Iowa City's aging population is continuing to increase, and health officials have united to try and address a prominent issue with this subgroup: access to affordable dental care.
A report from the Pew Center on the States released last month stated Iowa received a “C” rating in dental care, with one issue being a lack of dental resources for homebound and aging Iowans in nursing homes.
“I don’t know if [aging Iowans receiving dental care] is overlooked, many understand it’s an issue of necessity,” said Suzanna Heckenlaible, executive director at Delta Dental of Iowa Foundation. “But how to address the issue, people don’t know.”
In 2010, Iowa had the fifth highest percentage of its residents over 65 years old in the nation — with residents making up 14.9 percent of Iowa's total population. To help with what Delta Dental of Iowa saw as a larger problem, they created a coalition which brings together various health care providers, with one of its main goals being to help aging Iowans receive better access to dental care.
The coalition’s initiative was launched in 2012 but is just “getting off the ground,” Heckenlaible said, and is made up of 12 organizations across the state.
“It was an opportunity to reach out to oral health professions; it brings us all together,” said Cindy Baddeloo, deputy director of the Iowa Health Care Association, a member of the coalition. “We’re all on the same team, and we’ll work as a team to get something done.”
While some aging Iowans do not have too much of an issue receiving dental care because of the University of Iowa Geriatrics Mobile Dental Unit, some nursing home officials say the one resource is not enough.
“When we called, the [University of Iowa] College of Dentistry [mobile dental unit] has always come,” Lindsay Nibes, director of nursing at Briarwood Health Care Center, 605 Greenwood Dr. Iowa City, said. “But emergency issues are a problem. There’s not many resources out there, and not many dentists are willing to come in and do on-site work.”
The mobile dental unit, created in 1979, consists of dentistry students and faculty, traveling across six counties in eastern Iowa to visit residents of nursing homes and homebound Iowans, both of which do not have access to dentists’ services.
Dr. Howard Cowen, the director of the UI Geriatrics Mobile Dental Unit, said the unit had to cut back to helping 30 different locations of need, to the current 10 they serve now. The dental unit is the only resource in Iowa City that helps aging Iowans receive dental care in their homes.
"We can't handle the demand, but we can handle the need," Cowen said, adding the places the unit does visit provides whatever services the residents need. "It's a real frustration [for the lack of access] throughout the state. It's hard when a nursing home calls you for help and all you can say is 'I'm sorry.'"
The main reason dentists do not do off-site work, Cowen said, is because many of the residents are paying for their services with Medicaid, which gives dentists a very small reimbursement and ultimately makes many of the services they provide essentially free — which a majority of dentists cannot afford. There is also the problem of dentists not knowing how to treat aging Iowans that may have behavioral or physical impediments, something Cowen said the UI is now specifically teaching young dental students how to handle.
While dentists visiting residents in their homes may be problematic, Carol Thompson, a resident at Briarwood Health Care Center, argued receiving dental care in their own homes is much more convenient, and may keep other patients accountable for their overall oral care as well.
"When you're 87 or 88 like I am, it's a lot more convenient for them to take care of you," said Carol Thompson, who, before the dental unit came to Briarwood, would have her children take time off work to take her to the dentist. "And I'm sure it encourages people who haven't been diligent going to the dentist. It's something you always put off; you never want to go to the dentist."
Dental health officials hope eventually the accessibility issue will be alleviated, a goal they set to accomplish by 2020 — with initiatives set in place such as offering education opportunities for health care providers and creating the coalition.“Sometimes it’s about engaging conversation,”Heckenlaible said. “Access is an understanding problem — we want to increase access to education, access to training. So it becomes a much broader issue, but it has much more impact.”