In the 1980s, when Alisa Kauffman was a young dentist starting her practice in New York City, her close friend’s father had a stroke. He had always taken good care of his teeth, getting them cleaned every three months, but now it was hard for him to leave the house.
Thirty years later, she is still zipping around town to fill cavities, make dentures, extract teeth, or administer cleanings to patients who can no longer visit a dental office. Most live in Manhattan, and many are the oldest of the old – their average age is 89, and her oldest patient is 107.
The number of Americans 65 and over is expected to nearly double in the next thirty years, but few dentists focus on the very old, said Kauffman, who lectures on geriatric dentistry at the University of Pennsylvania. Even fewer make house calls – perhaps one or two in each state, said Judith Jones, a spokesperson for the American Dental Association and a dentistry professor at the University of Detroit Mercy.
Medicare does not cover dentistry except for under some emergency circumstances; Medicaid covers it only in some states and even that can change from year to year, Jones said. She estimated that around a third of people 65 or older are unable to afford dental care, leaving them vulnerable to higher rates of health problems from infection to cardiovascular disease.
As the country’s population ages, there is an increasing need for geriatric dentistry, including home visits, Jones said, adding that in a recent survey, “when they asked Medicare recipients what they would want, the number one thing people asked for was dental care.”
Kauffman, who charges rates similar to those of local office visits, says she has been pushing for Medicare to cover dentistry. She is also working on a training program to teach dentists in other parts of the country to do what she does.
Making house calls has opened the doors to more interesting worlds than a standard office practice might afford. Her patients often regale her with their life histories, including a woman who survived the Titanic sinking in 1912.
“She was a little girl,” she said. “For the rest of her life, whenever she heard the expression, ‘Women and children first,’ it would bring back the good and bad memories – glad that she survived and sad that others didn’t.”
Some of her patients are celebrities – “Somebody makes up a pseudonym and when I get there it’s some famous old actor.”
Many have dementia, which makes treating them exponentially harder.
“They are not able to sit in a waiting room and be calm,” Kauffman said. “They are not comfortable sitting in a dental chair…and you can’t sit and reason with a dementia patient in your office for 45 minutes.”
Over the years, Kauffman has refined certain techniques to calm them down, such as looking a patient straight in the eyes, or putting a reassuring hand on a patient’s shoulder. She knows how to distract – gushing over a photo of a grandchild just at the moment when she goes in with a needle to give an injection.
Moving around the city, Kauffman wears trim navy blue scrubs and totes a rolling suitcase and a dufflebag containing drills, extraction instruments, composite fillings, and personalized lobster bibs printed with her name. She avoids paying the overhead of maintaining a brick-and-mortar office, and has the luxury of spending as long as necessary with each patient.
“I am what doctors used to feel like fifty years ago, where people really trusted their doctors and couldn’t say enough good about them,” she said.
Mollie Silverman, 91, had to stop visiting her regular dentist on Long Island after the commute became too hard, so she called Kauffman.
“I couldn’t believe what I saw; she had all kinds of equipment with her,” she said. Kauffman performed extractions at Silverman’s kitchen table while her worried husband yelled from the living room to make sure she was okay. “She took out about five of my teeth and I can honestly say I felt practically no pain,” Silverman said.
Sheila Menkes called Kauffman to treat her 74-year-old sister, Joyce, who was homebound and needed major dental work. “She spoke to her as if she was talking to her own family member,” Menkes said. “She sat close to her and told her what she was going to do…It made it easy on all of us.”
Sasha Greene, a geriatric social worker who often refers patients to Kauffman, said that many haven’t seen a dentist for a long time.
“They’re petrified, and she comes in with a smiling face and a great burst of energy, and in a matter of minutes they’ve relaxed, they’re receptive, and all the fear is gone,” she said, adding that part of the reason is Kauffman’s manner, which is different from old-school dentists. “She has this cute little girly voice, ‘Hi, here I am, I’m a dentist.’ She bypasses all that formality, goes into the bedroom, sits on the bed, and cuts right through all that.”
To become Kauffman’s patient, a person must be truly unable to leave the house without difficulty. Once, when she arrived for an appointment at a new patient’s house and was told the patient was out to lunch with friends — without an aide — she walked out. “This is not a concierge service for rich people,” she said.
Because of her patients’ age, she regularly loses them. She dreads calling to remind them that it’s time for a visit. “That’s usually how I find out they have passed,” she said.
But Kauffman also gets perks that regular dentists don’t get. One, a 97-year-old Holocaust survivor, “won’t let me clean her teeth until I sit down and have a sandwich or a piece of cake because I’ve been working so hard.”
She asks them for their secrets to longevity. Mostly, they tell her, it is about avoiding stress. But the 107-year-old, who still has 32 teeth, had another tip.
“She told me the reason she has all her teeth is that she flossed her teeth when it wasn’t fashionable.”