Smoking update: Three approaches

Bogey did it. Bette Davis did it. James Dean did it. Soldiers in foxholes did it. In the 1920s, ″30s and for the greater part of the 20th century, lighting up a cigarette was suave, sexy, cool, elegant, mysterious-at only 25 cents a pack. However, this is the 21st century and how things have changed. Regulations on providing smoke-free public environments are on the books nationwide. Statutes vary across the country and, at present, some states exclude nursing homes from obligatory compliance to smoking ban regulations. Despite this, an increasing number of facilities are voluntarily adopting the public policy with a focus on employee behavior. Residents who light up are also becoming affected by smoking bans-to the dismay of some and the delight of others.

LeadingAge’s Steve Maag, director of residential communities, notes that the association’s membership is clearly trending toward smoke-free environments. “However,” he says, “a facility cannot just decide to do it overnight. There must be advanced warning given to staff and residents.” He recommends phasing the conversion in over a period of months or years.

A HEALTH ISSUE? A LIFESTYLE ISSUE?

It’s generally accepted that smoking is not good for one’s health. However, it is an activity that some people have enjoyed for many years and while it seems contradictory in the LTC environment, organizations have faced this issue in a variety of ways that work in their particular culture. Smoking? No smoking? Some smoking? How a facility approaches these questions is a reflection of its culture. Whether or not you agree, the tobacco issue continues to have an impact on the fabric of long-term care. The following three organizations have shared their approaches and how they deal with the issue.

A SMOKE-FREE STAFF

Carlyle Place in Macon, Ga., is an example of providing a seamless transition for its employees to kick the habit. Director of Human Resources Cheryl Weatherly didn’t want the mandate to be a bombshell for staff. “On January 1, 2010, we rolled out the plan to our employees with a one-year transition period,” says Weatherly. “We understand the difficulties in changing a lifetime habit and were prepared to offer any and all encouragement and cessation tools to help them,” she states, noting that about 20% of her staff were smokers. Weatherly wanted to be upfront with staff. Each month motivational articles ran in the employee newsletter including information on the cessation program and education about the benefits of stopping.

“This was a year-long effort and we did everything we could to get employee buy-in-and we succeeded,” Weatherly says. On January 1, 2011-exactly one year later-smoking areas were removed and “No Smoking” signs were installed throughout the campus. Employees are not allowed to smoke in their cars on the property. They might clock out and go off the premises, says Weatherly, but if they come back and smell of smoke, they have to leave. “That might sound harsh, but it is part of our personal care policy,” she adds.

Although Weatherly would like to offer an entirely smoke-free campus, residents are still allowed to smoke in their units, their homes. “To address the smoke odor problem, residents who choose to smoke are assessed a small fee for a device that neutralizes the smoke so it doesn’t permeate the building,” she explains. The transition has been smooth and seamless across the board because everyone was prepared.

TOBACCO TOLERANT

Byron Health Center in Fort Wayne, Ind., has not lowered the boom on smoking, according to Executive Director Peter Marotti. “While we understand the health implications that are precipitated by tobacco use, our residents-and staff-are permitted to smoke in well-designed, well-ventilated and well-positioned designated smoking areas,” he explains. The locations are situated so that a nonsmoker never has to pass through any smoking area to access another part of the building.

Residents are permitted to smoke in their units but only in specific areas that are ventilated outdoors. “We have about 205 residents of which 15% or so are smokers and we’ve never had a controversy and both groups are mutually respectful of the other,” says Marotti. “In fact, some areas have become social hubs for the smokers where they can relax, have coffee and read the paper without guilt.”

Byron Health Center’s resident population has a high incidence of individuals with mental illness. “We have talked with psychiatrists and read various research papers that show that smoking has a calming effect on people with mental issues,” says Marotti. He adds that this does not include residents with Alzheimer’s disease or dementia. “Actually, the progression of the disease itself causes the individual to lose interest or forget about the habit altogether,” he explains.

The facility has also had some residents transfer there specifically because of their tolerant smoking policy. Marotti states: “Smoking has never been an issue here. Smokers are comfortable with the arrangements we have; nonsmokers are comfortable and confident that they don’t have to be subjected to unnecessary smoke. It’s an amiable coexistence.”

MULTICAMPUS APPROACH

Jewish Home Lifecare/Sarah Neuman Center in Westchester, N.Y., provided designated smoking areas for staff and residents but, over time, the population for this facility has changed. “We’ve had fewer and fewer smoking residents moving in,” notes Yvette Allen, Sarah Neuman’s safety officer. “Last year I met with residents and many complained that, especially in summer, smoke would come into the building from the outside smoking area.” Through the facility’s Environment of Care committee, it was decided that Sarah Neuman Center would become a smoke-free campus. “The few smokers that lived here were grandfathered into the program, but we currently have no smokers,” she says.

“Even though we’ve only been smoke free for a short time, the transition has been relatively painless and very successful.”

Health and safety concerns helped to create buy-in for the switch. The time was right and Resident Council was excited about the conversion when told about it. All smoking areas were closed and waste receptacles were removed on May 1, 2011. “Before instituting the policy, we sent a letter to residents and family members describing our plan and the feedback was positive,” says Allen. Because it’s their home, communicating with residents is key. She adds, “Even though we’ve only been smoke free for a short time, the transition has been relatively painless and very successful.

Jewish Home Lifecare’s other New York facilities are in the Bronx and Manhattan. These campuses have retained their smoking rooms and follow city ordinances. “Those homes have younger residents and more ethnicity so transition will have to take place over time,” explains Allen.

WEIGH YOUR OPTIONS

Three different organizations have shared their takes on smoking. Will this issue ever go away? It’s very hard to say since, although numbers have declined, younger people are still picking up the habit. Is this stepping into an area of dictating social morality? Only time will tell. For now, each facility is doing what it feels is right in serving its residents.

Long-Term Living 2011 June;60(6):44-45

Sandra Hoban

Sandra Hoban was on I Advance Senior Care / Long-Term Living’s editorial staff for 17 years. She is one of the country’s longest-serving senior care journalists. Before joining Long-Term Living, she was a member of the promotions department at Advanstar Communications. In addition to her editorial experience, Sandi has served past roles in print and broadcast advertising as a traffic and talent coordinator.