Besnette - Founder/Editor for Assisted Living Directory Summary: What is the smoking policy at your assisted
living facility, or a facility that you are considering? If you
are a smoker, or a non-smoker, understanding a facility's rules,
as well as any state regulations will help to avoid conflicts
with the facility management, and other residents. Smoking rules
and regulations affect the health of both smokers, and non-smokers
in a variety of ways. Make sure to get a facility's smoking policy
in writing before signing an agreement or contract, and remember
that rules mean nothing if there is no enforcement!
I have a pretty hard-lined
stance when it comes to smoking. My belief is that if the smoke
from a cigarette has any chance of coming in contact with a
non-smoker, then is should be against the law in that particular
place. Smokers should only be able to smoke, in my view, in
their own, controlled environment, where there are no other
non-smokers present. I am an ex-smoker (19 years), so I feel
comfortable being a little preachy about this. Let's face it,
smoking is a terrible addiction, and first and second-hand smoke
can cause harm in many ways. Each year in the United States
alone, it is responsible for:
An estimated 46,000 deaths from heart disease in people who
are current non-smokers
About 3,400 nonsmoking adults die of lung cancer as a result
of breathing SHS
Worse asthma and asthma -related problems in up to 1 million
Between 150,000 and 300,000 lower respiratory tract infections
in children under 18 months of age, and lung infections resulting
in 7,500 to 15,000 hospitalizations each year
I know that a 100% nationwide
ban on smoking indoors is an impossibility in our society (right
now, at least), but I do believe that we have made some progress.
Many restaurants, public areas, and health facilities have had
smoking within their walls banned by state regulations, and
I think this is a huge win. I must admit that I get a little
tingle of satisfaction when I see a group of smokers huddled
in the cold outside a bar or restaurant to get their fix.
Restaurant and bar-scene
aside, I get even more serious when it comes to children and
the elderly. We've all seen the mother or father driving around
in a car with the windows closed, sucking on a cigarette with
kids strapped in the back. Angry, boiling mad, and furious -
emotions that I quickly feel when I see this.
However, I would guess
that most of us have not witnessed an elderly person, living
in an assisted living facility or nursing home, suffering from
unable to escape the haze of smoke produced by other residents,
or even the employees at the facility.
Yes, it happens, and
I'd say these folks are the most helpless to do anything about
it. They've probably signed a lease, or a contract at the facility,
coupled with a possible movement disorder or other handicap,
with the added touch of possible dementia or Alzheimer's rendering
them incapable of clearly speaking their mind, or expressing
their desire to move, or ability to complain. Even if there
is a non-smoking policy at the facility, I'd say it is a safe
bet that most residents (especially those in a memory-care environment)
don't know, or understand the rules of the facility. Those details
were probably quickly glanced over by a family member sometime
in the past, and have been long forgotten.
"Of the over 416,000
smoking-related deaths annually in the U.S., over 94% are to
persons aged 50 and over, while over 70% are to persons aged
65 and over. All the major causes of death among the elderly
(cancer, heart disease, and stroke) are associated with smoking
or environmental tobacco smoke. Recent research also indicates
that smoking is related to a number of health problems and diseases
that are generally associated with aging, including hearing
loss, dementia, and Alzheimer's." (Source:
Center for Social Gerontology).
Unfortunately, as assisted
living is largely regulated state-to-state, there is no national
policy or law that has dictated how states, and the facilities
within those states, should handle smoking.
Some states, like Wisconsin,
have enacted laws prohibiting smoking in all Nursing homes.
The Wisconsin Clean Indoor Act states "Effective July 5,
2010 the Wisconsin
Clean Indoor Air Act (section 101.123, Wis. Stats.) prohibits
smoking in all inpatient health care facilities, including nursing
homes, within the state of Wisconsin. Nursing homes with a current
policy that allows smoking in designated area(s) within the
facility will need to change the policy and notify all residents
of the change."
On most levels this
is a win. Non-smokers in Wisconsin can rejoice that the tide
of fresh-air is turing in their favor. However, there are a
What about the
rights of smokers, and their well-being?
Sure, smokers do have
rights, and it is not an illegal activity to smoke. In-fact,
I am almost embarrassed to say (given my hard-lined stance above),
that for some people, smoking is one of the few, remaining pleasures
that they still have in their lives. My aunt is a perfect example.
She has smoked for as long
as I can remember, and she has recently moved into an assisted
living home in Utah. She's tried quitting before, but we all
know now that it just isn't going to happen. She is happier
when she smokes, and she deals with life better when she is
able to. It's cliche, but smoking has been one of her true,
loyal friends for her entire life, and I would hate to take
that away from her. She has the right to smoke - as long as
it can be done without affecting the rights, and health of non-smokers.
especially in the case of assisted living facilities and nursing
homes is the safety of the residents who are forced to go outside
(at times, in inclement weather) to partake. I have seen designated
smoking areas in the remote corners of parking lots, or under
icy overhangs in a cold, slippery courtyard of facilities. Residents,
especially those with mobility or balance problems, or compromised
immune systems who are forced to spend time in these areas are
put in an uncontrolled environment, which could result in injury,
lawsuit, or worse.
States that allow still allow smoking in assisted living facilities
have their own set of rules and guidelines about how it should
be handled. Texas, for example, under Texas Administrative Code,
Social Services and Assistance, Department of Aging and Disability
Services - Licensing Standards for Assisted Living Facilities
- Facility Construction (Title
40/Part 1/Chapter 92/Subchapter D/Rule §92.62) states:
(3) Smoking regulations
must be established, and smoking areas must be designated for
residents and staff. Ashtrays of noncombustible material and
safe design must be provided in smoking areas.
Of course, there are
numerous other rules in Texas's Code that dictates safety, fire
drills, evacuation plans, and the like - to minimize the potential
dangers of smoking indoors.
However, Texas's model creates it's own set of possible hazards
and issues. Firstly, even if there are 'designated areas' for
smokers, how do we know that they will be used? I know enough
to know that some smokers can be rebellious, and will smoke
wherever they please, regardless of the rules. We have seen
it, and heard about it on airplanes, in restaurants, and even
in hospitals. I have seen many times the news stories of facilities
that have burned to the ground, or lives that have been lost
due to a resident deciding to light up in his or her room, and
causing a fire from falling asleep, or not paying attention.
A video highlighting
the dangers of smoking in assisted living or nursing environments:
Nursing homes are subject to federal laws that require them
to use smoke alarms and sprinkler systems. Unfortunately, assisted
living facilities and group homes are not.
Another consideration for this is that smoke really knows no
boundaries, especially if there is a common ventilation system.
I remember living in an apartment years ago, and people often
asked me if I was a smoker because my clothes always had that
musty odor. I wasn't a smoker at the time - it was my next-door
neighbors, and their dirty air coming into my pace via the air
ducts. I also remember seeing a designated smoking area at an
assisted living facility that was outside, right next to a row
of residents' windows - all of which were open on that warm
summer day. Smoke was clearly entering their rooms.
Dueling Banjos - Does A Facility Follow State or Local
Assisted Living Facilities
or Nursing Homes can be caught in the middle of this debate,
and the regulations imposed. I am aware of one county in Delaware
that imposed a ban on smoking several years ago in all work
places, which includes nursing homes, but this ban contradicted
other state and federal laws. "If a nursing home bans smoking,
they could lose federal funding for failing to comply with regulations,
but if they allow smoking they could face fines or a lawsuit
from the county health department, officials said." See
the conversation "Smoking
ban raises problems for nursing homes."
In 2007, Hanover County,
North Carolina enacted a law banning smoking in assisted living
facilities. "Starting Monday residents have to go outside
to smoke. Rep. Justice discovered all elder-care facilities
in North Carolina allowed smoking and that there was no law
on the books to stop people from lighting up." See the
law bans smoking in assisted living facilities."
Again, this is a win
for non-smokers, but for those smokers who have smoked all of
their lives, and who live in an assisted living home - 'What
do we do with these seniors that move here, and who've smoked
all their life, and you're asking them to make a major life
change in a addition to making a major life change.'" Rep.
Justice says some assisted living administrators told her smoking
helps calm down mentally ill patients. She says she wants to
look into that issue further during the next session to see
if the law should be modified to possibly allow those patients
These examples of local
governments stepping in to regulate smoking touches on the bigger
debate of whether we should more closely regulate the assisted
living and nursing home industries on a federal level, so there
is more consistency, and less confusion with regulations across
Rules vs Enforcement
Really, what this whole
debate comes down to at this point is that it highlights the
need for individuals and families to ask very pointed questions
of their facility, and to make sure they understand the rules,
laws, and facility regulations regarding smoking. Since there
is no clear-cut answer, and no real solutions that will satisfy
everyone (smokers and non-smokers), consumers will need to take
the extra time to research possible facilities that fit their
lifestyle and smoking preferences.
If there are specific
rules in place at a facility, they won't do much good if there
isn't any enforcement. This means that families and individuals
need to get the policy in writing, and understand what will
happen if the rules are broken. If a resident is caught smoking
in a non-smoking facility, will that resident be asked to move
out? If a non-smoker is subject to smoke issues at a facility
that claims to be smoke-free, can that resident break his or
her contact or lease with the facility with no penalty?
Furthermore, if the
policy or policies regarding smoking change in the future, due
to newly local, state federal, or facility level initiatives,
how will that affect the lease, agreements, and rights of current
Taking the extra time
and care up-front to understand a facility's policies - before
signing any contract, or making any decisions, will help to
minimize any future issues or conflicts, and help to ensure
the happiness and well-being of everyone involved. As we know,
seniors are less-mobile than most of the rest of us. Any physical
move that a senior is forced to make, especially when considering
those suffering from dementia or memory disorders, can be extremely
traumatic for both the senior, and the families who are caring
Bottom Line: Know
what you are getting into before you make a move for yourself,
or on behalf of a loved-one. If a facility has policies on smoking
or non-smoking, then they should be followed. If the rules are
not being enforced, then it is the facility who is 'blowing
- by the staff at
Assisted Living Directory Top of Page
Nothing worse than a gross facility smelling like an ashtray.
Doesn't say a lot for how they care to present themselves.
30 January 2013 at 11.05 am
I walked into a facility to 'tour' with my mother, and the overwhelming
whiff of stale smoke we got turned us around immediately.
12 June 2012 at 2.25 pm
Living Directory Wrote:
It wasn't easy for sure! I planned on quitting on New Year's Eve
of that year, and around October I started cutting back a little
each day, so by the time I got there, I was at only 1 or 2 a day.
Then, from the 1st through about the 10th, I took time off from
work and school so I could sit at home, and sleep, and tough it
out. Sleep, no-stress, and lots of snacks helped. By about the
15th of the month, I had lost the cravings. I was thrilled, and
shocked. Making sure you try to quit when you are not stressed,
or working, if possible, is my one big piece of advice.
10 April 2012 at 2.25 pm
You mention that you have been an ex-smoker for 17 years. How
did you quit?
10 April 2012 at 2.21 pm
Banning smoking in assisted living and nursing homes will also
severely limit the potential pool of employees and labor. Many
of those folks are smokers too.
5 April 2012 at 9.25 am
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