COMMITTEE RECOMMENDATIONS

That Council recommend that the City of Ottawa sponsor the following resolution to the FCM (Federation of Canadian Municipalities) Annual General Meeting in May 2005:

Whereas Dental Care is not an included service under the publicly funded medical care system and must be financed by individual Canadians;

And whereas low income (lower socio economic) individuals tend to suffer higher rates of dental disease and decay;

And whereas the current system of dental services varies from community to community, but is very limited for low-income families and adults who do not typically have access to private dental benefits packages;

Therefore be it resolved that the Federation of Canadian Municipalities call on the Government of Canada in consultation with Provincial, Territorial and Local Governments to develop a comprehensive National Oral Health Strategy that would have as its goal, providing universal access of both preventative and treatment services, to all Canadians; and,

Be it further resolved that the Government of Canada, in developing a comprehensive, universal, national dental strategy be asked to evaluate the following four key areas of possible action, and to assess the effectiveness of each in either increasing the range of specific dental services or reducing the portion of the population excluded from access to dental care:

1.         Increase the level of service to ensure that all Canadians have access to a basic level of dental care;

2.         Change the eligibility for access into the programs so that more residents could access the current level of dental services;

3.         Examine access to care and the factors leading to under utilization of existing programs.  Increase the participation rate of those who currently have access to these programs from the estimated 20-25% utilization rate, and/or;

4.         Continue to develop programs that target adults or children that have a direct impact on the other detriments of health and indirectly support oral health.

RECOMMENDATIONS DU COMITÉ

Que le Conseil municipal recommande que la Ville d’Ottawa parraine la résolution suivante à l’assemblée générale annuelle de la Fédération canadienne des municipalités (FCM) qui aura lieu en mai 2005 :

Attendu que les soins dentaires ne sont pas compris dans les services couverts par le système d’assurance médicale subventionnée par l’État et que les Canadiens et les Canadiennes doivent les payer de leur poche;

Attendu que les personnes ayant un faible revenu (ou faisant partie d’un milieu socioéconomique défavorisé) ont tendance à souffrir d’un taux plus élevé de maladies bucco-dentaires et de caries;

Attendu que le système actuel de soins dentaires varie d’une collectivité à l’autre, et que l’accès à ces soins est très limité pour les familles à faible revenu et les adultes qui n’ont pas en général une assurance privée pour les soins dentaires;

Il est résolu que la FCM pressera le gouvernement du Canada, en consultation avec les gouvernements locaux, provinciaux et territoriaux, de développer une stratégie d’hygiène buccale globale nationale qui aura pour but de fournir aux Canadiens et aux Canadiennes un accès universel à des services de prévention et de traitement; et

Qu’il soit de plus résolu que l’on demandera au gouvernement du Canada, dans le cadre de l’élaboration de cette stratégie, d’évaluer les quatre mesures possibles suivantes afin de déterminer l’efficacité de chacune pour soit accroître la gamme de services dentaires offerts, soit diminuer la portion de la population qui n’y a pas accès;

1.         Accroître le niveau de service afin de s’assurer que tous les Canadiens et Canadiennes ont accès à des soins dentaires de base;

2.         Modifier les conditions d’admissibilité aux programmes afin qu’un plus grand nombre de résidents et de résidentes ait accès au niveau actuel de soins dentaires;

3.         Examiner l’accès aux soins et les facteurs qui entraînent une sous-utilisation des programmes actuels. Accroître le taux de participation (qui se situe actuellement entre 20 et 25 %) des personnes qui ont accès à ces programmes, et/où;

4.         Continuer le développement de programmes qui ciblent les adultes et les enfants, et qui ont un impact direct sur les détriments pour la santé tout en favorisant la santé bucco-dentaire.

DOCUMENTATION

1.                  S. Kanellakos, Deputy City Manager, Community and Protective Services report dated 24 September 2004 (ACS2004-CPS-PAR-0012).

, will be distributed prior to the Council meeting of 27 October 2004

REPORT RECOMMENDATIONS

That the Health, Recreation and Social Services Committee receive this report as information to assist councillors in drafting a resolution to the FCM recommending a National Dental Care Strategy.   

That the Health, Recreation and Social Services Committee and Council direct Community and Protective Services staff to:

Review all Day Programs and make recommendations on the adequacy of funding levels in time for the 2006 budget; and

1.Continue negotiations with the Anglican Diocese for the phased elimination of Supports to Daily Living now directed to the Women’s Emergency Shelter by March 2006.

That the Health, Recreation and Social Services Committee and Council direct People Services staff to:

1.Review all Day Programs and make recommendations on the adequacy of funding levels in time for the 2006 budget;

Continue negotiating with the Anglican Diocese for the phased elimination of Supports to Daily Living Funding now directed to the Women’s Emergency Shelter by March 2006; and

.

RECOMMAENDATION DU RAPPORT

Que le Comité de la santé, des loisirs et des services sociaux et le Conseil demande aux Services communautaires et     :

1.de revoir tous les programmes de jour et de formuler des recommandations sur la suffisance des niveaux de financement, et ce, à temps pour le budget de 2006; et

1.de poursuivre les négociations avec le Diocèse anglican quant à l’élimination graduelle de l’aide accordée au financement lié aux activités de la vie quotidienne maintenant accordée au Refuge d’urgence pour les femmes au plus tard en mars 2006.

Que le Comité de la santé, des loisirs et des services sociaux prenne connaissance du présent rapport, à titre d’information, que les conseillers pourront utiliser afin de rédiger l’ébauche d’une résolution à la FCM recommandant une stratégie nationale de soins dentaires.

During the 2004 budget review, Council approved the following motion:

That staff review the value of the programs operated by the Anglican Diocese of Ottawa on behalf of the City - Centre 454, The Well and Cornerstone – and the adequacy of the current funding arrangements  and report to the committee no later than June 2004, with recommendations.

At the Health, Recreation and Social Services 2004 budget meeting, the Anglican Diocese made a presentation as part of the public delegations.  The Diocese expressed concerns regarding the budgettheir budget pressures.   experienced by the Diocese as a result of the implementation of their pay equity plan.  The Diocese has indicated to the City that their present financial difficulties are tied to the implementation of their pay equity plan.

BACKGROUND

*This amount reflects a 30% decrease in SDL funding ($100,886) in 2004.  This SDL funding for the women’s shelter will be completely phased out by the end of 2005 as the mandate for that funding stream is for residents of supportive housing services, not emergency shelters.

This amount which reflects a 30% decrease in SDL funding ($100,886) in 2004 will be phased out by the end of 2005 as the SDL funding is mandated for supportive housing services, not emergency shelter services.

Funding for Residential Services - Cornerstone

The City purchases services from The Anglican Diocese through Cornerstone at the women’s emergency shelter and two supportive housing facilities, 515 McLaren and McPhail House, as indicated in Table 2.

The women’s shelter appears to have the greatest financial difficulty.  There are 49 beds that are all occupied most nights.  The City provides the maximum per diem of $38 that is allocated to the seven other emergency shelter services in the community and the family shelters operated by the City.  As in all the other shelters, there is also funding for one Housing Support Worker to help the clients find and retain housing.  The City also provides the actual facility with maintenance and cleaning services.  Unfortunately, Cornerstone does not appear to have access to donations and other sustaining funds as do the other shelters.  Thus, with its small numbers, the women’s shelter is expensive to operate.

Throughout several discussions with Cornerstone over the past two years, People Services staff has encouraged the Diocese to explore ways to increase their revenue and decrease their expenses.  In 2004, they added six beds that increased the potential per diem funding by $80,000 per annum.  They have assessed their staffing model but decided they are committed to providing more than the minimum standard.  While the City respects this decision, it does add considerably to their operating expenses.

Over the next several months, the Anglican Diocese will be invited to participate in a process for sector planning around issues of homelessness.  This is all part of the community capacity building that has planning money from federal homelessness funds. This process will include assessments of agency capacity to deliver services and purposeful outreach to other agencies to become involved in service delivery.  It has been recognized that women’s services, both emergency shelter and supportive housing, are a priority for this planning.  It is expected that the community will have developed this plan by December 2004.  The City’s role is to facilitate this process.         

Centre 454 and The Well/La Source are two of seven Day Programs presently funded through the Community Funding Division.  Funding for Day Programs is intended to contribute to the core functions of the program, including: coordination and administration, space and utilities, expenses related to run core services (such as office and program supplies, equipment repairs), legal, audit, insurance and Board expenses.  Table 3. compares the levels of funding across the City’s seven Day Programs as well as the numbers of clients served. 

Funding for Day Programs

Table 3.  Funding for Day Programs and Number of Clients Served

This present review did not allow for a thorough evaluation of services provided, other sources of funding, other programs provided by agency, and total budget of agency.  In order to assess the adequacy of the City’s funding for the programs offered by the Anglican Diocese, a more thorough qualitative and quantitative review would need to be undertaken that would include the other Day Programs funded by the City in its scope. 

PPay Equity

Ontario introduced Pay Equity Legislation in 1991.  In 1994, the Anglican Diocese submitted an implementation plan to the Province and proceeded with salary adjustments.  The Province originally provided additional financial resources in order to assist the agencies to meet their pay equity obligations. 

The following points summarize the history of pay equity funding to the Anglican Diocese for its day Day Pprograms and Rresidential Sservices.

Prior to the transfer download of Supports to Daily Living (SDL) to the City in 2000, the Ministry of Community and Social Services (MCSS) provided funds, through the SDL funding allocated to Cornerstone, to help the Diocese meet their delivered pPay eEquity obligationsto the Anglican Diocese through the SDL funding allocated to Cornerstone.  These funds is Pay Equity money waswere distributed through the Diocese to The Well and Centre 454.

Effective January 2000, the Ministry reduced Cornerstone’s total allocation by $61,095; in effect the amount of Pay Equity previously allocated to The Well and Centre 454.

May 2001, People Services forwarded funds, provided by MCSS, in the amount of $50,877 with the understanding that, in conjunction with $10,182 previously issued by MCSS, the issues of pay equity with the Diocese was resolved. 

A letter of August 19, 2002 from Dick Stewart to the Diocese confirmed that position.

Since the download transfer of the of the SDL funding stream, MCSS has indicated to the the Diocese and to the City that the total amount has insisted that $336,000 of their ($856,000)  SDL allocation was designated for Pay Equity.  The City has taken the position that these funds were only is designated for Supports to Daily Living services, not for Pay Equity.

February In February 2004, MCSS confirmed in writing to the City that SDL funding does not include Pay Equity.Equity.

As a result of the 2003 Pay Equity Memorandum of Settlement coming out of a challenge to the Courts by the hearing onthe  Childcare network, MCSS has flowed funds there has been some money for Pay Equity from the Ministry to Cornerstone, which was flowed through People ServicesCommunity and Protective Services on behalf of the Ministry. The City has simply been the transfer agency for that Provincial funding.

The Pay Equity Act and MCSS confirm and the Ministry’s position is that Ppay eEquity is the responsibility of the employer and should be considered aa cost of doing business.

Although Council’s motion did not mention pay equity, the Anglican Diocese has clearly expressed that they link their present financial pressures to the implementation of their pay equity plan. 

Ontario introduced Pay Equity Legislation in 1991.  In 199??, the Anglican Diocese submitted an implementation plan to the Province and proceeded with salary adjustments.  The Province provided additional financial resources in order to assist the agencies to meet their pay equity obligations.  Since 2001??, the Province has clearly indicated to the Diocese and to the City that pay equity is the responsibility of the employer and a cost of doing business.  The Pay Equity Act states that pay equity is the responsibility of the employer, not the funder. 

In 2003, following a Court challenge, a Pay Equity Memorandum of Settlement has provided compensation for agencies funded through the Province. 

People ServicesCommunity and Protective Services has consulted with Legal Services on the issue.  Legal Services has confirmed that there is no legal requirement foron  the City to assist the Anglican Diocese, nor any other employer, with their pay equity issues.  No other agency funded by the City receives or has ever received any additional funding to meet its pay equity obligations. 

CONSULTATION

Staff in People ServicesCommunity and Protective Services have consulted with Legal Services. 

FINANCIAL IMPLICATIONS

There are no financial implications for the 2004 budget. 

DISPOSITION

People ServicesCommunity and Protective Services will implement the decisions of Council.

This report is in response to the HRSS Committee’s request for more details following the June 17, 2004 presentation to committee by the Dental Officer of Health on gaps in dental care.  The report provides background information to assist councillors to draft a resolution to the FCM recommending a National Dental Care Strategy.

DISCUSSIONBACKGROUND

Dental Care is not an included service under the publicly funded medical care system and must be financed by individual Canadians.  A significant portion of the Canadian population has access to a private dental benefits package through their employers that defrays a portion of the costs of dental services.  Dental care packages typically have a monthly contribution paid by the employee and employer.  Reimbursement for covered services typically ranges from 50% to 90% of the actual costs with the employee paying the difference.  Limitations in scope of treatment, frequency of treatment, and yearly maximum reimbursement are common features.  For the purpose of income tax determination, contributions paid by subscribers and employers are not considered taxable benefits.  Access to dental care is greatly determined by employment status and ability to pay for care.

Earlier this year, the Poverty Advisory Committee highlighted the problems in accessing dental services for low-income groups.  Canada does not have an official oral health strategy and dental care services are not part of our medical care system.  In terms of addressing oral health, there is no single Government entity charged with determining and responding to the oral health status of Canadians.  Unlike other aspects of Canadian health, there are currently no personnel within Health Canada with responsibility for overseeing the oral health of all Canadians.  Despite considerable improvements in overall oral health of Canadians, a significant portion of the population continues to suffer from dental disease and has limited access to care.  There is currently a patchwork of initiatives and care programs for those without private dental coverage, however the scope of initiatives varies greatly across the country.

Government Roles

Over the past few decades, the government role in Canada focused on four key areas:

1)      Water fluoridation in the municipal water supply;

2)      Prevention Programs – specific targeted programs for school age children and low income groups;

3)      Treatment Programs – a variety of limited treatment services and benefits for select targeted populations, primarily children on social assistance and families on disability assistance programs;

4)      Education/Awareness/Advocacy – Resource development of educational material, teacher in-service opportunities, Dental Education Weeks, Health fairs etc.

Federal Role – Canada

There is no national oral health strategy in Canada.  Unlike other medical areas, Health Canada does not have national specialists dedicated to dental population health.[1] The Federal Government provides dental care for four main groups of citizens:  the military, Federal government employees, veterans, and the Inuit and First Nations.  Federal employees and their immediate families have a dental benefit plan with a utilization rate of approximately 80% that allows them to obtain care through private dental offices.  The Canadian Armed Forces employs full-time dentists to provide mandatory dental care directly to enlisted members of the Canadian military.  Immediate families of military personnel access dental services through private dental offices and have a benefits package to defray treatment costs (similar for veterans).  The Non-Insured Health Benefits Program covers First Nations and Inuit populations and provides access to dental services through a program coordinated by the First Nations and Inuit Health Branch, Non-Insured Health Benefits Directorate of Health Canada.  Payment is made directly to the private dentist who participates in this program.  As with all typical benefits plans, there are frequency limitations and the plans may not address all ranges of potential treatment that an individual may need.  The utilization rate for this plan is estimated at 36%-38%.

Provincial and Municipal Role

All other existing dental health programs are provincially and/or municipally initiated, and are generally targeted towards low-income individuals and families.  None of the provinces offer universal treatment programs for adults, and coverage for those eligible is limited to very rudimentary treatment of pain and infection.  Children are usually eligible for a broader and varying range of services depending on the province.

Limited treatment, prevention, and education programs are offered in each province to targeted low-income populations, but the scope and depth of these programs varies greatly.  Dental health programs are developed and delivered by some combination of the following organizations depending on the province: ‘provincial health departments’, ‘social services departments’, ‘regional health authorities’, or local municipalities.  This lack of consistency means that levels of service and eligibility of care vary dramatically across the country.  In Ontario, responsibility for dental services is divided between the Province and the Municipalities; the province mandates programs while the municipalities implement the programs and contribute funding.  Municipalities deliver dental services indirectly through private dental providers,providers; also, as is the case in Ottawa and Toronto, they may supplement the indirect system by operating their own municipal clinics.  Municipalities also play an administrative role, identifying and tracking patients and coordinating funding.

Existing Provincial/Municipal Programs in Ontario

Existing programs are targeted towards low-income individuals and families.  In general in Canada, there are no universal programs for adults and coverage for those eligible is limited to very rudimentary treatment of pain and infection.  Children are usually eligible for a broader and varying range of services depending on the jurisdiction.

Ontario currently separates its responsibilities between two ministries:  The Ministry of Community and Social Services (MCSS) and the Ministry of Health and Long Term Care (MOHLTC).  The Ministry of Community and Social Services (MCSS) directly administers (through a third party agent – Accerta Ltd.) Mandatory dental programs that are available to families eligible for the Ontario Disability Support Plan (ODSP).  This program is not administered by municipalitiesMunicipalities do not administer this program, however the municipalities do contribute 20% of the funding. 

MCSS also sets the program guidelines for a mandatory dental program for Ontario Works dependent children up to the age of 18.  The OW program is administered by municipalities, and is cost shared 80% provincial and 20% municipal.  Both programs have limited benefits that provide a basic level of coverage at a private dental office with frequency limitations.  Denture services are not included.  Dentists in private offices who participate in this program accept lower fees that are less than 60% of the customary fee.  In addition to the services mentioned above, municipalities are obligated to provide some limited coverage for Ontario Works Adults.  The service level is at the discretion of the municipality and varies across the province of Ontario.  Ottawa provides emergency/urgent services at the three city dental clinics and a limited denture services program for ODSP and OW adults.

The Ministry of Health and Long Term Care (MOHLTC), through the mandatory health programs, defines another set of services that municipalities (local health units) must provide and funds these at approximately 50%.  Mandatory screenings of the dental health of school children are done annually (up to grade 8). In Ottawa, these screenings are done by dental hygenistshygienists who are employed by the City’s Public Health Branch.  Children in need of dental care who are not eligible for other assistance are referred to the Children in Need of Treatment Program (CINOT).  CINOT, which is delivered by the City and cost-shared 50/50 with the province, provides limited services to identified children with no dental insurance and who financially would be unable to purchase treatment services in the private market.  CINOT provides a single course of treatment, but does not provide ongoing care.  The Ministry also mandates limited preventive services such as fluoride application and pit and fissure sealants to targeted children, and these services are provided through the City’s dental clinics.

To summarize, at the municipal level the role is as follows:

1)      to deliver provincially mandated programs and targeted prevention and treatment programs;

2)      to cost-share with the province on the mandated programs (80%province of Ontario/20%city for ODSP/OW and 50%province of Ontario/50%city for CINOT);

3)      to balance the service level between programs,

4)      to determine what discretionary care will be provided,

5)      to provide prevention and education services that target high-risk groups.

See Appendix 1 for details of Ccity of Ottawa dental services.

Gaps and Limitations in the Current System

Adults on Ontario Works do not have access to routine checkups, cleanings and ongoing care.  The target group of low-income adults generally needs far more dental care but is eligible for much lower level of service.  Over time, their oral health declines and their needs increase resulting in increased demand for emergency services.  The range of services provided in the city of Ottawa clinics, while limited, covers more essential pain relief services than found in other municipalities.  The three city clinics have emergency walk-in times each morning and afternoon for one hour and fifteen minutes (total of 2.5 hrs/day).  Their goal is to treat the pain at this appointment.  There is no access to advanced procedures.  The city is increasingly being asked to assist more low-income residents to access treatment and to provide higher level services than the current limited emergency level procedures for adults.

Many low-income adults and children are not eligible for any of the targeted programs and therefore receive no care.  Municipalities do not have the resources to expand treatment services; this would require a commitment from the federal and provincial governments to the oral health of Canadians.  In this respect, there is a great need for a Canadian Oral Health Strategy to focus on ways to both reduce the disease rates in the disadvantaged segments of the population and improve their access to care.  There are four main types of barriers to access that need to be addressed by a National Oral Health Strategy: Financial barriers, geographic barriers, social/cultural barriers and legislative barriers.  If oral health is to improve in more at-risk people, it is necessary to reduce or eliminate the barriers that restrict access to health care.

Towards a National Oral Health Strategy

The need for a national oral health strategy has been recognized and there are several initiatives underway however many are grassroots organizations with no mandate to further this initiative and no funding.  Oral Health Coalitions are now established in Toronto, Niagara and Ottawa.  Dr Aaron Burry, Dental Officer of Health for Ottawa, is the liaison with dental health coalitions in Ontario and across Canada.  The Toronto Oral Health Coalition produced a report called Dental Care:  Who has Access, October 2002.  This Coalition is not yet ready to do political advocacy.  A petition campaign to raise awareness of the issue resulted in over 5000 signatures.  The Toronto Board of Health endorsed a motion that was sent to the province and to the Romanow Commission.

The Federal, Provincial, Territorial Dental Directors (FPTDD) have provided a leadership initiative by developing “A Canadian Oral Health Strategy” document that is in draft form and is being circulated to a variety of stakeholders for comment.  However one drawback is that this group does not have any government mandate or significant funding to advance the initiative.

The Canadian Association of Public Health Dentists (CAPHD) is a national organization that advocates and encourages the development and maintenance of measures to improve oral health for all Canadians.  A key component of this is a national oral health strategy that addresses gaps and proposes measures that would result in continuous improvement in oral health for all Canadians.

Factors Affecting Oral Health

There are three key indicators of good oral health: cavities, periodontal disease and oral cancer.

In the past three decades, the prevalence of cavities has declined significantly, with rates in children today being less than one quarter of what they were in the early 1970’s.[2] This reduction, however, has not been even across the population and the decay incidence has become very polarized.  One quarter of the population still suffers from higher decay rates, and many of these people have little or no access to preventive and restorative care.  The highest prevalence of dental decay in children occurs in aboriginal children, recent immigrants to Canada and low-income families.[3]  Even with the great decline in dental decay rates, early childhood dental decay is still the most prevalent childhood disease, being seven times more common than asthma.[4]  In Ottawa approximately 4% of school aged children screened have urgent dental needs (obvious pain, open cavities and infection).

There is a lack of current data on the oral health of Canadians.  However, like many diseases, oral diseases such as dental decay, periodontal disease and oral cancer are more prevalent among people of lower socioeconomic levels.[5]  Not only do the disadvantaged groups in society have higher disease rates, they also have less access to dental care.  The highest dental decay rates are amongst low-income people, recent immigrants, Aboriginal peoples, and those with compromised health conditions.  Studies have shown that people on the lower end of the economic scale have decay rates and treatment needs that are 2 ½-3 times that of people in the higher income levels.[6] Low-income adults often experience significant dental problems during their childhood that translates to ongoing, lifelong dental problems.  Smoking is more prevalent in low-income groups and they generally lose their teeth earlier.[7]

There is a growing body of evidence that indicates that oral health is directly linked to general health. As was stated in the first Surgeon General’s Report on Oral Health in the United States “oral health and general health should not be interpreted as separate entities.” and “Oral Health is integral to general health…you cannot be healthy without oral health.”[8]. There are many different areas that impact on the oral health and general health of an individual.  These have been identified as the determinants of health and include the following: as access to care, basic needs, family experience, self-esteem, employment, socio-economic status, education/training, social supports, sense of control, environment, access to education/training, geography, recreation, marginalization-language, gender race, sexual orientation, and poverty.

The loss of all adult teeth has decreased in the past four decades due to the improvements in general oral health and access to preventive and restorative care.  There is a major problem looming in the next two or three decades, as more and more people will enter their senior years with more of their own natural teeth in varying degrees of periodontal health and repair and that will require more maintenance in order to sustain their health.  Many of these individuals will have reduced capacity to provide self-care that prevents further oral disease, and limited financial ability to purchase needed maintenance and treatment.  The breakdown of heavily repaired teeth at a time when other medical conditions and the cost of more extensive repairs will be a major concern.[9]  The majority of dental benefit plans are provided through the employer and coverage ceases upon retirement.  Therefore in the years following retirement, demands for dental treatment will increase while they are on fixed incomes with no dental benefit plans to defray costs.

For the most part dental decay is preventable through simple, effective and safe methods, including tooth brushing (using a fluoride containing tooth paste), targeted professionally applied topical fluoride (for higher risk individuals), and diet control (amount, texture and frequency of sugars, carbohydrates, etc.).  In order to reduce decay rates in the future, particularly in the higher-risk individuals, it will be necessary to increase health promotion and prevention activities, and also to enable those who have little or no access to dental care to be able to access preventive and treatment services.[10]

Conclusion

There are four key areas of possible action that either increase the range of specific dental services or reduces the portion of the population excluded from access to dental care.  Each area on its own would require a significant financial commitment from all levels of government and should be seen as an investment in public health.  Each option also impacts on the determinants of health.

1)      Increase the range of services to provide a basic level of services rather than the current emergency level;

2)       Change the eligibility for access into the programs so that more residents could access the current level of dental services;

3)      Increase the participation rate of those who currently have access to these programs from the estimated 20-25% utilization rate; or

4)      Develop programs to target adults or children or any of the other determinants of health.

There is a need for increased care and increased funding, but it is difficult for the City to act alone.  In order to meet the high demand for dental care, especially among the low-income population, the federal and provincial governments need to commit to a national oral health strategy, and support this commitment with more funding for dental health care.

CONSULTATION

There was no consultation associated with the preparation of this information report.

FINANCIAL IMPLICATIONS

There are no direct financial implications associated with this report.

SUPPORTING DOCUMENTATION

Appendix 1 - Ottawa Dental Services: Developed to Ensure Access to Dental Care for Low-Income Residents of Ottawa

DISPOSITION

A draft resolution will be available for the consideration of the HRSS Committee at its meeting of October 7.

Appendix 1

 -

Ottawa Dental Services: Developed to Ensure Access to Dental Care for Low-Income Residents of Ottawa

The City of Ottawa Dental Services was established in 1969 as a public health preventive service.  The first dental treatment clinic was added in 1972 and expanded in 1981 to three clinics to provide treatment to social assistance clients.  The program downsized in 1996 and in 1997 was asked to manage the Ottawa Children’s Aid Society dental benefit plan.  In 1997, a pilot project at Island Lodge, Long Term Care facility provided important insight into the needs and issues in providing urgent dental services to institutionalized seniors.  In 1998 new Ontario social assistance legislation came into effect that re-modeled dental programs for social assistance clients into the current ODSP and OW programs.  Part of this implementation resulted in Ottawa Public Health Branch, Dental Services becoming the Administrator of the OW dental benefits programs for Ottawa.  In 2001 a dental suite was set up in the new Peter D. Clark center.  The city clinics provide service to the homeless, street kids, and adults from the Salvation Army and Shepherds of Good Hope.  Children under OW can access care in a private dental office or at a city clinic.  Adults are limited to services at the three city clinics.  Schools are linked into the clinics for emergency situations and for action relating to children at risk.  Coordination of benefits and care is provided to seniors in Elizabeth Bruyere Health Center and St Vincent Hospital along with long-term care facilities.

In 2003 the city dental clinics provided 28,000 visits and were operating six days per week with day and evening hours.  Denture services were provided to 1900 patients.  Dentists are paid on salary.  The fees charges are approximately 69% of the customary private practice fees. The clinics caseload is 60% adults and 40% children.  Due to the rotating nature of the social assistance caseload over 64,000 individuals are eligible for services each year.  As the Administrator for the Ontario Works dental plan the city deals with private dental offices that accept these patients.  Private dental offices are currently providing 52% of all service with the remaining 48% provided at city clinics.

School dental screening is provided each year by three dental hygienists, employed with the Public Health Branch of the City, who screen approximately 27,000 children.  Urgent problems are identified in 7% and of those 4% have no dental insurance and no financial ability to pay for services.  Each school screened is rated as high risk, moderate or low risk depending on the number of children identified as having urgent dental needs.  Children can also be screened at any of the three city clinics.  Each year some cases are referred to the Children’s Aid Society for follow-up action since severe dental neglect can often be indicative of other types of neglect.

For oral health prevention, the city has two project officers dedicated to oral health issues.  Education sessions are offered to teachers, ESL groups and multicultural groups.  Resources have been developed and are available in many languages for daycares and community groups.  Articles on dental issues are placed in community newsletters and magazines.  Promotion and educational activities are provided such as Dental Health Month activities and participation in community health fairs.

In 2003 the city was asked to provide a dental pilot project at R. E. Wilson public school in Vanier.  The staff at this high-risk school worked with city staff to provide assist parents in taking full advantage of the benefits to which their children were entitled.  The children targeted were those who were identified with urgent needs, yet following the normal process of parent notification, no action had been taken.  An offer was then made to provide transportation from the school to the city clinic during school hours.  A school resource worker accompanied the nine children who participated.  The number of appointments to complete the work ranged from three to nine.  Intensive attention and education was provided to these children in an attempt to teach them to accept responsibility for keeping their teeth clean. This project showed that there are some groups within Ottawa that do not access treatment for their children even though they have access to dental benefits and the urgent needs of the children have been identified to their parents.

Partnerships

The city works in partnership with the dental community and has established strong links to deliver and support dental services to low-income residents.  The Ottawa Hospital Dental Clinic which serves in-hospital patients who often have serious dental needsClinic, which serves in-hospital patients who often have serious dental needs, has been completely renovated and is now a state of the art dental clinic.  This was achieved through extensive fundraising within the dental community.  The Ottawa Dental Society regularly donates toothbrushes and toothpaste estimated at $3000 annually to local community events.  CHEO Dental Clinic, dental specialists, private dental offices, laboratories, and the Ottawa Orthodontic Society all work together to provide access to care.  A new initiative announced in the Spring 2004 is a two-year pilot project to provide medical/dental preventive services for street kids at the Youth Services Bureau.  This is a link between the University of Ottawa, School of Medicine and Algonquin College Dental Hygienist Program.

Efficiencies of Ottawa Service Delivery Model

The Ottawa service delivery model has been recognized as an Ontario and North American Best Practice.  It has a high level of partnerships using both internal and external service providers.  The system is flexible yet has defined limitations for benefits that provide fairness across all requests for service.  A business case evaluation of this system by a consulting firm in 2000 concluded that the current system of service delivery provided the most cost effective and efficient means of service delivery and providing access to care.  This business case was updated in 2003 and again the same result was found to conclude that approximately $500,000 in cost savings resulted.