CCHCC: Building a Community Safety Net
March 2007, Maryland: In 2007, 12-year-old Deamonte Driver died when a tooth infection spread to his brain. The Maryland boy underwent two operations and six weeks of hospital care, totaling $250,000. Doctors said a routine $80 tooth extraction could have saved his life. His family was uninsured and low-income.
August 2011, Cincinnati: A 24-year-old Cincinnati father died from a tooth infection because he could not afford his medication. Kyle Willis' wisdom tooth started hurting two weeks prior to his death. When dentists told him that his tooth needed to be pulled, Mr. Willis decided to forgo the procedure because he was unemployed and had no health insurance. When his face started swelling and his head began to ache, Mr. Willis went to the ER, only to receive prescriptions for antibiotics and pain medications. Mr. Willis could not afford both, so he chose the pain medications. The tooth infection spread, causing his brain to swell, and he died as a result.
These stories made national news and shocked the nation. The deaths of young Deamonte Driver and Kyle Willis are sobering reminders of both the importance of oral health, and the absence of a safety net to provide even the most basic forms of dental or health care.
Champaign County Health Care Consumers (CCHCC) has been organizing to build a safety net in our community for those in need of dental care. Our community organizing work has been the catalyst for many improvements in dental access locally, and our direct work with clients has helped thousands of Champaign County children, adults, and seniors. But our work is far from over, and we need your support.
A “silent epidemic” of oral disease – a national perspective
As shocking and tragic as the above news stories are, they are not rare isolated instances of something gone terribly wrong. They are, in fact, the most serious symptoms of what is a national epidemic that has gone on for far too long – the epidemic of untreated oral health problems (usually simple cavities and gingivitis) resulting from the lack of affordable access to the most basic forms of dental care and health care.
These health disparities were highlighted in the year 2000, in Surgeon General David Satcher’s report, Oral Health in America, where it was reported that no less than a “silent epidemic of oral diseases is affecting our most vulnerable citizens – poor children, the elderly, and many members of racial and ethnic minority groups.” The Surgeon General wrote of the importance of oral health as the gateway to general health and wellbeing, and revealed how oral disease is a silent problem, especially in underserved populations.
But getting access to dental care is becoming even tougher as the economy worsens. In April 2011, the Kaiser Family Foundation reported that 33% of people surveyed skipped dental care or dental checkups because they could not afford them.
Feeling the pain in our community
Even before the Surgeon General’s 2000 report, CCHCC has long known about the “epidemic” of oral disease affecting our community’s most vulnerable citizens. On a daily basis we talk to community members who are desperately seeking help trying to get the dental care they cannot afford.
Our Consumer Health Hotline is our direct link to community members who are having problems with the health care system. Through our Hotline, staff and volunteer advocates provide free one-on-one referral, assistance, and advocacy services to hundreds of Hotline callers and walk-in clients each month. About half of all callers every month are seeking help in finding affordable dental care. And at least half of those callers (about 50 people per month) are people who are in crisis and are in need of immediate treatment. They are in crisis because they are experiencing tremendous pain and have been suffering the pain for weeks or even months at a time, and they simply cannot find, or afford, the dental care or oral surgery that they need.
Our clients are low-income adults, children, and seniors who are unable to access even basic routine dental care – the kind of care that could prevent and treat cavities and gingivitis before they become full-blown, potentially life-threatening infections requiring oral surgery as the infection spreads from tooth or gum to bone, and beyond. We help them find the care that they need.
CCHCC’s response to the “silent epidemic” of oral disease
CCHCC’s response to the “silent epidemic” of oral disease began over 20 years ago when we organized the Dental Referral Program (DRP) to help low-income adults get affordable, discounted dental care. And for the last 12 years, CCHCC has been organizing to build a safety net in our community for those in need of dental care. In the past year, we have made great strides. Our community organizing work has been the catalyst for many improvements locally, and our direct work with clients has helped thousands of Champaign County children and adults.
It is part of CCHCC’s mission of “health care for all” to work to expand dental access for all members of our community. Although CCHCC cannot directly provide dental care to individuals who need it, CCHCC has unique strengths, skills, and knowledge that allow us to be a catalyst for creating programs and resources to serve our community. Specifically, CCHCC is able to:
• Work with affected consumers to identify the problems that they face in getting the care they need (their experience makes them the “experts” on where the system is broken or failing);
• Research solutions and models for addressing the problem, and identify our community’s resources and assets that can be brought to bear on the solution;
• Provide information about the problem and possible solutions to the community – including dental and health care professionals – and encourage their leadership to help create community-based solutions;
• Utilize our community organizing skills to work with consumers, community groups, dentists, and other health care professionals to foster collaboration and create new affordable care programs for preventive, restorative, and emergency dental care;
• Advocate at the state and national level for policies that would improve access to dental care for low-income individuals, providing real-life examples from consumers, and sensible solutions.
Please read on to learn more about the work that we are doing to improve dental access in our community, and to learn how you can help!
CCHCC’s Dental Referral Program
CCHCC’s first response to the “silent epidemic” of oral disease began in 1992 when we organized the Dental Referral Program (DRP). The DRP is a collaboration with area dentists who agree to provide dental care on a discounted, sliding-scale rate to low-income uninsured adults in Champaign County. The DRP dentists agree to provide discounts of 20%, 40%, or 60% off their regular costs and to accept a certain number of new clients each month. CCHCC determines the client’s eligibility and discount level, and matches them up with one of the DRP dentists. The DRP provides CCHCC clients with a dental home, so that they are able to receive ongoing care at an affordable cost. And in turn, the DRP gives dentists an opportunity to contribute toward improving our community’s health by giving care to people who might not otherwise be able to visit a dentist.
Dr. Norman Schutt, who is now retiring, was asked what he liked best about being a participating provider in the DRP. Dr. Schutt said, “I enjoyed helping people and feeling like I could give something back to the community. It has been a good relationship [with CCHCC].” Dr. Schutt and his Rantoul-based dental practice have been serving clients of the DRP since 1997. We thank Dr. Schutt for his dedication and service!
Growing the Dental Referral Program. We are happy to report that the Dental Referral Program now helps more Champaign County residents than ever before! Every month new clients are added to the program. And in November, as a result of CCHCC's recruiting efforts, three new dentists agreed to participate in the program, making it possible for us to provide even more new patient appointments each month!
CCHCC’s work to build the dental health safety net
Nine years ago, in 2003, former Surgeon General Richard H. Carmona released a National Call to Action to Promote Oral Health, which built upon Surgeon General Satcher's 2000 report and underscored the many disparities related to oral health.
It charged individuals, whether as community leaders, volunteers, health care professionals, researchers, or policy makers, to collaborate to promote oral health and reduce disparities.
CCHCC’s work to build the dental health safety net in our community began well before this national call to action. Twelve years ago, we started with efforts to educate community leaders and health care providers about the problem, the costs to our community (not to mention the impact on the individuals who were suffering from the problem), and the possibilities for collaboration to address the problem. Since then, CCHCC has been working systematically to improve access to dental care for low-income people in our community.
We organized the Community Health Partnership (CHP) – which included our hospitals, clinics, local government leaders, social service organizations, labor groups, and more – to develop projects to improve the health of our community. The CHP made Dental Access one of its priorities. This group helped advocate to the Champaign County Board of Health that they create a dental program for low-income children. Ultimately, the Board of Health and the County Board agreed to create and fund the Child Dental Access Program to provide free dental care to low-income Champaign County children. The Child Dental Access Program continues today, and is operated by SmileHealthy.
Local hospitals did not know about the dental crisis in our community
Believe it or not, most health care professionals, including doctors, dentists, and hospital administrators, did not know about the “silent epidemic” of oral disease in our community. Much of CCHCC’s work in being a catalyst for the creation of new programs and services in our community involved a campaign to educate health care professionals. Fortunately, because of CCHCC’s other work involving hospital financial assistance programs, we had a good relationship with our local hospitals and met with hospital administrators regularly. This gave us the opportunity to bring up the dental crisis. Hospital administrators were shocked and in disbelief to hear about what a tremendous problem access to dental care was. We challenged our local hospital administrators to look at the data from their own Emergency Rooms (ERs). They were stunned to see how many patients each month were visiting the ER because of tooth pain stemming from untreated oral infections that could have been prevented by basic dental care. They were also stunned to see how many of these patients had to return to the ER many times, over a course of weeks, months, and even years, for the same problem as it went untreated.
As a result of this education campaign, our local hospitals – Carle Foundation Hospital and Provena Covenant Medical Center – are now leaders in the local collaborations to improve access to dental care for low-income community members. They provide significant leadership and financial resources to the local efforts.
The results are promising!
Now, compared to even just five years ago, our community is very fortunate to have several new important programs that make dental care available to low-income children and adults. Low-income children and families are now wonderfully served by the programs of SmileHealthy. And the new Frances Nelson Dental Health Center serves low-income uninsured adults and adults with Medicaid. This dental center is the result of an amazing collaboration by SmileHealthy, Carle, United Way of Champaign County, Provena Covenant, Frances Nelson, local dentists, private foundations, and others.
CCHCC cannot and does not want to take credit for the work of these organizations and the services that they provide. However, CCHCC’s work as a community catalyst has played a crucial role in sowing the seeds that made these new resources and programs possible in our community.
Turning our attention to access to oral surgery
Many of the patients who visit our hospitals’ ERs on a regular basis require oral surgery in order to treat their dental problem. The problem may have started as something small, but over time, left untreated, grew to be a greater problem requiring more intensive medical/dental intervention.
Until recently, when calling to schedule an appointment at Carle’s Oral and Maxillofacial Surgery Department, Carle patients with Medicaid would be instructed to call during one of two days per year to compete for a limited number of appointment slots. Patients with no insurance, Medicare, or medical insurance would be told that they could be seen, but that they would have to pay out-of-pocket on the day of their surgery. Many of these individuals would then become discouraged and wait.
After seeing many of our clients returning to the ER to treat their dental pain but not receiving the care that they needed to resolve the problem, we began to work with Carle to bring about systemic change. Now, instead of having two days a year for patients with Medicaid to call and make an appointment, Carle will hold a set number of slots every week for these individuals! This has made a tremendous difference in the lives of Medicaid patients requiring oral surgery.
A grateful CCHCC client’s testimony: Carle has also been working closely with CCHCC to expand oral surgery access to clients that are covered by Carle Community Care (Carle’s financial assistance program). Our client, Suzann from Champaign, came to us after she had seen two dentists, both of whom referred her to an oral surgeon to treat a tooth that had been causing her pain. She is a member of our Dental Referral Program, and did not know how she would be able to pay for a costly oral surgery on a fixed income.
After working with Carle, we were able to get her surgery completely covered by the Community Care Discount Program. Suzann later told us, “For people like me, a senior with a low-income, you all are angels in disguise. I don’t know what to do without you. Like me, a lot of seniors don’t know where to go. You are a god-send.”
What's next and how you can help!
For us at CCHCC, the tragic news of the deaths of Deamonte Driver and Kyle Willis serve as stark reminders of the importance of our ongoing work to improve access to dental care for low-income people. Without help from our Hotline and Dental Referral Program, some of our clients could have similarly tragic outcomes. Some have been dangerously close to similar fates by the time they came to us.
The safety net that we have begun to build in our community through collaboration with other important organizations must be strengthened and expanded. There are tens of thousands of community residents who still need access to affordable dental care. While we have made very important strides in meeting that need, we still need to strengthen and expand our community’s resources. CCHCC’s work will continue to focus on those efforts, as well as our efforts to recruit more dentists to participate in our Dental Referral Program.
Community survey on access to care: This spring, CCHCC, in collaboration with other organizations, will be conducting a community survey on access to care. We want to hear from local residents who are having problems accessing any kind of health care they need, including dental care, mental health services, medical care, prescription drugs, vision care, durable medical equipment, and more.
The community survey on access to care will help us identify other outstanding health care access needs in our community and the barriers that limit people’s ability to get the care that they need. Identifying problems is a crucial step in developing community-based solutions. CCHCC is confident that we can continue to help grow our community’s efforts to meet local health care needs. Through the dental access work over the past few years, we have an unprecedented level of collaboration among community groups, health care providers, local funders, and other stakeholders – and this new era of collaboration holds tremendous promise for the possibility of improving the health of our community!
How you can help: You can help by getting involved! You can be involved as a volunteer to work on these efforts, a dental Advocate to help individuals get the dental care they need, and if you are experiencing access to care problems, you can take our survey this spring. You can also help by making a tax-deductible financial contribution to support our efforts to expand our Dental Referral Program and our community organizing work to build our local safety net and eliminate the barriers to health care.
Thank you for your support! As always, we are grateful for your support and involvement because it makes CCHCC’s work possible. Through the work that we do – providing one-on-one free services, advocacy, and community organizing – CCHCC is making our community better! Please help us come one year closer to eliminating barriers to dental care in Champaign County!
Claudia Lennhoff, CCHCC Executive Director