BH.01.OCT0219.R20 - 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 well-being. Older adults and low-income individuals are at particular risk of poor oral health.
• The Ontario government will be making a $90 million annual investment in a new Ontario Seniors Dental Care Program (OSDCP). Public health units are the lead agencies for this program and receive dedicated funding from the Ministry of Health (the “Ministry”).
• Wellington-Dufferin-Guelph Public Health (WDGPH) is planning to launch this program per the staged implementation plan outlined by the Ministry. Preventative and restorative services will be provided at WDGPH offices, with specialist services provided by community partners.
• WDGPH will be carefully managing this program during its first year of implementation and evaluating it to ensure it achieves its intended outcomes.

Discussion

Oral Health Needs in Wellington-Dufferin-Guelph

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) WDGPH’s 2015 Oral Health Survey found that half of respondents reported that poor oral health affects how they feel about themselves and 16% reported that it impacted their ability to gain employment.(2)

Access to preventative or restorative oral health care can be limited, especially for marginalized groups such as low-income individuals and families.3 76% of low-income Guelph residents reported that cost was a barrier to seeking routine dental care.(2) Across Canada, members of the lowest-income families are substantially less likely to access dental care and are more likely to seek care on an emergency basis (Figure 1).(3) Preventable oral health problems are an important contributor to hallway health care,  which is an area of focus for the current provincial government.(4)

WDGPH currently provides preventative and restorative oral health services to eligible children as part of the Healthy Smiles Ontario program (HSO). However, oral health is also an important issue for older adults. According to data from the Canadian Community Health Survey, only 31% of Wellington-Dufferin-Guelph (WDG) residents age 65 years or older have access to dental insurance.

Figure 1: Indicators of dental care access by family levels in Canada (3)
(Data from the 2007-2009 Canadian Health Measures Survey)

New Ontario Seniors Dental Care Program (OSDCP)

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. WDGPH is the lead agency for this program within the health unit geography.

WDGPH’s 2019 funding letter indicated that the health unit will receive $869,100 in funding for this program from the Ministry.5 The Ministry has indicated that it intends to maintain this as a 100%-provincially funded program through 2020.

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 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. Public health units are currently awaiting the final service schedule.  However, the Ministry has indicated that it will include:

• 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;
• Periodontal services to treat gum disease and other conditions; and
• Prosthodontic services, including manufacture and fitting of dentures, with a 10% client copayment.

The Ministry has outlined a staged implementation process for the OSDCP. During Stage One (late summer 2019), dental care will be delivered to eligible seniors using existing infrastructure and new Ministry funding. Service delivery will be expanded during Stage Two (winter 2020) based upon new infrastructure. In August, WDGPH submitted a capital funding application to support service delivery during Stage 2.

Figure 2: Staged Implementation of the Ontario Seniors Dental Care Program (6)

Service Delivery Model for Wellington-Dufferin-Guelph

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 HSO.

Examinations and preventative (hygiene) services will be delivered at WDGPH offices in Guelph (Chancellors Way) and Orangeville using registered dental hygienists. Restorative dental care services will be delivered by dentists working at the Guelph (Chancellors Way) and Orangeville offices.

To support enhanced service delivery from the Guelph (Chancellors Way) and Orangeville offices, WDGPH has requested capital funding for infrastructure enhancements from the Ministry. The funding requests, totalling $891,470, include:

• Renovations to clinic space to create greater number of hygiene suites and dentist suites in Orangeville and Guelph (Chancellors Way);
• 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.

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 regional partnerships with neighbouring public health units.

Next Steps

The OSCDP planning team has been in touch with the Ministry to gather program details as they become available. The Ministry has indicated that they are finalizing the service delivery schedule and will be announcing the Stage One launch date shortly.

During Stage One, the OSDCP will focus on providing preventative dental care to seniors using existing staff and dental clinic space. Pending approval of WDGPH’s capital funding request, the agency will invest in new clinic infrastructure and recruit additional dental providers to provide additional capacity in Stage Two. The planning team will also be developing referral networks and community partnerships to provide the full scope of covered dental services.

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 will be launching the OSDCP in 2019 and 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 WDG and will leverage lessons learned from HSO. 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 WDG.

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.