BH.01.FEB0520.R01 - Ontario Seniors Dental Care Program

Recommendations

It is recommended that the Board of Health:

1.    Receive this report for information.

Key Points

• Oral health is an important contributor to overall physical, mental and social wellbeing. Older adults and low-income individuals are at particular risk of poor oral health.
• Stage 1 of the new Ontario Seniors Dental Care Program (OSDCP) launched on November 20, 2019. The OSDCP is a government-funded dental care program that provides free, routine dental services for low-income seniors.
• To provide the capacity needed for service delivery, the Ministry of Health (the “Ministry”) has provided funding for capital investments at the Guelph and Orangeville offices. Renovation work at these offices will take place in Q1/Q2, 2020.
• Following renovations, the OSDCP will transition to Stage 2. This will involve recruitment of new dental providers and expansion of services available.

Discussion

New Ontario Seniors Dental Care Program (OSDCP)

Oral health is an important determinant of health across the lifespan. Diseases and conditions such as tooth decay, oral infections and periodontal (gum) disease limit activities such as biting, chewing, smiling, speaking and psychosocial functioning.(1) However, the cost of dental care and limited access to insurance make it challenging for low-income individuals and older adults to achieve good oral health.(2)

In April 2019, the Government of Ontario announced that it would be investing $90 million, annually, to implement a dental care program for low-income older adults.(4) Under this program, services will be delivered by public health units, community health centres and Aboriginal Health Access Centres across the province. Wellington-Dufferin-Guelph Public Health (WDGPH) is the lead agency for this program within the health unit geography.

WDGPH will receive $869,100 in annual funding for this program from the Ministry.(5) In 2020, the OSDCP will be the only public health program that remains 100% provincially funded.

Seniors will be eligible to receive services under the OSDCP if they:

• Are 65 years of age or older;
• Are residents of Ontario;
• Meet Ministry-specified income eligibility thresholds (less than $19,300 after tax for single seniors, or less than $32,300 combined after tax for senior couples); and
• Have no access to any private or public dental benefits (including through the Ontario Disability Support Program or Ontario Works).

Program enrolment will be managed by the Ministry. Eligibility will be assessed annually, and seniors will be able to continue to access services provided they meet the eligibility criteria. The Ministry estimates that 1,541 seniors in the WDGPH catchment area will receive dental care through the OSDCP, based on an assumption that 40% of eligible seniors will seek care.(6)

The OSDCP will be responsible for delivering a ‘basket’ of dental care services based on a schedule developed by the Ministry which includes:

• Examinations/assessments;
• Preventive services, including polishing, fluoride, sealants and scaling;
• Restorative services, such as temporary fillings, permanent fillings and crowns;
• Radiographs;
• Oral surgery, to remove teeth or abnormal tissue;
• Anaesthesia;
• Endodontic services (e.g. root canals) to treat oral infections and pain; and
• Periodontal services to treat gum disease and other conditions.

Prosthodontic services, including manufacture and fitting of dentures, will be partially covered by the OSDCP. Clients will be charged a standard copayment set by the Ministry. This copayment may impact the ability of low-income seniors to access prosthodontic services.

Current Service Delivery Model (Stage 1)

The Ministry launched Stage 1 of the OSDCP on November 20, 2019. During Stage 1, dental care will be delivered to eligible seniors using existing infrastructure pending completion of capital investments.  Since November 21, 2019, WDGPH has begun offering appointments for screenings/examinations conducted by a Registered Dental Hygienist (RDH) and Certified Dental Assistant (CDA) on Tuesdays and Thursdays at the Guelph office. Clients with emergent dental needs are referred to a partner dentist in the community for appropriate intervention. Clients requiring non-emergent follow-up are added to the waitlist for Stage 2 of the program. All WDGPH offices provide seniors with support completing their application for the OSDCP.

Key performance indicators for the OSDCP are included in Table 1.

Table 1: Key Performance Indicators for the OSDCP (current as of January 22, 2020).

Capital Investments

To provide adequate capacity for service delivery from the Guelph and Orangeville offices, WDGPH requested capital funding for infrastructure enhancements from the Ministry in August 2019. A total of $891,470 was requested for three capital projects. This was revised in October to $640,117 following approval from the Ministry to begin procuring equipment using 2019 operating dollars.

Table 2: WDGPH Capital Requests for the OSDCP

On December 9, 2019, the Ministry approved $404,500 in funding for two of the projects. This is sufficient to cover the balance of necessary equipment and renovations. The capital funding is provided in the form of a 2019-20 one-time grant.

The planned investments include:

• Renovations to clinic space to create greater number of hygiene suites and dentist suites in Orangeville and Guelph;
• Upgrades to the Orangeville site to allow for x-ray capabilities;
• Upgrades to existing rooms to support service delivery for seniors (e.g. enhanced audio capabilities); and
• Enhancements to WDGPH’s instrument reprocessing capabilities.

Future Service Delivery Model (Stage 2)

WDGPH is proposing a service delivery model that is based on the principals of good quality dental care, equitable access, tailored solutions for a diverse population, accessibility and value for money. WDGPH will build on existing dental infrastructure and will leverage lessons learned from the Healthy Smiles Ontario (HSO) program.

All clients that are screened in Stage 1 are placed on a waitlist to be part of the dental clinic in Stage 2. Once WDGPH has onboarded a dentist for Stage 2, these clients will be called and booked for their first patient exam at a WDGPH clinic. 

During Stage 2, examinations and preventative (hygiene) services will be delivered at WDGPH offices in Guelph and Orangeville using registered dental hygienists. Restorative dental care services will be delivered by dentists working at the Guelph and Orangeville offices.

Service delivery will be provided with a contractor/turnkey model similar to what was implemented in the HSO program and found to be successful. The Stage 2 delivery model will start with one part-time dentist and gradually increase dentist capacity as the demand for services increases and we learn from the model implementation. The OSDCP planning team is currently in the process of recruiting a dentist in anticipation of Stage 2. 

Specialist services (including oral surgery, prosthodontic, endodontic and periodontic services) will be delivered by community partners on a referral basis from WDGPH’s clinics. The OSDCP planning team is currently developing referral networks with local providers and is also exploring opportunities for program alignments with neighbouring public health units.

The OSDCP will also be providing oral health promotion, education and system navigation services to eligible seniors. This program will be evaluated following implementation to ensure that it is having the intended impact and achieving good value for money.

Conclusion

WDGPH launched the OSDCP in 2019 and will be expanding service scope in 2020, in alignment with the Ministry’s staged implementation plan. The program will support more equitable access to oral health care for older adults in Wellington, Dufferin and Guelph and will leverage lessons learned from the HSO program. The OSDCP represents a significant new investment from the current provincial government and the planning team is committed to implementing this program effectively and efficiently.

Ontario Public Health Standard

Chronic Disease Prevention and Wellbeing
The board of health shall develop and implement a program of public health interventions using a comprehensive health promotion approach that addresses chronic disease risk and protective factors to reduce the burden of illness from chronic diseases in the health unit population.

WDGPH Strategic Direction(s)

 ✓ Health Equity: We will provide programs and services that integrate health equity principles to reduce or eliminate health differences between population groups.

 ✓ Organizational Capacity: We will improve our capacity to effectively deliver public health programs and services.

 ✓ Service Centred Approach: We are committed to providing excellent service to anyone interacting with WDG Public Health.

 ✓ Building Healthy Communities: We will work with communities to support the health and well-being of everyone.

Health Equity

Oral health is an important contributor to overall physical, mental and social wellbeing. Older adults and low-income individuals are at particular risk of poor oral health and face greater barriers to accessing appropriate and necessary dental care in Wellington, Dufferin and Guelph.

The OSDCP is a new program that meets the oral health needs of low-income older adults. Dental care will be provided to eligible seniors without regard to insurance coverage or ability to pay. This program is intended to address oral health problems in a preventive (‘upstream’) manner, wherever possible, to improve population health and reduce burden on the acute health care system.

References

1. World Health Organization. Oral health. [internet]. 2018 September 24. [cited 2019 September 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/oral-health
2. Wellington-Dufferin-Guelph Public Health. Oral health status report. [internet]. 2015. [cited 2019 September 23]. Available from: https://www.wdgpublichealth.ca/reports/2015-oral-health-status-report
3. Canadian Academy of Health Sciences. Improving access to oral health care for vulnerable people living in Canada. [Internet]. 2014. [cited 2019 September 23]. Available from: http://cahs-acss.ca/wp-content/uploads/2015/07/Access_to_Oral_Care_FINAL…
4. Ontario. Ministry of Finance. 2019 Ontario Budget: Protecting What Matters Most. Toronto, ON: Queen’s Printer for Ontario; 2019.
5. Elliott C. 2019-20 PHU funding letter Regarding a dental care program for low income seniors. Letter to George Bridge 2019 June 7.
6. Ministry of Health and Long-Term Care. Overview of Ontario Seniors Dental Care Program – Capital Process. [Slide deck]. 2019 June 24.

Appendices

None.