Place-Based Care

Melanie Simmer-Beck | 07.31.2014

Place-Based Care

It is not uncommon for older adults, especially those residing in residential facilities, to lack ready access to oral health care (1).  This is because dental care in the United States is typically provided directly in private dental offices or safety net clinics by dentists and personnel supervised by dentists (2).  Older adults must identify the need for care, call to schedule an appointment, and find transportation to the appointment before they can receive care.  Older adults who are unable to do this must rely on their care providers for identifying the need and coordinating care.   This can be a difficult task.

The need to provide oral health care to older adults directly where they live, worship, or receive social services is increasing (3). This phenomenon is referred to as “place-based care.”  Integration of place-based care, directly in residential facilities, is an efficient way to utilize resources, get the community involved in taking care of one another, and meet older adults’ oral health needs (4, 5).   A wide variety of place-based care models are in existence across the U.S.  The structure of the models, and the care that can be provided, relies heavily on the state’s individual dental practice act.  Many states have begun revising their dental practice acts to allow dental hygienists direct patient access (6).

If you, or a loved one, are considering place-based care, some key questions to ask are:

• Who owns the place-based care program?  How is it funded?  What are my financial obligations?  Are uninsured individuals offered the same services as insured individuals?
• Are your providers licensed in the state where the dental services are being offered?
• What treatments will be offered?  When will they be provided?  Where will they be provided?  How long will it take?
• How is the need for follow-up care handled?  How is urgent care handled?  Who coordinates this?
• Who will answer questions or concerns about treatment after it has been provided?  How do I contact this individual?
• How can I get copies of my dental records to share with future dental providers?
• How will the information you get be shared with the residential facility?
• Do you have a letter of reference?


Melanie Simmer-Beck, RDH, Ph.D.
Associate Professor
University of Missouri-Kansas City
School of Dentistry

1. Dye BA, Fisher MA, Yellowitz JA, Fryar CD, Vargas CM. Receipt of dental care, dental status and workforce in U.S. nursing homes: 1997 National Nursing Home Survey. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 2007;27(5):177-86.
2. Helgeson M, Glassman P. Oral health delivery systems for older adults and people with disabilities. Spec Care Dentist. 2013;33(4):177-89.
3. ASTDD. Mobile-portable dental manual: ASTDD; 2014 06/03/201.
4. Mueller KJ, MacKinney AC, Gutierrez M, Richgels J. Place-based policies:  The road to healthy rural people and places. Columbia, MO: Rural Policy Research Institute; 2011 March 2011.
5. Committee on the Future of Rural Health. Quality through collaboration:  The future of rural health. Washington, D.C.: Institute of Medicine; 2005.
6. American Dental Hygienists' Association, cartographer Direct access 2013 37 states. Chicago, IL: American Dental Hygienists' Association; 2013.