The Care Quality Commission has recently published a review of oral healthcare in care homes, which comes 3 years following the release of the NICE guidance ‘Oral health for adults in care homes’ (NICE, 2016). Their findings suggest that the guidance has had little impact on the quality of oral healthcare in care homes, and that awareness of this guidance is lacking. In summary, CQC found that:
- 52 per cent of care homes had no policy to promote and protect people’s oral health;
- 47 per cent were not training staff to support daily oral healthcare;
- 73 per cent of care plans reviewed only partly covered oral health or did not cover it at all;
- There were consistent difficulties with resident access to dental care;
- 10 per cent of homes had no way to access emergency dental treatment for residents (CQC, 2019).
Dental care for the older adult has changed over the years; there is a greater awareness throughout adult life of the importance of dental treatment and hygiene, and a greater emphasis on “smile-enhancing” cosmetic treatments. Whereas previous generations would be seeking denture care in their older years, now it is likely that they will have kept some, if not all, of their own teeth.
There is strong evidence to support better outcomes and quality-of-life factors for older people who keep their own teeth. A study by researchers at King’s College London Dental Institute found that older people who lose the most teeth are at greatest risk of musculoskeletal frailty as this severely restricts their ability to eat certain foods (Sabbah, 2018).
The NICE (2016) care home guide should be an embedded part of care home policy 3 years on, but there is also a wealth of credible information online and some great evidenced-based ideas to help promote a positive oral healthcare message.
The Healthy Smile, Healthy Me project, undertaken by a team of preregistration nursing students, piloted the development of an “oral health box”. The box contains oral hygiene products tailored to the resident and has a checklist printed on the exterior to prompt good practice and support changes in staff behaviour (McAnulla, 2018). This idea can easily be replicated, for a relatively low cost, and will mean that all the oral healthcare products needed to support the resident are to hand during personal care, while the checklist ensures that some overlooked aspects of oral care, such as brushing the tongue, are not forgotten.
CQC emphasises the need for specific training in this area, but also concedes that due to the requirements of the care certificate, other areas of care staff training are prioritised. They have suggested that oral healthcare become a mandatory component of the care certificate, which may create additional burdens to care homes in terms of training compliance. Rather than having to put their staff through additional mandatory training all at once, it may be prudent to start early by ensuring your current training provider offer some oral healthcare training as part of their portfolio.
To support oral healthcare training for healthcare assistants working in a care home setting, take a look at the clinicalskills.net procedure, “Mouth care in a care home setting”, and the accompanying competency checklist, written by Jackie Hunt of Oxford Brookes University: https://www.clinicalskills.net/node/3823
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Guest blogger Vickie Wylde RGN,
former care home manager
Care Quality Commission (CQC). (2019) Smiling matters: oral health care in care homes. London, UK: CQC.
McAnulla A, Reid B, Zieba M. (2018) Developing an integrated resource to promote oral health in nursing homes. Nursing Older People 30(2): 25–28. PMID: 29480656; DOI: 10.7748/nop.2018.e1019
National Institute for Health and Care Excellence (NICE). (2016) Oral health for adults in care homes, London, UK: NICE.
Sabbah W, Lee S. (2018) Association between number of teeth, use of dentures and musculoskeletal frailty among older adults. Geriatrics & Gerontology International 18(4): 592–598. PMID: 29218839; DOI:10.1111/ggi.13220