Smoking Rights and Responsibilities  
Smoking is a serious problem for residents and staff in Nursing Homes. Resident rights, physical addictions, social practices, safety, and health concerns are all involved in this issue.

Several basic factors need to be considered. Many residents have smoked for a lifetime. Smoking meets physical as well as social needs in their life. Moving into a long term care facility does not eliminate this need.

On the other hand, many residents have physical or mental disabilities that make smoking or inhaling secondhand smoke inadvisable. They may have lung cancer, emphysema, asthma, or dementia. Any or all of these conditions can complicate the smoking issue.

A resident's financial situation can present a problem. Most residents have limited incomes. Medicaid recipients have only $30 per month for their personal use. Tobacco can cost more than residents monthly incomes. Heavy smokers may have to choose between smoking, the hairdresser, cokes, or clothing.

Running out of cigarettes can cause physical problems for residents. Protecting residents from the unpleasant physical symptoms of nicotine deprivation is a reasonable concern for caregivers. Additionally, if residents are reduced to begging for cigarettes or stealing them when they run out, it is an affront to their dignity. This raises the issue of caregivers rationing cigarettes for residents. In light of the limited financial resources of some residents, it does make sense for staff to control cigarette use in order to stretch the resident's resources as far as possible. This should be done with the resident's permission.

It would be a violation of a resident's rights to ration tobacco use when money is not a concern. A provider does not have the right to restrict a resident's access to their own property, money or tobacco.

Limiting smoking areas is reasonable. Segregating smokers from non-smokers in recreation areas and requiring all smoking to take place in a common area is appropriate. It is appropriate to forbid smoking in resident rooms. Care givers may need to keep cigarettes and/or lighters at the nurse's station in order to assure that smoking policies are followed. Providers have the right, and indeed the duty, to assure safety in the facility. Smoking rules need to be tempered with genuine concern for the resident's welfare.

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