Oral health in residential care
You may recall a recent report from the Care Quality Commission (CQC) regarding oral health in residential care settings. CQC inspectors visited 100 residential care homes for either older people or those with a disability. Their findings show that too many people living in care homes are not being supported to maintain and improve their oral health. Three years on from the publication of the NICE guideline (NG48), oral health in care homes is still not a priority and people are not always able to access the dental care they need.
This guideline recommends that “care staff carrying out admissions or assessments assess the mouth care needs of all residents as soon as they start living in a care home, regardless of the length or purpose of their stay.” Although 73% of care homes said people had some form of oral health assessment, they varied in detail and less than half of all care homes (44%) used a recognised assessment tool.
CQC reports some excellent examples of person-centred care planning, which was driven by a thorough assessment of a person’s preferences and needs. However, when they reviewed 291 care plans across the 100 care homes that they visited, they saw that: 27% of care plans fully covered oral health, 63% of care plans partly covered oral health 10% of care plans did not cover oral health at all.
Of the care home managers spoken with, 39% were not at all aware of the guideline and only 28% had heard of it and read it. Of those who had heard of it and read it, only 39% felt they had fully implemented the recommendations.
Once people are living in a care home, it is expected that all dental check-ups or treatment will be recorded in their care record, usually within its ‘professional visits’ section. There were some care homes where a member of staff reported they recorded such visits, but there was no evidence of this taking place. Issues with recording can mean that care home staff are unable to fully understand people’s care needs. For example, a lack of information about someone’s poor oral health may prevent staff from monitoring their eating and drinking, which could lead to tissue viability issues, such as pressure ulcers, resulting from malnutrition.
Action for readers:
- Make the NICE guideline (NG48) the primary standard for planning, documenting, and delivering oral care within your organisation: https://www.nice.org.uk/guidance/ng48
- Make sure that your organisation’s care plans are up to date with regard to oral health for adults at risk.
- Read the CQC report: https://www.cqc.org.uk/sites/default/files/20190624_smiling_matters_summary.pdf