[Congressional Record Volume 150, Number 124 (Tuesday, October 5, 2004)]
[Senate]
[Page S10431]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
[[Page S10431]]
ORAL HEALTH AND OLDER AMERICANS
Mr. BREAUX. Mr. President, the oral health of older Americans is in a
state of decay. Millions of vulnerable seniors are unable to access the
oral health care they need, suffer needlessly, and ultimately require
costly and invasive treatments that unnecessarily burden our troubled
health care system.
Good oral health care should begin at birth as part of overall health
care. This important component of health care should not--and cannot--
end at retirement. Proper dental care must be a lifetime commitment.
Unfortunately, for far too many older Americans, oral health care is a
luxury. Too many of our ``greatest generation'' suffer from chronic
oral pain and disease, severely limiting regular activities of daily
living and impeding their independence. Neglect of oral health may
result in the deterioration of overall physical health. Lack of access
to care for even routine dental cleanings and exams can exacerbate
serious and complicated overall health problems that increase with age.
Limited access to oral health care poses one of the greatest crises
for the health and well being of America's elderly. Not one older
American receives routine dental care under Medicare. Medigap, used by
some older Americans as a supplemental insurance to Medicare, is an
expensive cavity when it comes to dental coverage. Less than 20 percent
of Americans 75 and older have any form of private dental insurance.
Under Medicaid, adult dental care is optional and close to 30 States
are failing to meet even the most minimal standards of care. Millions
suffer, often in silence.
Older adults suffer from the cumulative toll of oral diseases over
their lifetime. This results in extensive oral and periodontal disease.
Surveys have shown that nursing home residents with teeth suffer
particularly from untreated tooth decay, while those without teeth also
have a variety of oral health problems. Medications often adversely
affect oral health as well. Evidence suggests that periodontal disease
can complicate or is linked to diabetes, heart disease, stroke and
pneumonia.
Some older Americans--especially those with special needs, the frail,
and those classified by the Social Security Administration to be aged,
blind and disabled--are often plagued with challenging oral health
needs. Being disabled, medically compromised, homebound, or
institutionalized increases the likelihood of serious dental problems
and limited access to dental care. Dental care for the 1.65 million
people in long-term care facilities is problematic at best.
I would like to tell you about Marcia Ball, who lives in a nursing
home in Lafayette, LA. She is 64. One morning last July, she awoke to
find her cheek swollen up like a balloon. An untreated abscess had run
rampant, sending her to the hospital with a raging fever and labored
breathing. After a surgical team drained the infection, her heart and
lungs suddenly stopped working. She pulled through, but four days later
developed pneumonia. A member of the medical team says that the
bacteria from untreated tooth decay entered her lungs every time she
inhaled. She returned to her nursing home after two weeks at the
hospital. Medicaid paid for three rounds of antibiotics, two trips to
the emergency room, two days in intensive care, and the remainder of
her hospital stay. But Medicaid in Louisiana, like many other States,
won't pay for extractions. So she still has badly decayed teeth, but
she doesn't have the $60 needed to cover an extraction or insurance for
routine dental care.
Marcia Ball's story is not unusual, according to Dr. Greg Folse, a
geriatric dentist in Lafayette. Most of Dr. Folse's patients are
keeping their teeth as they age, but he says that over 85 percent have
moderate to severe gum disease and 60 percent have tooth decay.
Medicaid dental services in Louisiana, where Dr. Folse takes his
practice to patients in his van, are limited to dentures, which are not
much use for people who still have their teeth.
A national report card released in September by the advocacy group
Oral Health America before a forum of the U.S. Senate Special Committee
on Aging examined seniors' access to key dental services and gave
failing or near failing grades to each State and gave the Nation an
overall ``D'' grade. When it comes to caring for vulnerable
populations, the report said, the country is flat out failing.
This lack of access to oral health care is compounded by a shortage
of skilled geriatric dental care professionals, part of a larger
national shortage of geriatricians described to the U.S. Senate Special
Committee on Aging by the Alliance for Aging Research in their report,
Medical Never Never Land. Just finding a dentist can pose a
considerable challenge for older Americans and those with a disability.
The good work of community health centers is limited to providing
preventative and basic dental care to only about one-in-twelve patients
who are fortunate enough to have access to such a facility. In many
States that provide a dental benefit, reimbursement rates are too low
to attract a sufficient number of dentists willing to treat Medicaid
patients.
With scientific advances and the graying of millions of baby boomers,
this year the number of elderly on the planet passed the number of
children for the first time. Although we have made great strides in
promoting independence, productivity and quality of life, old age still
brings inadequate health care, isolation, impoverishment, abuse and
neglect for far too many Americans.
Oral diseases can impact an otherwise independent, productive life,
triggering a downward spiral that can result in malnutrition, serious
illness and even death.
In 2000, the Surgeon General's office called oral disease in this
country a ``silent epidemic,'' but oral health continues to be an
afterthought to other health care issues, and off the radar screen for
most national leaders. Congress has never addressed the lack of oral
health coverage for older Americans, failing to place these this issue
into the national consciousness and addressed the issues at a national
level.
We need new infrastructure and funding--focusing resources, creating
accountability and changing how we think about oral health in our
country, particularly as it affects vulnerable populations. We must lay
the foundation to address, in a meaningful and lasting way, a
devastating and growing problem that has been invisible for far too
long. We can no longer neglect these difficult issues afflicting frail
and elderly victims.
This effort needs to take numerous steps to improve access to oral
health care:
We need to ensure the provision of oral health screening, diagnostic,
and treatment services, particularly for vulnerable individuals, and
nursing home and long-term care residents.
We must eliminate the barriers requiring determination of medical
necessity. We must ensure that States comply with applied income laws.
We need to ensure greater communication among States and nursing home
and long-term care facilities about the need for and availability of
oral health services.
More and more of us will enjoy longer, healthier lives with our teeth
intact, but with this gift comes the responsibility to prevent the
needless suffering too often borne by our frailest citizens.
I appreciate the work of my fellow members and a wide array of
excellent groups such as Oral Health America, Special Care Dentistry,
and the Alliance for Aging Research, and individuals like Dr. Greg
Folse on behalf of oral health and older Americans and look forward to
continued support from both sides of the aisle and in both Houses to
make oral health a reality for all Americans.
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