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FEATURE: Michael Rodolico has Taken On the Challenge of Providing Oral Health Services to Low-Income Seniors In Reno: Will It Pay Off?
Saturday, November 17, 2007
“An elderly woman on social security called me at home, crying and in pain. She had just been discharged from the hospital, where she was admitted because she had so much infection in her mouth resulting from cracked teeth. She went to the ER because she had no money and no place else to go. A hospital isn’t a safety net for oral care. They discharged her with 3 days worth of pain medication and an antibiotic. She came to our dental clinic and we repaired two cracked teeth. We would like to have done more for her -- but the money just isn’t there. This is just one case - but they come in every day. Because of what we learned at the conference, we are able to care for our seniors with more knowledge and confidence.”
Mike Rodolico (CHL 2006)
Executive Director
Health Access Washoe County (HAWC)
Community Health Center
Reno, Nevada
Michael Rodolico is the executive director of Health Access Washoe County (HAWC) Community Health Center, a successful full service community health center providing low or no cost primary care, mental health and dental care to its target population of the working uninsured (80% women and children, 56% minorities) in northern Nevada.
In 1998, Rodolico opened the area’s only low cost dental clinic. Today, there are two sites providing cleanings, x-rays, restorative dentistry, endodontics, and tooth extractions. The dental clinics now have 4 full-time dentists, 8 full-time dental assistants, 2.8 full-time hygienists and a full-time project coordinator. In 2006, HAWC treated 8,000 dental patients. Recently, Rodolico added oral health services for qualified seniors to HAWC’s growing list of services. In doing so, Rodolico has raised the consciousness of many in his Northern Nevada community to the growing need for access to geriatric oral care.
 In August 2007, Michael Rodolico (CHL 2006) hosted a successful conference for oral health professionals, bringing together the best minds in geriatric oral health from across the United States. They planned for 125 to attend and ended up with 290 dentists and hygienists participating from 10 states. The following is an interview with Rodolico about the impetus for the conference and lessons learned.
CHL: How did you determine the need for a conference focusing on treating the dental and oral health issues of seniors?
MR: A retired dentist and my CHL nominator Lloyd Diedrichson came to me and asked if we could do for seniors what we had done for children and families in oral health. No one in the community was doing much about it. We know that low income seniors have trouble accessing dental care in our community. There is a growing population of people over 65 living on minimum incomes all of whom meet the poverty guidelines. In 2006, 7.4% of HAWC patients were aged 60+. At the time of the conference in August, senior oral health services were not being fully implemented. We anticipate a much bigger increase in usage in 2008, but we did see an increase from 2006 to present.
CHL: What are the barriers to accessing geriatric dental services in Reno?
MR: A senior’s income is the biggest barrier in Reno or anywhere. If you are affluent and a senior, there is no barrier. Affluent seniors can always get care. There is no safety net in oral health. We are dependent on funders who are all too happy to support children’s oral health programs. Economics is driving this. With children, you can get them in and out. It is high profit and high volume. It is exactly the opposite with seniors. You need adequate physical space to accommodate wheelchairs in the exam room; visits are longer and more complicated; and there are medication management issues. Overall it is a more complex and less profitable undertaking. Consequently, we have to put a cap on what we can provide.
Our aim is to get people out of pain, fix cracked teeth and crowns. We can make dentures, but do not do cosmetic work. We get some money to subsidize care, but it doesn’t last long and we have to keep going after it. Right now this care is actually hurting our bottom line. We can treat 3-4 kids to every one senior.
The other issue we faced was training our dental team. We found the dental equipment, hardware and software to implement the program; we could not find any continuing education in this field, short of a residency program. So we decided to bring the mountain to Mohammed, so to speak, and hold a conference in Reno.
CHL: Can you identify 3 main areas of focus or recommendations from the conference that may be particularly useful in Reno?
MR: For us, the conference was all about technique and training, not the safety net. We are the only safety net organization in Reno. We know we have to continue to be passionate about making a case to funders that want to target seniors. But for this conference, we were most concerned with providing our clinicians and staff with training.
We attracted the best of the best in geriatric dentistry focusing on pharmacology -- cancer, especially early detection of oral cancers -- and the compassionate treatment of elderly.
CHL: Where are other leaders likely to find champions and resources for improving geriatric dental services in their communities?
MR: Look locally for support. We had tremendous support in our community. The Northern Nevada Dental Society, the Alzheimer’s Association, Washington Dental Services Foundation, and others, recognized the importance of what we were doing and got on board.
Sandra Lopacki, from the Robert Wood Foundation’s Local Initiative Funding Partners, was instrumental in pointing me in the right direction with leads and suggestions. We ended up with the biggest names in geriatric dentistry agreeing to participate.
There are key centers of excellence at the Universities of California, Colorado and Minnesota. We got the top expert on oral cancer Dr. Sol Silverman to come from the University of California, School of Dentistry. He’s written 340 articles and chapters on oral cancer. It was the same with all of our speakers who were so focused and gave such great information, like the pharmacologist who talked about the 15-20 medications that seniors frequently take that can complicate a dental visit. Community dentists are starved for this level of information.
CHL: Is your participation at the conference likely to prompt any change in the way things are done at HAWC?
MR: Yes, we got ideas and information for design of the clinic. As a result of the conference, our dental director and clinicians have a better understanding and will begin to implement more in depth treatment plans. We will be upgrading our software to track complicated cases more closely. More than anything it has renewed our passion for securing grants for patient care so we can treat more seniors in our community.
For more information on HAWC and the community it serves visit www.hawcinc.org and look for the link to HAWC’s latest annual report to the community. You can e-mail Mike Rodolico with questions at MRodolico@hawcinc.org. | 
