Smoke-Free Policies in Facilities While the numbers of elders
affected by secondhand smoke are astronomical, little is currently known
about smoking policies in facilities serving older persons. A variety of
facilities have been specifically created to serve an older clientele
almost exclusively, including residential and non-residential
facilities. Residential facilities include assisted living facilities
(ALFs), nursing homes, rest homes, and related
accommodations. Non-residential facilities include senior centers, adult
day care facilities, adult foster care, and related types of day program
settings. Except for a 1997 survey by TCSG (see study below) that provided some
of the first data on smoke-free policies in community-based Michigan
facilities serving elders, few studies have examined smoking policies in
non-residential or residential facilities. Yet, such policies have a
direct bearing on the smoking habits and health of elders and a direct
effect on non-smoking elders' health as a result of secondhand smoke. Any discussion of smoking policies in these facilities must also
address the thorny issues growing out of the fact that the residential
facilities are the homes of the older residents, whereas the
non-residential facilities are normally occupied during just a portion of
the day by the individuals using them. These differences create a need to
address the balancing act related to the rights of residents in certain of
these facilities versus the rights of other users of these residential
facilities. Thus, there may be a need to have different smoking policies
for residential and non-residential facilities. This web site is intended to provide information on and access to
materials concerning smoking policies in facilities serving older
persons. The site is also intended to spur more study of the issues
related to this topic. Since materials on this topic are limited, we have
also included below links to TCSG's Bibliography of Tobacco & Older
Persons Articles, which lists some related articles, and to TCSG's
Smoke-Free Environments Law Project site, which has sections on Secondhand
Smoke and Apartments & Condominiums and on Smoke-Free Regulations,
Ordinances & Policies which are relevant to this topic. Smoking Policies in Long-Term Care & Residential Facilities Serving Older Persons In October, 2003, Jim Bergman, J.D., Co-Director of The Center for Social Gerontology (TCSG), gave presentations at the National Aging & Law Conference and at the Annual Conference of the National Citizens Coalition for Nursing Home Reform (NCCNHR) in Washington, D.C. on Smoking Policies in Long-Term Care & Residential Facilities Serving Older Persons. This 36-slide presentation discussed: how all truth passes through 3 stages, including concerning smoke-free policies; the health dangers of secondhand smoke; sources of research on secondhand smoke; whether smoke-free policies should be different in residential settings than in other workplaces and public places; the fire dangers of smoking in long-term care and elderly housing facilities; what federal and state laws -- including the Americans with Disabilities Act and the Fair Housing Act -- say about smoking in nursing homes, assisted living facilities and apartments; what JCAHO accreditation standards say about smoking in long-term care facilities; TCSG's model smoking policies in nursing homes, assisted living facilities, and elderly housing; online resources for more information on this topic; and the findings of TCSG's national survey of smoking policies in nursing homes and assisted living facilities. Click above to access the presentation and adapt it for your use. Tobacco's Impact on Senior Citizens On August 27, 2003, Cliff Douglas -- President of the Board of The Center for Social Gerontology (TCSG) and a consulting attorney for TCSG's Smoke-Free Environments Law Project (as well as an internationally-known authority on tobacco and secondhand smoke issues) -- gave a presentation titled Tobacco's Impact on Seniors at a conference sponsored by the Tobacco Reduction Action Coalition in Oakland County, Michigan. The conference was titled "The Costs of Secondhand Smoke to the Individual, Business and the Community." In this 55-slide PowerPoint presentation, Cliff provided an excellent description of the health consequences of smoking and secondhand smoke on older persons. The presentation provides a wide assortment of slides and data, including some classic slides such as the 7 tobacco company executives swearing before Congress that tobacco is not addictive and the classic swimming pool slide demonstrating that secondhand smoke does not stay within boundaries. Click above to access the presentation and adapt it for your use. Link to Other PowerPoint Presentations on Smoke-Free Environments & Tobacco Issues This link to the "PowerPoint Presentations" section of the Smoke-Free Environments Law Project site provides access to almost 20 PowerPoint presentations on smoke-free environments and tobacco issues.
TCSG newsletter on Non-smoking Policies in Michigan facilities
serving older persons Tobacco Control Journal article on Non-smoking Policies in Michigan facilities serving older
persons Press Release
announcing Smoking Policies in Elderly Facilities study by TCSG MODEL SMOKE-FREE POLICIES IN FACILITIES SERVING OLDER PERSONS
Serving Older
Persons
The Center for Social
Gerontology
2307
Shelby Avenue, Ann Arbor, MI 48103 tel: 734 665-1126 fax: 734
665-2071
tcsg@tcsg.org
This section contains model policies developed by The Center for Social Gerontology (TCSG) through a project funded by the Robert Wood Johnson Foundation. TCSG has developed model policies which can be utilized by others for state legislation, state regulations, or facility-specific policies; which is most appropriate will depend on the state and the user of the model. Further, because non-residential facilities -- Senior Centers and Adult Day Care Facilities -- are used during just a portion of the day, TCSG's model policies call for totally smoke-free facilities. TCSG's recommendations for residential facilities -- Nursing Homes and Assisted Living Facilities -- recognize that secondhand smoke is an extremely dangerous substance which results in serious health problems, including chronic diseases and death; therefore, a primary focus is the protection of the health of all older persons, and employees in these facilities, and their protection from secondhand smoke, as well as from residential fires caused by cigarettes. Therefore, we have developed model policies which call for totally smoke-free residential facilities. However, we also recognize that about 10% of older persons are smokers and that some currently, or will in the future, reside in Nursing Homes or Assisted Living Facilities; therefore, we have also developed model policies which would accommodate these persons, while attempting to protect nonsmokers from the secondhand smoke. In each of the policies, we have attempted to draft a model which we think will maximize the health and safety of older persons and employees in the facility, as well as protecting all person's rights. We will leave it to users of these model policies to decide which of the policies they wish to utilize.
MODEL POLICY FOR SMOKE-FREE SENIOR CENTERS
This policy is intended to be a model for state legislation to create smoke-free Senior Centers. To that end, this policy provides for smoke-free environments both indoors and outdoors at Senior Centers. This policy can also be easily adapted for use as a state regulation or as a policy for an individual Senior Center facility. Click above to access the model policy.
MODEL POLICY FOR SMOKE-FREE ADULT DAY CARE CENTERS
This policy is intended to be a model for a state regulation to create smoke-free Adult Day Care Centers. This model regulation would provide for smoke-free environments indoors and sets forth language which would enable those using this model to choose to either prohibit or regulate smoking on the outdoor grounds of Adult Day Care Centers. This model can also be easily adapted for use as state legislation or as a policy for an individual Adult Day Care Center facility. Click above to access the model policy.
MODEL POLICY FOR SMOKE-FREE NURSING HOMES
This policy is intended to be a model for a state regulation to create smoke-free Nursing Homes. This model regulation would provide for smoke-free environments indoors, but would provide for indoor designated smoking areas only for current residents of nursing homes who are smokers. This policy allows for "grandfathering" of existing residents who are smokers, with the ultimate goal of having a smoke-free facility indoors. The policy allows for designated smoking areas outdoors. This model regulation can also be easily adapted for use as state legislation or as a policy for an individual Nursing Home facility. Click above to access the model policy.
MODEL POLICY REGULATING SMOKING IN NURSING HOMES
This policy is intended to be a model for a state regulation to regulate smoking in Nursing Homes. This model regulation would require smoke-free environments inside nursing homes, but would allow for indoor designated smoking areas for use by current and future residents of nursing homes who are smokers. This policy also allows for designated smoking areas outdoors. This model regulation can also be easily adapted for use as state legislation or as a policy for an individual Nursing Home facility. Click above to access the model policy.
MODEL SMOKE-FREE POLICY FOR NEW ASSISTED LIVING FACILITIES
This policy is intended to be a model for new Assisted Living Facilities which would like to adopt a smoke-free facility and campus policy prior to accepting residents. This policy provides for a smoke-free Assisted Living Facility both indoors and outdoors. This policy does not contain provisions for grandfathering of existing smoking residents because, presumably, there are no existing residents to grandfather. This model policy can also be adapted for use as state legislation or as a state regulation for Assisted Living Facilities. Click above to access the model policy.
MODEL POLICY FOR SMOKE-FREE ASSISTED LIVING FACILITIES
This policy is intended to be a model for a state regulation to create smoke-free Assisted Living Facilities. This model regulation would provide for smoke-free environments indoors, but would provide for indoor designated smoking areas only for current residents of Assisted Living Facilities who are smokers. This policy allows for "grandfathering" of existing residents who are smokers, with the ultimate goal of having a smoke-free facility indoors. The policy allows for designated smoking areas outdoors. This model regulation can also be easily adapted for use as state legislation or as a policy for an individual Assisted Living Facility. Click above to access the model policy.
MODEL POLICY REGULATING SMOKING IN ASSISTED LIVING FACILITIES
This policy is intended to be a model for a state regulation to regulate smoking in Assisted Living Facilities. This model regulation would require smoke-free environments inside Assisted Living Facilities, but would allow for indoor designated smoking areas for use by current and future residents of Assisted Living Facilities who are smokers. This policy also allows for designated smoking areas outdoors. This model regulation can also be easily adapted for use as state legislation or as a policy for an individual Assisted Living Facility. Click above to access the model policy.
FEDERAL MEDICAID AND MEDICARE LAWS DO NOT REQUIRE LOCALITIES OR STATES TO EXEMPT NURSING HOME RESIDENTS FROM SMOKE-FREE LAWS
In 2006, a lobbying organization for Indiana's for-profit nursing homes pressured Delaware County Commissioners to exempt nursing home residents who are currently smokers from having to adhere to the county's smoke-free law. They claimed that federal and state Medicaid and Medicare laws require localities to exempt current residents who are smokers from the smoke-free law. TCSG's Smoke-Free Environments Law Project (SFELP) was contacted by Indiana health groups about these claims and asked if we would prepare a response to the nursing home lobbyist's assertions. We researched the issue and concluded that the nursing home lobbyists were incorrect. In fact, the answer is demonstrably clear that federal and state Medicaid and Medicare laws do not require such an exemption. On October 2, 2006, the Delaware County Commissioners unanimously rejected the proposal to exempt nursing homes from the smoke-free law, saying the issue was "phony" and citing the SFELP research as a basis for their decision. To access a copy of a 3-page memorandum prepared by TCSG's Co-Director, Jim Bergman, addressing these issues, click here. For a September, 2006 news report about the Delaware County situation, click here. For an October 3, 2006 news report of the rejection of the exemption for nursing homes by the Delaware County Commissioners, click here. Periodically, these issues arise around the country, and this memorandum should assist in addressing the issues.
JCAHO ACCREDITATION STANDARDS FOR LONG-TERM CARE FACILITIES CONCERNING SMOKING
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in their newly revised 2004 accreditation standards for long-term care facilities in the chapter titled "Management of the Environment of Care," has Standard EC.1.30 titled The organization develops and implements a policy to prohibit smoking except in specified circumstances. (The JCAHO standards are now available online in a "pre-publication edition;" the official JCAHO accreditation manuals will be published in fall, 2003.) Inasmuch as JCAHO standards are the key benchmark for long term care facilities, we are setting forth below the entire content of this standard:
Standard EC.1.30
The organization develops and implements a policy to prohibit smoking except in specified circumstances.
Rationale for EC.1.30
This standard is intended to reduce the following risks:
To people who smoke, including possible adverse effects on care, treatment, or services.
Of passive smoking for others.
Of fire.
The standard prohibits smoking in all areas of all building(s) under the organization's control, except for residents in circumstances specified in the Elements of Performance below.
Elements of Performance for EC.1.30
1. The organization develops a policy regarding smoking in all areas of all building(s) under the organization's control.
2. The organization's policy prohibits smoking in all areas of all building(s) under the organization's control (no medical exceptions allowed) for all children or adolescent residents.
3. The organization's policy may permit residents to smoke in the organization's buildings under the following circumstance(s):
A resident meets criteria developed and approved by the organization's leaders.
4. When residents are permitted to smoke in the organization's buildings, they smoke only under the following circumstance(s):
In designated locations environmentally separate from care, treatment, or service areas [see note 1 below].
After the organization has taken measures to minimize fire risks.
5. Residents who do smoke in the organization's buildings are discouraged from doing so and are provided education, including information about options for smoking cessation.
6. The organization identifies and implements a process(es) for monitoring compliance with the policy.
7. The organization develops strategies to eliminate the incidence of policy violations when identified.
Note 1.: This does not require that a designated smoking area be a specific distance from care, treatment, or service areas. A physically separate, well-ventilated room (a designated area for authorized smoking by residents that is exhausted to the outside) is acceptable.
[The above JCAHO standard is accessible online on the JCAHO site by clicking here and then clicking on "Traditional LTC" under "Long Term Care" and going to the "Management of the Environment of Care" section and going to Standard EC.1.30.]
SMOKING-CAUSED FIRES IN LONG-TERM CARE FACILITIES AND ELDERLY HOUSINGOlder Persons & Smoking-Caused Fires in Residential Facilities
News Reports of Smoking-Caused Fires in Nursing HomesCase: Unsupervised 78-year-old nursing home resident killed in cigarette-caused fire
Case: Partially paralyzed Iowa nursing home resident dies in fire caused by cigarette
Case: Cigarette-Caused Blaze Forces Evacuation of Nursing Home; Smoking Policy Not Enforced Properly
News Reports of Smoking-Caused Fires in Assisted Living FacilitiesCase: Woman Critically Burned in Assisted Living Facility
Case: Cigarette Catches Man's Clothes On Fire in Assisted Living Facility
News Reports of Smoking-Caused Fires in Elderly HousingCase: Smoking, oxygen tank blamed in fatal blaze in Senior Citizens' housing in Chicago
Case: 83-Year Old Living in Elderly Housing Dies in Cigarette-Caused Fire
Case: After Cigarette-Caused Fire, Condo Owners, Including Elders, Wait Over 9 Months to Return Home
Case: Cigarette To Blame In High-Rise Apartment Fire; Forces Evacuation Of Elderly Residents
Case: 11 injured in midnight fire at senior housing complex; Cigarette is cause
LINKS TO RELATED RESOURCESHealth Effects of Environmental Tobacco Smoke
Tobacco-Related Health Problems & Older Persons
Environmental Tobacco Smoke & Apartments and Condominiums
Smoke-Free Environments Law Project site
TCSG's National Center for Tobacco-Free Older Persons site
Bibliography of Tobacco & Older Persons Articles
Home page of The Center for Social Gerontology (TCSG)