In yesterday’s budget, the Government of Ontario took an important step forward in providing free dental care for low-income seniors. The move by the government shows growing recognition that good oral health is an essential component of comprehensive health.
“This is an important first step in filling the gaps in dental care. Most government initiatives that provide dental care to low-income Ontarians are aimed at children and youth through Healthy Smiles Ontario,” says Dr. Samir Sinha, NIA Director of Health Policy Research and Director of Geriatrics at Sinai Health System and the University Health Network. “There are great examples of dental initiatives at the municipal level for low-income seniors, but today’s announcement will allow low-income seniors across Ontario to maintain oral health and to seek the care that might otherwise be unaffordable.”
What does the plan include?
The plan announced yesterday will provide approximately $90M annually when fully implemented. It includes coverage for single seniors age 65 and older with incomes of $19,300 or less (or senior couples with combined incomes of less than $32,300) and seniors who don’t have existing dental benefits. The program is slated to start by summer 2019. Services will be administered by public health units, community health centres, and Aboriginal Health Access Centres located throughout the province. According to the government, the program will be expanded in the winter with the inclusion of new dental services in underserviced areas, including through mobile dental buses and an increased number of dental suites in public health units.
Why is it important?
Access to dental care is increasingly recognized as a component of comprehensive health. Dr. Sinha – who is also the provincial lead for the Ontario Seniors Strategy and expert advisor to the Ministry of Seniors Affairs and Accessibility and the Ministry of Health and Long-Term Care, has long advocated for dental care to be recognized as a component of comprehensive health. His 2012 report to the Ontario government, Living Well, Living Longer, makes the case by showing the association between poor oral health medical conditions such as pneumonia, diabetes, cardiovascular disease, osteoporosis and rheumatoid arthritis.
The push for targeted dental programs in Ontario has been years in the making. Also in 2012, Public Health Ontario published a Report on Access to Dental Care and Oral Health Inequalities in Ontario, which showed that adults 65 and older had significantly poorer access to dental care compared to other age groups. Older adults were less likely to be insured, with only 36.1 per cent having private insurance coverage. The report also found that only 58.6 per cent of seniors in Ontario visited the dentist in the previous year.
We also know that 32 per cent of Canadians have no dental insurance and many of these are seniors who don’t have access to affordable supplementary dental coverage after they retire, as post-retirement employer benefit plans are increasingly rare and individual insurance plans can be unaffordable at lower income levels. As such, older Ontarians are turning to the emergency room for treatment that doesn’t resolve the underlying dental problem. In 2014, 5,880 Ontarians over the age of 65 went to hospitals to seek treatment for acute dental problems, costing approximately $3 million.
The NIA’s National Seniors’ Strategy shows that low income seniors face negative health outcomes when they can’t access care that isn’t covered by OHIP, including dental care. Financial barriers, co-pays, deductibles and lack of supplementary insurance coverage all lead to worse health outcomes for seniors.
Coverage in Ontario and Municipalities leading the charge
In Ontario, most initiatives offering dental care to low income individuals are aimed at children and youth through Healthy Smiles Ontario. In response to limited availability of dental care for low income older adults, some municipalities across Ontario have been creative in leveraging the infrastructure of their Healthy Smiles dental clinics and other initiatives to fund and develop programs for seniors.
At the City of Toronto, there are programs offered through Toronto Public Health that provide access to dental care for seniors 65 and older. The South East Local Health Integration (LHIN) Program also offers a Community Health Centre- Oral Health Program. This Program was launched in 2013, and according to the South East LHIN, it has provided services to individuals in their geographic catchment area who were otherwise not able to afford dental care. In Peel Region, the Peel Public Health Seniors’ Dental Program covers the costs of basic care (cleanings, fillings, dentures) for low-income seniors who would otherwise have no access to any form of dental care. But the coverage is limited and there are long waits. In the 2012 report, Living Well, Living Longer, Dr. Sinha’s says, “The fact that this program currently has a one-year waiting list speaks to the need for more programs like these across the province.”
Programs that increase access to dental care not only improve oral health but overall health. These programs have generally had a positive impact in their respective communities. Free dental care for low-income seniors improves access to appropriate dental care, and has the potential to reduce ER visits.
Is the government plan good policy?
Seniors routinely forgo regular dental care due to cost. Older, lower-income seniors in particular don’t receive enough dental care. In that regard, targeted approaches that benefit the people who need it the most will make a difference. The goal of increasing free access via a variety of access points, including public health units, community health centres, and Aboriginal Health Access Centres, is another indication that government is aiming the new funding at the most underserved seniors. The use of existing infrastructure also means that more of the funding can go to direct service provision.
By the same token, it will be incumbent on government, health providers, and community organizations to effectively reach the seniors who need care. Social isolation, language, and other barriers, can often cause targeted communities to miss out on government programs. Outreach will be key.
It’s also not clear at this time how much care will be provided to seniors. The announcement doesn’t say whether or not the full spectrum of dental care will be included, and included at all access points. We don’t know, for example if oral surgery is included. But the importance of regular cleanings and check-up can’t be overstated.
While we wait for additional information of the new province-wide plan, this is a positive first step and one the NIA hopes this and other governments will build on to ensure seniors get the care they need without having to go the ER.
The National Institute on Ageing is a Ryerson University think tank focused on the realities of Canada’s ageing population. We are Canada’s only think tank dedicated to policy solutions at the intersections of healthcare, financial security, and social well-being. Through our work, our mission is to enhance successful ageing across the life course and to make Canada the best place grow up and grow old.
By Arianne Persaud, Manager of Advocacy, Government Relations and Stakeholders, National Institute on Ageing | Email: email@example.com. Follow us on Twitter and sign up for our mailing list.