My mother's dentist called with concern that my mom has not been receiving any oral care. She lives in ALC. Advice with how to handle this?

I had an aide at the AL tell me Mom would not brush her teeth. I asked if the aide put the paste on the brush and then hand it to Mom? I got "that look", so I knew the aide didn't. If she had done what I asked, Mom would have brushed her teeth.

I would talk to the RN. She is over the aides. It may not be on Moms careplan that aides need to help with dental care. Assisted living is exactly what it has, they assist. Mom's care maybe more than the AL is willing to do.

Bring in a lawyer why? Because your mother is not properly brushing her teeth, at 95 years old, and you feel it's the ALs responsibility to brush her teeth?? My mother lived in AL for 4 years and NEVER was it written into her care plan that aides would brush her teeth! AL is not designed for such things. Was it discussed with your mom's AL that her teeth be brushed by the staff?

At 95, to have front teeth that "could break off" is not a major concern in my book. All teeth could and will break off at that age, with or w/o meticulous dental hygiene that rarely takes place under any circumstances.

I'd question any dentist wanting to put a 95 year old thru any level of tooth repair on the off chance of breakage. And then I'd go down to the AL and speak to the ED in person. Although, again, unless it was written into moms care plan that she have her teeth brushed daily by the staff, I don't think you'll get very far. My dad was the highest level of care at his AL and didn't have that service included. In Memory Care Assisted Living, my mother got help with her dental hygiene for more than two and a half times the cost of AL.

Good luck.

Um, excuse me, the dental work is likely going to be HUGELY traumatic to your mother at her age and very likely completely unnecessary. It sounds like a giant money grab by the dentist if I may be honest.

Please see this for what it is…. An unnecessary infliction of pain on your mother.

I should have mentioned that teeth brushing is on her care plan.
Thanks

Well.. first hand experience, this was a major mistake on my part. Mom ended up in ER after getting her teeth cleaned. 88 years old.. she had a seizure…
it was horrible :(
the ER DOCTOR came out and asked why would I even think it was a good idea to get this woman’s teeth cleaned at her age…? He was dead serious.
So, if YOU are not there to see exactly what is being done to mom, and the stress level she is experiencing, with just teeth cleaning, then just think how much stress it will be to go anything more invasive.

if your mom can follow simple directions, and her dr says it’s ok, she can rinse her mouth out with warm saltwater.

DO NOT SWALLOW, just rinse and spit. This will help if there are any aches in the mouth. It’s kinda soothing

When in doubt get a second opinion.
honestly, she’s 95. My mother was so stressed she had a full on seizure.
yhe dentist is used to the power water cleansing method. Old patients are not.

a family member, should be at the dental cleaning.
all eyes on LO..

the least you can tell the AL employees..

rinse with warm saltwater.


4 years prior,
when mom’s original dentist Dr. M, retired, a new guy right out of college took over. DR. M. Clients were all older people. When new dr took over, he saw bank..$$$$
and an age group that can be duped.
New college grad started working on moms mouth, fitting her with veneers for her back teeth. While the veneers were being made, college guy would start the next week on another quadrant of mouth. (Mind you this was before mom got dementia. Back then she could drive herself)

anyway, she was very distraught, crying thinking her mouth was deteriorating..
I went to the office.. and the waiting room was packed with older people sitting and waiting patiently for a dentist, who was out finishing a round of golf…
I ended up taking her to my dads dentist.. they saw different dentists.
when dad’s retired, I found one close to home.. she did the power wash method.. not good for some older people.

take heed. Ask mom if her mouth hurts. Try warm saltwater to ease the pain. Spit and rinse again.

maybe her dentist is looking out for her


maybe her dentist wants money

get a second opinion

other family members? Talk with them

Unless the lawyer will come and brush mom's teeth I can not see what good a lawyer would do.
If Oral care is on her care plan ask to see the documentation that they have been doing the oral care.
They can not "force" mom to comply with oral care so if she is declining it that should also be documented and taken into consideration.
A few Personal Opinion comments from me though.
Is mom in pain? Are there infections currently?
If the answer to both of those are no I probably would not get bent out of shape.
If the dentist is planning on extracting teeth who is going to follow though on Oral care of the wounds that she will have?
Mom is 95 her teeth are probably 85 years old! (give or take a year or two) Even if she was getting oral care 2 times a day her teeth may break off anyway. I am a bit younger than your mom by about 26 years and I have teeth that my break. My dentist cautions me each time I see her.
I would be very cautious of doing extreme dental work

After 90, I think it depends on the individual, how much dental work they will tolerate. The rule I follow is, only do what needs to be done to keep her comfortable. A couple of years ago mom's dentist sold the practice and the new young woman dentist told my mom she needed 5 teeth extracted and referred us to a dental surgeon. The dental surgeon told us that if it was his mother he would only pull them if they were bothering her. So that is what we have done. She gets her teeth cleaned every 3 months because she gets a lot of tartar build-up and she does not do much brushing at home. The last visit, one of the teeth had broken so the dentist pulled it then. It came out easily and there was little pain or bleeding afterwards. I think the frequent cleanings keep her healthier, but if the visits were stressful we would not bother.

"I am not sure what my next steps should be including whether I should bring in a lawyer." LOL seriously dude, a lawyer?

Your mother's teeth have more issues than not getting a regular once a year dental visit. How is that assisted livings responsibility?

Your mother's teeth did not get damaged to the point where they look like they are about to "break off" because she didn't get her teeth brushed daily.

Adding most dentists are down right scammers. They have bills to pay.

Hopefully you don't get duped into getting a lot of work done on mom. She's 95 for pete's sake. If a tooth breaks then get it pulled and move on. No root canals or veneers at her age.

Why didn't this dentist notice the situation with moms teeth at her yearly visit?

At the age of 97, my dentist took me aside and told me that I had to take over teeth cleaning for my Mom. He found very, very old food still between her teeth. It grossed me out, however, since then, I brush her teeth for a good cleaning once a day. Of course it took the dentist to tell my Mom, not once but at least 4 times, that I needed to brush her teeth.

The bottom line is that as a person gets older, they will not brush their teeth nearly as well as they did earlier in their life. Add to that, that many of the elderly, do NOT want someone else to brush their teeth, because from their vantage point, they do it well enough. Also, you do feel very vulnerable with your mouth wide open with someone else controlling something that you can feel in your mouth. Add to the fact that at most managed care facilities, a person's teeth is not cleaned nearly as well as a dental hygienist would like it to be, simply because the patient doesn't want them to be and the fact that they do not have time.

Ask the dentist for his recommendation on how your Mom can get her teeth cleaner. Getting your Mom to brush better is not the answer. Also expecting the managed care facility to brush her teeth better is not the answer either.

My mother is 98 and yes losing some teeth, she has few left, she has a top plate, we took her to the dentist to have her plate adjusted as her gums are shrinking.

We asked "Does she need her teeth cleaned" his response was "At 98? No, ...don't put her under any unnecessary stress, she has had enough in her life"!

A lawyer? Surely you gest!

Call a lawyer that deals with elder law. Seems your mother's condition is directly attributed to their neglect. At the least, they should cover costs for her dental care and the repair work. Might want to consider if this place is worth continuing to use. If not, start looking for another place pronto.

“whether I should bring in a lawyer”

imho this would be a waste of your $, time & emotion.
Why? if she cannot do basics of daily life to some degree on her own and know & try to do these when reminded, it is not Assisted Living type of facilities responsibility to do force her to do them. If she voiced concerns on her teeth or staff noticed issues with them, AL did proper follow up.

By ALC, I assume this is Assisted Living Care, correct?
if so AL means that they are basically able to do the basics of everyday life.… can awaken on their own, get dressed, toilet, eat, go about their day, go to activities or outings if they want to, take medications*, make themselves ready for bed HOWEVER should they need help with some aspects of this at times, the AL has staff who can ASSIST & help them or REMIND them. AL staff are not their servants.

Oral care is on her to do daily brushing & flossing. Staff can put toothpaste on a brush, set out a floss line, refill water pitcher, replace disposable cups in her bathroom, but they cannot brush her teeth. They can remind her to brush. If she says “I’m fine”, when reminded, staff cannot go and physically remove food that’s squirrel packed in your mom’s mouth. Aides cannot be doing dental hygiene work.

It could very well be that you haven’t heard from them as they are determining level of care for her. And that will likely be that she is not suitable for AL but “at need” for placement in a facility that can provide a higher level of care, e.g. NH or maybe MC. If they do a needs assessment on her and it shows this, she is toast on remaining there. It won’t matter what her contract reads or whether or not she can afford a NH. If an assessment shows higher level of care needed, that this facility as a AL does not do, she’s out.

It’s important that you realize that AL has no - again HAS NO - requirements to get her placed & ensure a safe transfer into another facility. As it’s AL, she in theory to be even living there is good on her basic ADL so she can be asked to leave or sent to a shelter or even evicted. She is not in a NH which is required under Medicare regulations and State licensing to move her into a “like” skilled care facility and done under safe transfer terms. Now for an AL to evict is bad PR so what ALs tend to do is find a plausible reason to call EMS - often it’s an TIA aka transient ischemic attack as they are real subjective as to how they present - and have her taken to ER/ED. Then when discharge planner at the hospital calls AL to come and take her back, they will say they cannot provide the level of care needed, sorry. Next call from the discharge planner will be to you to come and get your mom.

Realistically what AL staff provides are daily reminders and some daily assistance. Like pull up a back zipper, help them transition in/out & help with bathing couple of times a week, get down stored winter clothing in their closet. Help them get into vans to go on a medical visit or shopping trip. They are checked into every morning and during the day REMINDED to do things, like take their meds, dress appropriately for weather, brush their teeth or that an appointment is coming up. Meals provided and if they need something done - like heavy proteins get mechanized, veggies cut smaller, special diet**- dietary can do this.

*Medication management (meds on a schedule with oversight) tends to be a separate fee. $100/$200 a week at an AL.
**Special diet tends to be at higher fee in AL. For NH if they have medical requirements for special diet or treatment to how food served (like mechanized), costs associated with this are including in their bill.

Taking on wanting AL to do dental care as your line in the sand, imo, is a loosing cause.
If she cannot do it, what will happen is use of a “Toothette”. It’s a single use disposable pink tipped sponge swab. Toothette is standard go-to for oral care in facilities & hospitals unless the individual can do their own brushing.

Goodness, such vitriol over brushing teeth! Clearly, the OP thinks it’s a problem, so she has to get clarification. If it’s in her mom’s AL plan and the AL isn’t doing it, she is within her rights to escalate. If no one wants to talk to her about something that’s already written into the plan, then, yes, get the blasted lawyer! Always be your mom’s advocate. That’s the whole point of you being involved. If you discuss with her GP and the dentist, and everyone agrees that there’s really no point in worrying about her dental health, then drop it. As Cover mentioned, though, gum disease and deep infection are way more painful than a tooth cleaning! And by the way, everyone should be using electric toothbrushes. The stupid manual ones are useless.

I'll be 87 soon and still get my teeth cleaned 2-3X/year. Rather surprising, really, since I'm a total dental phobic! However, thanks to nitrous oxide, dental insurance and switching to a dentist closer to home, I have been able to maintain pretty good oral health in my old age. I got used to the power water cleaning method used now and still have most of my teeth.

I don't believe it's assisted living job to make sure her hygiene (physical/dental) is being taken care of. If they notice she's not able to care for herself, then I believe that they would recommend memory care. Being in assisted living also causes a different mindset depending on how long they've been there.
Less to take care of and nothing to do. It throws off the daily routine.
Do you notice if the toothpaste is running out? Does she floss?
You must be doing the grocery shopping, right? I have to make sure Mom gets her supplies and treats that she needs.
I have my mother in hospice and her teeth were bothering her so much and being bedridden she's unable to be treated. At her age (90 and AFib) it's not a good idea to put her under for any dental work., she's under do not recessitate. The hospice nurse is treating her with magic mouthwash and she's feeling better. I've got to tell you my mother was a constant dental freak and constantly had work done. One time, she had some work done and she believed that they totally messed up her mouth and she was having nerve damage and I think that's what's bothering her now.
You are responsible for your mom and her healthcare. I've never seen a contract when AL is responsible for anything but her meals and making sure she is there, not wandering.
It's really good that the facility brought her to the appointment.
I don't see personal chauffeur included in her care. They are helping but not responsible.
I've written to the staff about things and haven't received anything either. It doesn't mean they don't care, it means I/ you have to be more concerned and keep an eye out for our loved ones.
Could I suggest making brushing more fun? Buy a powered toothbrush and have a bubble gum or anything flavored to encourage brushing? Hey Mom, look at this new toy!! Anything that encourages her to keep up her care!

AL facilities are not responsible for medical and dental care.

Sedation dentistry!

Perhaps show this to the director and see if they might want to offer this convenience: https://www.jetdental.com/mobile-dental-clinic-indiana/

BFTimm: It would not be a lawyer's job to ensure that your mother's oral care is being addressed at her Assisted Living. Perhaps she requires a higher level of care than what an AL can offer as it would be doubtful for teeth brushing to be in her care plan.