Oral Health for Care Home Residents

Theme:  Improving Health and Healthcare

Cohort 6

Project Title

Oral health for care home residents.

Aim of Project

To improve the oral health of residents by strengthening staff knowledge, skills and confidence in provision of oral care.

Description of the Intervention 

As part of the My Home Life Leadership Programme, participants identified oral health as a priority area for quality improvement within care home settings. The project was undertaken during the COVID-19 pandemic, a period that presented significant challenges for care home staff, residents, and organisations. Despite these pressures, the cohort recognised oral health as an aspect of care that required greater attention and development.

The project was informed by Quality Improvement (QI) methodology provided through the My Home Life programme. A combined approach using Plan-Do-Study-Act (PDSA) cycles and Appreciative Inquiry principles of Discover, Envision, Co-Create and Embed was adopted to guide implementation. This framework enabled the active involvement of staff, residents, relatives, and wider health and social care partners throughout the improvement process. The initiative sought to ensure that residents remained at the centre of decision-making processes and that oral healthcare interventions reflected individual preferences and needs.

Partnership working was a key component of the initiative. Participants accessed specialist support from Professor Gerry McKenna, Clinical Reader and Consultant in Restorative Dentistry at Queen's University Belfast, and worked collaboratively with Health and Social Care Trust dental teams to inform practice development and access evidence-based resources.

A recent group of managers who participated in the MHL Leadership Support programme, engaged care home residents, their families, and staff in a quality improvement initiative to improve the oral health of the residents in their care homes.  This involved using pictures/images to elicit views on oral health care from residents with cognitive impairment. Using carefully chosen pictures and both verbal and non-verbal communication helped these residents to give their opinion on how their oral health could be improved.

Participants completed pre and post audits on current understanding of oral health and consulted with residents, relative and staff throughout the initiative. Additionally, they had input from Dr Gerry McKenna a Gerontologist at Queens university to explore mechanisms to increase awareness of oral health in care homes

Who  was involved?

Residents, relatives and staff.

Which MHL tools were used?

Image Cards to get resident's input.

Changes Implemented

A range of interventions were introduced to improve oral healthcare practices within participating care homes.

Baseline data were collected to assess current practice, including staff knowledge and confidence in providing oral care, and residents' experiences of oral health support. This information informed the design of targeted improvement activities.

The following changes were implemented:

  • Delivery of oral health education and training programmes for care staff.
  • Review and enhancement of oral health care planning to ensure care plans were personalised and reflected residents' individual needs and preferences.
  • Increased availability of oral health resources, equipment and educational materials within care homes.
  • Use of visual communication tools to support participation of residents with communication difficulties.
  • Development of oral health awareness campaigns for residents, relatives and staff through the use of posters and information resources.
  • Establishment of Oral Health Champion roles within many participating homes to promote and sustain improvements in practice.
  • Strengthened partnerships with dental professionals and specialist services to provide guidance, support and access to up-to-date evidence.

A person-centred approach was maintained throughout the project. Particular attention was given to ensuring that residents' preferences and choices informed care decisions. For example, residents who chose not to pursue denture treatment were supported to make informed decisions and have their wishes respected.

Evidence of Impact and Outcomes

Evaluation data demonstrated several positive outcomes resulting from the initiative.

Staff questionnaires completed before and after implementation showed a significant increase in confidence regarding the delivery of oral healthcare. While many staff initially reported understanding the importance of oral health, they did not feel confident providing oral care effectively. Following the intervention, over 95% of staff reported feeling confident in supporting residents with oral care.

The project also led to substantial improvements in care planning. By the conclusion of the initiative, over 90% of residents had a personalised oral health care plan in place, supporting a more structured and individualised approach to oral healthcare.

Participants reported greater confidence in using Quality Improvement methodologies and indicated that they had transferred this learning to other areas of care home practice.

Sustainability and Spread 

The establishment of Oral Health Champions helped embed oral health within everyday practice and provided local leadership for ongoing improvement. Participating care homes reported that these roles were effective in maintaining focus on oral health and supporting sustainability of the changes introduced.

Several organisations continued to develop oral health initiatives beyond the project, including participation in wider oral health research programmes and the application of QI approaches to other service improvement priorities.