Failure to Provide Timely Dental Services Resulting in Unmet Oral Health Needs
Penalty
Summary
A resident who was alert, oriented, and able to communicate needs verbally reported ongoing mouth discomfort and tooth pain, expressing a need to see a dentist. The resident had only a few remaining back teeth, which were discolored, with swollen and red gums. The resident stated that most of the upper teeth had been removed months prior, but the remaining problematic teeth had not been addressed, resulting in difficulty eating and a restricted diet to soft foods. The electronic medical record documented a history of seizures, obesity, benign prostatic hyperplasia, dysarthria, major depressive disorder, and hemiplegia, with the Minimum Data Set indicating mouth or facial pain and difficulty chewing. A physician order for a dental consult was present, and social service notes indicated multiple attempts to arrange dental care, including referrals for emergency dental visits and coordination with dental providers. Despite these efforts, the resident did not receive timely follow-up dental care. The dental company providing in-house services noted that referrals could be made to any dental office, but the facility typically used a single office that accepted Medicaid and could accommodate wheelchair access. Scheduling difficulties and a backlog at the preferred dental office led to significant delays, and no recent follow-up inquiries were made after the last attempt in March. Interviews with facility staff revealed a lack of clear communication and follow-through regarding the resident's ongoing dental needs. The social worker was unaware of dental needs unless notified by the MDS department, and the medical records clerk confirmed that alternative dental offices were not pursued due to cost concerns. The nursing home administrator stated that the facility would have paid for services if aware of the urgency. The facility's policy required providing or obtaining routine and emergency dental services, but in this case, the resident's oral health needs and discomfort were not met due to delays and lack of effective coordination.