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The Quest for Better Senior Care Stuart Boekeloo, DDS

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The current care model in senior care facilities was getting old, so a dentist decided to do something about it.

by Stuart Boekeloo, DDS

sterile rooms, shiny tools and a clean, professional setting. For people living in senior living facilities, however, this might not be the case. Instead imagine having your chipped tooth fixed in the facility's beauty salon, or having a foot operation in your shower.

Conditions like these are commonplace in even the best assisted living facilities (ALF), as I found out two years ago. I was asked to be the onsite dentist at a local ALF and on an afternoon off, scheduled a tour with the facility's medical coordinator. On the tour, I saw a number of familiar faces and the beautiful rooms and decor that made this an award-winning ALF. It had big-screen televisions, a spacious dining area, a pharmacy, a game room and comfortable couches that reminded me of home.
After the tour I asked, "Where do the residents get their dental care?" The answer stunned me. The medical coordinator told me that the last on-site dentist had made do with mobile equipment in the hair salon. I took a second look at the salon, unable to figure out how the chairs could support an individual during a dental procedure, let alone an emergency. The tiny bits of hair and pervasive scent of hairspray filled my head with thoughts of infection control problems.

I also worried about record keeping, dignity, privacy and cross contamination of the other patients, because there might be an occasion when visiting a site as a caregiver, one wouldn't just see one patient, but possibly several.

I asked my peers in the local dental society about the issue. Had they ever visited these facilities? How did they cope with the strange conditions? After a few minutes of poking and prodding, one of the dentists finally spoke up. "Yes, I go to these facilities. I don't use the hair salon, but keep the residents in their beds, put a flashlight in my mouth, and do what I can... which is not much. I get out and bill as fast as I can!" he said.

Shocked by his answer, I called the facility medical director the very next day, wondering if other health-care providers also practiced directly in the facility, like I would as an on-site dentist. She told me that all kinds of health-care providers entered the facility – podiatrists, dermatologists, psychiatrists, counselors, community health workers, eye doctors, audiologists, etc. It's very common to have health-care providers from many different disciplines visit assisted living facilities. There are often blood drives, flu shots, vaccinations, hearing tests and eye tests administered. Using the patients' beds and showers, as well as common areas such as hair salons and dining halls, as venues for medical procedures is simply not in compliance with common medical practices.

In order to determine if there was a better system out there, I pretended to be a shopper for my aging parents and took tours of dozens of ALFs.

One facility had a 30-year-old donated dental chair stored in a closet, which the podiatrist would use during his visits. Most on-site care providers, or "gypsy dentists," utilized the hair salon. Other less-equipped facilities were even more creative. One ALF had large showers in the residents' rooms that could accommodate a chair, providing a place where the doctor could rinse the patient's blood down the drain. Most foot surgeries occurred in the resident's bed, with weekly vacuum cleaning as the infection control method.

The facility staff obviously cared for their residents, wanting them to receive the best care possible. Yet nobody had taken the time or energy to make the necessary improvements.

Transporting patients off site to their various medical and dental appointments can be equally, if not more daunting. One of our local ALF residents was scheduled to visit my office to get a "rough tooth" fixed. Since we had no idea how much time to set aside, we scheduled a 40-minute appointment. We did not want to be short on time, which would have required him to come back to finish the procedure. The patient arrived 30 minutes early with a walker and a hired adjunct caregiver via a van service. When the patient's appointment time came, the entourage and my staff escorted him into the treatment room. I asked the caregiver a few basic questions and received a blank stare in response.

The patient had a chipped tooth on a removable partial denture. He smiled after I quickly smoothed it, and told me he had no more issues. I was happy to visit with him for the next 30 minutes, but felt the experience was inefficient and expensive for the patient.

Off-site appointments and scheduling is a burden for all involved. Family members of these residents, often the residents' grown children, are burdened with the task of scheduling and transporting their elderly relatives to their various health-care appointments.

I kept looking for an ALF with a better system. There were no better situations.

I realized that I was not the first one to face this dilemma. It turned out to be a pervasive issue throughout the entire industry, which consists of approximately 50,000 ALFs. These elderly people need the same level and standard of care as every one else.

Recent studies have shown that two out of every three Americans who reach the age of 65 will need long-term care, services or support. Residents of assisted living facilities are, as one CEO of a large health network stated, the frequent fliers into the health-care system. This is confirmed by the fact that one-third of a person's lifetime health-care dollars are spent in the last three years of life.

"Assisted living has become synonymous with a philosophy of care that allows seniors to age with dignity, independence and choice," said Richard Grimes, the President and CEO of the Assisted Living Federation of America, the nation's leading association for professionally managed assisted living providers. Obviously we have thus far overlooked some very important issues in terms of convenient, safe and efficient health care for the individuals about whom he speaks.

I started looking to help create a solution. Hours and hours, then months and months, went into looking through all kinds of medical equipment. Surely somebody had created a multi-purpose care room, one that provided the necessary space and equipment for all on-site care providers from dentists to podiatrists.

Finding no reference to such a room, I contacted a trusted friend in the medical industry. He was the CEO of one of the largest medical device manufacturers in the world. He sat in silence as I told him my story. After I finished, he got up and explained that his mother had recently passed away at the age of 92, and his family had experienced all of the challenges I'd just described. He knew of no other entity looking at the apparent disjoint in on-site care.

My friend gave me his card and said, "Consider me your first advisor. Go find the best attorneys and suppliers, and get it done!" With my friend's encouragement under my hat, I started designing the ideal on-site, multi-purpose care room through which all the health-care providers could offer their treatment. I sought the assistance of the best medical and dental designers and manufacturers in the country. We came up with a solution called the Aleydis Center.

Named after the patron saint of suffering, the Aleydis Center would allow the various health-care providers to rotate through and render care to the patients in their living facilities, rather than the patients traveling all over their communities to see each doctor. Families need not worry about all those transportation costs, and the time and effort spent trying to juggle different appointments.

It is the first of its kind in the world; Aleydis Centers, LLC, of St. Joseph, Michigan, is the only company that designs, installs, services and provides supplies for a treatment room through which various health-care providers can provide their services.

Each center provides a multi-functional, sterilized medical hub which can be designed to integrate into the existing facility plan or via new construction. Off-site emergency care will be improved with the featured electronic medical record keeping and imaging capabilities, which allow for easy transmission for referral and emergency room needs. It can also be the designated location for consultations with providers and for emergency care in the unlikely event of a disaster.

Access to standard health care becomes more and more burdensome as one ages. Senior citizens often lose their driving privileges, becoming reliant on family members or adjunct caregivers to get them to doctors' offices for appointments. No longer will seniors put off their care or suffer in silence to avoid becoming an inconvenience to their families. No longer will these individuals be shuttled to and from doctors' offices, being exposed to others infections or the risk of slipping on ice in winter months.

Aleydis Center's mission is to increase access to care while decreasing costs. It is a new way of delivering care on site with the patient as the focus. A facility with an Aleydis Center will give the residents and their family members the assurance that care is given to the highest standard, with dignity, and with the necessary infection controls.

Every licensed health-care professional is required to practice to the standard of their state's licensing board. And when we say standard, we don't mean regular. We mean to the highest level. Aleydis Centers allow them to accomplish this.

Providers are going see quality, ease of use and consistency. All Aleydis Centers are exactly the same. So when health-care providers come into an Aleydis Center, they can focus on the patient, not the newness of the equipment or the change in design.

Hospital and health-care networks will benefit also. They will experience reduced hospital readmission rates and emergency room usage, "capturing" health-care dollars by rotating their providers through the assisted living facilities.

Aleydis Center, LLC, now has 1,400 contracted installation and warranty specialists and suppliers, and are able to install in all 50 states. The showroom is in Versailles, Ohio, and the first installation is anticipated to be in Chicago. We launched our concept last year at the Assisted Living Federation of America's national convention and have been contacted by many other institutions for other applications of our multi-care rooms. Dentists and other providers will be able to practice in these facilities in compliance with their state licensing standards with the necessary infection controls. Families of residents will finally be able to opt for facilities that have an Aleydis Center for their loved ones.

Assisted living facilities need to look at how care is currently given, and the liability the present system creates. The Aleydis Center can alleviate those worries. It can also minimize the worries for a health-care provider, because instead of using a substandard way of delivering care, we have the ability to provide top-of-the line care the way that it should be given.
Author’s Bio
Stuart Boekeloo graduated from University of Michigan School of Dentistry in 1987 and from University of Notre Dame with his MBA in 1990. He currently serves as president of his local dental society and serves on the finance committee for the Michigan Dental Associate Insurance and Financial Group. He has held offices for various other clubs and foundations as well. Dr. Boekeloo can be contacted at aleydiscenters@aol.com.
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