Dentistry and the county home resident: a statewide survey

A flow chart (illustration) depicts the delivery process whereby county home residents either receive or do not receive dental treatment. Also included are the major findings of the survey, given in triangles A, B, and C. The initial step involved in this delivery process is that of recognizing a need. If the need is not recognized, it remains unmet and the patient receives no treatment (terminate). If the need is recognized, a treatment decision is required. If the decision is negative, the need remains unmet and the patient receives no treatment. If the decision is positive, the patient proceeds toward the goal of receiving dental treatment. However, potential delivery problems exist and the patient may have to overcome one or more of these before proceeding toward the goal. If problems do exist and are not resolved, the patient either does not receive treatment or treatment is delayed until satisfactory solutions are found. The first finding, A, shows that more than 72% of dental needs were identified because of some dental emergency experienced by the patient, 39.3% of needs were identified through routine checkups, 16.4% by a county home requirement, 14.8% through a state requirement, and 4.9%, "other." The second finding, B, shows that the county home steward makes the decision about whether dental treatment should be rendered in more than 85% of the homes. Physicians made 54.1% of the dental treatment decisions; nurses, 31.1%; dentists, 26.2%; patients, 24.6%; patient's family, 13.1%; supervisor or trustee, 4.9%; and "other," 3.3%. The third finding, C, represents delivery problems. More than 44% of the stewards said that the patient's mental or physical disabilities were a delivery problem; 39.3% indicated availability of dentists; 36.1% said reluctance of patient; 19.7% responded inadequate funding; and 14.8% indicated "other." A hypothetical county home resident can be dentally characterized as an emergency patient whose need for treatment is determined by a county home steward, and the main problem in obtaining treatment, according to the steward, is the patient's own inability to receive treatment because of mental or physical disabilities, or both.