Mouth Care in Assisted Living: Potential Areas for Improvement

Abstract

Background: Poor oral care may lead to systemic disease, and there is evidence that assisted living (AL) residents lack quality oral care; in AL, poor care may be due to staff knowledge and attitudes, as well as organizational barriers to providing care.

Objectives: Determine AL staff knowledge and attitudes regarding mouth care and barriers to changing care.

Design: Self-administered repeated-measures questionnaires completed before and after oral care training.

Setting and participants: A total of 2012 direct care staff and administrators from 180 AL communities.

Methods: Nine knowledge questions and 8 attitude and practice intention questions, and open-ended questions regarding training and obstacles to providing oral care.

Results: Overall, 2012 participants completed pretraining questionnaires, and 1977 completed posttraining questionnaires. Baseline knowledge was high, but staff were not uniformly aware of the systemic-oral link whereby mouth care affects pneumonia and diabetes. Almost all staff reported learning a new technique (96%), including for residents who resist care (95%). Suggested areas to improve mouth care included having more hands-on experience. The primary perceived obstacles to care centered around residents who resist care and a lack of time.

Conclusions and implications: Based on reports of having benefitted from training, AL staff overwhelmingly noted that new knowledge was helpful, suggesting the benefit of skills-based training, especially in dementia care. Mouth care in AL has been sorely understudied, and merits additional attention.

Keywords: Oral care; assisted living communities; educational training; intervention; mouth care.