Dental Services for Medicaid Beneficiaries at Two Local Nonprofits

Seniors on Medicaid in Washington state know how difficult it is to find a dentist to care for them. In April, the Seattle Times shined a light on the issue when it exposed a budget deficit at the University of Washington’s School of Dentistry caused in large part because 65 percent of the patients the school sees are on Medicaid, which doesn’t cover the cost of the services.

But one dentist and two Seattle nonprofit organizations are bucking the trend by providing dental care for seniors on Medicaid. The program involves Dr. Allison Jacobs LeGendre, a veteran dentist who works with hundreds of these seniors at Foss Home and Village and at Providence ElderPlace, both in Seattle.

LeGendre, who is affiliated with the UW and has had a long career as a dentist and dental products designer, is trying to change the way seniors receive dental care. As a Foss dental services employee, she is able to provide comprehensive dental care—cleanings, extractions, fillings and dentures—to meet the needs of a population that otherwise has a very hard time finding dental care.

Few dentists serve Medicaid patients because the reimbursements are so low. And those who do almost always cap the number of Medicaid patients they’ll see. Luckily for the residents at Foss and the participants at ElderPlace, they have a place to go.

Foss launched its dental program as a clinical training site for UW dental students who were interested in geriatric dentistry with a small dental clinic in the 1980s, serving a limited number of Foss residents. In 1991, Foss received a $39,000 grant from Washington Dental Service Foundation for upgraded equipment and expansion, allowing Foss to offer more services to a greater number of Foss residents.

In February, Foss partnered with Providence ElderPlace to offer dental services to participants, many of whom had waited years to see a dentist, said Velaa Chinn, an ElderPlace manager, who said she spent 1.5 years trying to find a dentist for her ElderPlace participants before partnering with Foss.

Proper dental care and oversight is important throughout life. But seniors are especially vulnerable to dental issues. Seniors are at a disproportionate risk for oral health problems including:

• Inadequate nutrition because of dry mouth, soreness, tooth loss.
• Dry mouth from medications, that can lead to cavities and gum disease. In fact, more than 30 percent of older adults have untreated cavities.
• Chronic health issues such as diabetes, heart disease, stroke, and respiratory disease.

The dental care that Foss residents and ElderPlace participants receive enhances their quality of life by removing any barriers to eating nutritional food and reducing the possibility of further infection.

LeGendre, who teaches a geriatric rotation to fourth-year UW dental students at the Foss clinic, also is changing the way dental care is delivered to seniors. She’s able to treat patients who have mouth pain but perhaps are so disoriented and agitated because of dementia that other dentists won’t treat them. She can treat patients in wheelchairs without having to have them get out of their chairs with a dental chair at Foss that is equipped with a wheelchair lift.

She is able to treat a wide range of patients, including those who are either in a nursing home or a nursing home alternative like ElderPlace. “When a patient comes in, they know that they will receive continuous dental care and I will be their dentist,” she said. “The landmark is that Foss and ElderPlace are delivering this care. Continued oral care is huge, and that has not been delivered before.”

The goal is to see if the program is sustainable through the UW, LeGendre said. “We deviate from the protocol that we see at an out-patient setting by customizing treatment to fit their needs.” Instead of using traditional, expensive dental care, LeGendre looks for solutions designed not to outlive her patients. Crowns and implants are rare. Cavities are treated with a new oral chemotherapy agent approved by the FDA in July.

LeGendre has already seen more than 120 ElderPlace participants, in addition to the hundreds she’s seen at Foss. “To have one reliable, consistent dentist that they can see all the time is comfortable for them,” Chinn said. “She’s trustworthy. She’s also given them tools, beyond telling them how to brush their teeth. People could end up in the hospital because of dental problems.”

LeGendre continues to try to find more creative solutions for her patients. “I feel honored that Providence has given me the opportunity to provide for the needs of the patient first,” she said. “We, as a healthcare team, are working toward improving patients’ quality of life. Oral care is certainly an important part of that equation.”

For more information, contact Providence ElderPlace at 206-320-5325 or Foss at 206-364-1300.

Contributor Cynthia Flash owns media relations firm Flash Media Services.