Failure to Timely Arrange Dental Services for Replacement of Missing Denture in Resident With Dysphagia
Penalty
Summary
The deficiency involves the facility’s failure to arrange necessary dental services to replace a missing lower denture for a resident with dysphagia and dementia. The resident was admitted with diagnoses including dysphagia and dementia and had a physician’s order for a modified texture diet of soft bite-size food with mildly thick liquids. A quarterly MDS assessment documented severe cognitive impairment, moderately impaired vision, and a need for setup or cleanup assistance with eating and oral hygiene. At the time of that assessment, the resident had no documented dental issues and was receiving a mechanical and therapeutic diet. A grievance was filed by the resident’s Responsible Party (RP) reporting that the resident’s lower denture was missing. The Social Worker documented that the family brought in an extra pair of dentures and that paperwork was being completed so the resident could receive in-house dental care, with the grievance resolution stating that in-house dental would come at the beginning of the year as the earliest time to start replacing dentures. The Social Worker reported she did not receive the completed paperwork back until several weeks later, at which time she scheduled an in-house dental appointment for denture replacement, with the earliest available date several months away. She did not attempt to obtain an earlier appointment or contact an outside dentist, despite the resident’s dysphagia diagnosis. The RP reported that the temporary lower denture brought from home did not fit well, caused the resident pain, and that the resident did not like to wear it. Staff interviews confirmed that the resident had a lower denture in the room that she did not like to wear because it caused pain, and that she could indicate pain by grimacing or saying no. A care plan revision documented oral and dental health problems with risk for further decline and decline in nutritional intake related to wearing dentures, with an intervention to coordinate dental care as needed. Observation showed the resident eating soft bite-size foods without the lower denture, chewing slowly and with food smeared on a towel. Therapy staff and the Speech Therapist noted the resident’s high risk of choking and the importance of a full set of dentures, and the DON later acknowledged awareness of the missing denture but not of the long delay in scheduling replacement, and stated that an outside dentist should have been used if the in-house appointment was six months away.
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