February 22, 2018

Increasing Access To Dental Care For Seniors To Improve Overall Health


Shirley, like other senior residents in downtown San Diego, faces stark choices in day-to-day life. With more than 40 percent of seniors in San Diego living below the self-sufficiency level, many, like Shirley, have to choose between paying rent and buying medicine, between purchasing food and taking care of their teeth—choices none of us would ever want to make.

Shirley is among many low-income seniors who are missing some or all of their teeth because of lack of access to affordable oral health care. When Shirley was growing up, her mom never took her to the dentist because the family didn’t have the money for routine dental care. As an adult, most of Shirley’s teeth have been pulled to avoid more costly options, such as implants, bridges, or crowns.

San Diego’s lower-income senior community mirrors nationwide trends: nationally, more than 70 percent of seniors have periodontal disease, which can often lead to increased risks of acquiring other diseases, including heart disease and stroke, among others. In addition, poor oral health can directly impact nutrition, self-esteem, and mental health. Nationwide, less than 20 percent of seniors with incomes under the Federal Poverty Level saw a dentist in 2013.

In San Diego, a beacon of light for many seniors like Shirley has been the Gary and Mary West Senior Wellness Center, operated by one of the Gary and Mary West Foundation’s flagship grantees, Serving Seniors. That nonprofit provides disadvantaged older adults with access to daily nutritious meals and to more than thirty nonprofit organizations offering comprehensive, holistic, and coordinated care such as clinical, behavioral health, housing, and other social services and supports.

Our founders, Gary and Mary West, and the entire foundation team regularly volunteer at the Senior Wellness Center. We see, firsthand, the many challenges of poor oral health care. Seniors who have not had good and regular care experience pain or have missing teeth, and this affects their ability to eat meals that the Senior Wellness Center provides. Others cover their mouths with their hands when speaking because they are so self-conscious about their teeth or have trouble swallowing food because of gaps in their teeth that prevent them from closing their mouths completely. Dental care is clearly a critical service these seniors need.

Our journey to develop an innovative approach to addressing oral health care needs was the subject of a February Grantmakers in Aging (GIA) webinar titled Reimagining Oral Healthcare for Our Nation’s Seniors. We discussed how the West Foundation has already invested more than $1 million to create the state-of-the-art Gary and Mary West Senior Dental Center, which is scheduled to open later this year. The Senior Dental Center will be integrated within the Senior Wellness Center, so that community-based clinical, dental, and social services all will be provided under one roof.

Every senior who visits the Senior Dental Center as a client will receive a Comprehensive Geriatric Assessment designed to evaluate his or her functional ability and physical, dental, mental, and other socioenvironmental circumstances to ensure that he or she receives the right care at the right time. Our goal is to ensure that older adults receive the holistic care and services that allow them to stay healthy, regardless of their ability to pay for services.

We are also exploring which are the appropriate payment and reimbursement models to tackle the cost and access barriers that continue to be a challenge for seniors to receive proper oral health care. Medicaid only provides limited dental coverage that can vary by state and, unfortunately, these adult dental benefits can be unstable because they are vulnerable to being reduced or eliminated during periods of financial crisis when states constrain spending to balance their budgets. This happened in California in 2009, after which, for a period of five years, all adults on Medi-Cal (California Medicaid) had no covered dental benefits until 2014 when some of the adult Denti-Cal benefits were restored, but at reduced levels.

In California, dentists who accepted Denti-Cal were only reimbursed for 29 percent of commercial dental insurance charges in 2014. This has resulted in a lack of providers willing to accept Denti-Cal because the reimbursement rate is so low. Research conducted by the Gary and Mary West Policy Center in Washington, D.C., will help us advocate and work collaboratively with others to advance policies that have the greatest potential for increasing access to oral health care for seniors.

Through the shared efforts of the West Foundation, the related West Health Institute, and Serving Seniors, we are embarking on research studies to look at the impact this unique oral health and care coordination model at the senior center will have on seniors’ health outcomes and quality of life.

Opportunities such as the GIA webinar help us build public awareness and provide a platform to invite others to join us in our work to advance a truly integrated approach to care that enables seniors to age successfully and protects their dignity, quality of life, and independence.

We want all seniors who are like Shirley—in downtown San Diego and around the nation—to have the opportunity for optimal health and well-being. Improving access to oral health care is essential to achieving this goal.

Editor’s note: The California Wellness Foundation and the County of San Diego have also provided funding for the Senior Dental Clinic mentioned above.

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