KJIPUKTUK (Halifax) – The Income Assistance policy manual is brutally clear about when you qualify for dental care when you’re on welfare. Don’t bother looking for help if it doesn’t bleed, hurt, or stop you from getting a job. Preventative care isn’t even mentioned in the manual.
People tell me that even when you are in pain it often remains an uphill battle to get the support you need. As a result, people who have no money whatsoever end up paying for dental care themselves.
Others end up at an emergency room or a doctor’s office, at great cost to the healthcare system.
This is from a letter I received recently
“Last year I had such extreme jaw pain I landed in the ER. I was given antibiotics and told to go to the dentist…When I talked to my case worker they told me I could get reimbursed for a portion of an emergency appointment, but only severe pain and suffering were considered an emergency. How does one save up to pay the dentist when you don’t have enough to buy basic food? Which several weeks are we not supposed to eat to have this money to pay the dentist? How do we wait for a reimbursement? How can we risk the appointment on the chance the dentist determines it’s not an emergency (and we won’t be reimbursed a portion of the fee)?”
“Unfortunately my daughter needs extensive dental work…her top jaw is smaller than lower jaw. None of this was or will be covered. She gets headaches, pains in her jaw etc but that’s apparently irrelevant. I could honestly buy a home in Cape Breton for the amount this will eventually cost.”
“I usually pay $100 to $150 for a visit. My grocery budget is $60”
We also talked with Joe (not his real name), a soft spoken middle-aged man who lives with disabilities and relies on income assistance. I interviewed him before on a different matter.
Joe’s teeth are prone to dental issues, and has no choice but to pay for check ups and cleanings out of his own pocket. He also pays for fillings, which are only partly covered by Community Services.
“The last time I went, andI am looking at the bill now, I paid $117 and Community Services covered $47. I usually pay $100 to $150. My next appointment includes x-rays too, and I think that alone will be roughly $50, maybe less, maybe more,” he says.
The problem is, that’s money he really doesn’t have.
“My food budget for the entire month is about $50 to $60 by the time I pay my rent, insurance. Tax credits pay for the dentist, and usually takes up all of that, depending on what I need to have done,” says Joe.
“I often have have issues with my teeth and gums, partly because of my borderline diabetes. I have premature recession of my gums and a few other things going on. Some of the medication I take makes my mouth dry, and that can result in cavities and other issues.
“All of these things are why I have regular check ups now, every six months. My dentist would like to see me more often than that, but I can’t afford it. What I do is when I get my HST check, most of that goes to my dental bill,” Joe says.
As is so often the case when dealing with Community Services, many of the decisions seem arbitrary, and are difficult to understand. Joe talks about the time he had three cavities, but the department and its group insurer, Green Shield, only (partly) covered two fillings.
Or the time when it wasn’t a dental emergency, but it sure looked (and felt) like one.
“It turned out that the terrible pain was the result of a crazy sinus infection and not a broken tooth, but neither my dentist nor I knew that at the time the visit was booked. Long story short, my small Christmas budget was decimated,” says Joe.
High risk people are least likely to get preventative care
“Low income people tend to be at higher risk for cavities,” says Brandon Doucet, a recent graduate of the Dalhousie Dentistry Faculty and an activist for universal dental care.
“People who are lower risk can afford checkups and cleanings, the people who are high risk are the least able to get preventative care. You can imagine the state of their teeth by the time they come to us in pain. Instead of fillings you probably get teeth taken out, which doesn’t take into account quality of life,” Doucet says.
“There’s a report that shows that in Ontario people with dental pain show up at a doctor’s office every three minutes, and at an ER every nine minutes. That’s mostly people who can’t afford a dentist. These visits don’t fix anything, people get antibiotics or pain medication,” Doucet says.
Also, dental issues aren’t trivial, and can quickly escalate.
“You can have swelling that compresses your airways. Dental issues can cause serious damage, it can even kill you. You may end up in hospital at a cost of $6000 per day,” says Doucet.
And brushing more, although always a good thing, will not take away the need for cleanings. “After six months or so, you just can’t clean that build up,” he says.
Community Services responds
“The ESIA dental care program does not cover preventative dental treatment, as Employment Support and Income Assistance is typically meant to provide shorter term support to recipients as they become self-sufficient,” writes Shannon Kerr, a communication consultant for the department.
“For those individuals who do not qualify for this program, there are often dental services available at reduced costs, such as those offered at the Dalhousie Faculty of Dentistry clinic or dentists in the local area who may be able to help by providing dental services at a reduced cost.”
“The department will pay 100% of the 2014 Dental Fee Guide rates. In circumstances where a client has high dental costs above the ESIA dental fee guide rates, these costs may be considered as an exception.”
“However, we recognize that there are some recipients who require longer term support. As part of our ongoing transformation, we are currently working to determine what further enhanced support may be considered under ESIA,” writes Kerr.
However, going to a Dalhousie clinic will not work for folks who live in rural Nova Scotia, and although there are dentist who will charge less in some cases, finding them isn’t easy. In fact, I also hear about dentists who try to stay away from treating patients who are on social assistance.
And with some 70% of people on income assistance living with some kind of disability, people like Joe, you have to wonder to what extent social assistance is truly “meant to provide shorter term support to recipients as they become self-sufficient.”
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