House Call Dentistry: A Rewarding Career Path
Access to regular dental care can be a serious problem for homebound patients. However, more and more dentists are finding house call dentistry to be not only a profitable business but also a rewarding career path.
According to the Urban Institute, “The number of Americans ages 65 and older will more than double over the next 40 years, reaching 80 million in 2040. The number of adults ages 85 and older, the group most often needing help with basic personal care, will nearly quadruple between 2000 and 2040.”1 Many older patients are homebound, due to either physical or mental health limitations. With this in mind, a number of dentists are dedicating more of their practice (and, in some cases, their entire practice) to making house calls. While providing care within the homes of older patients comes with its own set of challenges, the rewarding nature of the work has convinced many to stay on this career path.
The Typical Patient Base
House call dentistry is primarily meant to service patients who are homebound and would find it difficult or impossible to visit a dental office. While house call dentists typically visit older patients, many individuals — due to injury or illness — are homebound at a relatively young age and benefit from these dental services as well.
Alisa Kauffman, DDS, founder and CEO of Manhattan-based Geriatric House Call Dentistry; Joy V. Poskozim, DDS, FSCD, CDP, of Chicago-based Joyful Dental Care; and Michael Reed, DDS, FAGD, founder of Dallas-based Mobile Dental Care, all work as house call dentists who specialize in visiting older patients. Kauffman and Reed focus on visiting older patients who are frail and homebound (or living in long-term care facilities), not easily transportable, and/or dealing with cognitive issues such as Alzheimer’s disease or dementia. While Poskozim also takes care of older patients, she says that she tends to work more with “the sickest of the sick — those who are completely immobile and bedbound. I see hospice patients, end-stage dementia patients and other similarly highly vulnerable populations.”
Not Your Standard Challenges
House call dentists are required to bring all the necessary equipment and supplies with them to each and every patient. However, this does not diminish the level of care they’re able to provide the patient in any way, explains Kauffman. Recent advances in technology have made the dental tools necessary for most common exams and procedures available in mobile formats, which enables house call dentists to provide the same care one would find in a brick-and-mortar practice. However, Kauffman cautions that some procedures cannot and should not be performed in a patient’s home, including root canals, large crowns and bridges.
While all dentists face their own business challenges, many brick-and-mortar dentists don’t regularly worry about where the power outlets in their buildings are located or if a patient’s medical power of attorney (POA) is the same as their financial POA. However, these are crucial questions for house call dentists to have answered prior to seeing their patients, says Poskozim. For example, if there aren’t power outlets near the patient, the dentist may need to bring extension cords so that his or her equipment will work. And if the medical POA isn’t the same as the financial POA, house call dentists must ensure that both parties agree ahead of time on what services they’re willing to pay for.
“Many times, I found that the medical POA was very willing to have me clean, repair or extract whatever was needed, but the financial POA later refused to pay for these services after the work was completed,” said Poskozim.
Upon entering a home, house call dentists have to get creative with how they provide their services. Typically, the patient is located in a wheelchair, recliner or bed. This requires dentists to be much more flexible, both physically and emotionally, Poskozim explains.
“Not only do you need to be willing to stand, sit or kneel to provide services, but you may even have to straddle patients when necessary,” she added. “Once, I had to extract an upper front tooth while the woman was sitting in a wheelchair. Her head was literally on my chest while I stood over her and pulled the tooth.”
And house call dentists who serve the geriatric population must also find unique ways to communicate with their patients.
“Many geriatric patients are dealing with cognitive issues and find it difficult to follow simple commands such as, ‘Open your mouth,’ or, ‘Put your teeth together.’ Many times, I have to show the patient what I want them to do with my own mouth, or I may even have to use my hands to physically open their mouth, close it, etc.,” said Reed.
A Weighty Moral Dilemma
Reed, who began making house calls in the 1980s and has transitioned to making calls at long-term facilities, has found that house call dentists face another unique challenge: the moral dilemma of determining what the appropriate level of care is for an older patient who is dying.
“It’s a very complicated question — both for the dentist and for the family members of the patient,” he said. “These are medically and cognitively complicated patients. For example, if my geriatric patient needs an extensive procedure, will it stress her body to the point of her having a stroke? If she’s not complaining of pain, does the problem need to be fixed?”
Kauffman agrees, noting that she almost always calls the patient’s primary doctor before doing anything to ensure that her treatment won’t cause medical problems or be hindered by the patient’s current health conditions.
For these reasons, Reed feels that older, more experienced dentists are likely a better fit for any practice that serves geriatric patients at their homes or in long-term care facilities.
“You’ve got to understand dentistry first before you can see patients who have very complicated oral dental issues stacked on top of complicated medical issues,” he said. “You can’t treat them the way you would a mainstream patient. You have to focus on doing what’s in the best interest of the patient, which, quite frankly, can be quite a gray area.”
On the other hand, Kauffman believes that house call dentistry can be a great option for dentists as soon as they leave residency.
“When you get out of your residency, you’ll have seen so many things, and it will all be fresh in your mind,” she said.
Rewards Outweigh the Challenges
With so many challenges, why do these individuals continue to practice as house call dentists? The answer is simple: It’s an incredibly rewarding career path.
“It was never my intention to do any kind of house call dentistry when I got out of dental school,” said Poskozim. “It was never even really proposed to me as a possibility.”
When Poskozim graduated from dental school in 1999, veneers and esthetic dentistry were the “hot ticket,” and that’s what she expected her career to focus on. But her career took a sharp turn when word got out that she had visited her grandmother at her home and not only cleaned her teeth, but also created a new lower partial denture for her.
Soon after, Poskozim was asked to visit an older woman — the matriarch of a large family — who was completely paralyzed due to the effects of a stroke and had an odor coming from her mouth that no one in her family could seem to eradicate.
After peering in her mouth, Poskozim realized that she had horrible thrush from a set of dentures that had not been removed or cleaned since before her stroke two years prior. This was because the family members didn’t know she had dentures, the hospital never checked, and the home healthcare agency took the family’s word that her teeth were natural.
“After this experience, I realized that there was a way for me to use my degree in a much more useful way,” said Poskozim. “I continue to run into similar situations where families who love and care very much for their elderly parents or grandparents are dealing with family members who are suffering because the nurses, doctors and physician assistants they rely on have not been trained to pay attention to the patients’ mouths.”
Kauffman began her house call dentistry practice after a friend’s father had a stroke and needed to have his teeth cleaned every three months.
“I volunteered to do that for him and, at the same time, the patient population in my practice was beginning to age,” she said. “So, I would sometimes go to a patient’s home to help them out. All of a sudden, word got out that I did house calls, and I became incredibly popular. It made me realize there was a real need for this type of practice. The more I did it, the more I loved being able to provide oral care for those who would otherwise be unable to get treatment.”
In addition to the reward that comes with truly helping those in need, Kauffman thoroughly enjoys owning her own house call practice, saying there are a myriad of benefits, including virtually zero overhead after the initial purchase of equipment. Other positive considerations include the ability to create one’s own schedule and decide what procedures to limit your practice to, as well as the choice of whether to bring an assistant or have a caregiver help you.
“Owning this type of practice allows me to schedule work around my life rather than my life around my work,” she said. “You never have to miss a day in your kid’s life because you control the schedule. It provides excellent work/life balance.”
And Kauffman has truly put her money where her mouth is — it’s been 38 years since she started making house calls and 35 years since she started doing it full-time.
Poskozim and Reed, however, continue to maintain their brick-and-mortar businesses while also making house calls.
“I think the way of the future is larger dental practices with two or three dentists who operate out of a brick-and-mortar location so that they can share the large business expenses of a dental practice (software, IT, dental equipment, etc.). This allows dentists to see patients both in the office and in their homes, which provides a variety of revenue streams, cuts down on costs, and creates greater job security and scheduling flexibility,” Reed said.
Michal Christine Escobar is a freelance writer based in Chicago. To comment on this article, email impact@agd.org.
Reference
1. “The US Population Is Aging.” Urban Institute, urban.org/policy-centers/cross-center-initiatives/program-retirement-policy/projects/data-warehouse/what-future-holds/us-population-aging. Accessed 2 Jan. 2023
According to the Urban Institute, “The number of Americans ages 65 and older will more than double over the next 40 years, reaching 80 million in 2040. The number of adults ages 85 and older, the group most often needing help with basic personal care, will nearly quadruple between 2000 and 2040.”1 Many older patients are homebound, due to either physical or mental health limitations. With this in mind, a number of dentists are dedicating more of their practice (and, in some cases, their entire practice) to making house calls. While providing care within the homes of older patients comes with its own set of challenges, the rewarding nature of the work has convinced many to stay on this career path.
The Typical Patient Base
House call dentistry is primarily meant to service patients who are homebound and would find it difficult or impossible to visit a dental office. While house call dentists typically visit older patients, many individuals — due to injury or illness — are homebound at a relatively young age and benefit from these dental services as well.
Alisa Kauffman, DDS, founder and CEO of Manhattan-based Geriatric House Call Dentistry; Joy V. Poskozim, DDS, FSCD, CDP, of Chicago-based Joyful Dental Care; and Michael Reed, DDS, FAGD, founder of Dallas-based Mobile Dental Care, all work as house call dentists who specialize in visiting older patients. Kauffman and Reed focus on visiting older patients who are frail and homebound (or living in long-term care facilities), not easily transportable, and/or dealing with cognitive issues such as Alzheimer’s disease or dementia. While Poskozim also takes care of older patients, she says that she tends to work more with “the sickest of the sick — those who are completely immobile and bedbound. I see hospice patients, end-stage dementia patients and other similarly highly vulnerable populations.”
Not Your Standard Challenges
House call dentists are required to bring all the necessary equipment and supplies with them to each and every patient. However, this does not diminish the level of care they’re able to provide the patient in any way, explains Kauffman. Recent advances in technology have made the dental tools necessary for most common exams and procedures available in mobile formats, which enables house call dentists to provide the same care one would find in a brick-and-mortar practice. However, Kauffman cautions that some procedures cannot and should not be performed in a patient’s home, including root canals, large crowns and bridges.
While all dentists face their own business challenges, many brick-and-mortar dentists don’t regularly worry about where the power outlets in their buildings are located or if a patient’s medical power of attorney (POA) is the same as their financial POA. However, these are crucial questions for house call dentists to have answered prior to seeing their patients, says Poskozim. For example, if there aren’t power outlets near the patient, the dentist may need to bring extension cords so that his or her equipment will work. And if the medical POA isn’t the same as the financial POA, house call dentists must ensure that both parties agree ahead of time on what services they’re willing to pay for.
“Many times, I found that the medical POA was very willing to have me clean, repair or extract whatever was needed, but the financial POA later refused to pay for these services after the work was completed,” said Poskozim.
Upon entering a home, house call dentists have to get creative with how they provide their services. Typically, the patient is located in a wheelchair, recliner or bed. This requires dentists to be much more flexible, both physically and emotionally, Poskozim explains.
“Not only do you need to be willing to stand, sit or kneel to provide services, but you may even have to straddle patients when necessary,” she added. “Once, I had to extract an upper front tooth while the woman was sitting in a wheelchair. Her head was literally on my chest while I stood over her and pulled the tooth.”
And house call dentists who serve the geriatric population must also find unique ways to communicate with their patients.
“Many geriatric patients are dealing with cognitive issues and find it difficult to follow simple commands such as, ‘Open your mouth,’ or, ‘Put your teeth together.’ Many times, I have to show the patient what I want them to do with my own mouth, or I may even have to use my hands to physically open their mouth, close it, etc.,” said Reed.
A Weighty Moral Dilemma
Reed, who began making house calls in the 1980s and has transitioned to making calls at long-term facilities, has found that house call dentists face another unique challenge: the moral dilemma of determining what the appropriate level of care is for an older patient who is dying.
“It’s a very complicated question — both for the dentist and for the family members of the patient,” he said. “These are medically and cognitively complicated patients. For example, if my geriatric patient needs an extensive procedure, will it stress her body to the point of her having a stroke? If she’s not complaining of pain, does the problem need to be fixed?”
Kauffman agrees, noting that she almost always calls the patient’s primary doctor before doing anything to ensure that her treatment won’t cause medical problems or be hindered by the patient’s current health conditions.
For these reasons, Reed feels that older, more experienced dentists are likely a better fit for any practice that serves geriatric patients at their homes or in long-term care facilities.
“You’ve got to understand dentistry first before you can see patients who have very complicated oral dental issues stacked on top of complicated medical issues,” he said. “You can’t treat them the way you would a mainstream patient. You have to focus on doing what’s in the best interest of the patient, which, quite frankly, can be quite a gray area.”
On the other hand, Kauffman believes that house call dentistry can be a great option for dentists as soon as they leave residency.
“When you get out of your residency, you’ll have seen so many things, and it will all be fresh in your mind,” she said.
Rewards Outweigh the Challenges
With so many challenges, why do these individuals continue to practice as house call dentists? The answer is simple: It’s an incredibly rewarding career path.
“It was never my intention to do any kind of house call dentistry when I got out of dental school,” said Poskozim. “It was never even really proposed to me as a possibility.”
When Poskozim graduated from dental school in 1999, veneers and esthetic dentistry were the “hot ticket,” and that’s what she expected her career to focus on. But her career took a sharp turn when word got out that she had visited her grandmother at her home and not only cleaned her teeth, but also created a new lower partial denture for her.
Soon after, Poskozim was asked to visit an older woman — the matriarch of a large family — who was completely paralyzed due to the effects of a stroke and had an odor coming from her mouth that no one in her family could seem to eradicate.
After peering in her mouth, Poskozim realized that she had horrible thrush from a set of dentures that had not been removed or cleaned since before her stroke two years prior. This was because the family members didn’t know she had dentures, the hospital never checked, and the home healthcare agency took the family’s word that her teeth were natural.
“After this experience, I realized that there was a way for me to use my degree in a much more useful way,” said Poskozim. “I continue to run into similar situations where families who love and care very much for their elderly parents or grandparents are dealing with family members who are suffering because the nurses, doctors and physician assistants they rely on have not been trained to pay attention to the patients’ mouths.”
Kauffman began her house call dentistry practice after a friend’s father had a stroke and needed to have his teeth cleaned every three months.
“I volunteered to do that for him and, at the same time, the patient population in my practice was beginning to age,” she said. “So, I would sometimes go to a patient’s home to help them out. All of a sudden, word got out that I did house calls, and I became incredibly popular. It made me realize there was a real need for this type of practice. The more I did it, the more I loved being able to provide oral care for those who would otherwise be unable to get treatment.”
In addition to the reward that comes with truly helping those in need, Kauffman thoroughly enjoys owning her own house call practice, saying there are a myriad of benefits, including virtually zero overhead after the initial purchase of equipment. Other positive considerations include the ability to create one’s own schedule and decide what procedures to limit your practice to, as well as the choice of whether to bring an assistant or have a caregiver help you.
“Owning this type of practice allows me to schedule work around my life rather than my life around my work,” she said. “You never have to miss a day in your kid’s life because you control the schedule. It provides excellent work/life balance.”
And Kauffman has truly put her money where her mouth is — it’s been 38 years since she started making house calls and 35 years since she started doing it full-time.
Poskozim and Reed, however, continue to maintain their brick-and-mortar businesses while also making house calls.
“I think the way of the future is larger dental practices with two or three dentists who operate out of a brick-and-mortar location so that they can share the large business expenses of a dental practice (software, IT, dental equipment, etc.). This allows dentists to see patients both in the office and in their homes, which provides a variety of revenue streams, cuts down on costs, and creates greater job security and scheduling flexibility,” Reed said.
Michal Christine Escobar is a freelance writer based in Chicago. To comment on this article, email impact@agd.org.
Reference
1. “The US Population Is Aging.” Urban Institute, urban.org/policy-centers/cross-center-initiatives/program-retirement-policy/projects/data-warehouse/what-future-holds/us-population-aging. Accessed 2 Jan. 2023