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DENTISTRY FOR HOSPICE

In-Service Program: Dentistry for Hospice Care


Patricia Adesanya
Texas A&M Health Science Center
HCPI 557 Contemporary Health Care Issues

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ASSESSMENT PHASE
Introduction
Special healthcare needs can be defined as any physical, developmental, mental,
sensory, behavioral, cognitive/ emotional impairment, or limiting condition that
requires medical management, health care intervention and the use of specialized
services. Patients that are admitted into hospice can be considered as patients with
special needs. This includes those patients who have Alzheimers.
Special Care Patient Facility
Community Hospice of Texas Hospice House in James L. West Alzheimers Facility

Services
This facility offers expert care (routine care, continuous care, respite care, inpatient
care), support and guidance. Also, pediatric, veterans, pathways, and bereavement
services are provided.

Mission and Goals


The Community Hospice of Texass priority is their patients, their families, and the
community. They are committed to increasing access to hospice care, providing
community education and outreach, offering special programs enhancing quality of
life, and activism in local, state, and national healthcare and hospice organizations.

Their philosophy focuses on the importance of advocating the needs of the


terminally ill.

The mission of Community Hospice of Texas is to provide compassionate end of life


care services.

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Their vision is to be the recognized leader for end of life care in all of our
communities.

Staff employed within the James L. West Alzheimers Facility:

Hedieh Davanloo, M.D., Geriatric and Internal Medicine

Janice Knebl, D.O., Geriatric Medicine

Alvin Mathe, M.D., Hospice and Palliative Medicine

Amy Moss, M.D., Internal Medicine

Timothy Allen, M.D., Internal Medicine

Population Served
The Community Hospice of Texas serves 25 counties in North Central Texas and
serves approximately 3,562 unduplicated patients annually.

Eligibility
To be eligible for hospice care at the Community Hospice of Texas Hospice House in
James L. West Alzheimers Facility, patients must have a: diagnosis of a life limiting
illness, a desire for comfort care rather than curative care, and Alzheimers.
Geographic Area
The Community Hospice of Texas has numerous facilities and serves both rural and
urban areas. The counties served under the hospice include the following: Bell,
Bosque, Collin, Coryell, Dallas, Denton, Falls, Freestone, Hamilton, Hill, Hood,
Johnson, Kaufman, Leon, Limestone, McLennan, Milam, Navarro, Parker, Robertson,
Rockwall, Somervel, Tarrant, & Wise.
Target Group Description
Since the hospice/ Alzheimers patients are not in good physical state to directly
target the program to, it is important to target those people who are responsible for
the patients well being. The in service program would target the family

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members/caregivers of the patient in hospice care as well as the staff employed
within the Community Hospice of Texas Hospice House in James L. West Alzheimers
Facility. Even though family members/ caregivers are not a part of the medical
system, it is important for them to be knowledgeable of what is going on and to
hold the staff members of the facility accountable for their treatment and care to
the patients.
The caregivers and staff can come from all levels of socioeconomic statuses, race,
and sex. The staff at this particular facility has completed some level of professional
school (M.D. and D.O.).
Dental Needs of the Target Group
The patients who are in hospice are in need of routine dental maintenance as well
as possible visits from the dentist to monitor tooth wear, pain, and infections. The
general population may not be aware of the importance of maintaining optimal oral
health which will result in enhancing overall health. The hospice facility mentioned
that they advocate the importance of the needs of the terminally ill. Dental care
should be considered as one of these needs.
Oral problems can develop as a side effect of medications that are used in the
treatment of systemic disease, and can also be linked to development of
cardiovascular disease/ other illnesses. It should be a goal to decrease the pain,
morbidity, and potential for local or disseminated infections of dental origin.
Target Groups Ability/Inability to Access Health Care Services
Prior to being in hospice, the Alzheimers patients may have had cognitive and
physical challenges in maintaining good oral health and access to dental care. Now
that these patients are in a hospice facility, their condition may be so extreme and
terminal that they are dependant of other people to provide the dental care that
they need. This begins with a concerted effort between the patient and the
healthcare and dental teams. The chosen facility does not have a dentist as part of
the team (only M.Ds). This could limit the ability of the patients in hospice to have
access to more extreme dental services. Also, there may be a conflict between the
caregiver and the dental professional due to the caregivers lack of interest in need
for dental care for someone who is in hospice or near death. This could also limit the
amount of dental care that could be provided for these patients.
Literature Review

Kim, Fall and Wang (2005) acknowledged that for dying patients, it is most
important to improve quality of life and relieve suffering. Therefore, the quality of
life is important for those patients who are in hospice facilities. Palliative care can

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be defined as the active total care of patients whose disease is not responsive to
curative treatment (Kim, Fall, Wang, 2005). According to Saini et al. (2009),
palliative care for the terminally ill is based on a multidisciplinary approach to
provide whole person comfort care and maintain optimal function. Interdisciplinary
teamwork is vital to ensure that every patient need is fulfilled and a holistic
approach to the patient and family is maintained (Kim, Fall, Wang, 2005). It would
be reasonable to assume that dentists are involved in the interdisciplinary team at
hospice facilities. However, in reference to research conducted in 2011, dentists
have not been included as members of the hospice care team, even though the
need has been reported (Wilwert et al, 2011). If dentists were involved in hospice
care, they could prevent symptoms from escalating and significantly improve the
patients end of life quality.
A report from the U.S. Surgeon General noted that oral problems (e.g.,
dental caries periodontal disease, tooth loss, dry mouth, oral cancer, chewing
problems, pain or discomfort) in older adult and disabled populations are the most
common unmet health needs, and that oral diseases are often related to general
health problems (Bilder, Yavnai, Zini, 2014). The prevalence of oral disease and
symptoms among patients in hospice programs is high (Wilwert et al, 2011).
Improper maintenance of the oral cavity, infections, or lesions could have significant
impact on patients with advanced diseases (Kim, Fall, Wang, 2005). As stated by
Saini et al. (2009), there are studies that demonstrate presence of candidosis in
hospice patients oral cavity along with twenty to thirty-five percent of patients with
active dental caries, thirty-six percent of patients with gingivitis, patients with
xerostomia, swallowing problems, and pain.

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Dental care for the institutionalized is often limited to emergency care and is
not aimed to daily oral care (Bilder, Yavnai, Zini, 2014). Although traditional oral
hygiene may not be possible for patients who are in hospice, there are still
palliative care strategies that can give the patient comfort and enhance the
patients overall health (Saini et al, 2009).
Hospice programs in Iowa, have dentists who have been involved in the care
of the facilitys admitted patients. With the use of a survey to request information
from dentists who were found in the Iowa health Professional Database, it was found
that forty-six percent of the participants had some involvement in hospice care
(Wilwert et al, 2011). Dentists did procedures ranging from denture relines,
examinations and emergency treatment.
If dentists were part of the hospice team, they could help maintain oral
hygiene, pursue with dental examination to locate infections or dental diseases, and
reduce the risk of oral pain/symptoms. Also, if a dentist is not available, a team
work effort followed by the non-dentist palliative care physician and other staff
members could take place.
The suggested in -service program that targets the caregivers and staff
members at hospice facilities such as The Community Hospice of Texas and focuses
on the importance of oral care for hospice patients could be beneficial in bringing
new knowledge and awareness to the facility. The medical doctors on staff at the
hospice facility can learn palliative oral care strategies and the caregivers can hold
them responsible to perform these treatments. Dental care may be important in
allowing a patient to eat properly, speak, and be relieved from infection and pain.

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Future consideration should be taken for placing an actual dentist on the
hospice staff so that a multidimensional team effort can take place to make patients
as comfortable as possible. If dentists are to be included in hospice care, they will
need to have the proper education and training to treat patients in this type of
condition.
The review of the literature proves that there is a need for dental care
treatments for patients who are in hospice care. As stated by Wilwert et al. (2011),
the palliative approach of oral care for hospice patients is done with the purpose to
enhance the quality of life.

References
Kim, A., Fall, P., Wang, D. 2005. Palliative care: optimizing quality of life. J Am
Osteopath Assoc., 105 (Suppl 5): S9-14.
Saini,R., Marawar, P., Shete, S., Saini, S., Mani, A. 2009. Dental expression and
role in palliative treatment. Indian J Palliat Care, 15 (1):26-29.
Wilwert, MM., Watkins, CA., Ettinger, RL., Cowen, HJ., Qian, F. 2011. The
involvement of Iowa dentists in hospice care. Special Care Dentist, 31(6): 204-9.
Bilder, L., Yavnai, N., Zini, A. 2014. Oral health status among long- term
hospitalized adults: a cross sectional study. PeerJ , (1):423.

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DEVELOPMENT PHASE
Goal
To promote the need of dentist involvement in the interdisciplinary care for people
in hospice facilities and to raise awareness of the importance of maintaining optimal
oral health which will in turn enhance their overall health.
Objectives
Define palliative care and the role this type of care has in hospice facilities.
Discuss the relationship between oral health and overall health, as well as,
the significance/impact of managing oral care for patients with Alzheimers in
hospice facilities.
Describe the various issues that can develop in the oral cavity: dental caries,
periodontal disease, tooth loss, dry mouth, oral cancer, chewing problems,
pain or discomfort, and enhancement of systemic diseases.
Identify appropriate dental treatments that hospice patients may receive to
improve overall well being.
Program Planning

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Participants of the in-service program will view an instructional Prezi presentation
related to the goal. A photograph slide show of the different oral diseases and
lesions taking place in the oral cavity of geriatric patients/ patients with special
needs would be included to heighten the effect of how serious this matter is.
Handouts would include informative information for caregivers and family that
would help them to understand the importance of providing oral care to hospice
patients. Models would be passed around as another visual aid. A video would be
shown of guest speakers who support the inclusion of dentists in the
interdisciplinary team at hospice facilities. The audience would have the opportunity
to participate in an open discussion where they can voice their opinion on why they
think dentists should or should not be involved in the interdisciplinary team at a
hospice facility.
See Powerpoint