The vast majority of older adults, including Mr. and Mrs. Smith continue to live in the community. It is important to recognize that while there are support services to help keep people in the community, most of them do not address oral health even though oral health might be central to their mission.

• Meal programs may not take into account whether their clients have adequate oral function to consume the food that they are providing. A study of Meals on Wheels recipients in New York City revealed that 38 percent of them are either avoiding the food they receive, or modifying it in some way because they are having difficulty eating due to the problems in their mouth. Some meal programs can modify the texture of the food provided but this is not a standard service, and must be ordered by the client’s physician.


• Home care workers are not required to receive training about the provision of daily oral care and it is not monitored. In addition, nurses in the homecare system are not required to assess the oral cavity or oversee daily oral care by home care workers. It is important to stress to home care workers that you want your family member’s oral health monitored. It is the responsibility of the client to provide the daily oral health care aides.


• While Access a ride provides individuals with disabilities with transportation to and from medical appointments, navigation of this service may be difficult. Trips must be scheduled one or two days in advance. If a person wants a ride at 2 p.m., the dispatcher can offer only a pickup between 1 and 3. Passengers must cancel with three hours’ notice, and rides are shared, so routes between pickup and dropoff are often circuitous.