Financial, physical, mental barriers can squeeze seniors out of dental care

HIBBING, Minn. -- When Sunrae Beasy needs to visit the dentist, it's a 300-mile round trip.

Beasy, a patient at Chris Jensen Rehabilitation Center, suffers from seizures and dementia, said her sister, Jewel Skahl, 71, of Hibbing. Jensen is "hard to manage," Skahl said.

So to receive dental care, Beasy needs to be under sedation, and currently the only place Skahl knows to bring her sister is the University of Minnesota School of Dentistry in Minneapolis.

Beasy, who had two teeth removed during her last visit, is an illustration of the special challenges that can occur in providing dental care for senior citizens.

"Some residents -- as they age -- a lot of the follow-up care for dental is not being done," said Barbara Frosch, clinical director for The Shores, the assisted living and memory care facility at Ecumen Lakeshore.

The reasons, Frosch said, can be financial, physical or mental. The former starts with the fact that Medicare doesn't provide dental coverage. Seniors who want dental benefits need to purchase supplemental coverage -- if they can afford it.

Medicare, Medicaid

"It's very unfortunate that Medicare doesn't have a dentall component," said Cheryl Larsen, dental manager at the Lake Superior Community Health Center, which provides care on a sliding scale based on income. "It has been a thorn in my side for all of the time I've been in dentistry, almost 20 years."

People whose income is low enough to qualify can get dental coverage through Medicaid in both Minnesota and Wisconsin. In fact, Minnesota ranked first and Wisconsin fifth in the country in a 2013 report on dental care for seniors compiled by Oral Health America, a Chicago-based nonprofit. Each state got a top score in the adult Medicaid coverage category.

But seniors with too much money to qualify for Medicaid still might not be able to pay for dental procedures.

"If you're hit with an extremely painful dental need and have to pay for an implant or a bridge, it can cost thousands of dollars," said Dora Fisher, director of older adult programs for Oral Health America.

Moreover, Medicaid -- known as Medical Assistance in Minnesota -- is only effective when medical professionals accept it.

"Even if you are on Medical Assistance, it's sometimes difficult to find an available dentist," said Marjori Bottila, Contact Center coordinator for the Senior Linkage Line at the Arrowhead Agency on Aging. "It's not an automatic that every dentist participates."

Whatever the reason, some people in all age groups are skipping dental visits.

Dentistry in the ER

When people don't see the dentist, it can develop problems that lead to the emergency room. The emergency department at St. Luke's hospital in Duluth saw 441 oral health cases last year, according to its medical records department. Eighteen of those involved patients 65 or older.

That's not good on two counts, said Dr. Alejandro Aguirre, a Twin Cities endodontist who is chairman of the Minnesota Mission of Mercy that will provide two days of free dental care this weekend in Duluth.

"It's way more expensive to see a patient in the emergency room," Aguirre said. "And really the problem is not corrected properly."

Dr. Christopher Delp, an emergency physician at St. Luke's, agreed.

"We're not dentists, and we're being forced into a role for emergency dental care," Delp said. "Our training is just enough to provide the stopgap measures and refer them to dentists. And you find out that referral means nothing because they can't afford to go to the dentist or they can't get there."

When senior citizens come to the ER, their oral health cases tend to involve infections and are more serious than those seen in younger people, Delp said.

"For a multitude of reasons, (seniors) don't come to the ER right away," he said. "They have higher pain tolerance. They are reluctant to present to the emergency department."

But their infections can be life-threatening, Delp said. He told of a patient a little more than a year ago who came to the ER with an infection on the floor of the mouth that caused rapid swelling and was threatening to cut off the patient's airway.

All of the oral health cases seen in the ER could have been prevented, Delp said, and it's such cases that place a strain on emergency department resources.

"Our ER has gotten increasingly crowded, and wait times are unacceptable," he said. "That's one of the biggest frustrations of our job."

Other choices

In the Twin Ports, some lower-cost dental care options are available. During the school year, Lake Superior College's dental clinic provides preventive care through its dental hygiene program.

The Lake Superior Community Health Center operates dental clinics in both Duluth and Superior, offering services on an income-based sliding scale for people who don't have insurance.

The Duluth clinic has two full-time dentists, one part-time dentist, three dental hygienists and seven dental assistants, Larsen said.

But the clinic is swamped, seeing 280-300 patients a week, she said. Patients are seen by appointment, but walk-ins with emergency dental needs also are accommodated. And that's where the strain comes.

"There have been days that we have had about 12 emergency walk-in patients in addition to the schedule," Larsen said. "We will take the ones that we can take."

Others are sent upstairs to the medical clinic, she said.

The need is greater than the capacity, Larsen said.

"If we had the staff and the facilities, we could probably expand our dental clinic threefold and be full," she said in late June. "I had to go to the end of August to (schedule) a cleaning appointment. We just don't have the physical capacity."

Different challenges

Some senior citizens face barriers that have nothing to do with money or dentist availability.

"If they're wheelchair-bound, they may not be able to get out of their wheelchair and into their exam chair," said Jena Evans, marketing manager at Ecumen Lakeshore. "That presents a different kind of challenge."

Still another set of challenges faces people with dementia, said Frosch. At least half of the 20 residents in memory care at The Shores have dental issues, she said.

"They can't tell us there's an issue," Frosch said. "It's my staff that are noticing their gums are bleeding or they're pocketing their food. ... And some people can't communicate to you that they're in pain."

One memory care resident was taken to the dentist for an abscess, she said. The woman was confused by the process and resisted. Her family evaluated their mother's status: She was still eating and she was maintaining her weight. They chose not to send her to the dentist again.

Evans and Frosch said they'd like to see dental care come to Ecumen Lakeshore. Other services come to the senior care complex, such as a regular podiatrist visit, they said.

Dental care is often brought to schools or to other venues with children, they said. But senior citizens don't get the same attention.

"Children are always considered for their dental care, which is extremely important," Evans said. "I think it's exactly how it should be. However, the elderly people are forgotten. ... Their cares and needs are an afterthought."