BIBLIOGRAPHY Brody, E. M. and Spark, G. M. Institutionalization of the aged; A family crisis. Family Process. Vol. 5, #1, March, 1966. Butler, C. Pastoral needs of older persons: A clinical approach. of Pastoral Care. Vol. XXII, #2, 75-81, June, 1968. Journal Chaplain's Department. Guidelines and procedures for clergymen who serve in Lutheran hospital and medical center. Wheat Ridge, Colorado. Kastenbaum, R. Old age as a social issue. The Journal of Social Issues. Klink, T. W. Pastoral care of the long-term patient. Pastoral Psychology. Vol. 19, #188, November, 1968. Lieberman, M. A. and Lakin, M. On becoming an institutionalized aged person. Processes of Aging. Chapter 22. pp. 475-503. Edited by Richard H. Williams, Clark Tibbits and Wilma Donahue. New York: Atherton Press, 1963. Maves, P. B. Aging, religion, and the church. Handbook of Social Gerontology. Chapter 29, pp. 698-749. Edited by Clark Tibbits. University of Pederson, W. D. The broadening role of the hospital chaplain. Hospitals. Vol. 42, pp. 58-60, May 1, 1968. Reisch, H. W. The minister and the elderly. Pastoral Psychology. #170, pp. 41-48, January, 1967. Vol. 17, Stark, R. Age and faith: A changing outlook or an old process. Sociological Analysis. Vol. 29, #1, 1-10, Spring, 1968. Bibliographic Assistance by: Mrs. Priscilla Kirshbaum Ira J. Taylor Library Illif School of Theology CASE STUDY THE PROVISION OF DENTAL SERVICES IN AN EXTENDED CARE FACILITY Background Information: The Colonial Hills Nursing Home, a 100-bed long-term care facility, wishes to have regular and emergency dental service available for its patients. A local dentist has worked with the owners in designing an area in the home for providing dental services. The patient population of this new home will be drawn from Tiller County and could include a considerable number of welfare patients. The County Health Department has no dental program specifically for the aged. The administrator does not have available good information on the dental needs of a nursing home population. He also does not know how many patients might have their own dentists, how he will staff the home, how much the services might cost, and how the care might be provided. He therefore has asked the local Dental Society for assistance in developing a dental program. The administrator's request for assistance was read at the executive board meeting of the Dental Society with very little reaction. The matter was assigned to the Dental Health Committee. The problem was discussed at its next meeting. All members expressed ignorance about the dental needs of nursing home residents and cautioned against committing the Dental Society to any action without thorough study. They also did not feel justified in developing any type of program for a single proprietary home. For assistance, they asked the Dental Director of the State Health Department to meet with the committee to give them background information and advice. From this meeting, the committee outlined the following approach: Obtain and study information and reports from similar programs. Consider the community-wide problem of providing dental care for home bound and institutionalized chronically ill. Give dental examinations to a sample of this population to obtain Determine how much and what types of dental care these patients were now receiving. 5. Explore the types of portable dental equipment available. Over a period of eight months, the committee: 1. Involved most members of the Dental Society in a survey and learned: a. b. A few patients had their own dentists and would be transported to the office for treatment. Most patients had had no dental service since being admitted. 2 2. 3. 4. Problem: C. d. e. f. g. h. There was general neglect of the teeth, the supporting tissues, and personal oral hygiene. Occasionally dental care was given in the home, but only if emergency in nature. None of the homes in the area had a dental facility or an The nursing home administrators were interested in dental care for patients because of the recent legislation. Many of the patients needed no care, many wanted no care or were too sick to be treated, and many required only minor repairs or adjustments to their dentures. The home bound were apparently receiving only emergency dental care. Learned that other communities had developed successful programs. Learned that there were several types of suitable portable equipment available on the market. Reported their findings to the Dental Society at several meetings. On the basis of the information gathered, the Dental Society is faced with the problem of developing a dental program which will meet not only the needs of Colonial Hills but those of other extended care facilities and the community as well. Question: 1. 2. What procedure might the Dental Society initiate to get a program underway to provide care for institutionalized and home bound chronically ill? What can be expected as the outcome of the Dental Society's action? CASE STUDY THE PROVISION OF DENTAL SERVICES IN AN EXTENDED CARE FACILITY Possible Solutions to Problems and Discussion: Question: What procedure might the Dental Society initiate to get a program underway to provide care for institutionalized and home bound chronically ill? Administrative decisions and action: 1. 2. 3. 4. 5. 6. Question: The Dental Society formed a community-wide committee with representation from the nursing home administrators, medical society, health department, welfare department, voluntary agencies, civic clubs, and the Dental Society to develop community support, explore financing (Old Age Assistance, Medicare, Medicaid, foundations, agencies, and fees), and to consider arrangements for transportation. The Dental Society determined, by questionnaire, those members willing to participate in a program. a. The Dental Society held for its members a short course in use of portable dental equipment and management of the chronically ill patient. The Dental Health Committee, with the assistance of a public health hygienist from the State Health Department planned to give training to nurses and nurse's aides in nursing care of the oral cavity. Nursing home administrators were asked to purchase portable dental equipment. Arrangements were made with the hospital for oral surgery which could not be performed safely in the home or office. A small corps of volunteers was organized to provide transportation for the home bound when the nursing home could not provide it. What can be expected as the outcome of the Dental Society's action? The outcome: 1. In setting up the program, the Dental Society had to take into account 7 -2 2. 3. 4. 5. 6. 7. A group of dentists willing to participate in the program under these circumstances was identified. The dentists agreed to accept welfare fees for medically indigent patients. The nursing homes purchased portable dental equipment and provided suitable space. Patients' oral hygiene was improved through a training course for nurse's aides. Dentists were trained in the use of portable equipment and the Some financing was obtained from community groups and welfare to |