Since my mother started grinding her teeth, I’ve been on the hunt for dental services that are affordable and safe for someone with dementia. I wish I could tell you I found some, but I now think it’s impossible to find care that is prompt, safe, and covered by Medicare insurance.
Mom is from a generation deeply scarred by childhood encounters with cruel, old-school dentistry. Although she bought a long-term care plan before she got dementia, she didn’t think much about her oral health. She has a Medicare Part B insurance plan which covers dental check-ups, but almost none of the providers listed in the directory are accepting new patients. Those that are adding to their patient roster have long wait times for an appointment. Others on the list may give you an appointment but they require that you pay out of pocket. One provider — where she got a basic check-up last year — told me that most dentists don’t accept Medicare coverage because the reimbursement rates are so low. According to the billing office at that clinic, they get less than ten percent of what it actually costs to treat a patient.
While affordable dental care eludes the elderly, it’s also a problem across our entire society. According to Bonnie Kavoussi’s June 26 article in the Huffington Post, “one in three Americans can’t afford to see the dentist” and more than 100 million Americans do not go to the dentist for checkups and cleanings because of the cost. The issue is explained in greater detail in a PBS special produced by FRONTLINE and the Center for Public Integrity. According to the FRONTLINE program — Dollars and Dentists — “one in four Medicare beneficiaries are missing all of their natural teeth — a problem that threatens not only among the elderly, but also the very poor.”
The PBS special also reveals ways that for-profit providers have taken advantage of elderly people who need dental care. According to FRONTLINE, companies like “Aspen Dental offer credit cards and payment plans to help people finance their procedures if they can’t afford it. But the cards, which are provided in the dentists’ offices, come with hefty financing rates. Aspen says it only offers financing when the care is absolutely necessary, but former employees tell FRONTLINE they were rewarded for getting patients to buy — and finance — as much dental care as possible.” Heather Haynes, a former Aspen employee, stated that, “Even if they had insurance, we were still required to push the finance options on them, and still proceed with the paperwork.”
At this point, we’ve decided to take my mother to a hospital-based clinic and make the up-front investment in solving her problem. The first appointment will cost $125 — nearly as much as her monthly Part B health premium. We know we’re in for more big bills afterward. But ignoring her dental problems is not an option. Eating is one of her few remaining pleasures. If she breaks her teeth, even that sweet joy could disappear.
In some towns, caregivers can ease the financial burden of dementia care by getting aid from public programs for the elderly. But funding varies widely by county and state. That’s often because certain elected officials champion the interests of the elderly. In Carbon County PA, where I live, elders were helped for many years by Charles Getz, a county commissioner who just retired from public office. I talked with Mr. Getz to learn how and why he supported elder programs.
Although Mr. Getz owns several private businesses — including a horse farm and a bus company — he spent much of his life in public service. In 1977 he won his first election as a local township supervisor. He was later elected to office as a county commissioner. Though he won his final election in November 2011, he chose to retire before serving his term. Mr. Getz felt that the mood during his final campaign season was nasty and divisive, so he opted to retire before a negative political environment could disrupt the quality of his family life.
Mr. Getz became a champion of services for seniors partly because he had been raised to respect the elderly. He attended a one-room school house for his first years of elementary education and spent a lot of time with older people who shared knowledge he came to value. Mr. Getz was also deeply affected by the experience of looking after his own mother who suffered from Alzheimer’s Disease. With the help of his wife and short weekly visits from a nursing aide, they cared for his mother at their home until the end of her life at age 86. Getz was also distressed by the economic plight of elders in his district. When seniors submitted applications to enter Weatherwood, a county-funded home for the aged, they were required to declare their annual earnings. Mr. Getz was shocked at the tiny income on which many elders survived.
During the annual county budgeting process, Mr. Getz’ advocacy for elder care funding was aided by the director of the county’s Agency on Aging. She was zealous in her efforts to educate officials about the need for services and she took steps to cuts costs whenever possible. It was wise, Getz felt, to fund services that helped seniors live safely in their homes for a long time. Many residents in his district had worked hard in coal mines or mills and bought homes in tight-knit communities with strong support networks. Programs that helped them stay at home also cost much less than publicly-funded nursing homes.
Today the number of elderly residents in Carbon County continues to rise. I asked Mr. Getz if he felt the county was prepared for the rapid growth of the elderly population. He says, “The network of services and providers is strong” but “elected officials will be forced to make hard choices” if the current trend of cutting taxes and public services continues. Eventually, he says, programs “will reach a point where costs cannot be cut further” and needs will not diminish. He feels that the plight of those who have worked hard all their lives should not be neglected. While in office, Mr. Getz listened to constituents when they spoke to him about urgent issues and programs they valued. He believes that government functions best when all branches (local, state and federal) work together. So the bottom line on funding for elder programs is this: To protect public programs that help your loved one — or help you as a caregiver — you must share your views with all candidates running for office during election season.