Coalition works to boost access for senior citizens

CEDAR RAPIDS — As Iowa's population continues to age, there's a large public health concern staring the state in the face — people's mouths.

That's because while there are more than 450,000 adults aged 65 years and older in the state — many of whom still have their natural teeth, a change from years past — three out of four don't have dental insurance, according to Delta Dental, the state's largest dental insurance company.

Countless others aren't able to go to the dentist because they lack transportation, have fixed incomes and are on tight budgets, or have disabilities, experts said.

But about one-third of adults in that same age group have untreated tooth decay, according to Delta Dental, and a healthy mouth is key to a healthy body — with research suggesting that unhealthy teeth and gums can be signs of bigger problems such as heart disease, diabetes and kidney disease.

A coalition of public and private groups across the state have been working for the past year to increase senior's access to oral health, distributing more than $600,000 in grants to fund efforts. But they all agree, there's still a lot of work to be done.

The Lifelong Smiles Coalition — made up of 13 state agencies, advocacy organizations, health care groups, academic institutions and the Delta Dental of Iowa Foundation — kicked off the campaign in November 2014, working to improve education and training opportunities, care coordination, and policies across the state, said Suzanne Heckenlaible, executive director of the Delta Dental of Iowa Foundation.

Since the start of the campaign, the coalition has become more organized, building a website, assigning committee chairs and putting together a public-service-announcement campaign that talks about the importance of oral health, Heckenlaible said.

'We're continuing to look at sustainable ways to help the population,' she said. 'How can we make it better and remove specific barriers?'

The initial round of funding went to three groups:

• The Iowa Department of Public Health, which is developing the I-Smile Silver project, a community-based system of care for those over the age of 60

• The Iowa Caregivers Association, which is providing education directly to care workers, including a curriculum that allows those care givers to obtain a specialist certificate in oral care

• The University of Iowa College of Dentistry and Dental Clinics to develop and evaluate continuing dental education programs for dentists, hygienists and assistants, specifically targeted at geriatric oral health care.

Tracy Rodgers, I-Smile Silver coordinator at the Iowa Department of Public Health and coordination and outreach committee chairwoman for the Lifelong Smiles campaign, said the state set up a two-year pilot program in Lee and Scott counties targeting Iowans in nursing facilities or receiving home and community-based services.

The program hired coordinators in those counties to build relationships with dentists, nursing facilities and the Area Agencies on Aging. In Lee County, nursing facilities and dentists now are working together to provide on-site care, bringing portable equipment into the facility, she said.

'The question is where do we go from here? What kind of funding is needed to go statewide?' Rodgers said.

Dr. Howard Cowen, a clinical professor at UI's college of dentistry, knows how beneficial traveling to nursing facilities is for the patients.

Cowen, who also is chairman of the education and training committee of the coalition, is in charge of the UI's Mobile Dental Unit, which is essentially a traveling dental clinic.

Cowen and his students work with 10 nursing homes throughout the year, spending about six weeks at a time with each facility, moving in equipment into empty rooms, including three or four dental chairs. His team looks at each resident, providing cleanings, filling cavities and performing other necessary tasks. Dental hygienists also follow up with the nursing homes, providing cleanings every six months, he said.

It visits both UnityPoint Health-St. Luke's Living Centers East and West, nursing homes that have short-term rehabilitation services and long-term care.

Andrew Wagner, the facility administer for Living Center West, is thankful for the service, adding that many of the facility's 76 residents would be unable to receive oral care without the Mobile Dental Unit's help.

'A lot of these people have chronic, serious health conditions,' he said.

The team used to see as many as 26 different facilities, but that became too difficult and it had to be cut down, he said, adding the need still is there. Dentists often are cautious to take on this expensive and complex population, he explained.

Dentists have a very high overhead cost to provide care, he said, and Medicare does not cover dental and Medicaid reimbursements barely cover that overhead cost.

'Most (dentists) don't want to deal with the complexity of the patient or the medical consequences — for instance, if a dementia patient is resistant to care,' he said.

UI is working to reverse those hesitations. It developed a graduate training program three years ago — additional schooling on top of dental school — that specifically focuses on the geriatric population, Cowen said. So far, about eight students have gone through it.

It's a small number, but it's a start.

'They are all extremely passionate, understanding people,' he said.