Dozens of Rhode Island nursing homes are having trouble offering dental services to their residents following the recent withdrawal of one of two providers from the market.
Roughly 40 facilities were left without contracts for dental services late last year after Access Dental Care of North Providence notified them that it would “no longer be able to perform dentistry” in the homes. In a letter to the facilities, it cited the physical challenge of providing care outside the office.
Access Dental officials could not be reached for comment.
That leaves only one company, Newton, Mass.-based HealthDrive Medical & Dental Practices, providing dental services to Rhode Island nursing homes. While HealthDrive has been able to pick up some of the slack, it appears many nursing homes – potentially representing thousands of residents – are without access to dental care.
Eight of 24 facilities surveyed last month by the Rhode Island Health Care Association, which represents for-profit nursing homes, said they did not have a dentist or dental hygienist available to them. There are about 100 nursing homes in the state.
Nursing homes by law are required to make available dental services to their residents. While some residents are able to visit dentist offices, most are treated on site via contracts with providers such as Access Dental or HealthDrive.
The crux of the recent problem, administrators and state officials say, is that most nursing home patients are covered by Medicaid, the state/federal medical program for the poor and disabled. Dentists in Rhode Island long have complained that reimbursement payments from Medicaid do not come close to covering the cost of treating patients.
John E. Gage, administrator at the 120-bed Riverview Healthcare Community nursing home in Coventry, said he recently made 10 calls to dentists in an effort to schedule an appointment for a resident who was in pain from grinding her teeth. The facility was left without a dental provider when Access Dental pulled out.
“They all said, ‘Sorry, we’re not taking new Medicaid patients,’” Gage said. He added that nearly 70 percent of his patients are covered by Medicaid.
The situation now facing the nursing home industry is part of a broader problem of inadequate access to dental services for low-income and disabled Rhode Islanders. A special state Senate commission issued a report in late 2001 that noted shrinking access to oral health care among Rhode Island Medicaid recipients.
The new access crunch at nursing homes has drawn attention from state officials in recent weeks. Sen. Elizabeth H. Roberts, a Cranston Democrat, last month assembled a committee representing nursing homes, dentists and state health and human services regulators to address the problem.
Ultimately, Roberts said the state must raise Medicaid reimbursement rates for dental services – which have been stagnant for more than a decade – in order to entice more dentists to see Medicaid patients.
“The long-term solution is to make Medicaid rates match the actual cost of providing services,” said Roberts, who is sponsoring a bill that would, in part, boost fees for dental procedures. She conceded, though, that any increase in rates this year is doubtful given the state’s budget shortfall.
In the meantime, officials are focusing on alternative solutions.
One possibility is to have dental hygienists provide basic dental screenings and cleanings at nursing homes while bringing in dentists for formal exams or procedures. That, however, would require the state to relax regulations that prohibit dental hygienists from working on patients without a dentist on site.
Another potential solution: creating a mobile dental service to visit nursing homes and other Medicaid populations, funded either through the state or charitable contributions. The state of Minnesota has such a program, according to members of the committee.
“We’re going at this from a number of different angles,” said Al Santos, executive director of the Rhode Island Health Care Association.
Riverview eventually contracted with HealthDrive for dental care – but there was a catch. Gage said the company would only agree to a contract for dental services if the nursing home also agreed to use HealthDrive for podiatry, optometry and audiology. Gage said he was told that those other contracts were necessary to make up for anticipated losses from providing dental care. HealthDrive officials could not be reached for comment.
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