2011/02/12 P-D: “Nursing homes find smoking ban a burden”

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The reaction of some nursing home operators to the new county and city smoke-free air laws creates a dilemma. An addicted smoker in a nursing home is likely to have a problem with being denied smoking privileges that formerly were taken for granted. At the same time, employees should not have to be exposed to secondhand smoke while on the job.

There’s also the issue of “Enabling behavior.” That’s the term used for someone who assists an alcoholic, for example, by denying that it’s a problem. The first priority from a health standpoint is instead to try and help that person to quit.

When it comes to smoking, though, enabling behavior seems to be the norm, at least in a nursing home! There’s something of a disconnect there, but clearly people are blind to it. It bears a striking similarity to what happened just last week when four Brentwood aldermen voted to allow smoking back in a VFW post.

And it wasn’t all THAT long ago that I recall smoking being allowed in hospitals, on the oncology floor with cancer patients no less. I visited Barnes Jewish Hospital, St. Louis, some years ago to speak to a person in public relations. I entered past a guard who was smoking, and waited in the visitor’s lobby where there was a smoking section.

The hospital gift shop also sold cigarettes and I asked about that too.

I was told it was unreasonable to expect patients (or their visitors) to smoke outside the hospital. And as for the gift shop, it was manned by volunteers raising money for the hospital and selling cigarettes was for the convenience of the patients.

Rather than set an example, ALL local hospitals – not just BJC – lagged behind in providing a smoke-free environment. Hospitals didn’t want to turn away their best customers: smokers suffering from smoking-induced illnesses. It all came down to money.

County smoking ban proves a burden for nursing homes

BY PAUL HAMPEL • phampel@post-dispatch.com > 314-727-6234 | Posted: Saturday, February 12, 2011 12:05 am | Comments (53 @ 2:42 pm 2/12/11)

CLAYTON • St. Louis County’s new smoking ban is proving to be a great inconvenience for nursing homes, operators say.
         The ban included an exemption that allows smoking in residents’ rooms if all occupants agree. But state law requires that all smoking be supervised in nursing homes.
         That was not a problem when smoking was permitted in common areas. But nursing home operators say they do not have enough personnel to supervise smoking in individual rooms.
         Last week, Cheryl Wilson, director of the Long Term Care Ombudsman Program in Brentwood, wrote to members of the County Council to ask them to revise the ordinance to allow smoking in designated areas of the facilities. The ombudsman program is federally funded and oversees long-term care facilities.
         “We’ve been getting calls from facilities asking ‘What do we do?'” Wilson said. “What this (ban) has done is effectively outlaw smoking in all nursing homes because it’s just impossible for them to supervise smoking in each and every room.”
         Wilson cited a state regulation that allows smoking “only in designated areas.”
         County Counselor Patricia Redington said the county’s ban, which took effect Jan. 2, is consistent with the state regulation, though she concedes that allowing smoking in individual rooms may prove inconvenient for nursing homes.
         “The ban was crafted to have very minimal exceptions and I suspect the County Council did not want smoking in lounges where workers might be exposed,” Redington said.
         A smoking ban that took effect in the city of St. Louis at the same time as the county’s prohibits smoking in all “private and semi-private rooms” of nursing homes and does not include an exemption for residents’ rooms.
         Wilson said that nursing home operators have told her that, by and large, they have been ignoring the law and allowing residents to continue smoking as they had before, though not in their rooms, as that is considered a fire hazard.
         “You can’t expect older people to go outside and smoke right after we’ve had an ice storm,” Wilson said. “One nursing home has a 100-year-old man who has been smoking since he was 10 years old. How can you tell him he can’t smoke anymore?”

County Council Chairman Steve Stenger, at swearing in ceremony, St. Louis County Government Center, January 1, 2011

         County Council Chairman Steve Stenger, D-Affton, said the smoking ban included an exemption to allow people to smoke inside their homes, and the council wanted nursing home residents to be included in that exemption.
         “Any time that you legislate for the public health, and particularly with a smoking ban, there are going to be ramifications,” Stenger said.
         He said the council is willing to meet with nursing home operators and residents.
         “We want to do anything we can for nursing homes to protect the rights of the residents and do that in the least-restrictive way possible,” Stenger said. “We’ll figure out something that is mutually agreeable.”

6 responses to “2011/02/12 P-D: “Nursing homes find smoking ban a burden”

  1. There’s an old story – many examples – one example suffices – south vietnamese refuges forced to flee their homeland at the end of the war wound up in the U.S. where the foods they had back home just simply were not available where they were settled. They also were not allowed to practice their religious beliefs. They had to eat what was available – and – they all got sick, and began to die. Finally, after years of denial, their needs were finally accommodated, and the otherwise inexplicable sicknesses and deaths ceased, they were able to live their normal life-spans, – happy and fullfilled, instead of suffering miserably and dying before they should.

    The reverse also happens. For those who are not born and raised on the south vietnamese foods and culture – deprived of their own – wither and die before their time too.

    Find a way to accommodate both sides of the smoking issue, or else committ a terrible wrong to one side – or the other.

    mogasp comment and note: I hardly think you can equate sustenance and diet to smoking, which causes premature death and sickness among both smokers and nonsmokers.
    Thanks for keeping within the 1,000 character limit; yours is 948.

  2. In Ohio Smoke Free Ohio which was the American Cancer Society and wrote the smokinge exempted nursing homes. This exemption destroys any credibility of the so called one wiff of cigarette smoke and your dead. We all know that resident patients are usually frail in their health with many having had stroke, heart attacks, cancer or respiratory problems.
    With that in mind it would seem as if the ACS
    1. Knows the claims of the danger of SHS are a lie
    2. They want to reduce health care by killing off the old geezers.
    3. Perhaps the ACS desires not to make enimies with those close to dying that might have estates they can receive by being ever so nice.
    A few ideas but do you have a logical reason for the ACS to write exemption for nursing homes?

    mogasp reply: Exemptions are almost invariably included with the express purpose of getting enough votes for passage. That’s what happened with both ordinances in St. Louis City and County. But language is getting more comprehensive all the time. If you go back 10 years or so in metro St. Louis you were lucky to get an ordinance requiring separate smoking and no smoking sections in restaurants. We’ve come a long way baby!

  3. You can equate living a free life in a free country, the elderly should be able to leave this world the way they lived their life, They are not beholding to you or me. You showed your pathetic card in your statement “An addicted smoker in a nursing home”

    While the anti-smokers love to play this card the fact is that it was a proposal by anti-smokers for anti-smokers. Nicotine is present in tomatoes,potatoes,eggplant etc etc etc and there is no evidence that anyone is jonseing for their tomato fix.

    You anti-smokers demand that they live their remaining days on your terms. Who gives you that right?

    mogasp reply: The issue should be determined exclusively by what is best for public health and welfare, not by my preference or your preference.

  4. I confess to being somewhat conflicted about nursing homes. On one hand, the nature of nursing homes is residential, at least to some extent, and I have no problem with people smoking in their own residence. On the other hand, like in many apartment communities, other residents are impacted. There are additional factors – do rooms have oxygen sources, making flames or cigarette embers hazardous? What is the setup – are the rooms really like private apartments or are they more like hospital rooms? Does the second hand smoke impact the staff?

    What some nursing homes are doing is declaring that as of a certain date, they will no longer permit new residents to smoke in the facility, thus gradually amortizing the problem.

    I’m sorry – I just don’t have an easy answer to this one. It is one thing to say they should quit smoking, but many of these residents may have smoked for more than fifty years and they cannot live outside such a facility nor can they break the habit. But I have a real problem with other residents and staff being subjected to the second hand smoke, especially if they are there for COPD or similar issues. So like I said, conflicted.

  5. Second-hand smoking (the act of putting smoke in the air for others to breathe) is really about “not thinking about others,” isn’t it?
    Metaphorically, there is so much secondhand smoke.
    A zen priest said, “walk on the earth as if it is your mother’s face.” That is what not second-hand smoking is all about to me.

  6. I don’t understand why Missouri nursing homes don’t ban smoking. At the Heritage Nursing Home (Americare) in Kennett, the smoking room is adjacent to the main dining room. The smoking room is also used at meal times for the “feeding” of residents with so-called special problems. Smoke permeates the dining room, even though smoking isn’t allowed during meals. The residual smoke contaminates linger. The room was not planned for smoking and THE VENTILATION’S EFFECT HAS NEVER BEEN TESTED, and the room pronounced safe.

    mogasp comment: From your description it appears that second hand tobacco smoke levels must be significant. If smoking is to be allowed – and smoke-free is preferred – it should definitely be outside in an area separate from the building.

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