Dentist improves dental care in assisted living facilities

By Stuart Boekeloo, DDSPeople may be surprised to learn that a loved one in a senior living facility may be getting his or her teeth cleaned in the hair salon or having foot surgery in the shower.About two years ago, I was asked to be the on-site dentist at a local, award-winning assisted living facility. On an afternoon off, I scheduled a tour with the facility medical coordinator. The facility had many familiar faces and was beautiful. It had big-screen televisions, a great dining area, a pharmacy, a game room, and furnishings as nice as any home. After the tour I asked, "Where do the residents get their dental care?" The answer stunned me.I was told that the last dentist used mobile equipment in the hair salon. I asked to go back and see the hair salon one more time. I could not figure out how those chairs could support an individual during a dental procedure, and I did not even want to consider a medical emergency. Those funny-looking sinks with the yokes were equally as perplexing. Although it was the beautician’s day off, I could not help but notice the smell of shampoo and tiny bits of hair on all surfaces. I blocked out any thoughts of adequate infection control.That evening I had a dental society meeting of which I was the newly elected president. I asked my peers if they had ever visited these facilities. Two dentists immediately broke eye contact with me. It was clear that they were the ones who had knowledge of what I was seeking. After a few minutes of prodding, I got one of the dentists to speak up. I was expecting a logical explanation and a much different scenario than the one I had envisioned. My heart sank when he said, "Yes, I go to these places. I don't use the hair salon, I keep the residents in their beds, put a flashlight in my mouth, and do what I can ... which is not much. I get out and bill as fast as I can!"The next day I called the facility medical director and asked if other health-care providers came to the facility. The answer surprised me. She said that all kinds of other heath-care providers enter the facility — podiatrists, psychiatrists, counselors, community health workers, eye doctors, audiologists, etc. They are, as one CEO of a large health network stated, the frequent fliers into the health-care system. This is confirmed by the fact that one-third of your lifetime health-care dollars are spent in the last three years of life.The next day, one of the residents was scheduled to visit my office with the chief complaint as told by the wife, "Papa has a rough tooth." We had no clue how much time to set aside, so we scheduled 40 minutes. We did not want to be short on time, necessitating more visits. The patient arrived 30 minutes early, with a walker and hired adjunct caregiver. The wife no longer drove. They were delivered by a van service. When the patient’s appointment time came, the entourage was escorted into the treatment room. I asked the caregiver a few basic questions and was met with barely a blank stare. "I know nothing about what his problem is; I am here to make sure he does not fall." Her knitting skills were remarkable, however, as her hands did not stop moving the whole visit.I found the problematic issue of a chipped tooth on a removable partial denture. The patient smiled after I quickly smoothed it. I inquired as to whether there were any other dental issues, and the answer was no. For the next 30 minutes I listened to an oral history of naval battles in the Pacific during WWII. I was happy to visit with this older patient, but the whole experience seemed very inefficient and expensive for the patient.The whole health-care experience with all the necessary off-site appointments and scheduling for the families seemed like a huge burden for residents in facilities. On-site care was a disaster, in my opinion. Perhaps other facilities had a better plan.I decided to pretend to be a shopper for my aging parents, taking tours at dozens of facilities. To my dismay, there were no better situations. One facility had a 30-year-old donated dental chair in a closet, for the podiatrist. Most often the hair salon was the room of choice for the "gypsy dentists.” One facility had a unique solution for bloody foot surgery. It had large showers in the resident’s rooms that could accommodate a chair so the blood could be rinsed down the drain. Most foot surgeries occurred in the resident’s bed with the maid’s vacuum cleaner as the weekly carpet infection-control device. It was clear to me that care was being rendered in very clever ways by very caring people, but no one had taken the time to make improvements.Someone needed to design a multi-care room that included dentistry. Surely this had already been done. Finding no reference to such a room, I contacted a trusted friend in the medical industry. He was a CEO of one of the biggest medical device manufacturers in the world and one of America’s wealthiest individuals. I went to high school with his daughters. I told him my story, and he was totally silent during those 15 minutes. After I finished, he got up and said his mother had recently passed away at 92 and his family had experienced all of the challenges I described. He knew of no other entity looking at this disjoint in care. My friend gave me his card and said, "Consider me your first advisor. Go find the best attorneys and suppliers, and get it done!" Over the next year I did just that. Aleydis Centers LLC is the only company with a patent on a multi-care treatment room.

Stuart Boekeloo, DDS, is president of Aleydis Centers LLC. He obtained his DDS from the University of Michigan and his MBA from the University of Notre Dame. He is on the finance committee of the Michigan Dental Association Insurance and Financial Group; president of the Lakeland Dental Society; past-president of the St. Joseph Benton Harbor Rotary Club and the West Michigan Steering Committee of the Michigan Dental Association. He is a member of the Berrien Community Foundation, the Legislative Liason Action Team Leader of the Michigan Dental Association, and speaker for the American Dental Association Leadership Conference in Washington D.C. Contact him at [email protected]. For more information, visit www.AleydisCenters.com and link to the YouTube video.