Smoking in Aged Care

Wintringham Specialist Aged Care - Alcohol/Cigarette Program

The ability to smoke and/or drink when entering an aged care facility is an issue that affects many new residents. With Commonwealth Legislation banning smoking in enclosed places, management of all aged care facilities have had to implement policies that address this issue, whilst at the same time considering Work Health and Safety, and Duty of Care for their residents and staff, without taking away the residents mandatory freedom of choice.

Wintringham Specialist Aged Care is a specialised welfare company that provides housing and care to elderly, frail men and women who are homeless or at risk of homelessness. Many of these people epitomise everything that is the "Aussie Battler" coming from disadvantaged backgrounds, where smoking and drinking is very common and not something they can, or want, to give up. Since its formation in the 1980's Wintringham has designed and built hostels specifically with these people in mind and currently have 5 Residential Aged Care facilities throughout Melbourne.

The project design brief for all of the housing developments was to provide residents with a private lockable room that would lead out onto verandahs, garden areas, and/or courtyards giving residents extra space, as well as reducing the necessity of having to walk to a 'designated smoking zone' which would reduce the feeling of "being at home".

With the environment conducive to smokers, it was necessary to establish a policy that would respect an individual's rights to consume alcohol and/or cigarettes, whilst remaining within the guidelines of Work Health and Safety and Duty of Care issues.

Procedure

To maintain Wintringham's Values of Options, Dignity and Rights, residents who smoke and/or drink alcohol may spend their budgeted money on alcohol and cigarettes as they wish.

Many residents have the ability to monitor their allowance of alcohol and cigarettes understanding the principal of making it last until the next "pay day" when they receive their pension again.

However some may require assistance to manage their 'budget' where the self management of alcohol and / or cigarettes may be contributing to the resident's behaviour.

The "Alcohol and/or Cigarette Program" was established to assist residents to pro-actively manage their consumption if required.

If an 'Alcohol Program' is being considered a risk assessment is undertaken and detailed in the Residents Care Plan.

An agreed plan of care is developed in consultation with the resident, ensuring the following principals are considered:

• Residents should have as much control and choice as possible
• The budget will be reviewed whenever the resident requests to do so
• When a resident chooses to take on a program with increased independence (e.g. more pocket money so that they can purchase their own cigarettes), a footnote on the budget will state that this will be attempted. However, if either party believes that the budget is not working, the previous budget will be reinstated.

If staff raise concerns about the resident's behaviour and believe the self management of alcohol and / or cigarettes is contributing to the resident's behaviour the Program Manager will assess the situation and then explain the concerns to the resident. A program will be offered at this stage which the resident may or may not accept. If the resident chooses not to take up the offer and the behaviour continues, the Manager will meet with the resident and provide the option of a program or an application for an administrator through VCAT (Victorian Civil Administrative Tribunal).

VCAT may ultimately make a decision to appoint an administrator who would then allocate funds to the resident for their trust account. The Facility Manager then develops a budget in consultation with the resident which will highlight the need for money to be set aside for such items as podiatry, haircuts and medication. The remaining money can be allocated to the purchase of cigarettes, alcohol, recreation, newspapers and money for the pocket. It is explained to the resident that the budget helps them make their cigarettes and alcohol last from one pay day to the next and avoids the situation where they have to go without.

The resident may adjust the allocation of funds within their budget according to their preferences (for example some residents may choose to increase their cigarettes and decrease alcohol), and may also select the times at which they would like staff to give them their drinks and cigarettes.

An initial budget is agreed to (signed by the resident and the Program Manager) and it is explained that the budget can be revised at any stage if either party feels it could work better. A copy of the budget is given to the resident and a copy placed in their file.

Alcohol and cigarettes are purchased and decanted/separated into the appropriate quantities. Staff administers the supplies using a medication treatment sheet or "Cigarette Program Record". The residents at Wintringham are given as much control and choice as possible whilst ensuring their safety remains a primary consideration. If they choose to stop alcohol and/or cigarettes all together, assistance will be provided to link the individual with the appropriate detoxification and rehabilitation services to provide specialised support if needed.

Outcome

The staff at Wintringham realise the importance of maintaining a residents freedom of choice and understand that it is not Wintringham's model of care to take cigarettes and alcohol away, but to accommodate their needs, realising that by doing so will encourage "improvement in behaviours and provide a safe option for our residents". Philip Goulding - Deputy General Manager Operations.

This initiative has been applauded by the Aged Care Standards and Accreditation Agency suggesting that the management of Wintringham should submit an application for the Better Practice Awards. However the admirable and very humble reply is always "I would sooner put our funds and energy into our residents and improving our facilities"?. Philip Goulding - Deputy General Manager Operations.

In 2011, Wintringham was awarded the United Nations human settlements program Habitat Scroll of Honour: the first time it was awarded to an Australian entity. It acknowledged the difference Wintringham has made to the lives of thousands of older people as well as to the experience of urban life in Melbourne.