Engaging dental professionals in residential aged-care facilities: staff perspectives regarding access to oral care Lydia Hearn A and Linda Slack-Smith A,B A School of Dentistry M512, University of Western Australia, 17 Monash Avenue, Nedlands, WA 6009, Australia. B Corresponding author. Email: linda.slack-smith@uwa.edu.au Abstract. The limited access to oral care for older people living in residential aged care facilities (RACFs) has been noted repeatedly in the literature. The aim of this study was to explore RACF staff perspectives on how to engage dental professionals in the provision of oral care for RACF residents. Semi-structured interviews were conducted with 30 staff from six purposively selected RACFs located in high socioeconomic areas to gain understanding of the multidimensional issues that influenced the engagement of dental professionals from a carer perspective. Analysis revealed that staff perceived tensions regarding affordability, availability, accessibility and flexibility of dental professionals as significant barriers to better oral care for their residents. Participants raised a series of options for how to better engage dental professionals and reduce these barriers. Their ideas included: the engagement of RACF staff in collaborative discussions with representatives of public and private dental services, dental associations, corporate partners and academics; the use of hygienists/oral health therapists to educate and motivate RACF staff; the promotion of oral health information for troubleshooting and advice on how to deal with residents’ dental pain while waiting for support; the encouragement of onsite training for dental professionals; and the importance of gerodontology (geriatric dentistry). Findings highlighted the need to explore alternative approaches to delivering oral care that transcend the model of private clinical practice to focus instead on the needs of RACFs and take into account quality of end-of-life oral care. Additional keywords: aged care, barriers, geriatric dentistry, oral health care, primary care. Received 19 February 2015, accepted 17 August 2015, published online 16 November 2015 Introduction Research indicates that older people living in residential aged care facilities (RACFs) who are dependent on others for oral care have significantly more dental caries and plaque deposits than their community-dwelling counterparts (Chalmers et al. 2009; Hopcraft et al. 2012). Such oral disease may have a considerable impact on quality of life, including eating ability, speech, behaviour, appearance and social interaction (Sheiham 2005; Griffin et al. 2012). It has been suggested that older adults with poor oral health may also be more prone to preventable systemic diseases (Kandelman et al. 2008), including cardiovascular disease and stroke (Mattila et al. 2005). Studies indicate a lack of appropriate oral health systems for older people in the community (Grytten and Holst 2013). The focus is often on providing dental treatment in response to acute dental distress (Quiñonez et al. 2009). Older people in RACFs have even more limited access to appropriate oral health systems (Hearn and Slack-Smith 2015), preventative dental care and other dental services (Hopcraft et al. 2008). The absence of dental practitioners with skills and training in dealing with older people (MacEntee 2010; Slack-Smith et al. 2015), together with a lack of financial incentives, the need for portable dental equipment and limited provision of continual oral hygiene training for carers, have further hindered the promotion of primary oral care (Weening-Verbree et al. 2013; Bots- VantSpijker et al. 2014). Key barriers to accessing dental services in RACFs have been reported at policy, service and practitioner levels, with specific emphasis on inequalities in access to oral care among low-income adults (Miegel and Wachtel 2009; Tham and Hardy 2013; Hearn and Slack-Smith 2015). Residential aged care in Australia is government-subsidised and regulated by the Commonwealth Government’s Department of Social Services. RACFs in Australia fall primarily under the non-government sector, usually through religious/charitable and private sector providers/companies. Contributions for a resident’s care are calculated according to an income test. Legislation regulates the upper limit on fees that any approved RACF provider can charge a resident (Department of Social Services 2014). This limits the amount of money available for the RACF to spend on additional activities, including oral care. In reviewing barriers to oral care, emphasis to date has been placed on economically vulnerable groups (Miegel and Wachtel 2009; Wallace and MacEntee 2012; Tham and Hardy 2013). However, residents with financial and non-financial resources do not necessarily have ready access to oral care or dental services. Acknowledging the importance of single issues like affordability does not adequately address the complexity of accessing care (Watt 2007), nor the diverse barriers that can affect such care in Journal compilation Ó La Trobe University 2016 www.publish.csiro.au/journals/py CSIRO PUBLISHING Australian Journal of Primary Health, 2016, 22, 445–451 Research http://dx.doi.org/10.1071/PY15028