Hygienist provides dental care in retirement community

Nov. 1, 2012
Nestled in a wooded area in a small town near the Jersey Shore is Seabrook Village, a Continuing Care Retirement Community (CCRC).
Joanne Taylor, RDH, BS, chats with two residents at Seabrook Village retirement community. Photography by Travis Tanay.


Nestled in a wooded area in a small town near the Jersey Shore is Seabrook Village, a Continuing Care Retirement Community (CCRC). It is comprised of seven multistoried buildings spread out over 90 acres of land, which visitors liken to a college campus.

The majority of the more than 1,400 residents from the age of 62 up either live independently in apartment buildings connected by windowed walkways – or, should they require a higher level of care -- in a detached building offering assisted living and skilled nursing. Continuing care within one community means that a resident might start out in independent living, but, in the nature of the aging process, might need a more supportive kind of environment later on. This is an important benefit should one member of a couple require a higher level of care than the other — relocation to another venue is unnecessary. The overarching philosophy of Seabrook Village is that a resident is guaranteed a home for the rest of his or her life, regardless of unforeseen, adverse financial circumstances.

Amenities abound on the campus – there are three restaurants, transportation to nearby shopping and recreation, a swimming pool, fitness center, TV studio, and numerous areas where residents can pursue interests ranging from playing cards and games to attending classes on philosophy and learning a foreign language. Religious services for all faiths, movies and concerts are held in the 250-seat auditorium.

This CCRC boasts a full on-site medical center that is available to all residents, and, of special note, a privately-owned dental practice. Here’s where we meet Joanne Taylor, RDH, BS, and her employer and practice owner, James C. Burden, DMD, FAGD.

A Senior-Focused Practice

The attractive three operatories and small laboratory are filled with state-of-the-art equipment and supplies and operate two and a half days a week, catering solely to the community’s residents. Examinations or treatments are fee-for-service and comparable to fees charged by dental practices outside. All residents carry health-care insurance policies supplemental to Medicare, some of which offer modest dental benefits. In such cases, the practice bills accordingly with residents co-paying the difference.

Because Seabrook Village residents comprise a middle-class cohort (the entrance fees can be steep), they’ve benefitted from good oral health care over the years. So one wonders what the overall take on their oral health is, especially regarding periodontics. How much work, if any, is sent out to a specialist? Both practitioners claim a very small percentage is referred out for periodontal reasons, as many residents have already had previous periodontal surgery and are now in a maintenance mode. Plus, the hygienist keeps patients under control through regular appointments. (There is a per diem hygienist who comes in when the heavily periodontal schedule requires it.) Those patients who are referred out have medical issues that preclude treating them “in house,” or need a procedure that is best left in the hands of a specialist: root therapy for constricted canals in molars, for example, is one.

Dr. Burden points out that very few older adults present with a full complement of teeth. Most of them are missing at least one or even two teeth, with several restored or replaced. Bear in mind that many preventive products were not as yet in full use when these older adults were children.

What prompts a health-care professional to center on working with the geriatric population, where there are so many challenges? In Dr. Burden’s case, the challenges are exactly what he likes about his practice. He began an in-home dental practice to serve the needs of seniors and those with disabilities shortly after completing his hospital-based postdoctoral residency. Then, when the opportunity to rent space in this retirement community presented itself, he jumped at the chance. “Doing a filling or an extraction on someone who’s 96 is medically different from doing the same thing on someone who’s 26. I always ask myself, ‘What’s the best and safest way to proceed?’ I really like the challenges a geriatric practice holds,” he said.

When the health of a resident is such that he or she cannot come to the dental center, Dr. Burden and the practice dental assistant Linda Bronkowski pack up his custom-made portable dental unit and head over to the skilled nursing component to perform routine care.

What prompted Joanne to seek out this practice? She claims that her extensive periodontal background coupled with her knowledge of medications learned from caring for her ill parents, in-laws and aunts well qualified her to treat the medically compromised elderly population. “It just worked out,” she says, “plus Dr. Burden’s a phenomenal boss. He’s a family man, and if I have to leave because one of my kids is sick, he understands, as do the patients. They’ve been through the same thing with their children and grandchildren. I much appreciate that understanding. It makes all the difference.”

A Foreseen Start

Joanne knew she wanted to be an RDH since she was in grammar school, when her interest was piqued at a school science fair where two dentists presented. Then, when her mother took her to a nearby dental school to have her teeth cleaned by the dental hygiene student, she knew that becoming a dental hygienist was definitely in the cards for her as her career choice. “Most kids don’t know what they want to do when they grow up,” she says. “I knew when I was ten or eleven years old.” (Interestingly, Dr. Burden claims he knew he wanted to be a dentist from the age of seven!)

When asked how long she’s been a practicing dental hygienist, Joanne surprises herself when she exclaims, “27 years! Can that be right?” She had worked in a periodontal practice and a general practice for several years in the northern part of New Jersey. Then, when her family relocated to the shore area, she took a year off to care for her very ill mother, juggling her time between traveling to the northern part of the state where her mother lived to raising two young children many miles south. “It was tough,” she said, “but I didn’t have a job so it all worked out.”

After her mother died, Joanne began “temping” for a few years until she found this senior-focused practice in Seabrook Village. “I was waiting to find the right job,” she says, “and this is it! I’ve been here for six years and I just love it.”

“You have to be flexible,” she claims. “When patients cancel at the last minute because they’re sick, we try to fill in that slot. But one thing we don’t have to worry about is the weather! Residents don’t have to go outside to get to us. And if walking’s a problem, there’s a campus shuttle that will take them from their own residential building to the one the dental center is in, and the bus stops are in an enclosed area.”

A typical day for Joanne consists of reviewing home care, pocket depth measurement and root planing (if required), screening for oral cancer, checking periodontal maintenance, charting, exposing radiographs, reviewing medications, evaluating dry mouth, applying fluoride varnish, and tailoring home care to the patient’s specific strengths and weaknesses. Many of her patients have visual or dexterity issues, which means home care can be compromised.

“I spend a lot of time with patients with macular degeneration who cannot see how they’re brushing. I tell them to feel how they’re brushing and recommend a mechanical toothbrush with a pointed bristle that’s good for interproximal cleaning. I tell them to trace out the gumline with it. That’s been a successful approach to home care for many,” she says.

“I’m so grateful for my periodontal background, as many of our patients present with pocketing. The first thing that goes into my hand is a periodontal probe.” She’s had great success using a subgingival antibiotic delivered to the base of the pocket after deep scaling, often bringing a 5-mm pocket to a 3-mm one by the next recare appointment. She credits this treatment with slowing down the progression of the disease, stating it is best when used in isolated areas. “It saves the tooth,” she asserts.

She allows an hour and a half for new patients, and at least 45 minutes to one hour for recare or periodontal maintenance — the core of the practice. As she points out, “sometimes it takes ten minutes just to get the patient from the wheelchair into the unit chair, and ten minutes in reverse. This is where the whole team helps.” When asked if she ever worked with the staff dental assistant chairside, she replies, “Yes, especially if the patient has issues with breathing. The RDA suctions while I complete my work.”

Joanne commends the team approach this practice has. “I’ve been in many dental offices where there hasn’t been as helpful a team,” she says. “Without a doubt, we all share the same goal: the patient comes first.” She believes in treating her elderly patients with the same care and consideration she would have wanted had her parents and relatives needed care by a dental hygienist.

This earnest RDH participates in a study group that meets five or six times a year, the attendance at which counts towards mandatory continuing education credits. In addition to the formal learning component with a renowned speaker, she enjoys the give and take with other hygienists as they exchange valuable tips and information regarding new products and procedures. Her current plan is to get certified to administer local anesthesia, a procedure recently approved by the New Jersey State Board of Dentistry.

Joanne says practicing dental hygiene is not just her job, it’s her passion. “I’m a perfectionist,” she says. “It’s imperative to me that when I get into a mouth that I thoroughly check and do the best I can. Obviously, there are times when the patient’s health condition doesn’t permit me to do what I want to do to the extent I want to do it. That was hard for me to accept in the beginning,” she claims. “But I do the best I can under the circumstances and the patients are most grateful. Their gratitude is what keeps my passion going.” RDH

What’s a CCRC?

Continuing Care Retirement Communities, or CCRCs, are fast becoming the preferred option for retired active older adults who want to continue living their independent lifestyles, but like the security and peace of mind that comes from knowing there are a range of on-site support systems and health services available.

Although costs, contracts, and community size differ, all CCRCs offer three levels of living arrangements in a single setting: independent living, assisted living, and nursing care. CCRCs are not cheap. Contracts can range from a sizeable upfront entrance fee coupled with monthly maintenance that can change over time in exchange for a living unit, meals and health care coverage up to the nursing home level, to services offered on a month-to-month basis with health care coverage being paid for at the time of need.

Is a CCRC for everyone? It depends on what one’s needs are. Many factors, including income and personal preferences make each situation unique. However, people who do choose a CCRC have several things in common: they’re in good health and enjoy an active, healthy lifestyle; they want to maintain their freedom, privacy and independence; they want to get away from the care and maintenance of their present home; and perhaps most importantly, they want to take a proactive approach to their own aging.

But let the buyer beware. Costs, contracts and terms vary widely. Only a few states have an overall governing body that provides oversight on the many issues involved in running a CCRC. This means that the potential buyer, family and lawyer have to thoroughly investigate and understand just how much money will be needed in both the present and the future to support this lifestyle option. Ask to see all financial reports, licensing and inspection reports and any complaint investigations while touring the facility. Weigh the pros and cons carefully before committing.

For more information on CCRCs, visit www.retirementliving.com; www.aarp.org; www.ericksonliving.com.

REGINA DREYER THOMAS, RDH, BS, MPA, is a retired dental hygienist who lives in a CCRC, and writes and presents programs on love and aging. Her book, “Love & Successful Aging When You’re 70+ and Single,” is available in both print and as an e-book. To contact her, visit her website at www.loveat70.com for direct links to amazon.com and barnesandnoble.com, or email her at [email protected].

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