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Tuesday, December 5, 2023

Medicare covers every part of the body except for the mouth – and it’s time that changed

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Over the weekend, oral practitioners celebrated their industry on World Oral Health Day, but it was also a moment for pause for Australian practitioners, as they reflected on the inequities remaining in Australia’s supposed universal health system.

Leonie Short, dental therapist and director of Seniors Dental Care Australia – which provides training and education on oral health to health care workers – says it’s important that aged care nurses and workers know, that “by speaking up about oral health, it could save the life of an older person”.

“Poor oral health includes rotting teeth, infected gums, smelly mouths, dirty dentures, pain and infection,” she tells Aged Care News.

“This can lead to potentially preventable hospitalisations and deaths from aspiration pneumonia and infective endocarditis.”

Leonie Short has been visiting aged care facilities for 8 years and has noted that oral care is, across the board, of sub-par standard. She documents her experiences as an aged care oriented dental therapist in this Youtube video, produced by Australian Health Journal.

As Short has previously told Aged Care News, older Australians are at particular risk for serious illness in relation to unaddressed oral health conditions; even a seemingly minor issue such as dry-mouth can have insidious consequences.

Lorraine (surname withheld), whose mother was living in a Victorian residential aged care facility, says that her mother was victim to the horrific consequences of neglectful oral health care.

She told the Facebook forum Aged Care Matters (which has provided Aged Care News with permission to republish) in late February that after her mother was initiated on feeding through a tube “through her tummy”, oral care was sorely lacking.

“Most times I would help her on a daily basis as they either forgot or hadn’t the time… she suffered aspiration pneumonia caused, they said, by not cleaning her teeth.

“Mum was of sound mind and this happened on more than one occasion that saw her hospitalised.”

Having lost her mother in November 2021, Lorraine is determined for this issue to be taken more seriously by providers.

“Clean teeth isn’t just cosmetic it can be a matter of life and death.”

Calls for government to implement royal commission recommendations

Short notes that it is a serious inconsistency in our health care system to publicly subsidise care from general practitioners and the hospital system, but not dental.

Dental therapist and director of Seniors Dental Care Australia, Leonie Short, says older person’s should not be in a
position where they have to compromise on their oral care because of affordability concerns.

“Medicare covers the whole body but not the mouth,” she points out.

Dental care in Australia is mostly a private service, with limited public funding available for children and those on the pension, or who possess a health care concession card.

However, the public system is considered a failure in practice, with impossibly long waiting lists delaying vital care for months, even years: the average wait list time in Victoria is currently 24.8 months.  

These compounding pressures have caused many to simply avoid dental treatment all together.

New research from the Australian Institute of Health and Welfare (AIHW) reveals that in 2020–21, around 3 in 10 (32 per cent) persons who needed to see a dental professional delayed seeing or did not see one at least once in the previous 12 months.

One-in-seven persons surveyed explicitly stated that ‘cost’ was a reason for delaying or not seeing a dental professional.

According to Australian Dental Association (ADA) data from 2019, the average cost of a periodic check-up including an examination, scale and clean and a fluoride treatment is around $215; this represents 43 per cent of a single person’s weekly pension income, and 28 per cent of a couple’s.

Short says that older person’s should not be in a position where they have to compromise on their oral care because of affordability concerns.

 “Oral health is a right – not an optional extra,” she says.

In response to this worrying phenomenon, the National Oral Health Alliance – comprising a variety of dental and social advocacy organisations including the Australian Dental Association, Australian Council of Social Service (ACOSS) and Council on the Ageing (COTA) – has called on the Federal Government to honour a key recommendation of the Royal Commission into Aged Care Quality and Safety: implementing a Senior Dental Benefits Scheme (SDBS).

Ideally, the SDBS would function similarly to the Child Dental Benefits Scheme, which provides families, biennially, a maximum of $1026 per child in subsidies for check-ups, fillings and other basic dental services.

While the royal commissioners tabled a suggested start date of January 1, 2023, there has been little word from the Government as to the status of the program’s development.

Ian Yates, chief executive officer of COTA Australia, says that the Government should act immediately on implementing this program.

“A Senior Dental Benefits Scheme is a win-win,” he says. 

“Not only will it enhance older people’s lives but, as a preventive health measure, to lessen broader health system pressures.”

According to Dr Cassandra Goldie, CEO of ACOSS, 67,000 hospitalisations were preventable, yet caused by inaccessibility to primary dental care.  

“People on very low incomes are being forced to delay or forego dental treatment due to prohibitive costs and long waiting times for public dental,” she says.

“A substantial boost to funding for public dental services is urgently needed.”

The ADA has been calling for improved access to publicly-funded dental care for seniors since 2019, with the publishing of its Australian Dental Health Plan (ADHP), which advised the introduction two new, income-tested public dental schemes: one for adults aged 18–64 and another for seniors aged 65 and over.

For the seniors scheme, the eligible group would be those aged 65 and over who hold a Pensioner Concession Card, a Commonwealth Seniors Health Card, or a Health Care Card issued by the Australian Government.

By extending eligibility to those who hold one of these Commonwealth concession cards, these two new schedules would cover all adults and seniors in receipt of Commonwealth income support payments, and some on similarly low incomes who just miss out on eligibility for payment of Commonwealth pensions/allowances.

The ADA reiterated calls for this program to be established in its 2019 submission to the royal commission, with the full submission available via this link.

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