Assisted Living dental care

Peteena

Hello.

My Mom is 91 and in an AL facility. I have to handle her bills and stuff as DPOA and health care proxy. She was diagnosed about a year ago with dementia and we had to do the best we could for her before the stress killed us all. The place is very nice but we are depleting her life savings pretty quick after a year with a very uncertain future - maybe try a CELA soon. I think we waited too long for that.

I am posting because I am a neurotic basket case about everything, and every other day something new comes up and sends me into a panic. I seek advice here and know I am in company who understand.

The place has dentists who come there, and with stupid Covid, it was good for me since I work full time, and have a very hard time dealing with taking care of her medical appointments. Too much anxiety. They are now recommending she see them every 2 months for cleanings at around $300 a visit.  Seems like way too frequently -  she never had serious problems, but I don’t know why every 2 months. What’s got me upset is they now suggest she needs an oral surgeon for two extractions as well. My first thought was “she’s 91 - no way”

I will ask my only supportive loved ones what they think, and maybe try to ask the doctor why they have her on this plan.  Does this seem like necessary treatment at her age? I can ask mom what the dentist told her, if she remembers!  Does anyone have experience similar to this?

Sorry so long.........but I just have so many issues trying to make decisions for her, and we are going to run out of funds. I took on the DPOA and health proxy because I am the youngest, and was already on her accounts and another family member took care of mom until it was too much for them. Mom is physically good, but should not live alone. I just freak out every time I have to decide on stuff like this. I was not cut out to “parent” anyone - never mind how much stress we are all under!  I don’t expect a flood of replies, just need to vent here at least.

So grateful to read this forum since we no longer have a physical support group to attend.

ladyzetta

Dear Peteena,

This is a good place to vent so vent all you want. Most of us have been there done that. If it was me and I had to make a decision like this my main concern that she be in no pain. I would think the dentist who comes there should be able to pull 2 teeth without a Oral Surgeon. I also agree it seems way off to have her teeth cleaned every 2 months.  Tooth ache pain can be pretty bad so having those teeth pulled would be the way I would go. 

You are doing a good job taking care of your Mom. My DH was 90 when he passed away in a MC facility. He did not have any teeth problems but if he did I would have not called in a specialist. 

Becoming a Basket Case will happen if you allow it to so please take care of yourself. 

BassetHoundAnn

Hi, Pateena, 

Has the dentist explained why they think your mom needs a cleaning every two months? I have periodontal disease and need to get my teeth cleaned every 3 months. If I skip one cleaning things really go to heck. But even though the special perio cleanings are more expensive than regular cleanings they are not $300 each! That's a lot for a cleaning. 

When I took over the care of my mom I discovered that not only did she have lots of dental problems that had been long-neglected, but she had dental insurance through her Medicare Advantage plan that covered nearly everything and she was unaware of it. She was also eligible for low-cost dental insurance through her pension. I suggest checking if your mom has any overlooked dental insurance. In my mom's case I had to find a dentist that accepted her insurance. 

In the last 6 months I've taken my mom to the dentist 7 times. She's 94 so there are a lot of cavities and other issues we've not treated. But there have been painfully rotten teeth and broken teeth. The goal has been to keep her pain-free and eating comfortably. So far the only thing we've paid out of pocket is $100 for an oral surgeon to remove a rotten tooth. 

She does have a lot of rotten teeth we have not removed pro-actively because they are not giving her pain at the moment and tooth extraction is upsetting for her even if it's painless. 

The major stress of the visits has been that many times my mom suffers an Alzheimer's meltdown in the chair. The dental hygienists and dentists have been amazing and always do a great job calming her down. But sometimes we've had to curtail visits and bring her in a second time. 

I can really sympathize with how overwhelming it all is, especially for someone who works full-time. Driving my mom back and forth to the dentist so often has been a huge and trying commitment. It entails getting her dressed, calming her down, getting her into the car, maneuvering her through the dental clinic, calming her impatience and meltdowns, etc. It usually takes half the day. I cringe every time I get a late-night call from her reporting that another tooth broke or fell out and she's in pain but it seems to be happening more frequently. 

harshedbuzz

Peteena-

In reference to the question you didn't ask. Yes, see the CELA asap. Like make the appointment today. You need to make sure you- or someone else- don't do anything to jeopardize her transition to Medicaid if she's going to outlive her assets. You'll also want to check that the facility in which she lives will transfer her seamlessly to Medicaid. This varies a bit state-to-state; mine doesn't pay for Medicaid outside of a SNF while just across the rive it will cover a semi-private MCF room.

In regards to the cleaning, in AL and even in a MCF, residents are "prompted" to brush their teeth. If they don't comply, an aide might attempt to do it for them, but even if the PWD allows it, it won't be as good as needs done. When my aunt was guardian for her sister, oral hygiene was what drove the decision to move to a SNF where tooth brushing was more of a norm and the staff were better trained to do it. While a resident, their visiting dentist had my aunt on a 4/year schedule of cleanings. A few of the people on the spouses board have a similar set up to avoid dental issues.  And yeah, it was a bit more than the going rate at an office just as the costs were higher for the phlebotomist and X-ray techs who came to the residences.

HB

Peteena

Thank you everyone for your thoughts and advice! I re-read the email proposal from the dental place and saw that I overlooked that they want to see her again for a cleaning/eval in 2 months when they visit the AL facility - not EVERY 2 months. I have to say my brain is fogged all the time since I am in menopause and have major sleep problems to boot. Panic is my normal reaction to everything I have to do trying to help with my mom. 

I called mom and she said she didn’t have any pain or problems (never sure of her memory sometimes) I asked if she was flossing, but she said “ not like I should be”  so I think I will say OK for a cleaning, but maybe if Covid gives us a break - we can take her outside to the other dentist she went to for years.

CELA is on my mind 100%  - I need my involved family members to help me ( I cannot do that one by myself until they return from out of state soon. ) I have a person we want to see, also want to talk to the AL director/person. The AL has Medicaid beds in the Skilled Care floor - but this stuff is way to overwhelming for me.  One sibling plus awesome spouse will help me, but the other sib just up and stopped communicating at the first start of all this. 

Thank you for listening......I am overwhelmed and stressed, but will keep checking in on this forum.

Peteena