I could get some answers. I also wanted to meet with the head nurse to gather more information about Dad’s dental hygiene. After dinner, I broached Dad.
“Dad, who helps you brush your teeth each day?” I asked.
“I religiously brush my teeth twice a day,” he said. I listened with disbelief.
“Let’s go to your room so I can watch you brush your teeth,” I suggested.
“Okay,” he said. I wheeled him into the bathroom only to discover there was no toothbrush or toothpaste by the sink.
“Dad, where do you keep your toothbrush and toothpaste?” I asked.
“I don’t know,” he said. “They should be around here somewhere.”
I left him in the bathroom while I looked around his room. I found his unopened prescription toothpaste with extra fluoride sitting on a small counter near his bed. Across the room is his chest of drawers. I rummaged through his drawers and found a toothbrush in its unopened package in the top drawer, which he can’t reach. Apparently, a staff person put it there. I removed the toothbrush from its package and returned to the bathroom feeling victorious that Dad had what he needed to brush his teeth.
I then noticed a logistical problem. The sink was too high for someone in a wheelchair! How was he supposed to rinse and spit if he couldn’t lean over the sink? To make matters worse, I couldn’t find a water cup or anything for him to spit into. Moreover, nurses were scurrying in and out of rooms to help other residents, so I was hard pressed to get any help.
Dad was willing to persevere through these roadblocks. I put the toothpaste on his toothbrush and handed it to him, but he struggled. Instead of using his arm to create a brushing motion, he kept his arm still and moved his head to make his teeth rub against the toothbrush. I put my hand over his hand to encourage him to move his arm instead of his head. Since there was nowhere to spit, he swallowed. (I hear your groans from afar.)
I approached the head nurse. She was standing in the hallway by her cart filling small plastic cups with pills for residents, but she was willing to talk to me.
“Who handles the dental hygiene for my Dad each day?” I asked.
“Whoever is putting him to bed should be helping your Dad brush his teeth,” she replied.
“So how are you making sure that an aide is doing that?” I asked. “Do you require them to initial a log that indicates the task was done?”
She didn’t give an answer, and I could tell she didn’t want to continue the conversation. She wasn’t going to admit possible neglect.
I headed back to Dad’s room realizing there was a strong chance that dental hygiene wasn’t happening for my Dad. Two days later I decided to write the administrator to express my concern. I informed him of Dad’s eleven cavities and the $3,400 cost to fill them. I reminded him that Dad is in a nursing facility outside of Austin because that’s where he can afford care. His cash reserves are not plentiful. I asked him to share the protocol they follow to make sure residents are getting help with their teeth. Second, I asked him to assure me that he is implementing an action plan to make sure Dad will get help to brush his teeth daily going forward.
I received a prompt reply. He forwarded my email to the Director of Nursing to address this issue. He indicated that I would hear from her while he was on vacation, but that didn’t happen. Two weeks elapsed, and I never got a response on protocol or whether staff implemented a specific plan to assist my Dad.
I sent a follow-up email to the administrator requesting an update, including excerpts from the Admissions Agreement I signed for Dad in 2012, lending support for my position that Dad should be receiving help with basic dental hygiene. It’s been ten days with no response. I will wait four more days to give him a chance to reply.
But now I’m facing a crossroad and need your input. I feel tension between seeking accountability versus letting it go because it already feels like a losing battle. I can’t prove that Dad’s cavities were due to lack of dental hygiene. I want a simple result. I want to know with certainty that someone is helping my Dad brush his teeth daily. In the meantime I am working through some “what-if” scenarios:
• If the administrator doesn’t respond at the two-week mark, do I write another email and give him the benefit of the doubt, assuming that he has been conducting an in-house investigation, and ask what it revealed? If it appears that Dad did not get the consistent care he needed, should I ask the facility to pay at least half of his dental bill?
• Do I accept the possible reality that many facilities do not assist their residents with dental hygiene, which may be a norm in this industry?
• Do I talk to an attorney, which I don’t want to do, but may have to do? Dad’s resources are limited, so that doesn’t sound viable.
• If I seek accountability, can they decide to turn my Dad away and ask him to find a new facility for care because they don’t want to deal with us?
Being an advocate for parents who can’t defend themselves is harder than I thought. If you were in my shoes, how would you advocate for your Dad?
Blessings,
Lee Ann
I know you will pray and ask God for wisdom. I certainly understand your concern. I am assuming your dad is otherwise content in being at this facility so moving him might be detrimental and be harder than the monetary amount of his dental work. I personally would not go the attorney route at this time but would not let this issue rest and that’s based on me looking some day at a facility such as this. I will pray that God will answer you and you wil have some peace about the decision.
Thank you, Pat. I so appreciate your thoughts. You are correct that I am praying daily for “generous portions of wisdom” according to James 1:5 in all areas of my life, not just for Dad’s situation. I am also seeking godly counsel from dear people like you to make sure I am thinking through this issue soundly. Just your belief that I should not let this issue rest without going to an attorney is very helpful to me! Thank you!
Blessings,
Lee Ann
Lee Ann,
It’s your word against theirs (facility) but I sure wouldn’t count this one as a losing battle. I would be the “squeaky wheel” with the administrator. I would not stop inquiring until you get the answer and action that you expect. Isn’t there a regulatory agency to report to for this type of thing?
I have a loved one in an assisted living facility in Austin. This is a wonderful facility but they don’t have enough staff, and I seriously doubt that they are doing everything they say is on the “brochure”. I will remember to inquire about the teeth brushing – thank you.
Members of the family and I are dropping by at least every other day to make sure this person gets the care and attention he deserves. It certainly doesn’t get any easier because there’s someone else providing the care. I can certainly understand your frustration.
With regard to the dental expense, I know that you can call the Dental school at UT in San Antonio, have the work done by one of the senior dental students for a fraction of the price.
I will pray for you, your dad, and for the facility!
Thank you so much, Tracy! Being the “squeaky wheel” is not hard to do. I am sure there must be some regulatory body that gives oversight to skilled nursing facilities. The Admissions Agreement I signed lists the Texas Ombudsman as a place to turn to if the administrator won’t communicate with me, but I think that would be my last step. As I continue to think this through some more, I think I’m struggling to figure out how much longer do I try to get a satisfactory answer from the administrator versus going outside the facility to get a more authoritative voice involved. I just don’t have any experience in this area to know if sending another email or two is a “waste of time” and move on to the regulatory body. I do know that my own value system includes giving someone a chance to respond and rectify an issue without having to go to higher ups, but again, how much time do I give them?! Aaaarrrrggghhhh!!
I also resonate with the shortage of staff, which is part of the reason I feel this might be a losing battle. They can only serve so many residents at any given moment in time. But I will take to heart your admonition to “not stop inquiring until I get the answer and action I need.”
Thank you for letting me know about the Dental School at UT San Antonio, which is probably not far from my Dad’s facility in Lockhart. I will definitely look into that. I also thank you for your prayers!
Blessings,
Lee Ann
Have you thought of talking to the nursing home ombudsman? I think every nursing home has one and I believe they are there to represent the needs of the resident. He may have some advice. Will be praying for you.
Thank you so much, Betsy. The Admissions Agreement lists the Texas Ombudsman as a place to contact. As I mentioned in another reply, I think I’m struggling to figure out how much longer do I try to get a satisfactory answer from the administrator versus going outside the facility to get a more authoritative voice involved. Do you have any thoughts about that? If the shoe were on the other foot, I would want every opportunity to rectify the situation once the issue has been brought to my attention. What complicates things for me is when there is silence. Is the silence because he is still working on the issue and I need to give him more time to respond? Or is the silence because he thinks I will go away if he doesn’t get back with me? I work well with people who communicate. If I were the administrator, I would have at least sent an email saying “I am still investigating this issue. I’m not ignoring you. It may be “x” weeks before I can back to you…
I appreciate your prayers in this matter. I need to hear God’s voice as to when to take the issue outside of the facility if the administrator doesn’t get back to me at the 2-week mark.
It’s great to hear from you, Betsy! I trust you’re doing well.
Blessings,
Lee Ann
I’d try talking to the nurses aide that will be doing this personal care for your father directly. Approach them as a friend about your concern about your Dad’s teeth. The nurse’s aide is actually the most direct source to his care. Nurses are busy and are not concerned with that stuff and the administrator will address but it is going to take longer. What would be great is if you could get the nurses aide on your side to get this changed around. I know if I was working as a nurse’s aide just doing baths or whatever, and I was approached by someone concerned about their parents teeth, I’d make that part of their care if I previously wasn’t. You could create your own check list for teeth care by his bed to be checked off. If he has consistent staff care, there may be only a couple nurse’s aides to talk to. I’m not surprised this is being forgotten. The main focus is medication and baths, and many clients have dentures, so they are not brushing teeth in someone’s mouth.
Maybe this advice is helpful perhaps not. . . . just an idea to do along with the other stuff you are already doing.
Thank you for sharing your advice. I definitely believe there is merit to befriending an aide who regularly works the night shift and work with him/her to brush my Dad’s teeth. My logistical problem is that I am 45 minutes away, so cultivating that connection would be very difficult and limited. That doesn’t even take into consideration that there are different aides covering different evenings. If he were in a local facility, I think I could work toward that kind of arrangement and have a checklist and visit with the people who are providing the hands-on care.
Blessings,
Lee Ann
I’ve been through this with my mother who was at Westminster Manor for 12 years – only 8 of them in the nursing facility. Mother ran out of money and WMM forgave the $10,000 she owed them when she died. Now to the teeth issue. Mother didn’t have a cavity until she was in her 40’s. She had religiously brushed her teeth twice a day since she was a little girl. After she went into the nursing facility part of WMM, I noticed one day that her teeth were hollow!!!!!!!!!!!!!! And I mean hollow. She had no pain. That was in ’97 and I continue to ask every dentist what happened to my mother’s teeth and will that happen to mine?
Now to your situation: I don’t think you can get any financial help to take care of your dad’s teeth from the nursing facility. I would check back to the beginning to what they promised to do for your dad. Is it written anywhere that they will help them with their dental hygiene? If it isn’t in writing that they will – get him an electric toothbrush – it’s the gums that need massaging. If you can’t go daily to get him back into the routine of brushing – you might have to hire an outside aide for a week or a few weeks until you are certain that he is brushing.
That is my input. It’s really hard losing a parent to aging – I think it is God’s way of letting us know how much our parents did for us. We love them and take as good a care of them as possible because they took great care of us when we didn’t know it or appreciate it. God bless your father.
Thanks so much for your thoughts, Mickey! To answer “Is there anything written that they will help Dad with dental hygiene,” the answer is “yes.” In my follow-up email to the administrator, I included “excerpts from the Admissions Agreement” that indicated he should be getting dental hygiene. My concern is that he still hasn’t responded. I have asked him to define the protocol in place to raise our family’s comfort level that Dad should be getting this care.
I have had a couple of others suggest an electric toothbrush, which is a great idea. I think the need to massage the gums is very important, so I will look into that.
Blessings and Hugs,
Lee Ann
Ask your dad’s dentist can give you a favorable opinion. You may want to draft something yourself so you know the points are covered. If he’s been your dad ‘s regular dentist, his records will provide him with the knowledge he needs. If not, you can get you Dad’s records sent over to him. Your dad’s medications may lead to dental problems so he will need a list of them. His concluding sentence that the discovery of # number of cavities indicates dental neglect. Your father should receive (whatever the dentist recommend; their may be supplemental measures like rinsing with a certain solution).
Get some reputable information off the website or a resource to go to from your dentist that discusses the importance of dental hygiene in the elderly and the kind of health problems poor dental hygiene can lead to. He may be even more at risk given his medical condition.
The information on his current condition and lack of proper treatment is for now. I would propose the facility split the cost of the cavities 60/40 (they pay 60, you pay 40. If they refuse this may help you in a later step to address the mater of what the should pay you later. The request for a reasonable accomodation is the second part and speaks to the future. They are required to meet this. They cannot be required to do something that is cost prohibitive, but they are required to do something reasonable, which actually may be something simple – a required procedure, a required checklist with a weekly review by the supervisor. Probably something more, I can’t think of it know.
The bottom line is that basic dental hygiene is an absolute requirement, the facility should provide it, if they have not which all evidence points to, they should share in the cost of the results of their neglect, and they are now on notice through your request that they have to take steps to do so.
The letter does not need to be confrontal, just objective. Rather than couching it in terms of frustration, I would use the term concern and various synonyms for concern.
Cruise the net a little to see if this is a frequent problem; best Internet source would be from something other than a blog. Maybe something on the licensing requirements of facilities like the one your dad is in. See if complaints have been made against the facility.
Put your information together in writing with whatever additional supporting documents. Put it in a nice bounder with a label om the front with your dad’s name, facility name, and date..
Underneath in bold letters, Notification of neglect of health assistance with basic dental hygiene, and request for reasonable accomodation.
The ombudsman is the place to go. Their job is to be made aware of neglect of patient basic needs, and presentation of a request for reasonable accomodation. As a side issues, your dad nededs a sink he can reach. However, if this would require moving him to a other room and that would be disruptive to him, it might require a creative solution. Would a little ramp to the sink be feasible.
Sorry for the typos in this response. Hope I’ve provided some useful information.
Suzanne
(This is for the ombudsman.) The introduction to your letter should recite your attempts to proceed through the required channels at the facility.
Look at the licensing requirements. See if providing dental hygiene who require it is in their licensure requirement.
The fact that your dad can’t reach his sink, had unopened toothpaste and a toothbrush across the room, and didn’t know how to brush his teeth is overwhelming evidence that he requires assistance. You need to put the facility on written notice that he requires a reasonable accommodation to dental hygiene as recommended by his dentist.
Suzanne,
This is fantastic! Thank you so much for all of this input. The overall advice I’m receiving suggests to keep “pushing” the issue until the facility has rectified the problem. I appreciate your written road map. That was uber helpful!!
Love,
Lee Ann
You have already been a good advocate, but you can’t stop. I would not involve a lawyer. I would talk to the director of nursing. I think patient care is ultimately her responsibility; and if the administrator actually relayed your concerns, she has been negligent in not responding. She should be able to tell you if her staff is responsible for dental hygiene. If they are, ask her if it can be monitored for your dad. (a check list on the bathroom door dated and initialed by the aide sounds like a good idea.)
I wish they would pay the whole bill, but I don’t think they will pay any of it. If it is a service they are to provide, they are negligent. Proving it is another matter. Your dad’s testimony is he’s brushing twice a day; and since he already has a prescription toothpaste that seems to indicate an ongoing dental problem. Plus they could claim the cavities were a pre-existing condition. As far as no brush being available, they could say they had just thrown the old one out and were going to open the new one that night. Proving liability is too hard.
I wonder if they have a case manager, usually a social worker, on staff. They might know of a program to assist the elderly with dental bills. They may know other ways to lessen the financial load for his overall care.
I think for awhile you might need to go once a week to see him. I’ve heard it recommended that visits be unpredictable. You want the staff to think you could pop in at any moment.
Does the facility not have a handicapped room with a lower sink? If the cup is in place, and your dad can reach the faucets; I guess he could spit into the toilet. Not ideal, but maybe functional.
Your dad is so blessed to have your love and involvement. Keep advocating for him.
It also never hurts to give the staff some strokes. From the outside looking in, being an aide seems a thankless job. Try to find something they do well and call attention to it. You asked for input; hope this helps. p
Peggy,
These are excellent inputs! You are so right about finding all the right things they do, since Dad perceives that his overall care is good. I, too, have felt that trying to engage the legal system would be a losing battle, but the admonition I’m hearing is to keep the issue on the forefront so that it is properly dealt with. I have thought about bypassing the administrator and going to the Director of Nursing, and I may do that but be sure to send an email to the administrator the content of our conversation to keep things documented.
Blessings,
Lee Ann
Lee Ann, I used to be a certified Texas Ombudsman visiting Nursing Homes to be an advocate for the residents; it’s been many years since I was active, but an MD visited the Home monthly, I believe, & perhaps a dentist did, also. I’m not certain about that, but that would be my first question to the Administrator. It seems like they had hearing aid assistance also. I think that the cost would be maybe 1/3 of your quote, IF a dentist visits the home. The Administrator is the one to confer with; also ask if there is an Ombudsman to the home. You should contact the Area Agency on Aging at 512-916-6062. If the needed info is not there, they will refer you, & possibly to this number: 1-888-622-9111…not sure what it is but probably the State Agency on Aging. The aides are underpaid, but I would make friends with the 2 or 3 who put him to bed, giving them an extra $1 to brush his teeth nightly, with a kept record, of course; $30 a month would be worth it, don’t you think? Or an electric toothbrush makes brushing teeth fun, & if he can’t manage that, the aides could. I think the quoted price you rec’d is exorbitant, & the dentist would have to prove the 11 cavities to me. $100 per cavity would equal $1100 or less, I’d think, & crowns, etc. should not even be considered! Of course, that’s what I would do, but I’m of a different generation!!
Thank you, Murlene. I will make those phone calls to see what help they can offer. I will also check to see if a dentist is asked to make rounds at the facility.
Blessings,
Lee Ann