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Sunday Routine: How Alisa Kauffman, Geriatric House-Call Dentist, Spends Her Sundays

Sunday Routine: How Alisa Kauffman, Geriatric House-Call Dentist, Spends Her Sundays
Dr. Kaufman spends a good part of her day exercising and eating well. After all, she lugs around two suitcases full of dental equipment during the week.

Are you on staff at any hospitals?

Yes, Lenox Hill, North Shore LIJ, and Mount Sinai.

Can I call you to discuss an unusual situation?

My pleasure. Just email me your information and I will call you at my earliest convenience.

Can you make dentures in an apartment?

Yes, easy and I include all adjustment visits in my fee.

Do you come with sterilized instruments?

Of course ! Everything I use is disposable if available or sterilized in an autoclave for every patient.

Does Medicare cover the visit?

Unfortunately, Medicare does not cover any dental procedures except emergency extractions in the hospital.

Is the Dental Workforce Well-Prepared for Geriatric Dentistry?

Our nation continues to address this challenging question.  In 2005, the White House Conference of Aging called for legislative action to address this problem of underserved older patients.  Their calls to action included enlisting and training new health care providers in a variety of fields, including dentistry, geriatric medicine, mental health, and others that would combine to better serve this demographic.  Geriatric House Call Dentistry has taken this call to action seriously and is taking revolutionary steps to better serve our older patients.

Is There Public Support for Senior Dental Care?

Unfortunately, public support for dental care of older patients has been an ongoing area of concern.  Oral Health America recently reported: “There are significant structural problems in our oral health care system, and the problems are getting worse due to demographic trends, workforce trends, public health infrastructure inadequacies, and the increasing number of children, adults, elderly and special populations not covered by Medicare or Medicaid.”

My elderly parent has not seen the dentist for xrays in many years, and I know she will not cooperate with you to take them now. What can we do?

Please call the previous dentist and explain that your parent is now confined to her home. Kindly ask the office to send her xrays to you to keep in your possession. If they are digital xrays then please have a copy sent to my email as well as yours. I will review them before the housecall visit. Please include clinical notes and the previous dentist’s name and number in case I have any questions concerning past treatment.

My parent has dementia. Do you have special tricks to get her to cooperate?

Yes, I have tried and true methods that get our patients to cooperate. And I arm happy to teach the home health care aide how to keep your parent’s teeth clean.

My wife is on extensive medications. Would you call her primary care physician before the visit?

Of course, I need to know all medications before the visit, especially blood thinners such as aspirin, Plavix and Coumadin.

To What Extent Do Older Adults Use Dental Services?

In recent decades, older adults have been using dental services more and more.  For example, in National Health Interview Surveys, only 16.2% of adults over the age of 65 in 1957 reported having a dental visit during the past year while in 2002, 54% said they did.  In 2004, 16 million older patients were reported to have received about 74 million dental procedures overall.  This drastic change is also reflected in changing dental expenditures among older patients.

What About Vulnerable Older Patients?

A common phrase among those in the field, vulnerable older patients are those over the age of 65 who have some or all of the following: limited mobility, limited resources, or complex health status.  These typically include the homebound and those living in long-term care facilities.  Several recent studies have emphasized the fact that our current dental systems are inadequate to meet the needs of these populations.

In fact, in 1987 legislation was passed intended to improve dental care within nursing homes.  However, it did not prove as effective as hoped.  Some programs, however, have introduced inspiring models, including Apple Tree Dental’s effective use of portable dental equipment and improved communication with patients and families.  At Geriatric House Call Dentistry, we work to build on this good work as we provide access to excellent care for these subgroups of elders.

What Procedures Do Older Adults Receive?

The trends in dental procedures change from year to year.  However, in 2004, the most common procedures were diagnostic services, followed closely by preventative services.  Among those who received dental services, 29.7% also received a prosthetic service.  This marks an increase among diagnostic and preventative services, and a slight decrease among restorative services, including prosthetics.

Where would you prefer to see your patients, in bed, wheelchair or recliner?

I am happy to see my patients anywhere they are comfortable and preferably where there is the best light. I like when their head is supported and can make anything work.

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