Advice

How can you support a person with dementia living in a care home who smokes?

Question:

My aunt has dementia and her care home staff keep asking her not to smoke cigarettes in her room. What can we do to help support her?

Answer:

Work with the care home to support your aunt with smoking restrictions. The aim should be to respect her choices while ensuring her and other people’s safety.

Law and policies about smoking

There are good reasons to restrict indoor smoking. The care home needs to protect people from passive smoking and fire risks.

But the care home is also your aunt’s home, and she should be able to continue to smoke if she wants to. Because of this, care homes are partially exempt from indoor smoking bans.

Care homes do not have to provide areas where residents may smoke, but they can if they choose. This might be a person’s bedroom or a dedicated, ventilated smoking room.

Of course, your aunt’s dementia means it may be difficult for her to remember and follow the rules.

Talk to the care home about smoking

Start a conversation with care home staff. Helpful questions to ask them include:

• What is the care home’s smoking policy?
• Where are the designated smoking areas? A person’s bedroom, a specific smoking room, an outdoor smoking area or shelter, or somewhere else?
• How do they support residents who struggle to follow the rules?

Agree an approach with care home staff as a part of your aunt’s care plan. Review this with them so that it adapts as her needs change.

Involve your aunt in decisions wherever that is possible and try to be positive about it with her. Focus on safety, comfort and her having places where she can smoke.

Times and cues for smoking

Having a routine for when your aunt has a cigarette could help her keep it to places where smoking is OK. For example, would she usually smoke after a meal or while spending time in the garden?

Are there visual cues that will help her to recall where she can smoke? This could be a sign near her chair, or something else where she’s likely to see it at the right moment.

When you, staff or other visitors need to remind her, use gentle language and a calm tone. If there are changes to where or when she smokes, try to make these gradual to help avoid distress.

Reducing risks from smoking

If there are concerns about safety, there may be ways to reduce risk.

Could she use a fire-safe ashtray instead of an ordinary one, and a lighter instead of matches?

Would it help to have specific times when your aunt can smoke with someone there with her?

Could staff hold onto her cigarettes and lighters? Then they could give them to her at agreed times and in a place where she can smoke.

If smoking becomes too much of a risk, ask your GP about alternatives. Nicotine patches or lozenges can ease cravings.

She may also need supervision with e-cigarettes, as these still carry fire and safety risks if misused.