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Oral Health in Domiciliary Care Policy

This domiciliary care service recognises that good dental health is vital for the wellbeing of people who use services and that a healthy mouth and teeth are important for speaking, chewing and for general overall health.

The service aspires to providing high-quality oral healthcare based upon individual’s needs and as recorded in an individual plan for each person receiving care. Each plan will be determined by a full needs assessment which will identify any mouth care needs. The plan will be drawn up in partnership between the organisation and the person using services, and any relatives or carers that the person using services wants involved.

For people receiving domiciliary visits from dentists, the service recognises this area of dentistry has been greatly impacted by the Covid-19 pandemic. This domiciliary care service understands the CQC highlighted access to NHS dental care as an issue since pre-pandemic, and the problems have been compounded by Covid-19.

Some people are experiencing ongoing issues accessing NHS dental appointments due to the backlog resulting from the pandemic. Health care workers continue to provide support access to dental services and oral health needs of individuals.

Guidance

This service complies fully with recognised evidence-based guidelines on the provision of oral healthcare in adult social care.

Policy

In {{org_field_name}}:

• People who use services will be assessed, by a person trained to do such assessments, to identify oral healthcare needs. The assessment will include:
a) asking the person about their mouth care regime
b) asking the person if they require any help with their mouth care
c) finding out the name of the person using services’ dentist, when they were last seen and whether they have an appointment for a check-up.
• The assessment will be regularly reviewed, particularly if the person’s circumstances change.
• Where the person using services has no support needs identified, they will be encouraged to attend their check-ups with their dentist and supported/escorted if required. Where the person is self-caring in relation to their dental hygiene and tooth brushing, {{org_field_name}} will offer whatever support is required for them to maintain their independence.
• Where a person using services does have mouth care or dental support needs these will be identified and recorded in their needs assessment. Action to support those needs will be agreed with the person using the services and entered in their personalised plan of care. The person’s oral healthcare plan should be reviewed and updated as their mouth care needs change.
• Daily oral healthcare, where it is identified in an individual plan of care, should be given the same priority as other aspects of personal care. Care managers should ensure that staff are supported with effective training, supervision, equipment, time allocation and resources.
• Typically, daily dental care may involve:
a) a home care worker helping the person receiving care with tooth brushing and flossing, both for their natural teeth and for any dentures they may have
b) assisting the person in attending dental appointments and check-ups or attending any other oral healthcare appointments they may have.
• All people who use services will be encouraged to be registered with a dentist and to attend regular check-ups as advised by their dentist. Where a person does not have a dentist or wishes to register with a new dentist, the home care worker will help to facilitate this with a local dentist of their choice.
• If a person exhibits any of the following signs or symptoms they should be encouraged to attend their dentist or, if they are agreeable, to be referred to a dentist:
a) bleeding, red, swollen or tender gums
b) toothache
c) changes in the way teeth fit together
d) changes or discomfort in the fit of dentures or partials
e) very bad breath (which may be a sign of infection)
f) loss of taste and weight loss
g) loose, broken or chipped teeth.
• Home care workers will support whatever treatment regime is recommended by the dentist.
• Where a person using services has been known to have had Covid-19 infection, and subsequently developed “Long Covid”, additional care and home care workers should observe for and document any related oral health issues, such as: discoloration of teeth, dry mouth, gum inflammation and disease, oral ulcers, tooth fractures or cracking or tooth loss. Any issues noted will be documented in individual plans and reported to enable people to access necessary treatment.
• Where it is identified in the plan of care, home care staff will support people using services in twice-daily brushing of the teeth/dentures and regular flossing or cleaning between the teeth. Teeth/dentures should be brushed twice a day for about two minutes each time using light and even pressure and fluoride toothpaste of the person’s choice.
• For a person using services with dentures, the initial needs assessment should identify what help they require in looking after their dentures and how they want it done. Where necessary, this plan of care should be agreed with the person’s dentist and should determine whether they would like their dentures out at night, in which case the dentures should be placed in an appropriate cleaning solution.
• In all cases, the organisation will support good oral health promotion by supporting people to eat a balanced diet.
• Where a person using services refuses oral healthcare support or does not want to register with a dentist, their choices will be respected. The risks of poor dental care will be explained to them and they will be given all relevant information should they change their mind. Where the person is suspected to lack capacity, the requirements of the Mental Capacity Act 2005 will be applied and a best interest’s decision made about their oral healthcare in collaboration with their relatives, carers and representatives.
• An oral health champion role will be supported whereby one member of staff will receive additional training and act as a source of support for other staff and as a link between the organisation and dental professionals. The champion will also be tasked with supporting the implementation of NICE guidelines within the organisation and ensuring that people have the right products in the right condition to assist with day-to-day oral care.
• {{org_field_name}} is aware CQC priority areas for 2022 include oral health, and strives to ensure staff access training to support oral health, oral health care plans and arrangements for access to dental care and emergency dental treatment are in place for people receiving care. It will also continue to raise awareness of NICE oral health guidelines and identify those vulnerable to oral health issues.

Training

Care staff working for {{org_field_name}} should be introduced to this policy during their induction. The need for effective daily oral care should be included within both induction and ongoing care staff training programmes.

{{org_field_name}} supports a system of staff appraisal whereby all staff have an annual performance review. During this review, the member of staff will be expected to identify with their reviewer any training requirements and needs they might have relating to providing oral healthcare. These will be recorded in a training plan.


Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

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