[A good reason to purchase a long term home health care policy.]




"Smokers challenge caregivers"
Some nursing homes allow them to light up


By MEG HECKMAN
Monitor staff

September 16. 2007 12:01AM


"David Sinclair likes real maple syrup, sharp horseradish and menthol cigarettes. Since moving into the Merrimack Country Nursing Home last spring, he's managed to enjoy all three.

Sinclair, 64, stores a pint of syrup and a can of horseradish in the basket of his walker, and visits the smoking room a few times a day. With a ventilation fan whirring in the window, he drapes his gangly limbs across a seat, reaches into his breast pocket and pulls out a pack of Kools. Sometimes, he's alone. More often, he shares the space with a few other men, chit-chatting about bluegrass music and happenings around the home.

"It's something to do," he said. "I've gotten to meet people that I wouldn't usually hang around with."

Elderly smokers like Sinclair present a paradox of responsibility for nursing homes, especially with the increasing popularity of smoking bans like the one that takes effect tomorrow in New Hampshire restaurants. Regulations require nursing homes to promote healthy habits, but they also demand that residents, despite their physical disabilities, be allowed to exercise their rights. That means the right to refuse medical treatment, strike up a romance, watch TV until the wee hours or puff on a cigarette.

Residents "are used to calling their own shots," said Long Term Care Ombudsman Don Rabun, whose office advocates for elders' rights. "Suddenly, when they eat, when they sleep, smoking come into play. It's one of the many losses."

Rabun's offices spends a lot of time fielding smoking-related questions from elders and the people who care for them. Typical situations involves residents frustrated with regimented smoking breaks or restricted areas, staff members worried about fire hazards, or families whose loved one is about to be evicted for lighting up in the wrong place.
"We look to see if there's any middle ground," he said. "When it only affects one person, and they're willing to put themselves at risk, we're willing to support this. But when it affects another people, like the resident who sneaks a smoke near an oxygen tank and puts the whole facility at risk, the jeopardy outweighs the right."

Merrimack County's arrangement is typical of homes that permit smoking. Residents may only smoke in the ventilated room or on one side of the front porch. The room is equipped with a wall-mounted lighter to reduce the risk of fire and, for obvious reasons, oxygen tanks must be left outside. When they light up inside, residents must wear fire-resistant aprons to prevent burns.

Smokers without cognitive disabilities are permitted to carry their own cigarettes and light up when they choose. Those with dementia or a tendency to doze off must store their cigarettes at a nurses' station and ask a staff member to supervise them.

Fewer than a dozen of Merrimack County's nearly 300 residents smoke, but Administrator Lori Brown says those that do deserve the opportunity.

"You're trying to create a homelike environment, and smoking is something they would be able to do in their own homes," Brown said. "We certainly advise them on the risks, but we allow them to make the decision."

One in three

Nationally, about one in three nursing homes allow smoking, according to an informal study by the Center for Social Gerontology, a New York based think-tank that examines trends in elder care. When it comes to assisted-living centers, the study found that smoking is even less prevalent, with 94 percent of facilities banning the habit altogether.

The results surprised Jim Bergman, the center's co-director, especially since today's elders grew up during a time when lighting up was socially acceptable. Bergman, a lawyer, suspects the smoke-free trend will grow, but not because of the health concerns that drive many public smoking bans.

"It will not be the second-hand smoke issues, but the disastrous fire," he said. "Usually, it requires some form of crisis before you get this kind of policy change."

Here in New Hampshire, there's no tally of how many long-term care facilities permit smoking. John Poirier, president of the New Hampshire Healthcare Association, says each of the 85 facilities his organization represents handles the issue differently.

The newest often open with no-smoking signs in place. Some older facilities are slowly phasing out smoking, restricting it to outside areas or requesting that new residents kick the habit before they move in. Poirier said that safety is paramount, but recommends that staff and residents develop policy changes together.

"To take that away from folks who really want to smoke at a time in their lives when they're in their declining years is a really difficult thing," he said.

State regulators are offering guidance to assisted living centers with a new set of licensing criteria that explicitly address smoking. If a facility allows smoking, it must provide residents with a clear policy. The new rules also outline requirements for a smoking room, such as ventilation, metal waste baskets and ashtrays.

Nursing homes fall under a different set of regulations, some of which are tied to federal law. But John Martin, the state's licensing and certification manager, says expectations are similar for all types of long-term care facilities.

"If smoking is allowed, they're doing it in ways that will maintain safety," he said.

At the New Hampshire Veterans Home in Tilton, the smoking room, known as the "Ben Pen," is named after a former resident and equipped with sprinklers, a TV set and a large glass window so staff members can keep an eye on residents without inhaling smoke.

About 15 percent of the roughly 200 residents smoke, said Director of Operations Garry Naughton. Many picked up the habit in the military, back when combat rations included a few cigarettes tucked in with the food. As a result, even non-smoking residents protect their comrades' right to light-up.

"It's what gets them up everyday," Naughton said. "It's something to hang on to. To give up something they've been doing for 70 years . . ."

The Veterans Home and Merrimack County permit smoking, but they also implore residents to quit. Nicotine patches and gum are available from staff doctors, and nurses are happy to provide moral support. Even seniors who can't go cold turkey are often able to cut down.

Omar Tromblay, 76, inhaled two packs a day for 50 years, but since moving into the Merrimack County home earlier this year, he lights up just a few times between breakfast and bed.

"It's quite a chore to get to it," said Tromblay, a former Concord police officer with a mop of thick, gray hair. He's survived prostate cancer and doesn't worry much about the health risks of nicotine. "I figure, I've gone this far. Something is going to get me soon anyway."

But often, it's not medical advice or safety restrictions that cause an elder to drop a lifelong habit. Many residents with severe dementia simply forget they like to smoke.

"As the disease progresses, that addiction wanes," Brown said. "At some point, they stop asking to go down for a cigarette."

Concord Monitor