Needs Assessment

A. General Data
1. Description of the Site:

Rose Place is part of the Enlivant community which opened their

first senior residence in 1981. Enlivant has 200 communities in
19 states. Each location has 40 to 60 apartments on average and
is staffed with an on-site team that helps residents with different
daily needs. Roles include community leadership positions such
as executive director, community relations manager, and care
services managers. They also have community support positions
such as care partners, LPN/LVN, drivers, house keepers, cooking
and dining services, assistant maintenance tech, medication
assistance, and concierge. Enlivant mission is to enrich life
through meaningful relationships and vibrant communities and
their vision is to become the nations most trusted senior living
provider. Their five core values include compassion, humility,
integrity, excellence, and fun. Funding sources are available to
pay for residence care. These include commercial insurance,
private pay, social security, separate pricing structure, and
veterans benefits. The location of Rose Place is 8214 Anchor
Drive, Port Arthur, Texas 77642.

2. Description of Client Population and Target Group:

Our target population is elderly adults who are 75 years of age or

older. There are 8 residents who are participating in the Oral
Health Program. Of these eight, seven of them are females and
one is a male. All of the participants are currently taking
medications, but only three claim to suffer from xerostomia. They
also can brush and floss their teeth without assistance. Only two
of them claim to have many cavities when they go to the dentist.
One resident has been diagnosed with periodontal disease while
the others are unknown. Three of the residents wear both a
partial and denture, two wear only dentures, and one wears a
partial.

3. Description of Staff Population:

Roles include community leadership positions such as executive
director, community relations manager, and care services
managers. They also have community support positions such as
care partners, LPN/LVN, drivers, house keepers, cooking and
dining services, assistant maintenance tech, medication
assistance, and concierge

4. Description of Services Provided:

 The coordinator for any activities/programs for the elderly
residents at Rose Place is Dee Illman. Rose Place offers
stimulating activities such as card and board games, bingo,
church services, and live music programs. Residents also go on
visits to the local senior center and outings for shopping and
dining.

5. Other Pertinent Data

Water Fluoridation Level - .84ppm

B. Information Related to Dental Health

The nurses do not provide many dental services other than assistance
with brushing and flossing when requested by the resident.
Preventative measures utilized at Rose Place is brushing, flossing, and
water fluoridation. Supplies available include toothbrushes, floss,
mouth rinses, and aids to clean and place dentures and partials. There
have been no other oral health programs at Rose Place before. The
staffs knowledge and awareness of dental health is limited. (2)

C. Dental Health Status

1. Periodontal Disease

The latest National Health and Nutrition Survey of the United

States reveals that the prevalence of periodontal diseases in
senior adults, age 65 and over, has decreased from the early
1970s. Still, significant disparities remain in some population
groups. Older seniors, black and hispanic seniors, current
smokers, and those with lower incomes and less education are
more likely to have periodontal disease. In the United States,
21.53% of seniors who are 65+ and still have their natural
dentition have periodontal disease. Of this percentage, 12.97%
are male and 8.56% are female. The percentage of seniors 65+
who have moderate to severe periodontal disease increases to
35.01 % with 20.62% being male and 14.40% being female.

2. Dental Caries

According to the National Health and Nutrition Survey of the

United States, dental caries, both treated and untreated, have
also decreased since the 1970s. It was a significant decrease in
all population subgroups, however, substantial disparities are still
found in some population groups. 93% of seniors 65+ have had
dental caries in their permanent teeth. Of this 93%, 18% have
 untreated decay. In relation to the severity, 9.24% have decayed
or missing permanent teeth and 43.02% have decayed and
missing permanent surfaces. The prevalence of caries on
permanent teeth of seniors 75+, which is counted by tooth
surfaces for accuracy, is 92.70%.

3. Dental Visits
Ages: 18+
Total: 64.4%

AGES %
44-54 65.8%
55-64 67.1%
65+ 65.7%
GENDER %
Male 61.6%
Female 67.1%

RACE %
White 68.4%
Black 56.5%
Hispanic 54.2%

EDUCATION %
Less than High School 43.3%
High School or GED 58.9%
College Grad 79.3%

INCOME %
Less than 15,000 42.8%
25,000-34,999 57.7%
50,000+ 78.8%

Although more adults are keeping their teeth, many continue to

need treatment for dental problems. For every adult aged 19
years or older without medical insurance, there are three who do
not have dental insurance. (2)

4. Edentulous:
Ages: 65+
Total: 14.9%
 GENDER %
Male 14.1%
Female 15.5%

RACE %
White 14.3%
Black 22.1%
Hispanic 13.4%

EDUCATION %
Less than High School 31.8%
High School or GED 18.1%
College Grad 4.3%

INCOME %
Less than 15,000 28.3%
25,000-34,999 15.3%
50,000+ 5.7%

5. Oral Cancer
Ages: 65+
Total: 2.9% of all new cancer cases in the United States

AGES %
45-54 18.8%
55-64 30.5%
65+ 43%

GENDER %
Male 16.7%
Female 6.2%

RACE %
White 23.8%
Black 19.6%
Hispanic 14%
 Oral cavity and pharynx cancer is most frequently diagnosed
among people aged 54-64. The median age at diagnosis is 62.
Death rates of oral cancer are higher among males, particularly
those of African American descent. The median age at death is
67. (2)

Goal:

Establish, organize, and enforce an oral health program to educate the

elderly to help prevent disease and properly clean their teeth and dentures.

Objectives:
Design an oral health routine plan for the elderly to follow.
Implement oral cancer screening during patient assessment.
Increase the dental knowledge of the elderly by 20%.
Demonstrate oral health techniques.
Provide written instruction manual to assure accurate and complete
implementation of the program.

Rationale:

Across the United States, residents of nursing homes are experiencing an

epidemic of poor oral hygiene. Older adults are keeping their teeth longer
and therefore require increased dental care, but nursing home workers aren't
necessarily prepared to provide it (4). The major risks for tooth loss are tooth
decay and gum disease that may increase with age because of problems
with saliva production; receding gums that expose softer root surfaces to
decay-causing bacteria; or difficulties flossing and brushing because of poor
vision, cognitive problems, chronic disease, and physical limitations (3). The
demographic of older adults is growing and likely will be an increasingly large
part of dental practice in the coming years
(6). Typically, aging patients baseline health state can be complicated by
comorbid conditions and physiologic changes (6). They may regularly use
several prescriptions or over the counter medications making them
vulnerable to drug interactions or side effects (6). Older adults compromise
13% of the population, but accounts for 34% of all prescription medicine use
and 30% of all over-the-counter drug use. Four out of five older adults live
with one or more chronic conditions. Many take multiple medicines at the
same time. (5) These issues must be addressed to increase the oral health
and overall well-being of nursing home residents. (4).

Program Design:

A. Activities:

The purpose of our oral health program is to increase the awareness of

the elderly adults in regards to their oral health. The discussions will
include basic dental health, oral cancer screening, oral assessment,
oral hygiene practices, and dental prostheses care. The sessions will be
performed on a weekly basis at The Rose Place assisted living facility.
The sessions will be presented in the following:

1. Session 1 (week 1)
a. Administrators and Manager
Presentation of the overall oral health plan related to the oral
health of the patients.
1. Discuss the need for a preventive dental health program
for the patients.
2. Show the written pretest and posttest to assess the dental
knowledge of the patients.
3. Discuss the importance of good oral hygiene and how to
enforce a daily plaque regimen for the patients.
4. Discuss the importance of oral cancer screening for early
detection and prevention of oral cancer for the patients.
5. Discuss the importance of maintaining a clean dental
prosthesis.

This session will require an hour and will only need the
administrators and managers.

2. Session 2 (week 2)
a. Senior Residents
Presentation of general oral health information and preventative
methods. This session will include a pretest to evaluate the
dental knowledge of the senior residents.
1. Pretest will be given to determine the dental knowledge of
each individual.
2. Discuss and review, depending on individual knowledge, basic
oral health.
3. Differentiate healthy soft/hard tissue versus diseased by
PowerPoint presentations.
4. Discuss preventative methods such as brushing and flossing
using a typodont so they can perform and educate the family
care givers the correct techniques.
 This session will require an hour and a half and will need the
senior residents.

3. Session 3 (week 3)
a. Senior Residents
Presentation will be directed to the patients. Topics will
include oral cancer screening and dental prostheses cleaning.
1. Review topics discussed in prior session: basic dental
health, oral hygiene techniques, and the difference
between healthy soft/hard tissues versus diseased.
2. Demonstrate techniques to assess the condition of the oral
cavity.
3. Demonstrate denture cleaning using a denture brush and
denture cleaner.
4. Demonstrate denture cleaning using the ultrasonic cleaner.

This session will require an hour and a half and will need
the senior residents.

4. Session 4 (week 3)
a. Senior residents
Clinicians will observe at the patient/senior resident
provides an oral cancer screening and oral hygiene and/or
denture cleaning.
1. Observe patient perform oral cancer screening.
2. Observe patients knowledge on plaque and oral hygiene
instructions.
3. If the patient is wearing denture(s), observe the patient
clean the denture(s).

This session will require an hour and will need the senior
residents.

B. Constraints and Alternatives:

1. Constraint: There may be a lack of regular visits and many dental
needs among the homebound patients due to financial difficulties.
Alternatives:
1. Provide information on the utilization of the available dental
resources in the Port Arthur area (list provided).
2. Assist the staff in locating a local dentist that accepts
Medicaid/Medicare.
3. Notify the staff of the importance of informing their patients of
the importance of dental services.

2. Constraint:
 There could be a lack of interest on the patients part due to a lack
of skills and extra work.
Alternatives:
1. Include visual aids in the presentation to make a clear point.
2. Ask questions to make the presentation interactive.
3. Engage the patients with hands on activities.

3. Constraint:
There may be partial attendance of the patients due to different
daily schedules.
Alternatives:
1. Make a flyer to inform and/or remind the elderly residents of the
scheduled sessions.

C. Resources
The following resources will be required for implementation of the
program:
1. Personnel: administrators and manager (for the first session
only). Elderly residents (for the second, third, fourth and fifth
sessions).
2. Visual aids:
a. PowerPoint of healthy and unhealthy oral cavity.
b. Flip chart to demonstrate proper brushing and flossing.
c. Typodont and toothbrush provided by clinicians.
3. Supplies:
a. Toothbrushes, toothpaste and floss (8 kits). Denture
brushes and denture cleaner (8 kits).
b. Cups, disclosing solution, ultrasonic cleaner, sample
denture, gloves, cotton swabs, paper napkins, gauze,
tongue depressor provided by LIT Dental Hygiene
Clinic.
4. Evaluation material:
a. Pretest one form
b. Post-test same form
c. Administrator evaluation
5. Supplements:
a. An outline of the program plan provided by the
clinicians.
b. A brochure will be developed by the clinicians.

D. Budget:
The estimated cost for the dental hygiene health program is as
follows:
1. Toothbrush kits $60.00
2. Plastic cups $5.00
3. Gloves $30.00
 4. Denture cleaner $5.00
5. Denture brushes $24.00
6. Ultrasonic cleaner (donated by LIT Dental Hygiene Clinic for
use).
7. Gauze, cotton swabs, tongue depressors, napkins, and
disclosing solution (donated by the LIT Dental Hygiene Clinic).

E. Timetable:
All of the needed resources will be obtained prior to each session.
There will be four sessions spanning a 4 week period of time. The
schedule is as follows:
Session 1: week of March 20th-25th, 2017
Session 2: Week of March 27th-31st, 2017
Session 3: Week of April 3rd-7th, 2017
Session 4: Week of April 10th-14th, 2017

F. Evaluation:
A. Process evaluation (formative)
1. A weekly meeting with the manager will be done to evaluate
the progress of the oral health program.
2. A weekly review of the oral health techniques and denture
cleaning to assure mastery of the skill.
3. A weekly review of oral cancer screening to assure mastery of
the skill.
4. A weekly review of the dental knowledge of the senior
residents.
B. Product evaluation (summative)
1. A pretest and post-test will be administered to the senior
residents to assess and compare their level of knowledge in
dental health care concepts.
2. A questionnaire will be given to the senior residents to assess
the effectiveness and success of the oral health program.
3. An annual check with the administrator will be conducted to
verify that the senior residents are implementing the oral health
routine plan.
4. Provide a written instructional manual to the administrator
about the oral health program.
5. An annual check with the administrators will be conducted to
verify the utilization of oral cancer screening during patient
assessment.
Session One
Lesson Plan:

I. Introduction
The lesion is focused on administrators and managers. The goal of
the lesson is to inform them about the oral health program and
discuss the schedule for the program sessions. The lesson is
expected to last for one hour.

II. Objectives

COGNITIVE:
1. To design an oral health routine plan for the patients to follow
during the initial patient visit.

AFFECTIVE:
 1. To appreciate the importance of having routine oral care in the
elder population.

III. Content
1. Discuss the oral health plan and the time frame to inform the
administrators and manager of our plan.
2. Show the administrators and managers the materials such as
pictures that will be used in the entire oral health program.
3. Provide a written instruction manual to assure accurate and
complete implementation of the program.

IV. Method of Teaching

One-on-one discussion with administrators and managers on the
oral health program schedule and expectations.

V. Materials and Resources

A. Materials that will be needed are:

Toothbrush
Toothpaste and Floss
Disclosing Solution
PowerPoint presentation of healthy and unhealthy hard/soft
tissues of the oral cavity.
Computers for the PowerPoint presentation
Brochure and written instructional manual

B. The lesson will be conducted in the managers office of The Rose

Place facility with two dental hygiene students. It will be held on
March 21st, 2017 at 10:30 a.m.
VI. Evaluation and Assessment
A. Informal questioning of the oral health program.
Session Two
Lesson Plan

I. Introduction
The lesson is focused on eight senior residents. The goal of the
lesson is to increase basic dental knowledge and proper oral
hygiene techniques. The session is expected to last for one hour.

II. Objectives

COGNITIVE
1. The senior residents will identify what plaque is and where it
accumulates.
2. The senior residents will explain the importance of having a clean
oral cavity.

PSYCHOMOTOR
 1. The senior residents will demonstrate proper oral hygiene
techniques by the end of the session.

AFFECTIVE
1. The senior residents will understand their own susceptibility to
caries and periodontal disease.
2. The senior residents will appreciate the importance of an oral
health routine.

III. Content
1. Define plaque- a sticky, white biofilm that adheres to the teeth
and contains numerous amounts of bacteria. Plaque build-up can
cause the most common dental diseases which are caries and
periodontal diseases (Gingivitis and Periodontitis).
2. Present pictures of healthy and unhealthy oral cavitys using a
PowerPoint presentation.
3. Show where plaque accumulates in the mouth by putting
disclosing solution on the senior residents teeth.
4. Demonstrate proper oral hygiene techniques using a typodont
and a toothbrush.
5. Have the senior residents brush and floss their teeth (if able)
using the techniques learned.
6. Enumerate the benefits the senior residents can get from having
a clean and healthy mouth.

IV. Method of Teaching

A. Initiating Activities
1. Introduce yourself
2. Introduce the topic by asking the senior residents what plaque
is and what it does in the oral cavity.
3. Use a PowerPoint presentation as an attention grabber to
show pictures of healthy vs. unhealthy oral cavity, plaque
accumulation, and mouths with severe candidiasis.
4. A five-question pre-test will be given to evaluate how much
the senior residents know about the topics (a copy of the pre-
test/post-test is attached at the end of the lesson plan).

B. Developmental Activities
1. Define plaque plaque is a biofilm that builds up on the teeth,
usually clear, and contains bacteria. It does not only adhere on the
natural teeth but it can also accumulate on plastic and porcelain
teeth of partial and complete dentures. Plaque can cause
candidiasis.
2. The senior residents will be asked to apply disclosing
solution to their teeth.
 3. Explain what the experiment means. The areas that were tinted
are the areas where plaque accumulates.
4. Show them the proper way to brush and floss using a typodont
focusing on the areas where plaque accumulated.
5. Go over to the sink with them and observe if they are doing it the
proper way. Teach senior residents the Bass Sulcular Method.
6. Make them understand the importance of cleaning their teeth to
maintain and improve oral health. State the benefits the patients
can get from it.

C. Culminating Activities
1. Have the senior residents compare their plaque accumulation
before and after brushing and flossing.
2. Show pictures of healthy oral cavity, dental caries,
candidiasis, and periodontal disease.
3. As a review, ask the senior residents what benefits they can
get from having a clean mouth. The benefits are that the
patients will have a lower risk of getting infections such as
candidiasis, the patient will have fresh smelling breath, and
patients with systemic diseases such as diabetes will most
likely have a controlled blood sugar level if the oral cavity is
healthy.

Session Three
Lesson Plan

I. Introduction
The lesson is focused on eight of the senior residents. The goal of
the lesson is to educate the residents to increase their knowledge of
performing oral cancer screenings and dental prosthesis cleanings.
The lesson is expected to last one hour.

II. Objectives
COGNITIVE
 1. Following the presentation, the senior residents will be able to
identify signs and symptoms of oral cancer.

PSYCHOMOTOR
1. The senior residents will demonstrate techniques to assess the
condition of the oral cavity.
2. The senior residents will demonstrate dental prosthesis cleaning
using a denture brush and a denture cleaning solution.
3. The senior resident will demonstrate denture cleaning using the
ultrasonic cleaner.

III. Content
1. Show pictures of the signs and symptoms of oral cancer using a
PowerPoint presentation.
2. Teach the senior residents how to use the ABCD method to
identify oral cancer.
3. Present pictures of healthy and unhealthy oral cavity using
PowerPoint presentation.
4. Present pictures of the possible infections that arise from not
cleaning dentures daily.

IV. Method of Teaching

A. Initiating Activities
1. Introduce yourself
2. Review topics discussed during the last session.
3. Introduce the topic by questioning the senior residents about why
identifying oral cancer early on is important.
4. As an attention grabber, present pictures of a healthy vs.
unhealthy mouth, oral cancer, and denture induced infections using
a PowerPoint presentation.

B. Developmental Activities
1. Explain the ABCD method to identify oral cancer to the senior
residents.
2. Teach the senior residents about the most common oral
cancer sites in the oral cavity.
3. Explain to the senior residents the importance of cleaning
their dentures twice a day.
4. Demonstrate cleaning a denture with a denture brush.
5. Demonstrate denture cleaning using the ultrasonic cleaner.

C. Culminating Activities
1. Present pictures of healthy oral cavity, oral infections, and oral
cancers.
 2. As a review, ask the senior residents what benefits they can
get from cleaning their dentures twice a day. The benefits are
that the patients will have a lower risk of oral infections such
as candidiasis and denture stomatitis and the patient will also
have fresh smelling breath.

Session Four
Lesson Plan

I. Introduction
The lesson is focused on eight senior residents. The goal of the
lesson is for the clinicians to observe the senior residents
performing oral cancer screenings and oral hygiene and/or denture
cleaning. The session is expected to last for one hour.
 II. Objectives

COGNITIVE
1. As a review, question the senior residents about what plaque is
and what it causes.
2. As a review, question the senior residents about the importance
of early cancer detection.
3. Have the patients explain the importance of having a clean oral
cavity.

PSYCHOMOTOR
1. The senior residents will demonstrate proper brushing and
flossing techniques, denture cleaning, and oral cancer
screenings.

III. Content
1. Present pictures of healthy and unhealthy oral cavity using
PowerPoint presentation.
2. Present pictures of the signs and symptoms of oral cancer using
a PowerPoint presentation.
3. Present pictures of the possible infections that arise from not
cleaning dentures daily.
4. Review plaque- a sticky, white biofilm that adheres to the teeth
and contains numerous amounts of bacteria. Plaque build-up can
cause the most common dental diseases which are caries and
periodontal diseases (Gingivitis and Periodontitis).
5. Show where plaque accumulates in the mouth by putting
disclosing solution on the senior residents teeth.
6. Demonstrate proper brushing and flossing techniques, denture
cleaning, and oral cancer screenings. Have the senior residents
brush and floss their teeth (if able) using the techniques learned.
7. Emphasize the benefits the senior residents can get from having
a clean and healthy mouth.

IV. Methods of Teaching

A. Initiating Activities
1. Introduce yourself
2. Review topics discussed during the last session.

B. Developmental Activities
1. Review topics from each session and emphasize the importance of
maintaining a healthy oral cavity.

C. Culminating Activities
 1. As a review, present pictures of a healthy oral cavity vs. an
unhealthy oral cavity, oral infections, and oral cancers.

References
1. "Adult Oral Health | Basics | Division Of Oral Health | CDC". Cdc.gov. N.p., 2017. Web.
20 Mar. 2017.

2. "Cancer Of The Oral Cavity And Pharynx - Cancer Stat Facts". Seer.cancer.gov. N.p.,
2017. Web. 20 Mar. 2017.
3. "CDC | Open Data Tools | Division Of Oral Health". Cdc.gov. N.p., 2017. Web. 20 Mar.
2017.

4. "For Older Adults". Toothwisdom.org. N.p., 2017. Web. 20 Mar. 2017.

5. "MUST - A National Education Campaign For Older Adults And

Caregivers". Mustforseniors.org. N.p., 2017. Web. 20 Mar. 2017.

6. "Oral Health Topics". Ada.org. N.p., 2017. Web. 20 Mar. 2017.

7. "NHANES - National Health And Nutrition Examination Survey Homepage". Cdc.gov.

N.p., 2017. Web. 10 Apr. 2017.