The Omnibus Budget Reconciliation Act of 1987, provide the basic framework for reporting and reimbursement for geriatric oral care in long term facilities since most of the elderly are covered under Medicaid and Medicare. Despite these framework, these facilities encounter barriers to effective provide oral care to their resident. Nurses payroll account for a significate portion of the budget of these facilities, hence nurses spend time in completing section K of the MDs records which relates to oral care. Since these records provided by nurses are not effectively enforce and oral care marks are not taken into the overall evaluation of these facilities, most nurses are dishonest about the type of oral care provided to their residents by providing