The Fine Line Between Freedom and Safety at Eldercare Facilities: The Issue of Smoking at Nursing Homes and Assisted Living

Residents of a St. Petersburg, Florida nursing home recently staged a protest about rule changes related to smoking.  The nursing home, Shore Acres Rehabilitation and Health Center, in St. Pete has recently changed their smoking policy to better address concerns they have about resident safety. Anyone who has worked in a nursing facility or assisted residents of an eldercare facility knows smoking can be a “hot” issue.  Smokers feel passionate about maintaining their right to smoke and some amount of freedom, while a facility and its staff have a duty to balance residents’ rights with the safety and health of all residents.  The changes at Shore Acres in St. Pete were spurred by a letter form the Center for Medicare and Medicaid Services (CMS) about a nursing home resident who recently died in a fire when her cigarette caught her clothing on fire.

Residents with dementia or mobility issues in particular may have less safety awareness or more difficulty safely smoking, and be more prone to burns or not putting cigarettes out safely.  A nursing home resident with dementia who has access to his cigarettes may forget that rules state there is no smoking inside and may smoke in his room and bed. 

Nursing homes have various smoking policies to address safety concerns. Shore Acres’ new policy requires residents to turn over their cigarettes and lighters to staff.  Nursing home staff will then “accompany residents on nine scheduled 20-minute smoke breaks, with a two-cigarette limit per break”.  Due to the health concerns of smoke exposure, nursing homes generally do not allow smoking inside and are permitted to modify their policies regarding smoking areas, times etc. while providing current residents with options.

Working closely with many nursing home residents over the years, we have encountered various challenges related to smoking and client safety.  Here are some tips and ideas related to this eldercare issues (which can also be applied to many other residents’ rights and safety issues):

As a nursing home resident or family member:

• Care planning is vital for each nursing home resident.  Each resident is required to have a care plan, which is reviewed regularly (and after changes such as a hospitalization return).  Nursing homes use standard formats which cover various issues based on regulations. As an advocate for a nursing home resident, this care planning process (and resident/family/advocate input) is an essential way to cover important issues.  Take notes, prepare questions, attend the care plan meeting and discuss concerns and solutions.  This can apply to smoking and all health and care concerns and needs.
• You can advocate more effectively with an understanding of rules, regulations and the perspective of the facility.  This helps you know what is realistic and not, what to expect (and when someone is giving you an answer that is not satisfactory or even against residents rights or regulations).  This area is one of the biggest advantages to collaborating with a geriatric care manager, who understands all the ins and outs of eldercare facilities.   
• Come with suggestions, not just complaints.  Suggest a possible solution that might be a compromise or creatively address both sides of the issue.  Could a private duty caregiver help make your loved one’s situation better (to take the resident on more frequent breaks, personalize activities, or go out on outings)?  That is just one example, but there are many ideas that may help you work within the facility rules while personalizing the options a bit.

Prior to becoming a resident/choosing an eldercare facility:

• Read up on Nursing Home Resident Rights.  All nursing facilities are required to post these, along with survey results and where to direct complaints.
• Understand your care options and the pros and cons of various choices.  Talking with a geriatric care manager can help you evaluate options based on your specific needs and desires.  Which nursing facility might best meet your needs?  What factors are most important in the decision?  Would in-home care be an option?  What is daily life like in an eldercare facility?  What expectations are realistic with different care options?
• Prepare a list of customized questions.  For example, if you are concerned about smoking or your loved one wants to ask for a special request/accomodation or your family is worried about how something will be handled, address these issues in the decision-making process.  The specific answers, but also the tone of the discussion and way the questions are addressed, may be very telling.

Give us a call today to learn how our geriatric care managers can help with: choosing Florida nursing homes or assisted living, assessing needs and providing care options, patient advocacy services and care oversight and more!  You can reach us at 727-447-5845.