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The Gary and Mary West Senior Dental Center: An Integrated Model of Dental, Health, and Wellness Care for Older Adults
posted 11.22.2016

By Karen Becerra and Vyan Nguyen

Despite significant advances in dentistry to prevent many oral healthcare issues, dental disease remains one of the most serious and widespread chronic health problems in America. The problem is even more severe among low-income or impoverished older adults, who often lack access to high-quality, affordable care. The reason: oral health has remained a low priority public health issue—one that has been isolated from general health monitoring and largely overlooked by our nation’s medical system. The Gary and Mary West Senior Dental Center (Senior Dental Center), located in the Gary and Mary West Senior Wellness Center (Senior Wellness Center) in downtown San Diego, California, was created to address this significant, critical unmet need.

A Decade—and Counting—of Caring for Older Adults

Gary and Mary West founded the Gary and Mary West Foundation (www.gmwf.org) in 2006 to help older adults age successfully, with dignity, quality of life, independence, and access to high-quality healthcare and support services. In 2009, they created the West Health Institute, a nonprofit applied medical research organization in San Diego, California, and in 2012 launched the nonpartisan West Health Policy Center in Washington, D.C. Through a combination of applied research, policy, and community initiatives, as well as outcomes-based funding, these organizations comprise West Health and they are committed to creating and advancing sus­tainable, high-quality healthcare delivery mo­dels to improve care, at a lower cost, for older adults and their families.

In 2010, the Wests provided a $3 million contribution through their Foundation to Serving Seniors, a nonprofit organization with more than forty-five years of serving low-income older adults, to open the Gary and Mary West Senior Wellness Center in downtown San Diego. The gift marked the largest donation in Serving Seniors’ history and allowed the non­profit to implement state-of-the-art, cutting-edge programs and services designed to help older adults thrive.

The Gary & Mary West Senior Wellness Center in San Diego, Calif.

Today, it is a popular community hub that provides meals to as many as 900 low-income older adults daily. These older adults also have access to health, psychological, nutritional, social, and community supportive services 365 days a year, from more than thirty nonprofit organizations—all under one roof. The Foundation continues to provide support to the Senior Wellness Center in service of low-income older adults in San Diego, championing outcomes data collection that can validate the Center’s positive impact, and to share findings and practices with other communities throughout the country, serving as a national model for the next generation of senior services.

The majority of the older adults who visit the Senior Wellness Center are economically vulnerable, with 95 percent living at, or below, the federal poverty level, and nearly 30 percent are housing-­insecure—almost 20 percent are homeless. They come from a diverse set of racial and ethnic backgrounds with English, Mandarin, and Spanish being the most common languages spoken.

In 2014, the Gary and Mary West Foundation and Serving Seniors surveyed more than 300 older adults and discovered that dental care was their greatest unmet need. Forty-three percent of participants reported having pain in one or more teeth; 35 percent reported difficulty chewing; 22 percent reported issues with bad breath and dry mouth; and 21 percent reported bleeding gums. Fifty-eight percent of respondents stated they had not seen a dentist in more than a year (some hadn’t been seen for more than five or ten years), which exceeds the guidelines recommended by the American Dental Association of visits every six months. According to the survey, the top three barriers to receiving regular dental care were high cost, limited access to participating dentists in the Denti-Cal program due to the low reimbursement rates, and lack of transportation.

Read More from the Fall 2016 Issue of Generations

Older Health and Older Adults: A History of Public Neglect

 

The Mouth-Body Connection

Growing the Dental Workforce to Serve Rural Communities: University of Washington’s RIDE Program

 

Oral Healthcare Advocacy: Finally on the Upswing

 

As regular volunteers who often serve meals at the Senior Wellness Center, the Wests were not surprised by the survey results. They had seen firsthand the dire need for oral care among the older adults at the Center and knew they had to take action. As a result, in 2015 they decided to create the nonprofit Gary and Mary West Senior Dental Center, a community dental clinic located in the Senior Wellness Center that would provide access to high-quality, affordable dental care. The goal is to integrate its services with the existing Senior Wellness Center to create a better and more holistic model for delivering and coordinating care, resulting in improved clinical outcomes and higher patient and caregiver satisfaction.

Given the urgent need for oral healthcare services for older adults, an ambitious timeline was set to design and build the new Senior Dental Center. One challenge was to overcome the regulatory hurdles involved in obtaining a California license, given the high volume of clinics awaiting licenses to operate as a community health clinic. This was essential to support the Senior Dental Center’s nonprofit status and mission to provide older adults in need with affordable, high-quality oral healthcare with comprehensive education, clinical, and wellness services.

Ensuring the Right Care at the Right Time

Holistic patient-centered care is at the core of the Senior Dental Center’s work. In order to do this, a triaging system was established. This means that every older adult interested in receiving dental treatment must receive a Comprehensive Geriatric Assessment (CGA) to evaluate social, medical, and oral health needs, all of which are part of a seamless referral system. The CGA is administered by a dedicated staff member—the senior care navigator—who also supports patients throughout the treatment process with appointment reminders and who follows up on treatment plans.

To improve chances for long-term oral health, all participating older adults are also required to attend an educational workshop administered by a registered dental hygienist. These sessions provide participants the opportunity to learn about the importance of oral hygiene, best practices for dental care, and how to identify the signs and symptoms of oral health disease. These hour-long workshops are held in groups of ten to fifteen people, and are provided in several languages on a variety of topics. The workshops were developed based on input and guidance from focus groups that were conducted with older adults at the Senior Wellness Center.

Post workshop, the hygienist performs a Basic Screening Survey (BSS), which is an oral health surveillance tool used to triage older adults and assist with timely scheduling of those with the most urgent dental needs. Patient results from the CGA and BSS are used to identify the urgency with which older adults will be treated.

Designed for Efficiency and Financial Stability

Construction of the Senior Dental Center began in July 2015. Eleven months later, it became a fully licensed community health clinic. The state-of-the-art dental facility has four fully equipped dental operatories, and is led by Dr. Karen Becerra, D.D.S., M.P.H., who oversees a full dental professional staff and volunteer dentists from the community.

In 2015, the County of San Diego provided funding for dental equipment that creates crowns in-house, reducing the number of necessary return visits and decreasing outside lab fees. The Gary and Mary West Foundation also provided a grant to purchase a 3D-imaging machine that immediately displays X-rayed teeth on a computer monitor, provides a more comfortable experience for patients, and aids dental professionals in their treatment planning.

Senior Dental Center staff with Paul Downey, President and CEO of Serving Seniors (back row, third from left); Gary West (next to Paul Downey); and U.S. Representative Scott Peters (D-CA) (back row, at left).

To work toward financial sustainability, the Senior Dental Center team has started identifying cost-saving opportunities and is working to secure additional funding from many sources to help cover treatment costs. These include, but are not limited to, reimbursement from Denti-Cal and private insurance, a patient sliding-fee scale based on income and ability to pay, grant funding, donated services and goods, and monetary donations.

A National Model for Holistic Care Coordination

Working with the Senior Wellness Center and the Gary and Mary West Health Institute, the Senior Dental Center gathers rigorous data and shared electronic information for each patient to understand the needs and challenges in providing holistic care to such a vulnerable population. Eventually, this data will also help determine the impact and outcomes of providing dental services on this population’s overall health and well-being, including analyzing key metrics such as baseline CGA results, medical health status, emergency room visits, and quality of life.

The Senior Dental Center’s model also includes an ongoing collaboration with the Gary and Mary West Health Policy Center in Washington, D.C. Based on outcomes from the Senior Dental Center, the nonprofit, nonpartisan Policy Center works with the West Health Institute to advance payment and policy reforms that would enact positive change, and allow the Senior Dental Center model to be replicated on a national scale.

For the first time in decades, older adults at the Senior Wellness Center have access to dental services as part of their holistic care needs. Thanks to the West’s ongoing commitment to older adults, West Health will continue to fuel and advance innovative ways to ensure more older adults have the ability to age successfully with the dignity, quality of life, and independence they deserve.

Karen Becerra, D.D.S., M.P.H., is CEO and dental director of the Gary and Mary West Senior Dental Center in San Diego, California. Vyan Nguyen, M.D., is program officer of the Gary and Mary West Foundation, Solana Beach, California.

Editor’s Note: This article is taken from the Fall 2016 issue of ASA’s quarterly journal, Generations, an issue devoted to the topic “Aging and Oral Health.” ASA members receive Generations as a membership benefit; non-members may purchase subscriptions or single copies of issues at our online store. Full digital access to current and back issues of Generations is also available (and free of charge to ASA members and Generations subscribers) at Ingenta Connect.

Support for the Fall 2016 issue of Generations, “Aging and the Importance of Oral Health,” was provided by the Gary & Mary West Foundation.


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