What to do if you are ALF Shopping and a Parent Smokes

I have an Alzheimer's client whose caregiver informed me recently that she found 2 packs of cigarettes in the client's bedroom recently and that on occasion she smells cigarette smoke on arriving some mornings.  The family members are in the process of touring assisted living facilities for mom but don't know if they should divulge that information to the facilities they are touring.  Recently they informed me of a recent decline in activity that was noticed and it prompted me to address the smoking issue.   In realizing that this may be an issue with other family caregivers I'd like to share my experience in long term care administration and the regulations that govern these facilities.  I'd also like to invite any comments you may have.

On the smoking issue, Assisted Living Facilities are not mandated to accept a resident if they are a smoker. Nursing homes do, but Alf's adhere to different scrutiny by the Fire Administrative Code that dictates each incoming resident meet a capability assessment. If they admit a smoker it decreases their numbers which they of course want to keep high enough to pass the regulations. This is part of the reason you don’t see people in wheelchairs in a standard license ALF. Someone coming into the facility in a wheelchair puts them at greater liability with this assessment. If they admit a known smoker, they may require that the family hire a 24/7 caregiver to keep an eye on the resident to help prevent a smoker from setting the facility on fire.


What can you do? I would not withhold the information from facilities you will be touring. I encourage families discuss any reported smoking when touring to find out how each facility deals with this issue. Remember, residents will always find a way to get cigarettes from other visitors, staff, or other residents in exchange for money or other favors. You don’t want to know some of the bribes I’ve seen. Perhaps family members should enter into this discussion with their loved one as to why he/she is smoking, but I would reserve this conversation for any future visits. Perhaps if mom or dad really wants to live in an ALF in Florida, you can help the prospective resident understand that this will not be possible as a smoker.

And definitely, if your parent has a special relationship with his or her doctor, I would elicit the primary care provider's help with this.

What do you think? Have you had to face this issue with a family member?  Let me know your thoughts.