Failure to Ensure Timely Dental Services and Denture Replacement
Penalty
Summary
A deficiency occurred when the facility failed to assist and ensure timely dental services for a resident who required replacement dentures. The resident, admitted from another skilled nursing facility, had multiple medical conditions including a neck fracture, temporomandibular joint disorder, anemia, vitamin deficiency, and protein calorie malnutrition. Upon admission, it was noted that the resident did not have their dentures, and only an upper denture was later received from the previous facility. There was no further documentation or follow-up regarding the missing dentures until the issue was brought to the facility's attention by a surveyor several months later. The resident underwent an initial dental consult nearly a month after admission, and a follow-up visit resulted in the completion of initial impressions for new dentures. However, the dental provider informed the facility that Medicaid would not cover new dentures until several years later, and a private pay option was presented to the resident's representative. The facility did not document any efforts to assist the resident or their representative in obtaining the dentures through other means, nor did they reach out to the previous facility or external resources until prompted by the surveyor. The facility's social worker and administrator were both unaware of or unable to explain the process for assisting a Medicaid resident in this situation, and no clear plan was in place to address the resident's needs. The facility's policy on dental services was outdated and did not specify procedures for determining responsibility for lost dentures or for assisting residents in obtaining replacements. The lack of timely follow-up and assistance resulted in the resident remaining without dentures for approximately six months, despite being at risk for malnutrition and having a modified diet due to oral functional problems. The deficiency was identified through observation, interviews, and record review, which revealed significant gaps in the facility's response to the resident's dental needs.