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• W1983647035 abstract "Amid the uncertainties of best drug treatments for chronic obstructive pulmonary disease looms one important nonpharmacologic fact: Smoking cessation is the single most effective way to improve outcomes for patients at all stages of the disease. It is the only measure that has been definitively shown to reduce rates of lung function decline. Clinical practice guidelines from numerous organizations are unequivocal on this point, and some of them also point out that secondhand smoke can exacerbate COPD. What's unclear is how this knowledge is playing out in nursing homes, which face dueling responsibilities of ensuring residents' safety and respecting their individual rights. It is not known how many nursing homes have developed smoke-free policies, but several sources told Caring for the Ages that they believe the numbers are at least slowly ticking upward. Smoking cessation “is the number one treatment [for COPD],” said Claudia Marcelo, DO, a nursing home specialist for Life Care Physician Services. “Just as hospitals have been going smoke-free, I believe more nursing homes are starting to go smoke-free. … The barriers should be breaking down.” Like the Life Care Center in Lauderhill, FL, where Dr. Marcelo is the medical director and a full-time physician, many nursing homes are in a transition, prohibiting new residents from smoking, but allowing existing residents to continue, she said. Edgemoor DP SNF, a skilled nursing facility in Santee, CA, run by the County of San Diego, took smoking cessation a step further. In 2009, it began its quest to become smoke-free by reframing smoking as a privilege, rather than a right. Residents interested in continuing to smoke were required to have clinical assessments to determine their ability to handle all aspects of smoking. If deemed capable of independent smoking, they had to agree to a list of requirements for smoking – a contract, of sorts. The residents were then monitored for compliance, and with any violation – dropping a burning cigarette on the ground, for instance, or giving a cigarette to another resident – the smoking privilege was lost. In the meantime, individuals being admitted were told that the facility was smoke-free and that they would not be permitted to smoke. The attrition resulting from these changes was significant and brought Edgemoor close to being smoke-free. The facility faced one unforeseen obstacle, however: The edge of the facility grounds became a de-facto smoking area for several of the residents who were permitted to leave the facility unsupervised. Littered cigarette butts and the smoking itself created neighborhood tension, but leaders also worried about their compliance with interpretive guidelines for Medicare and Medicaid regulations, as well as California regulations, which mention the supervision of smoking. “If there's a de facto smoking area, one could argue that we must supervise it (for safety),” said Robert M. Gibson, PhD, JD, senior clinical psychologist at Edgemoor. “So we decided to further develop our contraband policy to address smoking materials and ensure that residents who were seen smoking were not bringing back smoking materials.” Repeated removal of contraband/smoking materials further discouraged even off-site smoking and smoking near the facility. Developing an effective smoke-free policy can be complicated, but it is wrong to assume that federal regulations prohibit nursing homes from going smoke-free, according to the Tobacco Control Legal Consortium. Medicare and Medicaid regulations do not specifically mention smoking in regard to resident choice, and although an interpretive guideline mentions the need to accommodate existing smokers, it cannot be read to confer a right to those who cannot smoke independently, or to confer the right to smoke indoors, the Consortium says. “You have to be deliberate and clinical, and careful that you're not taking away something from someone who already had it unless you have a reason,” said Rebecca Ferrini, MD, CMD, full-time medical director at Edgemoor. For Dr. Ferrini and her colleagues, smoking was not only a fire hazard; it entailed “using staff time to promote a dangerous behavior,” they said. As smoking rates declined, Dr. Ferrini said, staff observed fewer behavioral problems, particularly among those with dementia, fewer respiratory infections, and improved wound healing. “We haven't documented it specifically, but these changes [have definitely occurred],” she said. And surprisingly, she said, there was little need for nicotine replacement or other smoking cessation tools. “For the majority, we found that not having smoking visible and not having ‘smoking times’ was enough. It was no longer a social thing, and many just forgot.”" @default.
• W1983647035 created "2016-06-24" @default.
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• W1983647035 date "2015-02-01" @default.
• W1983647035 modified "2023-10-16" @default.
• W1983647035 title "Chasing the Smoke Away" @default.
• W1983647035 doi "https://doi.org/10.1016/j.carage.2015.01.010" @default.
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