Exploring Oral Care in Long-Term Care Homes: An Institutional Ethnography

Area of Science:

• Gerontology
• Public Health
• Healthcare Management

Background:

• Oral health in long-term care (LTC) settings is a persistent issue despite existing interventions.
• Understanding the social and organizational factors influencing oral care delivery is crucial.

Purpose of the Study:

• To explore the social organization of oral care within LTC homes from the perspective of healthcare aides (HCAs).
• To identify how care practices contribute to the poor oral health outcomes observed in LTC residents.

Main Methods:

• Institutional ethnography (IE) was employed, focusing on HCAs' experiences and interactions with institutional texts.
• Observations and interviews with HCAs were conducted, analyzing their oral care practices.
• Text-work-text (TWT) mappings were used to illustrate the social organization of oral care.

Main Results:

• HCAs determined the timing and methods of oral care delivery based on their own judgment.
• Standardized institutional texts were found to be insufficiently detailed to guide effective oral care.
• HCAs demonstrated limited knowledge of oral care beyond basic brushing and denture maintenance.

Conclusions:

• Inadequate institutional guidance forces HCAs to rely on personal experience, impacting oral care quality.
• Organizational factors significantly contribute to suboptimal oral health in LTC residents.
• The study highlights the need for improved intervention strategies and enhanced institutional support for oral care in LTC settings.