PRINCIPAL INVESTIGATOR: Michael MacEntee
SUMMARY: Open-ended interviews were conducted with 109 individuals, including administrators, staff, dental personnel, residents and family members, associated with 12 long-term care (LTC) facilities to contrast different human resource and organizational strategies for managing the delivery of oral health-care to the elderly residents. In addition, a dentist examined a small selection of the residents as a clinical reference for the interviews in each facility.
A multiple case-study analysis revealed that no particular organizational strategy was ideal, although three important components – oral hygiene, diagnostic assessments, and dental treatment – were common to all. The dentists felt adequately educated for the service in this setting, however, the dental personnel everywhere felt that oral health in the midst of other conflicting priorities received inadequate attention.
The administrators and staff did acknowledge readily that they were weak at recognizing oral disorders and assisting with oral hygiene. Salaried dental personnel with an on-site clinic, although very expensive, offered the environment that felt to those involved most conducive to comprehensive care.
In contrast, there were strong reservations about the economic sustainability of a salaried service and about the professional viability of fee-for-service in the context of LTC.
Overall, the residents were content with the services they received, and there was no obvious difference in clinical status that could be attributed to any particular strategy of care. Oral care specialists selected from among care-aides in one facility were considered particularly helpful in that facility, whilst on-site treatment and regular participation of dental personnel at the residents’ care conferences appeared to many as central to a good oral health service.
In all, the interviews offered a portrait of the conflicting priorities associated with LTC, and they provide practical insights to successful strategies of care in this population.
CO-INVESTIGATORS: Sally Thorne, Arminee Kazanjian
FUNDING: $57,550
SOURCE: Medical Research Council of Canada, and BC Health Research Foundation
DURATION: 1996-1998