Management perceptions on oral health policies in nursing homes using the interRAI instrument: a SWOT analysis

Improving poor oral health among nursing home residents requires a multi-level approach, including effective organizational oral health policies. The interRAI instrument for holistic care needs assessments supports policy development and enables identification and management of oral care needs by integrating the validated Oral Health Screener (OHS). This study explored the perceptions of nursing home staff, involved in policy development or implementation, on oral health policies in Flemish (Belgian) and Dutch nursing homes, and on experiences using the current oral health section or OHS in the interRAI instrument. Between May-November 2024, seven online focus groups (34 participants) and four interviews (five participants) were organized across 26 Flemish and four Dutch nursing homes, respectively. Participants were grouped based on nursing home characteristics, with a maximum of three participants per home. Semi-structured questions addressed perceptions on oral care guidelines, resources, collaborations, practices, and oral health assessments. Transcripts were coded in NVivo and analyzed using a SWOT framework to identify strengths, weaknesses, opportunities, and threats in current policies, while experiences using the current oral health section and the OHS were explored separately. Strengths included using the OHS in multidisciplinary consultations and oral care working groups. Common weaknesses were limited collaboration with oral health professionals and inconsistent oral health policies. Opportunities included enhancing interprofessional collaboration and involving dental hygienists. Threats included limited attention to oral health in caregivers' education and staff shortages. Differences were observed between Flemish and Dutch nursing homes, and a lack of standardization among Flemish ones. This study identified areas for improvement in nursing homes' oral health policies. Consistent, comprehensive policies can address care gaps and improve integration of oral care into daily practice, contributing to better resident health outcomes.