Medicare & children

The severe periodontal inflammation often seen in children with Down’s syndrome is directly linked to increased concentrations of oral bacteria. Several factors have been implicated in the periodontal problems of patients with Down’s syndrome, including poor oral hygiene, an impaired immune system, fragile periodontal tissue, and early senescence. The numbers of bacterial species increased with age, and the severity of the periodontal inflammation was directly related to increased concentrations of pathogens (Silver, 2000). Third party coverage represents 53% of dental costs, compared to 97% of hospital costs, and 84% of physician costs.

In addition, government expenditures cover less than 5% of dental costs, compared to 39% of hospital costs and 68% of physician costs. As a result, in many cases, youngsters with mental retardation or developmental disabilities, receive limited dental care, and eventually “age out of care” when they reach adulthood (Waldman, et al. , 2001). In actual practice, dentists often refuse to accept Medicaid patients. Additionally, people with MR are doubly burdened if behavioral issues make dental or medical treatments difficult (Fisher, 2004). Kentucky ranks 48th out of 50 states in services for the disabled adult.

This means that there is little funding for adults with disabilities in Kentucky (Schneider, 2004). The research and assessment findings that this paper is based upon are the participants at Harbor House in Louisville, Kentucky. In the immediate area, there aren’t any other facilities that give the services that Harbor House gives to their participants. All participants at Harbor House have some type of developmental disability, for example, mental retardation, Down’s syndrome, autism, seizure disorder, brain tumor or injury, etc and all are older than 21 years of age.

Harbor House is an institution that provides programs and services to those with mental retardation. Their mission is to “enhance the lives of people with disabilities through employment, self-determination, education, and community building opportunities, with an emphasis on person centered planning, vocational training, and supportive employment. ” The staff of Harbor House strives to give a friendly place for disabled people to turn to for assistance. The institution provides job training, as well as, personal assistance for developing personal and communication skills.

These skills will allow the participants to feel needed and will help them to be as self-sufficient as possible. Harbor House was founded in 1992 by the parents of eleven individuals with mental retardation. These parents were looking for a place that their children could turn to after they graduated high school at age 21. After this age, many institutions would no longer accept their children because they were considered adults; therefore they needed an adult facility that would still be able to provide services that were similar or built upon what they had learned in high school.

Like many communities around the globe, adult assistance is hard to find and even harder to pay for. There seems to be a lack of funding in the government and a lack of participation needed from community members that are required for these facilities to be established. The parents came together to develop what is now known as Harbor House. Harbor House became a refuge for the individuals with mental retardation and had developed reliance upon their parents. It is especially hard when this reliance is established without any teaching of self-sufficiency and then something happens to the parent and the child is left to fend for him or herself.

In the words of one of the original founders “The dedicated parents of Harbor House wanted their adults to continue to strive for their desires to work and socialize in the community. Harbor House offers the future for this vision by opening more doors throughout extensive programs and services. ” In the beginning Harbor House had 36 participants, and now today the number has expanded to 72 members. The participants of Harbor House use the institute as a way to stay involved with the community and to attain vital life skills that they will need as time goes on.

The facility is open so that they are available to attend the program Monday through Friday, from 8:00 am to 3:00 pm. Participants handle bulk mailings, industrial subassembly and medical records management, allowing them to develop a sense of responsibility and an increased measure of self-esteem, while gaining skills in communication and cooperation. Programs and services include, but are not limited to pre-vocational training, life skills training, day habilitation services, physical fitness, creative arts and social skills.

Recently certified as a Medicaid waiver program provider, Harbor House offers Supports for Community Living (SCL). The SCL program provides an alternative to institutional care for individuals with mental retardation or developmental disabilities. As an SCL provider, Harbor House provides: support coordination, community habilitation, supported employment, community living supports, behavior supports, respite and pre-vocational services. In 2004, Metro Council of Louisville voted $16,000 for Harbor House of Louisville Inc. for a program that gives jobs and training to people who are mentally retarded (The Courier-Journal, 2004).

Medicaid is a health care coverage program that is state funded. The federal funded version of this is Medicare. Most people with developmental disabilities have social security or disability payments that cover a fraction of their living expenses. For most participants at Harbor House with the history presented it is a range of anywhere from $564 to $584 a month that is paid as supplemental income. Medicaid does offer dental coverage for those that may use it. The coverage includes visitations and only medically approved procedures; for example, braces cannot be used as a cosmetic correction.

The next issue that comes into play is: Do the dentists accept Medicaid? There were 23 local dentist offices contacted and of those, only 3 accepted Medicaid. This could be a conflict with parents and guardians who wish to give their children dental care, because dentists don’t accept it, paying out of pocket are almost too expensive at times. This is also taking into consideration any supplemental income isn’t enough to pay out of pocket dental visits plus living expenses. If paying for the expenses isn’t an issue then maybe finding a dentist who accepts developmentally disabled patients might be.

Out of the 23 dentists offices called, 12 did accept those with developmental disabilities but if the patient were unable to actively cooperate then only 1 of those 12 would sedate if necessary (Appendix C). When observing the participants at Harbor House, the most notable characteristic was weight issues. On one given day, there were 46 participants that were measured heights and weights. These numbers were used to calculate body mass index (BMI) of each individual (Appendix A). The average BMI for the 46 participants was 32. 5; obese Body Mass Index considered > 30.

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