By Donna Domino, DrBicuspid.com features editor

May 11, 2010 -- In what seems like a throwback to a bygone era, an increasing number of dentists are making house calls to treat seniors, the disabled, and even busy people willing to pay for the convenience.

Some dentists, such as Amir Ghorbani, D.D.S., of Los Gatos, CA, are motivated by the growing number of calls they get from the elderly and infirm and from patients whose parents are unable to get to their offices due to physical or cognitive disabilities, or simply lack transportation.

“It's the most rewarding work I've done.”
— Amir Ghorbani, D.D.S., Los Gatos, CA

So Dr. Ghorbani and others like him are going to senior assisted-living facilities and private homes to deliver basic care, such as exams and prophylaxis, but also nearly every procedure usually done in an operatory, including restoratives, denture and bridge work, extractions, and periodontal treatments.

While many dentists do house calls as an adjunct to their regular office practice, Dr. Ghorbani gave up his practice in November and now makes only house calls. He performs all the procedures that were done in his office in the homes of patients, loading four metal boxes containing all the dental equipment he needs into his Mini Cooper. Like other house-call dentists, he does exams, x-rays, and prophylaxis alone and brings an assistant along for other procedures.

"It can be a challenge treating elderly patients who don't respond or aren't cooperative," he explained in an interview with DrBicuspid.com. "You kind of get creative."

Dr. Amir Ghorbani with his portable dental equipment, including a collapsible dental chair. Image courtesy of Home Care Dentist.

Patients with late-stage Alzheimer's disease can be among the most difficult to treat, said Lily Sarafan, Dr. Ghorbani's wife and co-founder of Home Care Dentist.

"Sometimes they don't understand what's going on, but they're the most rewarding because they're the most difficult to transport to the dentist's office," she said. "I've seen patients who haven't been to the dentist in eight to 10 years. Dental care is especially important at that age because it can lead to so many other problems."

Others who need such personalized service include the morbidly obese and patients with severe phobias -- who "can't stand hearing the sound of the drill," said Sarafan, who accompanies her husband to assisted-living facilities to treat patients.

But they also get calls from able-bodied patients with young children who want the convenience of having Dr. Ghorbani come to their home and treat the whole family, Sarafan said. "These are professionals who just don't want the inconvenience of driving in traffic to the doctor's office and waiting in the lobby," she explained in an interview with DrBicuspid.com.

Dr. Ghorbani charges $95 for travel, plus the same rates as for procedures done in the office. Sarafan estimates that he treats about 30 patients per month, about 80% of whom are elderly.

"It's the most rewarding work I've done," Dr. Ghorbani said. "It provides access to dental care for patients who wouldn't otherwise be able to get it. I'm contributing to their oral health and overall health because everything is connected."

Evenings and Saturdays

Sharad Pandhi, D.D.S., of Tucson, AZ, agrees.

How to make it work financially

For many dentists considering doing house calls, the big question might be: Can I make a decent income?

"We've only been doing this five months," said Lily Sarafan, co-founder of Home Care Dentist. "Obviously, you don't get your regular monthly revenue. But I'm optimistic we'll get to that point very soon."

For one thing, the overhead is dramatically less than operating an office, which for Amir Ghorbani, D.D.S. -- also of Home Care Dentist -- was about $30,000 per month for equipment, lab fees, and lease costs.

"You eliminate about 80% of those costs when you run a house-call practice," Sarafan noted.

Most house-call patients pay privately, but most dental insurance covers the costs on an out-of-network provider basis, Sarafan said.

Medicare does not cover routine dental procedures unless they are performed as part of another Medicare-covered service, such as jaw reconstruction after an accident, Medicare spokesperson Ellen Griffith explained to DrBicuspid.com. And many states have cut adult Medicaid benefits. But some patients living in long-term facilities do get dental benefits.

"I was doing a fellowship at the University of Washington School of Dentistry where I learned how to treat the developmentally disabled -- what their limitations are and what you have to worry about," he said in an interview with DrBicuspid.com. "So when I started my practice in 1987, I decided to provide this service since I had gained the knowledge of how to do it. The patients so appreciate it, and the families appreciate it."

In addition to his office practice, Dr. Pandhi does house calls on Fridays, when he treats up to 10 patients. He also makes home visits on Saturdays and weekday evenings and, like Dr. Ghorbani, charges $95 for travel, plus the same rates as for in-office procedures.

Transportation is the biggest issue for many of his patients, Dr. Pandhi said. "They're at the mercy of when they can get picked up, and they often had to wait four to five hours in the waiting room for their rides," he said.

"There's a growing aging population who have maintained their teeth a long time," Dr. Pandhi said. "There are a lot more people in their 90s with quite a few natural teeth; also, dentistry has improved a great deal."

But he does not make house calls to those who can come to his office. "I'm trying to provide services to those who otherwise wouldn't have access to dental treatment," Dr. Pandhi noted.

He performs nearly all the same procedures during house calls as in his office: fillings, root canals, crowns, bridges, restorative work, and periodontal treatments, including root planing and scaling. But he does not do surgical procedures or extractions out of concern about sepsis or providing a sterile field, Dr. Pandhi said. And he only uses sedation in hospital settings for the developmentally disabled.

Most of his house call patients are more than 70 years old, but he does treat younger patients with developmental disabilities.

The most difficult, Dr. Pandhi said, are those with developmental disabilities and elderly patients with Alzheimer's disease. "It's difficult to communicate with them," he said. "It's difficult to have a rapport with them so they can understand and follow instructions."

Special needs patients

For David Blende, D.D.S., chief of the dental divisions at San Francisco's Kaiser Permanente Medical Center and the California Pacific Medical Center, making house calls is familiar because he accompanied his physician father on home visits to remote areas near the Canadian border.

His San Francisco-based Blende Dental Group practice specializes in treating the disabled and patients with cognitive issues and severe phobias, and also specializes in sedation and sleep dentistry.

"By the time they need house calls, there's some barrier for them getting to a dental office," Dr. Blende explained to DrBicuspid.com. "But whatever the barriers are, they're very real for them or they're very real for the person who has to transport them, like trying to transport a very frail, elderly woman who's not sure she wants to be very far from her bathroom. When they find you'll come to them, they're very relieved and very grateful, which is nice."

Blende dental assistants take digital x-rays in a patient's home. Image courtesy of Blende Dental Group.

Most of the Blende Dental Group's patients are the elderly or disabled who live in nursing homes or senior assisted-living communities. "There's clearly a market with the aging population," said Amanda White, a nurse and practice manager for Blende. The dental group maintains an office, but its house-call services are a growing part of the operation, White noted.

In-home visits include patients with complex medical conditions, such as those with neck issues who can't lie in a dental chair. The most difficult patients include the morbidly obese and those suffering from dementia. "They can unpredictably try to hit you," White said.

The Blende Dental Group charges $35 per person at communal facilities and $375 for home visits, which includes an exam, digital x-rays, and a treatment plan; it also charges the same rates for procedures as those done in the office. Simple procedures such as prophylaxis, extractions, fillings, and denture repairs are done in the home, but root canals, crowns, bridges, and restorative work are done after the patient is transported to a hospital.

"If we walk in and it's really scary, we break it down in little parts," Dr. Blende said. "We say, 'You know, this is a little overwhelming for you to have done while you're awake. The medical model is to put people asleep if they need an appendectomy. They don't try to keep them awake and talk them through it, so why don't we put you to sleep, and it'll all be done in the safest possible environment.' "

"If we can do it safely in the bedroom or bathroom or kitchen we'll do it, but if not then everyone who works here is very equipped to take someone to the hospital," he said. "So we have all the options."

Copyright © 2010 DrBicuspid.com

 

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