ORAL CARE PLAN: Serenity Assisted Care Living

Alexis Barajas, Jackeline Barajas, Kourtine Jarvis

 Serenity Assisted Care Living, located at 1945 Pennsylvania Ave. Beaumont, Tx 77701
was established in 2006. (1) It is located near a hospital, fire station, and police department, the
one-story residence is gated, has monitored surveillance cameras, smoke, and fire alarms. (2)
This assisted care living is owned by a registered nurse Roselyne Vertil. (2) It is located in a
residential area, and operates under the direct supervision of the medical director who visits the
patients regularly. (1) Patient care is run by the director of nursing, who supervises the nurses
and nursing aids and is directly involved in the hiring and firing of the staff. (1 ) The residence
provides an array of services like 24-hour care, meals, companionship, dressing, bathing,
medications, management, transportation, laundry, and housekeeping. (1) They offer services
for those who cannot live independently. (1) Funding for the home is provided by the patients
and is $3-4,000.00 per patient. (1)
Serenity Assisted Care is for the elderly who need assistance and cannot live alone. (1)
This residence houses 40 residents. The age qualification at Serenity Assisted Care is for ages
between 65 to 100 years of age. (1)
The staff at this assisted care home includes multiple staff members which include, 1
administrator who plans and directs operations of the facility based on policies established by
the owner or governing board, they also oversee the hiring, firing, and training of the employees,
maintains and develops standards programs and operating procedures which comply with
federal and state regulations, attends meetings with staff and families of residents, the
governing body insurance companies, medicare and medicaid administrators. (1) This person
also interviews families who want to live in the facility. (1) 1 medical director who coordinates
physician services and medical care in the facility, makes sure the patient responsible physician
attends to the patient’s needs and follows and assists in the care planning and follows through
with the whole healthcare team including a pharmacist, dentist, and other clinical consultants.
(1) 2 managers who oversee all the operations, 2 life enhancement coordinators,1 wellness
coordinator, 1 kitchen manager, 1 kitchen operator, 1 housing man, 1 healthcare service
manager, 5 registered nurses, 5 LVN, 5 CNA’s, barbers, and beauticians, physical therapists,
occupational therapists, speech therapists, and palliative care therapists. (1) The staff must
have at least a high school diploma, the administrator must have a master’s degree, nurses
must have a bachelor’s and LVNs an associate, the Dr’s must have a doctorates degree. (1)
The coordinator of activities are the life coordinators and offer an array of services.
Some activities include chair yoga, movie days, art exhibits, and other things for the residents to
do. These activities are offered to the elderly residents that live there daily. The day-to-day
schedule includes morning baths, all personal hygiene, breakfast, a morning activity, lunch,
afternoon activity, a nap, evening dinner and dessert, afternoon activity, then bedtime. Plans
include plans to expand the facility, hire more nurses, and house more residents. (1)
Water fluoridation in the city where serenity assisted care living is located is 0.70 mg/L.
The source is community water fluoridation. (3)
 Information related to dental health services they provide include education on basic oral
hygiene like brushing twice a day. The facility have staff that helps the residents brush, clean
their dentures if any, and they do preventive measures. Supplies are bought by the residents;
the facility does not supply them. They have a dentist they bring in and a hygienist but they are
not on staff all the time.
30% of the residents have dentures and 10% have partials. (1) In previous dental health
programs it was discovered that 5% of residents have sound teeth, 41.1% had decayed teeth,
67.8% had filled teeth, 99.5% had missing teeth, 64.9% had decayed roots, 31.2% had tooth
mobility, 68.8% had unfilled anterior space, 8.30% had bleeding gums and 3.74% had dry
mouth. (4) The staff had a basic knowledge of dental hygiene and oral care. The dentist and
hygienists had extensive education and knowledge on oral care. The dentist had a DDS degree
and the hygienists had bachelor’s/associate DH degrees. (1)
The prevalence of dental disease and dental care for these groups have previously been
surveyed. The results indicated that 41.1% and 64.9% of residents had coronal and root caries.
10.1% of residents had bleeding gums and 99.5% had missing teeth, indicating possibilities of
periodontal disease. When regarding oral hygiene staff members reported difficulty in getting
the residents to comply, follow dental hygiene regimens, and even refusing to open their mouth
to have the staff assist in brushing their teeth. 5 out of 9 managers reported that they felt staff
should be trained to refer residents who require dental care. The clinical examination assessed
the condition of crowns and roots, spacing and occlusion, as well as soft tissues and conditions
relating to partial and complete dentures. Since the survey was performed, the nursing home
has initiated an oral health improvement program which includes oral health assessments of
new residents, residents being assisted to carry out their daily oral hygiene routine, and
improvement of dental services referral pathways. (4)

THE GOAL STATEMENT

To provide the knowledge and skills in maintaining optimal oral health for the staff and
residents of Serenity Assisted Care Living.

Objectives:
-To increase the dental health knowledge of staff and residents by 50%.
-Incorporate oral hygiene procedures into living skills class with competency tests at 75%.
-Demonstrate oral health techniques.
-Demonstrate how to properly care for dentures.
-Provide a written instructional manual to assure accurate and complete implementation.

Rationale:
Dental health is a vital component of your overall health. Oral health issues like periodontal
disease and tooth decay have been linked to systemic conditions such as heart disease,
stroke, and infection. With age, the risk of tooth loss and other oral health problems
increases, with more than 27% of people over age 65 having no remaining teeth (4).
Edentulism can make it difficult to enjoy a varied, nutritious diet, which leads to further
health complications and can diminish a person’s overall quality of life. For people in
assisted living communities, it is important for caretakers to be aware of the dental needs of
seniors and to take steps towards preventing dental and periodontal disease.
● Program Design
Activities:
1. Session 1 (week 1) April 7-11,2022.
○ Patients living in the assisted care facility.
○ Presentation of proper oral home care beginning with proper brushing
techniques. This session will include a pre-test to determine the patient's prior
knowledge and current brushing techniques.
■ 1.Discuss the importance of proper oral health techniques in their daily
regimen.
■ 2. Show the written pretest and address the improper current
techniques, what could change about these techniques, and the
damage improper brushing could do.
■ 3. Discuss the importance of good oral hygiene and how to enforce a
daily plaque regimen for the patients.
■ 4. Demonstrate with visual aids such as mannequins and videos how
to brush properly.
■ 5. Allow the patients to try the new brushing technique on mannequins
and in their mouths using a hand mirror, brush, and disclosing
solution.
■ This session will require an hour and will only need the attendance of
patients and clinicians.
2. Session 2 (week 2) April 14-18,2022.
● Patient living in the assisted care facility
■ 1. This session will include a pretest to evaluate the dental knowledge
of the patients flossing techniques.
■ 2. Pretests will be given to determine the dental knowledge of each
individual's ability to floss.
■ 3. Demonstrate flossing techniques on a manikin
■ 4. Discuss or review, depending on individual knowledge of flossing.
■ 5. Discuss the importance of flossing incorporated in daily routine
■ 6. This session will require an hour and will only need the participation
of the patients and clinicians

3. Session 3 (week 3) April 21-25,2022.

● Family caregiver, patient, nurse, and/or nurse’s aide. Clinicians will observe
as the nurse and/or nurse’s aide provide(s) oral health assessment, patient
education, oral hygiene, and/or denture cleaning.
■ 1. Post-tests, same as the pre-test, will be given to the staff to
determine oral health knowledge.
■ 2. Observe nurse and/or nurse’s aide perform the oral assessment.
 ■ 3. Observe nurse and/or nurse’s aide as they provide oral health
education including what plaque is and oral hygiene instructions to
patient and family caregiver.
■ 4. If the patient is wearing denture(s), observe the nurse and/or
nurse’s aide clean the denture(s).
■ 5. Ask for feedback regarding the oral health program.
■ 6. The session will require 2 hours and will need the nurse and/or
nurse’s aide, patient, and family caregiver.

Constraints and alternative strategies:

1. Constraint: There may be a lack of dexterity from the elderly patients, and
difficulty remembering where they brushed or if they brushed.

Alternatives: 1. Provide information on the benefits of using an electric

toothbrush, the different features of electric toothbrush applications. 2. Assist
the patients in modifying their brushing method by walking them through it
and moving their hands for them if needed to demonstrate proper angulation.
3. Notify the staff of the importance of informing their patients of the
importance of proper oral care regimens. 4. Give written instructions or a
pamphlet on how to properly brush.

2. Constraint: There may be a lack of interest from patients, nurse’s aides, and
family caregivers due to lack of skills and extra work.

Alternatives: 1. Include visual aids in the presentation to make a clear point.

2. Ask questions to make the presentation interactive. 3. Engage the nurses
and nurse aides with hands-on activities. 4. Give alternatives to different aids
for water pik or floss pik for easier use. 5. Give written instructions for flossing
and use of alternative products

3. Constraint: There may be few attendances from the staff due to different work
schedules.

Alternatives: 1. Make a flyer/handouts for the staff to be aware of the

scheduled sessions. 2. Ask the office manager to send an email to each staff
member needed during sessions to notify them of the schedule.
Resources:
The following resources will be required for the implementation of the program:

1. Personnel: Elderly patients that live at Serenity and clinicians (for all three sessions).
Nurses, nurse aides, and staff needed (for the second and third session).
2. Visual Aids:
a. PowerPoint of the healthy and unhealthy oral cavity.
b. Handout to demonstrate proper brushing and flossing.
c. Typodont, toothbrush, floss provided by the clinicians.
3. Supplies:
a. Toothbrushes, toothpaste, and floss (40 kits).
b. Denture brushes and denture cleaner (40 kits).
c. Cups, disclosing solution, sample denture, gloves, cotton swabs, paper napkins,
gauze, tongue depressor, barriers, electric toothbrush heads, hand mirror – provided by LIT
Dental Hygiene Clinic.
4. Evaluation Material:
a. Pretest-one form
b. Post-test – same form
5. Supplements:
a. An outline of the program plan- provided by the clinicians.
b. A brochure will be developed by the clinicians.

Budget:
The estimated cost for the dental health program is as follows:
1. Toothbrush kits $ 75.00
2. Plastic cups $ 5.00
3. Gloves $ 30.00
4. Denture cleaner $ 5.00
5. Denture brushes $ 30.00
6. Electric toothbrushes and electric toothbrush heads $11.99 pack of 12 (donated
by LIT Dental Hygiene Clinic for use).
7. Gauze, cotton swabs, tongue depressors, napkins, and disclosing solution
(donated by LIT Dental Hygiene Clinic).

Evaluation:
A. Process evaluation (formative):
1. A weekly meeting with the manager will be done to evaluate the progress of the oral
health program.
2. A weekly review of the oral health techniques and denture cleaning to assure mastery of
the skill.
4. A weekly review of the dental knowledge of the nurses, nurse’s aides, and appropriate
staff.
B. Product Evaluation (summative):
1. A pre-test and post-test will be administered to the nurses and nurses' aides, staff, and
patients to assess and compare their level of knowledge in dental health care concepts.
2. A questionnaire will be given to the staff to assess the effectiveness and success of the
oral health program.
3. An annual check with the administrator will be conducted to verify that the nurses/nurses’
aides and staff are implementing the oral health routine plan.
4. Provide a written instructional manual to the administrator about the oral health program.
5. An annual check with administrators will be conducted to verify the utilization of electric
toothbrushes and water piks.

Time table: All the needed resources will be obtained before each session. There will be
three sessions spanning three weeks. The schedule is as follows: Session 1: week of March
7-11, 2022 Session 2: week of March 14-18, 2022 Session 3: week of March 21-25, 2022.

References:

1: Person in charge (Mrs. Haynes),

2. Serenity assisted Care Living Beaumont, TX - serenity assisted care living Beaumont, TX.
Serenity Assisted Care Living Beaumont, TX - Serenity Assisted Care Living Beaumont, TX.
(n.d.). Retrieved March 3, 2022, from https://www.serenityassistedcare.com/

3. Nccd.cdc.gov. 2022. CDC - MWF - My Water's Fluoride Home. [online] Available at:
<https://nccd.cdc.gov/doh_mwf/default/default.aspx?eType=EmailBlastContent&eId=41b13fb0-
7089-4a25-ab59-04506720e174> [Accessed 3 March 2022].

4. Porter, J., Ntouva, A., Read, A., Murdoch, M., Ola, D. and Tsakos, G., 2022. The impact of
oral health on the quality of life of nursing home residents.

5. News, D., News, D., News, D., News, D., News, D., News, D., News, D. and News, D., 2022.
The Importance of Dental Care for Seniors in Assisted Living. [online] Dental News. Available
at: <https://www.dentalnews.com/2019/05/29/dental-care-for-seniors-in-assisted-livin>
[Accessed 3 March 2022].
Appendix:
• Pre-test and post-test
• Lesson plans (session 1 to session 3)
• Handout on plaque and brushing
• Handout on flossing and denture care
• Program evaluation

Name:
PRE-TEST
1. How often should you or your patient clean their mouth?
a. Once a day b. Twice a day c. Thrice a day d. After each meal
2. How often should you or your patient clean their denture?
a. Once a day b. Twice a day c. Thrice a day d. After each meal
3. What methods should be used to remove plaque accumulation from the oral cavity?
a. Brushing b. Flossing c. Mouth rinsed. All of the above
4. What is the best way to brush if there are dexterity issues?
a. Don't brush b. Electric toothbrush c. Manual toothbrush d. Sponge brush
5. It is important to clean your patient’s denture to prevent oral infection.
a. True b. False

Name: POST-TEST
1. How often should you or your patient clean their mouth?
a. Once a day b. Twice a day c. Thrice a day d. After each meal
2. How often should you or your patient clean their denture?
a. Once a day b. Twice a day c. Thrice a day d. After each meal
3. What methods should be used to remove plaque accumulation from the oral cavity?
a. Brushing b. Flossing c. Mouth rinsed. All of the above
4. What is the best way to brush if there are dexterity issues?
a. Don't brush b. Electric toothbrush c. Manual toothbrush d. Sponge brush
5. It is important to clean your patient’s denture to prevent oral infection.
a. True b. False