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

Oral health of long-term care (LTC) residents remains a concern despite many years of evidence-based interventions. This study aimed to explore the social organization of care contributing to poor oral health of residents in LTC homes.

Institutional ethnography (IE) was used from the healthcare aide (HCA) standpoint. The oral care provided by HCAs in the LTC homes was explored through observations and interviews that focused on HCAs' interactions with institutional texts. Data analysis included text-work-text (TWT) mappings to illustrate how oral care was socially organized.

HCAs determined how and when to provide oral care for residents. Standardized assessments designed by the regulatory health authority to assist LTC homes in complying with care standards were insufficiently detailed to guide the oral care provided by HCAs. HCAs lacked knowledge about oral care beyond tooth-brushing and denture care.

In the absence of effective institutional texts, HCAs used their discretion, relying on their personal experiences, to inform the oral care provided for residents. This study helps to understand the organizational factors that contribute to poor oral health and offers alternative intervention strategies.