Activities like bathing, showering, toileting, brushing teeth, cleaning hearing aids, or other personal care needs are known as “Activities of Daily Living.” They are to be provided or assisted with, as needed, by the caregiving staff daily.
Providing or assisting with activities of daily living (ADLs) may not be the most pleasant, but they are essential … particularly oral care. After all, nutrition begins in the mouth, and a clean mouth and good oral are critical to health.
Medications may cause dry mouth, and patients may lose the ability to enjoy the taste of food or the desire to eat and drink. A dirty mouth is not appetizing, gives the patient bad breath, causes gum disease, and leads to tooth loss.
Sadly, perhaps due to negligence, lack of staff, staff not interested, or not enough time, teeth may get “overlooked” and “forgotten”. The patient can develop painful sores, terrible breath and rotten teeth which eventually leads to tooth loss.
Recently one family member told me she had to go to the nursing home every day to brush her husband’s teeth because the nursing staff never did.
Not an Isolated Incident
Unfortunately, this is not an isolated incident. Another family member told me his father’s electric toothbrush had not been used in days.
Nursing staff have been trained to provide ADLs, including oral hygiene; when they are not provided, it is a deviation in the standards of care.
Teeth must be brushed daily. When you notice that they have not been brushed, promptly bring it up to the administration, the nursing staff, and especially the caregivers in charge of your loved one.
Often, due to this type of neglect, there is even more of a need to see a dentist. Seeing a dentist throughout our lives has been important and must continue while a person is in the facility, no matter the type of facility the patient is in.
Remember that if a dentist is needed to see patients and residents, this service must be available and provided in facilities. The administration will take care of the appointments and transportation, but you also need to be aware and follow up the dental appointment is provided.
Daily oral care and hygiene are necessary to maintain a quality of life, but sadly in too many long-term care facilities, this care may be poor or never provided at all. In such cases, the providers are out of compliance with the guidelines and protocols.[1]
It May be Challenging
Providing oral hygiene can be challenging if a patient has dementia, does not understand what is being done, does not open the mouth, or refuses to cooperate.
Dementia patients often bite down on the toothbrush, do not rinse, or spit out the oral rinse. They may become agitated when care is provided and hit or kick.
But having a diagnosis of dementia does not mean oral care will not be nor cannot be provided. The standard of nursing care requires that care be provided for quality of life and health.
Different toothpaste, brushes, and toothette swabs are available to provide ongoing care. Special types of oral rinse or plain water can be used if the patient swallows after brushing or cannot swish and spit.
Proper oral care is essential because the outcome of not brushing can be devastating.
A case I reviewed reflected that daily oral hygiene was never provided.
This 50-year-old gentleman had been a professional, high profile in his community, and a dignified man in his working life. His hygiene was always immaculate, brushing his teeth twice daily per his wife.
Upon admission to the long-term care facility, he had all his teeth, which were in good condition and repair. Before admission to the facility, he had appropriate healthcare and saw his dentist regularly for cleaning and oral needs.
Sadly, he was a victim of a stroke while working. He was hospitalized and was later placed in a long-term care facility. His family could not provide for and meet his personal needs at home.
While a resident in a long-term care facility, oral hygiene was not provided. His wife even wrote notes to the staff and administration, pleading, “Please brush his teeth daily.”
But unfortunately, the brushing of his teeth did not occur. Eventually, his teeth became rotten, gum disease occurred, and all the teeth had to be pulled.
Do Not Let This Happen!
Due to loss of income, he was now on Medicaid for the facility payment of “care.” Medicaid covered pulling his teeth but did not pay to provide him with false teeth. His family could not pay the cost of false teeth, and he was left with only his gums to start “chewing” his food.
As we know, the texture of food is important for us to enjoy the food we eat. The gentleman did not like being limited to liquid and pureed foods and often refused his meals after his teeth had been pulled.
Over time, this man wasted away, not eating and losing weight.
He suffered an early demise due to staff negligence[2], not having his teeth brushed. Unfortunately, the nursing staff did not honor but ignored the wife’s request to “Please brush his teeth daily.”
Clearly, the nursing standard of care was ignored.
The brushing of teeth should have been provided if the facility had sufficient and knowledgeable nursing staff to meet their resident’s needs.
In another case, in the hospital, a set of hearing aids were lost by the hospital staff. The hospital had the policy to replace these $5,000+ hearing aids.
The same should apply to dentures or partial dental plates. That’s why these items should be placed on the list of personal belongings on admission. If the facility loses these items, ask that the facility replace them. Do not just assume “they are gone.”
“Neglect” means the failure of the facility, its employees, or service providers to provide goods and services to a resident necessary to avoid physical harm, pain, mental anguish, or emotional distress.
Per 42 CFR 483.25 Activities of Daily Living, “The facility must provide, based on the comprehensive assessment and care plan and preferences of each resident, an ongoing program to support residents in their choice of activities…”.
In the above case, basic oral care was not provided, and the nursing standard of care was violated. [3]
[1] [2] [3] 42 CFR 483.25 – Quality of care
Thoughts? Questions? Leave a comment below and let me know what you think.