Recognizing the Importance of Dental Care for Low-Income Elderly

    • October 6, 2011

In 2006, the Robert Wood Johnson Foundation (RWJF) named Michael Rodolico, EdD, MPH, a Community Health Leader, recognizing his work to increase the availability of primary health and dental care to the citizens of Reno, Nev., regardless of their ability to pay. With his award, Rodolico focused on the growing need to provide oral care for low-income elderly.

The problem. Since establishing the first community health clinic in Reno, Nev., in 1995, Rodolico has worked to provide primary care, mental health and dental care to uninsured workers and to children in northern Nevada. But one demographic group—the elderly—did not have access to affordable dental care. How could Rodolico help solve the unmet need for geriatric oral care?

Bringing his Vietnam experience home. Michael Rodolico traces his passion for community health care to his experiences as a combat medic and preventative medicine specialist in Vietnam in 1968, when he was assigned to the U.S. Army Special Forces Civic Action Teams to help villagers in southeast Asia.

The U.S. Army's Action Teams were made up of physicians, dentists, nurses and epidemiologists, as well as other military personnel. "I went out on assignment with them, village to village, to do environmental assessments," recalled Rodolico. His assignment focused on mosquitos, snakes and scorpions, but it was the team approach that most impressed him.

"The physicians treated everything from tropical diseases to individual issues, the nurses were dealing with family and children's issues, and there were dentistry issues. The environmental guys would go in and teach basic sanitation and deal with waste, and clean wells to be more environmentally friendly. We were individual teams, but then we met at the end of the day as a group and compared what needed to be adjusted for the next day. It was the whole approach to health. As a young medic, that's really where I got my basis for community medicine."

After an honorable discharge from the U.S. Army in 1969, Rodolico completed his BS in health science/psychology at San Jose State University, and in 1972 he received his Master of Public Health degree from the University of Hawaii. For the next 12 years, he worked in two different health care-related positions—as director of data management for the Central Arizona Health Systems Agency and as executive director of the Arizona Emergency Medical Systems.

Then, in 1984, Rodlico became senior program director at the University of New Mexico School of Medicine, Emergency Medical Services Academy, responsible for the training of more than 4,000 students and medical personnel each year. Three years later, he was promoted to director of operations for the department of emergency medicine at the medical school, where he managed a yearly $10 million budget, 10 programs and 245 faculty and adjunct instructors. In 1992, he earned his Doctor of Education degree in Administration and Supervision/Organizational Development at the university.

That diverse background in health care systems, organizational development and community medicine was exactly what the creators of a new community health center in Reno, Nev., were looking for. In April 1995, Rodolico was hired to be the first executive director of Health Access Washoe County (HAWC), a nonprofit, multisite community health center developed by the Washoe County Medical Society in Reno to treat the working uninsured of northern Nevada.

Expanding health care access for uninsured people. Over the next decade, Rodolico built a community health center that provided more than 60,000 client visits every year—targeting the working uninsured and other low-income patients who could not afford visits to a private physician. In 1998, he established the area's first dental clinic for the uninsured, as well as the area's first free clinic for the homeless. With women and children accounting for 80 percent of all clinic visits, HAWC continued to expand to meet their needs by opening a women's health clinic in 1999 and a pediatric mental health clinic in 2003.

"With a community health center, 50 percent of your board are patients. That's where the priorities and ideas come from. They give you the authority to move forward," said Rodolico. "If you are true to your community, you have to stay grounded. I can't take credit for the ideas, but I can take credit for developing a participatory culture—and that's what I'm most proud of."

Growing the dental care program to serve seniors. In 2006, Rodolico decided to concentrate on a problem that he had not been able to solve in 11 years at HAWC: dental care for low-income seniors.

Although the dental clinic had more than 8,000 dental visits a year, HAWC still struggled to serve the elderly, who accounted for nearly 7.5 percent of HAWC patients. "You need adequate physical space to accommodate wheelchairs in the exam room; visits are longer and more complicated; and there are medication management issues," said Rodolico about elderly oral care services. "Overall it is a more complex and less profitable undertaking. Consequently, we had to put a cap on what we can provide. We can treat three to four kids to every one senior."

While he wrestled with the tradeoffs, a retired dentist named Lloyd Diedrichson approached Rodolico and asked him if HAWC "could do for seniors what we had done for children and families in oral health." Diedrichson, it turns out, had also nominated Rodolico as an RWJF Community Health Leader, an award that recognizes individuals who overcome daunting obstacles to improve health and health care in their communities.

Becoming a Community Health Leader. In 2006, RWJF named Rodolico a Community Health Leader. There was never any question about how he would use the funds that came with that award ($105,000 for a project of the leader's choosing and $20,000 for personal development of the leader). "I invested it in senior dental care," said Rodolico.

Recognizing a shortage of continuing education in the field, HAWC hosted a conference for oral health professionals in August 2007, bringing experts in geriatric oral health to Reno from across the United States. Though Rodolico had initially planned for 125 people, the conference attracted 290 dentists and hygienists from 10 states.

"For us, the conference was all about technique and training," said Rodolico. "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 people."

As a result, HAWC clinicians gained a better understanding of how to implement more in-depth treatment plans and closely track complicated cases. With new ideas about clinic design, a more educated staff, and the funds to purchase upgraded software, the Community Health Leader experience "definitely improved our dental program," said Rodolico. Another outcome was more amorphous, but perhaps even more important: He said the program's activities "renewed our passion for securing grants for patient care so we can treat more seniors in our community."

That's still not easy to do. Rodolico noted that the size of the RWJF grant initially made other funding sources reluctant to give additional money to HAWC. Nonetheless, "on the whole it was incredibly positive to bring that kind of national award and the reputation of RWJF to Reno. I think that it also encouraged others to apply for awards and gave them the confidence that we, in Nevada, could capture other grants."

Rodolico's experience as a Community Health Leader also proved to be personally rewarding, especially for someone aware that RWJF had pioneered 911 and emergency medical systems and trauma centers. "I was in awe of Robert Wood Johnson for my entire health career," he said. The opportunity to go to RWJF headquarters in Princeton, N.J., to meet other leaders was a powerful moment for him. "I just can't explain it. Being in public health all of my life, and to be recognized, it was just an incredible experience."

By the time Rodolico retired as HAWC's executive director in 2011, the community health center counted more than 70,000 patient visits a year for medical and dental care. But providing dental services to seniors "remains a very serious challenge," said Rodolico. Inadequate reimbursement is an issue, limiting HAWC's ability both to provide services and to make referrals for the extensive oral surgery that only private dentists can provide.

"I wish I could say that seniors are getting everything they need, that the prices are low and access is high. It's still a challenge, but the investment is worth it."

RWJF perspective: Since 1993, RWJF has recognized unsung and inspiring individuals who work in their communities-often among the most disenfranchised populations—to address some of the nation's most intractable health care problems. The formal recognition of these Robert Wood Johnson Foundation Community Health Leaders and their programs often launches them to greater levels of influence and extends their reach to serve more vulnerable populations.

Under the Community Health Leaders program, RWJF each year provides a financial award to 10 individuals and their organizations. RWJF also connects the Community Health Leaders with one another so they can build their programs upon the wisdom and experience of their peers and previous award winners.

"Community Health Leaders are characterized by three specific traits-they are courageous, they are creative and they are committed," says National Program Director Janice Ford Griffin. "The Foundation recognizes the tremendous resource of experiences among the leaders and we look forward to mining that resource as we consider future initiatives."

"Through the Robert Wood Johnson Foundation Community Health Leaders program, we at the Foundation have the opportunity to recognize innovative and courageous local leaders behind ground-breaking efforts in communities across the U.S." said Sallie George, MPH, program officer at RWJF. "These individuals remind us that one person can have a powerful impact on health and health care within their communities."