Replacement dentures for someone in a nursing home

[GAKKIEZ]

  What are the requirements for a nursing home to get replacement dentures for a patient that has broken theirs?  My aunt is in a nursing home (Medicare & Medicaid) and has broken her upper plate. Her weight has now dropped to 87lbs and the nursing home is saying it's not their responsibility.  HELP!

[GailL1]

@GAKKIEZ 

Difficult situation - but I am gonna agree that it isn’t the nursing home that has this responsibility -  

Although there are traveling dentist that could see your aunt in the nursing home, I am not sure if they would be able to fix or replace the dentures.  This is gonna require special equipment which is available at a dental lab or pricier at the office of a prosthodontist.  And they both would require a visit or more with the patient.

You can keep checking on your aunt in the nursing home and the meals they are giving her and how well she is eating.  Talk to them about a soft diet.  

The only thing I can advise you is to try to find a prosthedontist or a dental lab to talk to about what needs to be done and the cost - it might be covered. by Medicaid. I don’t know.   if she has that coverage - maybe the Medicaid program has a list of dental labs they work with -

[GAKKIEZ]

  @GailL1 Thanks for the comments.  I would think that this would be a priority for the nursing home and a form of abuse that her medical needs aren't being met since they are responsible for her care.

[GailL1]

Read my other reply also - but I did find this 2019 Medicaid Adult Dental Coverage by State - as you can see the Medicaid program for dental isn’t all that great - this may be the hardest thing to find - payment.

https://www.chcs.org/media/Medicaid-Adult-Dental-Benefits-Overview-Appendix_091519.pdf 

[GailL1]

A nursing home is a residence - they take care of the activities of daily living, supply meals for their residents.  They do little Medical care except a specifically trained /licensed caregiver can give out the meds.  A SKILLED NURSING FACILITY can do a bit more medical care like PT or OT therapy or wound care to get them recovered as much as possible but that’s rehab.   

Replacement or repair of dentures is out of their wheel well.  Original Medicare does not cover dental work except when it is directly related to a specific disease and then only minimally for the restorative function.  Medicaid might. cover it - I don’t know.  But even then the person that has the health authority for her has to locate the facility or professional that will do the work (and paid by Medicaid).  It may require a visit to their office or maybe more than one if fittings are involved.

A nursing home does not usually have decision making authority for their residents.  You may need to contact your state’s or local  LTC Ombudsman Program - they may be able to get you in contact with somebody that can help with the repair and any transport that may be needed.  They may also see if the nursing home has a provider/ vendor they use for such repair or work.  

A person can eat without teeth although it is probably better if they do have them if for no other reason than to keep the muscles in their face and jaw aligned.  The nursing home prepares her meals thus if they know of her situation can prepare soft foods since chewing food isn’t an option now.

There are several different types of MEDICAID - she could just have the type that pays for or helps pay for the nursing home.  If she is a dual eligible, she may have some dental coverage based on the Medicare plan that she has but even then repair or replacement of the dentures might not be covered - Medicaid based on her status with them may help cover the cost of repair or replacement but you would have to check her coverage in the state where she is a resident.