North West oral health survey of
services for dependant older people,
2012 to 2013
Report 1: ‘Care in your home’ services
Dental public health intelligence programme
About Public Health England
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and wellbeing, and reduce health inequalities. It does this through worldclass science, knowledge and intelligence, advocacy, partnerships and
the delivery of specialist public health services. PHE is an operationally
autonomous executive agency of the Department of Health.
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should be sent to publications@phe.gov.uk
Published December 2014
PHE publications gateway number: 2014496
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Dental public health intelligence programme
Contents
About Public Health England ………………………………………………………………..2
Preface …………………………………………………………………………………………………4
Introduction……………………………………………………………………………………………4
Summary ………………………………………………………………………………………………5
Section 1. Methodology …………………………………………………………………………..6
Section 2. Results…………………………………………………………………………………..7
Participation in the survey …………………………………………………………………….7
Oral care needs assessment…………………………………………………………………7
Help with oral hygiene………………………………………………………………………….9
Staff training……………………………………………………………………………………….9
Oral care policy …………………………………………………………………………………11
Additional comments………………………………………………………………………….12
Appendix A: …………………………………………………………………………………………13
Questionnaire about ‘care in your home’ services…………………………………..13
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Dental public health intelligence programme
Preface
Oral health surveys in England are undertaken with various population groups
as part of the PHE dental public health intelligence programme. Prior to the
2013 re-organisation such surveys came under the umbrella of the NHS dental
epidemiology programme. The survey reported here is one of three undertaken
over the time of transition and was initiated by a working group comprising
dental public health practitioners who now work within PHE in the operations
and chief knowledge officer’s directorates.
The survey was only run in the North West region as an opportunity lay within
the overall planned programme to do this while other regions undertook other
surveys.
The needs of older people are becoming a priority area and this survey was
undertaken to provide information that was lacking for this population group. It
recognises the stages of dependency that people go through and the different
services that support them through this. The learning from the North West
survey is now being used to plan national oral health surveys of dependent
older people which will take place in 2015 to 2016.
This report is 1 of a series of 3 and tells of the findings of oral health related
questionnaires run with managers of ‘care in your home’ services.
Introduction
Care in your home services (CIYHs) provide support for dependent older people
who are living in their own homes. The level of support provided varies widely
dependent upon the client’s needs. They may be provided by local authorities or
in private contract with the client or their family. A far greater number of older
people receive support from CIYHs than live in residential care and there are far
more services to meet this demand than there are residential homes. It is
possible that the impact of such services on general and oral health could be
substantial both in the short and long term.
The results of this survey of CIYHs are given here.
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Dental public health intelligence programme
Summary
The results show a wide range of practice among CIYH services. Some of these
could reflect the variations in the types of clients each service provides services
for.
Differences are evident with regard to initial assessments of oral care and
hygiene needs with many services undertaking these, but 37% not undertaking
them at all.
Most responders said that they have a system to ensure they can help clients
clean their own teeth but others commented that this was limited to soaking
dentures and that responsibility for arranging treatment was left to family
members because of confidentiality issues.
When asked about accessing services for clients there was a repeated theme of
difficulties accessing suitable services, particularly domiciliary services. Many
clients would have problems travelling to dental practices and climbing stairs to
upstairs surgeries. It was commented that there were costs associated with
sending a staff member with a client for dental treatment at a practice.
The survey prompted many managers to note gaps in their services in relation
to policy, training and knowledge. They commented on the shortcomings of their
service simply in considering oral health and about providing assistance with
hygiene. There was a clear demand for training by professionals and provision
of leaflets and guidance.
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Dental public health intelligence programme
Section 1 – Methodology
A survey containing 13 questions was used to gather the views of managers of
‘care in your home’ services for elderly people (aged 65 years and over) living in
the North West. The survey was observational and involved only questionnaires
of service managers, not patients or individual service users. A copy of the full
questionnaire is provided in appendix A.
Lists of agencies that provide care in people’s homes were provided by the
dental public health epidemiology team (DPHET) using Care Quality
Commission (CQC) information. Teams from community dental services were
commissioned to undertake the fieldwork. A random sample of at least 6
agencies, or 10% of the total (whichever was larger) was taken in each local
authority area. The sampled agencies were contacted and visits arranged to
allow the fieldwork team to meet with the CQC registered manager.
A total of 198 agencies took part in the survey across North West local
authorities (plus the Isle of Man). The surveys were conducted face-to-face and
by telephone between October 2012 and May 2013.
All data was analysed using statistical package for the social sciences (SPSS)
programme version 21. Missing responses were excluded from the analysis.
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Dental public health intelligence programme
Section 2 – Results
Participation in the survey
Two-thirds of agency managers (66.5%) reported receiving an information letter
about the survey prior to participating (table 1). Almost all had been given the
opportunity to ask questions about the survey (94.5%) and freely agreed to take
part (96.7%).
Table 1. Participant background questions
Has the agency
manager…
Yes No Not
sure
N
received the information
letter
66.5% 26.4% 7.1% 182
been given chance to ask
questions about the survey
94.5% 5.5% ~ 181
freely agreed to take part 96.7% 3.3% ~ 181
Oral care needs assessment
Over a third of agencies did not undertake a formal assessment of a client’s oral
care needs at the start of their care provision (37.1%, figure 1). A number of
additional comments were made in relation to this question (n=31), mainly
providing information about who conducts the assessments and when.
A range of agencies were reported to undertake needs assessments including
managers of the care in your home services, social workers, council employees,
community nurses and hospital personnel prior to the service being engaged.
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Dental public health intelligence programme
Figure 1. Responses to the question: ‘Is there a formal assessment
of each client’s oral care needs at the start of care provision by your
agency?’
n= 175
Of those who conducted assessments, the presence or absence of dentures
and the ability of the patient to eat food was checked by 83.9% of agencies
(table 2). The ability of the patient to clean their own teeth was checked by
85.7%, while the presence of oral conditions requiring urgent attention was
assessed by 55.4%.
Additional comments in relation to this question were that in some agencies,
assessment was only made if the client raises an issue (such as pain or
problems eating), or that the agency would expect oral health issues to have
already been picked up by other health care professionals prior to a client
receiving ‘care in your home’ services.
Table 2. Type of oral health needs assessment
Assessment of… Yes No
presence/absence of dentures 83.9% 16.1%
ability of the client to eat food when they want 83.9% 16.1%
ability of the client to clean their own teeth 85.7% 14.3%
presence of any oral conditions requiring urgent
attention
55.4% 44.6%
n=112
42.9%
20.0%
37.1%
Yes needed to complete
care plan
Yes but not as part of a
care plan
No
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Dental public health intelligence programme
The variation in coverage of assessments was illustrated by the comment that a
few services some simply ask about access to a dentist, while others reported
just asking about self-care.
Help with oral hygiene
Almost three-quarters (73.7%) of agencies had a system in place to ensure that
clients who required help with oral health received it (figure 2). Other comments
in relation to this question were provided by fifty three respondents. The most
common responses were:
• oral hygiene provided as part of general care/care plan (n=19)
• help/encourage where needed/requested (n=13)
• liaise with social worker or other health professional such as GP, GDP,
hygienist or district nurse (n=9)
• liaise with family (n=5)
• other (n=7)
Figure 2. Responses to question: ‘Is there a system to ensure clients
who need help with oral hygiene receive this help’?
n=175
Staff training
Managers were asked whether their staff had received training in five different
areas of oral health care (table 3). Across the five areas, agencies had most
commonly provided training on taking care of a client’s dentures (63.5%), while
the least common was assessing a client’s need for urgent dental treatment
(40.6%).
73.7%
13.1%
13.1%
Yes
No
In some cases
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Dental public health intelligence programme
Table 3. Staff assessment skills
Are care staff trained to…. Yes No N
assess a client’s need for assistance with oral
hygiene 45.6% 54.4% 169
give clients assistance with oral hygiene 62.1% 37.9% 169
take care of client’s dentures 63.5% 36.5% 170
assess a client’s need for urgent dental
treatment 40.6% 59.4% 170
obtain urgent dental treatment for clients from
the correct source 58.8% 41.2% 170
A number of respondents provided additional comments in relation to this
question (n=100). The most common responses were that if a problem was
spotted, a family member would be contacted or the client would be referred on
to another health professional (such as a dentist or hygienist). The need for
additional training on oral health and hygiene was also highlighted.
Respondents were asked ‘what are staff taught about obtaining dental
treatment for clients?’ A wide range of responses were received (n=171), with
key themes as follows:
• to contact relatives or social worker (n=59)
• to contact the client’s dentist (n=33)
• to report to manager (n=29)
• basic care/information (n=14)
• to access external resources (e.g. dental helpline, dental access centre,
training) (n=5)
• other (n=31)
Staff training about oral care for clients was provided by over half of agencies,
the majority as part of the induction process (33.7%), whilst others provide it on
an ad hoc (11.4%) or some other basis (8.6%; figure 3).
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Dental public health intelligence programme
Figure 1. Responses to question ‘Staff training: Is training about oral
care for clients provided?’
n=175
Among those agencies that did provide training (53.7%), this was through
various routes, the majority being in-house training by other staff or managers.
Other sources of training included external agencies or on-line resources, while
some agencies stated that staff had received this as part of their NVQ training.
The frequency with which training was provided varied across agencies. Ninetytwo agency managers answered the question ‘how often was training provided’
with the majority (n=46) stating that it was provided as part of the induction
process (ie one-off). The second most common response was on an ‘ad hoc/as
and when needed’ basis (n=15). Responses were as follows:
• at induction (n=46)
• ad hoc/as and when needed (n=15)
• once a year or less (n=13)
• more than once a year/other (n=10)
• on-going (n=8)
Just 16% of agencies made training materials or advice leaflets about oral care
available to staff. A number of respondents stated that such materials would be
useful (n=47).
Oral care policy
Agencies were asked whether they had a policy about oral care for clients in
place. Three-quarters of agencies (75.3%) did not have a policy in place (Figure
3). A number of respondents stated that they didn’t have a specific policy in
33.7%
11.4%
8.6%
46.3%
Yes as part of
induction
Yes on ad hoc basis
Yes on another basis
No
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Dental public health intelligence programme
relation to oral care but that it was included as part of a client’s general care
plan or as part of general policy (n=29).
Of those who did have a policy in place, just eight were able to provide a copy
at the time of the survey.
Figure 4. Responses to question ‘Does the agency have a policy
about oral care for clients?’
n=174
Additional comments
At the end of the survey, respondents were given an opportunity to provide
additional comments. A total of eighty three respondents provided comments
with two key themes emerging; requests for additional training and training
materials (leaflets, online resources etc.) and requests for more domiciliary
dental care services (and clear pathways for referral).
This report forms part of a series of three surveys of services for dependent
older people;
1. ‘Care in your home’ services provided by agencies, for care of adults over
65 years.
2. Adult hospices and care homes, with and without nursing, in which adults
over 65 years were resident.
3. Wards in hospitals providing in- patient care for adults over 65 years.
Results of all three surveys are presented in separate reports, all of which are
available online at www.nwph.net/dentalhealth
21.8%
75.3%
2.9%
Yes
No
In some cases
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Dental public health intelligence programme
Appendix A:
Questionnaire about ‘care in your home’ services
1. Has the agency manager received the information letter?
Yes
No
Not sure
2. Has the agency manager been given the chance to ask questions about the survey?
Yes
No
3. Has the agency manager freely agreed to take part?
Yes
No
4. Is there a formal assessment of each client’s oral care needs at the start of care
provision by your agency?
Yes, it is needed to complete each client’s care plan
Yes, usually this is done but not as part of a care plan
No – go to question 6
Comment:
5. If ‘yes’ – Is there an assessment of:
The presence or absence of dentures
The ability of the patient to eat the food they want
The ability of the patient to clean their own teeth
The presence of any oral conditions requiring urgent attention
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Comment:
6. Is there a system to ensure clients who need help with oral hygiene receive this help?
Yes
In some cases
No
Comment:
7. Are care staff trained to:
Assess a client’s need for assistance with oral hygiene?
Give clients assistance with oral hygiene?
Take care of client’s dentures?
Assess a client’s need for urgent dental treatment?
Obtain urgent dental treatment for clients from the correct source?
Comment:
8. What are staff taught about obtaining dental treatment for clients?
9. Staff training: is training about oral care for clients provided?
No – not provided for staff – go to question 12
Yes – as part of induction for new staff
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Dental public health intelligence programme
Yes – on an ad hoc basis for all staff
Yes – on another basis
If the answer is ‘Yes – training is provided –
10. Who provides training to staff?
……………………………………………………………………………………………………………….
……………………………………………………………………………………….………….……………
……………………………………………………………………………………………………………….
11. How often is training provided?
……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….
12. Do you have any training materials or advice leaflets for staff about oral care?
Yes
No
Comment:
13. Does the agency have a policy about oral care for clients?
Yes
In some cases
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Dental public health intelligence programme
No
Comment:
If “yes” are you able to provide a copy?
Yes
No
Any further comments you would like to make?
………………………………………………………………………………………….
………………………………………………………………………………………….
Thank you for helping with the survey.
