While the focus of the last year has been on protecting seniors from the coronavirus pandemic, the Minnesota Veterans Homes have continued a holistic approach to residents’ care by expanding an oral health program that provides on-site dental services, thanks in part to a generous grant from the Delta Dental of Minnesota Foundation.

Residents of the Veterans Homes, similar to Minnesota’s overall elderly population, may have a variety of chronic health issues, many directly affected by poor oral health such as dementia, cardiovascular disease, diabetes, history of stroke and respiratory diseases to name a few. While important to overall health, oral health is often lacking in long-term care and skilled nursing facilities.

“In general, there is a lack of a proper oral health education program and training for the elderly,” explains Simone Hogan, Senior Director - Veterans Healthcare, MDVA. “The Minnesota Veterans Homes are closing the gap on continuity of care and the importance of good oral care, which has a direct impact on overall health.”

On-site Dental Care 

In June 2018, the Minnesota Veterans Home - Minneapolis opened its on-site dental clinic (the first in the nation!) through the support of the Delta Dental of Minnesota Foundation and other community organizations. A second grant from the Delta Dental of Minnesota Foundation awarded in December 2020 is furthering the Veterans Homes’ mission to provide dental services to 700+ Residents of all five Minnesota Veterans Homes. In addition to Minneapolis, Minnesota Veterans Home are located in Fergus Falls, Hastings, Luverne and Silver Bay.

The latest Foundation grant will fund expansion of preventive services through products, equipment and oral healthcare education and training for staff. Each outstate location will receive a special mobile dental chair. The mobile clinic will also purchase back-up equipment such as a sterilizer, portable x-ray machine and a portable compressor.

The mobile dental chairs provide better ergonomics for the staff, improved access to the oral cavity, as well as increased comfort for the residents. These chairs will support expanding dental services beyond preventive care in the outstate Homes. “We will be able to do some prosthodontics, oral surgery and minor restorative procedures,” Hogan says. These chairs will also allow expanded access to dental care and services for residents who have challenges seeking appropriate dental care elsewhere because of physical and cognitive limitations.

Katie McNamara, RDH, Veterans Homes Dental Coordinator, is excited to see the oral health program expand. “This new funding will help us provide products like Silver Diamine Fluoride, fluoride varnish and pre-rinse with all initial and annual dental appointments, a benefit to all residents. These products are inexpensive and non-invasive ways to treat and prevent decay, especially in this elderly population.”

Indeed, over the past three years, the Veterans Homes Dental staff have observed that the use of these products plus regular preventive cleanings have resulted in improved gingival health and retention of dentition due to a general decrease in oral bacteria. The Dental team believes that a concerted effort using these products will keep this trend moving forward.

Staff Training

“The staff education component is the piece I’m most passionate about,” Katie says. The Delta Dental of Minnesota Foundation Grant is supporting the development and implementation of a comprehensive oral health education program for direct-caregiver staff. “This is a pivitol component in our state’s Oral Health Care Inititive Program,” Katie believes. “This piece will give staff both the knowledge and skills to properly monitor and address specific oral care needs of the challenging senior population we serve.”

Because the Dental team only sees residents once or twice a year, direct-caregivers and family members are key to overseeing and maintaining residents’ oral health. “This truly completes the circle of care and the importance of good oral care, which has direct impact on overall health” Katie notes.

In addition to Katie who is a Dental Hygienist, the Veterans Homes’ dedicated Dental staff includes Dentist Dr. Marcus Gustafson, DDS, and Dental Assistant Christee Kordosky.

Key components of the staff training include:

• Current and newly hired direct-caregiver staff attend a class that teaches:
  • The impact of oral health on overall health, especially in the geriatric population.
  • Types of oral infectious diseases, how they occur, effects if left untreated and preventive strategies to stop or slow down oral infections.
  • Oral Health Care Plans and proper techniques to perform them.
  • Strategies and person-centered techniques that can assist and increase confidence of direct-caregiver staff when providing oral care to residents with physical and cognitive impairments.
  • Demonstrations of oral care techniques.
• A one-on-one competency test on providing proper oral care conducted by a Dental staff member with a direct-caregiver staff and a resident.
• Training videos for off-site training and Annual Continuing Education training of direct-caregiver staff.
• Developing “Oral Healthcare Champions” for each building, floor or unit who are an additional resource for direct-caregiving staff and a liaison to the Dental Team, reinforcing the importance of oral care as part of overall resident care.

When family members are able to return to the residents’ floors, they will be provided with oral health education and training as well.

“We are extremely grateful to the Delta Dental of Minnesota Foundation for their generous support,” said Douglas Hughes, Deputy Commissioner – Veterans Healthcare, MDVA. “Our oral health initiative is a program that emphasizes and supports the concept that oral health is important at every age and it has a direct correlation to one’s overall health.”

Success Stories

The Silver Bay Veterans Home has realized the benefits of a comprehensive oral health program. Two residents in particular are all smiles now due to dental care they received.

In 2020, Resident David Beasley had been hospitalized for more than three months due to several medical challenges. When he was released back to the Silver Bay Veterans Home, he was not able to eat very well because of changes with his dentition and his lower partial. He was losing weight which affected his overall recovery.

Because he was not a candidate to see a local dentist, the Dental team’s Dentist Dr. Gustafson and Dental Hygienist Katie McNamara traveled to Silver Bay to assess Mr. Beasley’s situation and provided necessary adjustments to his lower partial. This improved his ability to eat more substantial food, leading to weight gain and a better recovery. The Dental team also educated him about his immediate and long-term options, once he was in a better health. He so appreciated the visit.

While at the Silver Bay Home, the Dental team also assessed five other residents with dental concerns and developed a plan to treat them.

More recently, in February Resident Richard Bunker needed an infected upper molar extraction; the procedure was successfully completed on site. This allowed the resident to avoid leaving the premises and traveling to see an oral surgeon in Duluth, a potentially lengthy and tiring trip. The Dental team was able to monitor Richard’s post-op recovery to ensure a good outcome.

The Dental team and their important services have been warmly welcomed at the Minnesota Veterans Homes. They are proud to provide this special care, leaving everyone all smiles.