Interfaith Dental, a nonprofit organization in Tennessee, is making strides in expanding oral healthcare for older adults in the state through a recently launched program.
Tennessee was recently ranked as one of the worst states for dental health and has more than 250 dental provider shortage areas. These shortages, compounded by other challenges, can make it difficult for patients age 65 and older to receive dental care.
The state's new program, Smile On 65+, is being funded through a grant contract between the state and Interfaith Dental. Through the initiative, older adults will gain access to oral health services at 20 dental clinics across the state. These services covered include cleanings, extractions, fillings and dentures.
Holly Plemons, chief officer of statewide initiatives, recently spoke with Becker's about the challenges facing older patients, the program's impact on patients and the program's plans for expansion.
Editor's note: Responses were lightly edited for length and clarity.
Question: What inspired the launch of this program?
Holly Plemons: Smile On 65+ plus that launched in August 2022 was launched after a pilot we did as Smile On 60+ that started in 2018 and ran through 2021. From that original pilot, we learned a lot about the landscape and what it took to manage a program of this magnitude, and how to find funding to sustain it. So that's what inspired the launch. We recognized that older adults really lack access to dental care in our state, especially low-income older adults. So it was the desire to continue providing them with a service that we saw was really invaluable to them.
Q: What kind of challenges did you have to overcome with the pilot program?
HP: What we've found was a challenge was clinic capacity, charitable care clinics having enough providers working in them to see the population that needs them, and then distance. If you are living in a rural area, sometimes you're a couple hours or 100 miles from a clinic that works for the program or has the opportunity to help you.
The other thing we found with older adults is a need for transportation. Sometimes they may not be able to drive themselves, so arranging transportation to get them to the clinic that can help them is sometimes a challenge. We have community dental health coordinators who work across the state. We have five of them now, and they are dental professionals with extra training and case management and navigation. What they do is work with patients one on one to figure out what is the barrier that's making it hard for them to get to a clinic and working with them to help resolve it. Sometimes that's coordinating transportation assistance, sometimes that's understanding the process of how to get into a clinic, just getting their paperwork and their documentation submitted so the clinic can can help them, or navigating a phone system. We have so many things, but the coordinators are really the goal of the program, I feel, because they work with a patient to help shepherd them into the clinic that then takes it from there and helps to care for them.
Q: What other challenges do older patients in the state face that could prevent them from accessing this dental care?
HP: Well, there is no dental in Medicare coverage. So when someone ages into that system, there isn't any benefit that goes along with that, unless it's hospital care. If they're in a hospital and it's emergent, there's a little there, but what you think of as your routine services that would happen at a dental office, there's no coverage for them there. So that is probably the biggest challenge, especially for those who are low income, which our program is designed to serve.
The other thing is going to be a lack of providers, especially in rural areas of our state. There is a shortage of dental providers, especially those who may see on a sliding fee scale or charity care clinic. It's harder to get to them, so cost and access is a challenge.
Q: How does the program ensure continuity of care?
HP: I think that's twofold. The partners in our network are committed to being a dental home for someone who needs them so the person knows who to call if they have a dental need. Once they are in with these clinics, they function like a patient of record, meaning that's their dental home, so they are able to get in for the follow-up care. Some of them save appointments for existing patients and bring them back for their routine maintenance, and oftentimes, we find it takes multiple appointments to help someone get well after they've been without dental care for quite some time. So we see our patients, by and large, having multiple appointments with the clinic they start getting care from. We also have our community dental health coordinators follow up with someone who gets referred to a clinic to see how it's going and what else they need and answer their questions, so they have that additional support built in as well.
Q: How has the experience been with the program so far since its launch? Are there any anecdotes you can share about people you've helped so far?
HP: This past year, we added four new sites into our network, so we have 21 partners with 38 locations and are planning to add additional sites in the current fiscal year we're in. By and large, what we hear from patients is that they're just overwhelmed that they can go get care now, that they can be seen at a clinic, that they can eat again. We had one individual who went through her treatment plan and completed it in East Tennessee, and she hadn't had functioning teeth that allowed her to eat what she wanted for more than 20 years … So it's giving someone back the ability to interact with their friends at church or senior center or their neighbors or their family because they can smile now, they can eat, [and it] makes them healthier overall. They don't have an infection in their mouth, so they feel better. There's just so many layers to it.
Q: What is planned in terms of expansion for the program?
HP: We are always working to expand the program. We are always looking for a charitable care clinic that's not partnering with us yet to talk with them and see if they may be able to do so if they have enough providers and room and the ability to do that. So that work continues and will throughout, particularly in West Tennessee. There are not a whole lot of providers in that area, so we are always on the lookout. We do that through networking with community organizations, working within our dental societies and with the Department of Health. This program is funded through a grant under the Tennessee Department of Health, and they are great partners. So it's just getting the word out, working in communities and extending the offer for anyone who can join us to do so.