Section 3 - Domiciliary, Residential and Palliative Care / 3.1 Article: Domiciliary & Residential Care

The objectives of a domiciliary oral healthcare service are primarily to:

• Establish a system which will identify individuals in the community who have an oral healthcare need and for whom domiciliary provision is the only reasonable option.
• Provide an oral healthcare service to address patients’ needs, taking into account their personal circumstances and their wishes, consistent with the most appropriate use of resources.
• Deliver high quality oral healthcare in a person- centred way that respects the dignity of the individual receiving it.

For full details please see the BSDH guidance document

Below is a list of the recognised pathways for accessing domiciliary care:

• Liaison - Patients that need access to domiciliary care can do so through their carers, health & social services and the voluntary sector. It is the responsibility of the PCT to ensure that appropriate referral pathways are in place for patients in residential homes
• Routine Referrals - Standard forms should be submitted to assess a patients suitability for domiciliary care
• Urgent referrals - Dental care providers need to establish criteria for determining whether urgent care is required following an urgent domiciliary request.
• Care homes - local care homes should have access to information on contacting local dental services
• New patients - New patients seeking domiciliary care need to be assessed for suitability at an individual level using an objective risk assessment tool.

For exemplar form and tools please see the BSDH guidance document

Initial assessment referrals should be acknowledged and, where possible, an indication of timeframes should be given by the dental service team.

For full details please see the BSDH guidance document

The term 'mix and match' refers to the care being split between domiciliary visits and surgery-based care. Mix and match care may be appropriate in cases where a relationship between the patient and the dental surgery needs to be built up over time, such as in the case of anxious patients.

For full details please see the BSDH guidance document

The dental team required for domiciliary care should be made up of the most appropriate members of staff for the specific needs of the patient. However, all team members should implement the acronym 'CAMPING' to deliver effective care:

C - communication
A - assertiveness and anticipation
M - manual handling and map reading
P - planning and time management
I - improvisation
N - networking and liaison (see Appendix 1)
G - gerodontology

For full details please see the BSDH guidance document

For non-emergency visits the following acronym 'CAMPING' is again used to detail the useful information to gather over the phone prior to the visit.

C - check full address and helpful directions
A - appointment to be sent in writing if possible
M - medical history and consent - note need to liaise with relevant people
P - parking facilities
I - information about who will be present
N - name of visiting dental profession (for patient security)
G - gerodontology specific training

It may not always be possible to contact the patient, in these cases the patients carer should be contacted to arrange the visit logistics

The following health and safety issues should be considered ahead of a domiciliary visit:

• Risk assessment
  
• Staff protection
• Chaperoning
• Employers liability
• Personal protection
• Manual handling
• Vehicle and equipment insurance

For full details please see the BSDH guidance document

Standardised procedures should be establish for all visit and treatment scenarios. Appropriate regulatory guidelines should be followed where relevant. Types of care that should follow governing procedures are as follows:

• The initial visit
• Adhesive dentistry
• Infection control
• Treatment planning and subsequent visits
• Confidentiality
• Consent

For full details please see the BSDH guidance document

Members of the dental teaming involved in domiciliary care should be trained appropriately due to the differences between domiciliary and standard clinical care. The likelihood of encountering a medical emergency is much greater in the domiciliary environment, as such, members of the dental team should be trained and equip to deal with possible medical emergencies. As a minimum, the following should be made available when domiciliary care is conducted:

• Portable suction apparatus
• Oral airways
• Intermittent positive pressure ventilation equipment
• Portable oxygen
• Emergency drugs

For full details please see the BSDH guidance document

According to the mental heath capacity act (2005), healthcare workers are able to diagnose and carry out treatments on the patients behalf, providing they can be proven to lack mental capacity. Patients lack mental capacity if they cannot do one or more of the following:

• Understand information given to them
• Retain that information long enough to be able to make the decision
  
• Weigh up the information available to make the decision
• Communicate their decision - this could be done by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand

Patients lacking mental capacity present a unique challenge for delivering oral health care. It is recommended that dental professionals familiarise themselves with the guidance from the BSDH. Detail of the specific legislation can be found on the UK Government website.

The principle of 'wide consultation' must be adopted in instances where treatment plans are disputed. This usually requires the seeking of further advice from senior colleagues and peers.

For full details please see the BSDH guidance document

Dental professionals must decide which equipment to take on a domiciliary visit, as it is not practical or affordable to take everything that may be required. The following list can be used to help determine the correct equipment for a visit:

• Frequency of use
• Types of treatment likely to be carried out
• Facilities already available
• Ease of adequate decontamination
  
• Weight of equipment and ease of transporting it
• Any other relevant features associated with the service you provide, and
• Cost

For full details please see the BSDH guidance document