Are nursing home residents allowed to smoke outside? Understanding policies and resident rights

While federal regulations provide guidance on resident rights and safety, a nursing home's smoking policy, including whether residents are allowed to smoke outside, is primarily determined at the state and facility levels. The policies must balance residents' personal freedoms with the need to ensure a safe environment for everyone on campus.

Quick Summary

Nursing home residents' ability to smoke outside depends on individual facility policies, which are influenced by state and local laws. Facilities can designate outdoor smoking areas or implement a campus-wide smoking ban, but must accommodate current residents who smoked before a policy change. Safety precautions, such as preventing oxygen use near smoking areas, are paramount.

Key Points

• No Single Rule: Whether nursing home residents can smoke outside is determined by individual facility policy, influenced by state and local regulations, not a single federal mandate. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}

• Designated Outdoor Areas: Facilities have the option to allow smoking in a specific, designated outdoor area, but must ensure it is safe, accessible, and protected from the elements. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}

• Campus-Wide Bans: Nursing homes can implement a total campus-wide smoking ban, but must still provide a designated outdoor area for residents who were admitted before the policy change. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}

• Resident Safety is Paramount: The facility is responsible for residents' safety and must take measures to prevent accidents, such as prohibiting smoking near oxygen supplies and supervising residents with cognitive impairments. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}

• Resident Rights: Under federal guidelines, residents have rights to self-determination. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}

• Policies Must Be Communicated: Facilities are required to inform all residents of their smoking policy in writing, especially when new policies are enacted.

• Liability Risks: Nursing homes can be held liable for injuries caused by smoking negligence, including inadequate supervision or failure to enforce safety protocols.

Navigating Nursing Home Smoking Policies

Whether a nursing home resident can smoke outside is determined by a combination of resident rights, fire safety regulations, and the facility's specific policies. There is no single federal rule; instead, state and local regulations allow facilities to choose between permitting smoking in designated outdoor areas or implementing a campus-wide ban.

Key Regulations and Considerations

Nursing home smoking policies are influenced by state and federal guidelines. The Centers for Medicare & Medicaid Services (CMS) emphasizes residents' rights while requiring facilities to maintain a safe environment.

Resident Rights: Federal regulations state that facilities must consider residents' needs and choices. If a facility changes its smoking policy, residents who smoked prior to the change must still be allowed to do so in a designated area, often outside, to maintain their quality of life. The National Fire Protection Association's (NFPA) Life Safety Code prohibits smoking near oxygen or flammable materials. Designated smoking areas must have noncombustible ashtrays and proper disposal containers.

State and Local Laws: State and local rules can be stricter than federal guidelines. Some states have implemented 100% smoke-free policies for healthcare facilities, including outdoor areas. Always check specific state and local regulations.

Policy Implementation: Designated Areas vs. Smoke-Free Campuses

Nursing homes must clearly communicate their smoking policies to residents. The main approaches are designated smoking areas or campus-wide smoking bans.

Option 1: Designated Outdoor Smoking Areas

• Location Requirements: The designated area must be safe, accessible, and away from building entrances, windows, and ventilation systems. It should be protected from the weather and include appropriate furnishings and waste containers.
• Supervision: Residents needing supervision must be monitored by staff while smoking. However, staff can refuse supervision if they are not comfortable with secondhand smoke. New residents must be informed of the smoking rules upon admission, as they do not have the same 'grandfathered' rights as long-term residents. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}

Option 2: Campus-Wide Smoking Ban

• Notification: Facilities implementing a full ban must notify current residents and their representatives in writing and orally. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}
• Grandfathered Residents: Residents who smoked before the ban must still be provided a designated outdoor smoking area under CMS guidance. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}
• Off-Campus Smoking: Some facilities allow residents to smoke off-campus, but remain responsible for their safety, potentially requiring supervision. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}

Comparison of Common Smoking Policy Types

Feature	Designated Outdoor Smoking Area Policy	Campus-Wide Smoke-Free Ban
Smoking Location	Limited to a specific outdoor area, away from buildings. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}	Prohibited on the entire nursing home campus, both indoors and outdoors.
Indoor Smoking	Prohibited for all residents. Some older policies may have exceptions.	Prohibited without exception.
Accommodating Current Residents	Requires the facility to maintain a designated outdoor area.	Must still provide an outdoor area for existing residents who smoked prior to the ban's effective date ('grandfathering').
Requirements for New Residents	Must follow the facility's designated area rules.	Must abide by the total smoking ban.
Staff Role	Staff may assist residents to and from the smoking area, but can refuse exposure to smoke.	Staff must enforce the policy and manage compliance.
Liability Risk	Higher, requiring stringent supervision protocols and enforcement.	Lower, reducing the risk of fire and accidents related to smoking.
Resident Choice	Balances resident choice with safety.	Limits resident choice but prioritizes a completely smoke-free environment.

Potential Liability and Safety Concerns

Smoking-related accidents are a significant cause of injuries and death in nursing homes. Facilities can be found negligent for inadequate supervision, failure to follow policies, or allowing smoking in hazardous conditions. Proper resident assessment is necessary to determine the required level of supervision. Facilities must ensure designated smoking areas are safe and enforce precautions, such as prohibiting smoking near oxygen.

Conclusion

The ability of nursing home residents to smoke outside depends on the facility's policy, state laws, and federal resident rights. Facilities can opt for designated outdoor smoking areas or a total ban, but must accommodate residents who smoked before a policy change. Balancing resident freedoms with safety is the primary concern. To understand a specific nursing home's policy, request a copy of their rules. For more information on resident rights, consult CMS resources. {Link: Smoking in Wisconsin Nursing Homes https://www.dhs.wisconsin.gov/publications/p01957.pdf}

Frequently Asked Questions

Can a nursing home ever take away a resident's right to smoke?

A nursing home cannot eliminate a resident's right to smoke entirely, particularly for long-term residents who were smoking before a policy change. However, facilities can place reasonable limitations and restrictions on smoking, such as requiring it only in designated outdoor areas and under supervision for safety.

What is a 'grandfathered' smoking policy?

A 'grandfathered' policy applies to residents who were already living and smoking at a facility before it implemented a new, stricter smoking ban. The policy allows these current residents to continue smoking in a designated outdoor area, even if all new residents are prohibited from smoking on campus.

Are e-cigarettes or vaping devices allowed in nursing homes?

The rules for e-cigarettes and vaping vary by facility and state. While some states' laws do not classify e-cigarettes as traditional tobacco, a facility can still create its own policy to regulate or ban their use, often communicating this policy upon admission.

How are designated outdoor smoking areas made safe?

Designated outdoor smoking areas must be safely accessible, protected from the weather, and located away from entrances and ventilation systems. They must include noncombustible ashtrays and self-closing containers for emptying ashes. Use of oxygen is strictly prohibited in these areas.

Can a nursing home require a resident to stop smoking?

No, a nursing home cannot force a resident to quit smoking. However, they are responsible for assessing a resident's ability to smoke safely and can require supervision based on the assessment. Facilities should also provide access to smoking cessation programs and resources.

What happens if a resident cannot safely smoke unsupervised?

If a nursing home determines that a resident cannot smoke safely without supervision, it can require that the resident only smoke when staff are available to monitor them. This assessment should be part of the resident's care plan.

Are visitors allowed to smoke with residents?

Visitor smoking policies depend on the specific facility. Some facilities may permit a resident's guest to smoke in the designated outdoor area, while others may prohibit it entirely. It is important to check the facility's specific rules.