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.

Photo Courtesy@Shutterstock.com/Jan Mika

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