A recent case that I have been handling here in our new city centre office on Park Place in Leeds involving an elderly gentleman with mental capacity issues resident in a local care home has focused my attention on an aspect of care commonly overlooked even by the seemingly most well organised and highly rated care homes; that being a failure to properly risk assess the oral health of adult residents.
In my case our client was resident in a care home for over 7 years and the care home has just admitted that at no time was any provision made for his oral health meaning that he had no access to dental services, oral health assessments or daily mouth care.
Just before my client went into the home he was assessed as having pristine teeth. Shortly after leaving the home his teeth were assessed as being so badly damaged that he needed a full upper dental clearance and at one point needed an emergency admission to hospital for illness related to an aspirated tooth.
Interestingly in this case the care home actually appeared to have carried out every other imaginable risk assessment and detailed virtually every other aspect of daily living but their lack of treatment in relation to his oral health left my client with rampant caries and needing extensive remedial dental treatment.
This case has left me wondering what might be the potential scale of this problem might be especially as with time waiting for no man and considering that there are currently 11 million people in the UK over the age of 65, a figure that is set to increase to 14 million by 2032 and recent guidance from NICE (The National Institute for Health and Care Excellence): ‘Oral health for adults in care homes’ estimated there are more than 400,000 adults living in UK care homes, 80% of whom have some form of dementia.
These figures, combined with the current statistics that indicate more than half of older adults in care homes have tooth decay compared to 40 per cent of over 75s and 33 per cent of over 85s who do not live in care homes, suggests to me that the chances are this could be quite a wide scale problem affecting many vulnerable adults in care.
It is known by dental professionals that significant factors in the progression of dental caries in individuals with disabilities are oral clearance, dietary habits, the ability to maintain oral hygiene and the ability to use fluorides appropriately.
Just on a human level these cases are upsetting because in addition to the pain and suffering caused as a result of the lack of care, older adults in care homes are more likely to have fewer natural teeth, and those with teeth are less likely to have enough teeth to eat comfortably and socialise without embarrassment, so it is actually an issue that will go to the heart of the resident’s quality of life and where there has been a lack of care it is very upsetting to family members who have put their trust in the care home to look after their loved ones.
There is certainly no lack of legal obligation in this area with various provisions including the Health and Social Care Act 2008 that should provide protection so why would an apparently competent care home overlook this type of assessment?
It is difficult to be certain but it could be a lack of awareness of availability of local oral health services and local general dental practices but essentially the problems start with a failure to properly risk assess the resident on admission and appreciate the need for assistance, which is a training issue, but also because a resident might not be able to complain about pain or discomfort it may be a basic activity of daily living that is simply neglected by care home staff but unknowingly is silently and relentlessly destructing the resident’s teeth.
Clearly some residents have much more pressing physical and psychological needs than the condition of their teeth but contributors to the NICE guidelines are in no doubt that oral health should be a priority in care homes. They say it is a priority because:
This is about maintaining basic human dignity in those who may need help in looking after themselves.
Fortunately, despite the efforts of the national press, we still live in a country where we can recover some compensation for injury that has been caused as a result of negligence and at Hudgell Solicitors we have a team of specialist solicitors who will be able to assist and if feel you or a relative has been affected by this type of issue.