What happens when elderly smokers and drinkers move into a carehome?

It’s a balancing act. We used to allow smokers to be outside accompanied by a carer who smoked. Another balancing act of matching smoking staff with smoking residents. Alcohol was allowed in moderation. You have to balance the necessities of medications not mixing well with alcohol, existing illness being exacerbated by alcohol and smoking. Plus it is other peoples home and workplace too.

A violent, intoxicated dementia patient is not something to be taken lightly, nor is it wise to allow dementia patients to smoke unsupervised. The safety of other residents and staff sometimes has to be a higher priority than an individuals wants.

We have a couple of alcoholics and a fair few more who enjoyed the odd tipple in our place. We have a group who always chip in on a few bottles of wine and snacks and gather in the lounge on a Saturday evening.

Wrt medication it depended upon whether they managed their own mediction and how drunk they were.

For people who managed their own medication there was nothing we could do. They were adults with full capacity and it was their choice to make.

If we were in charge of their medication it meant they had been assesed as not having the capacity to be in charge of their own medication. Legally, we had to follow the medication instructions to the letter. We could not administer medication if they had consumed alcohol without a qualified, medical professional (we had no nurses - only carers) telling us in writing that we could or 111 telling us over the phone that we could.

We were advised to operate common sense. If someone had a can of lager before bed or a small wine with dinner and a glass of sherry before bed we still gave them their medication. If they were obviously intoxicated we had to phone 111 for advice each and every time. Usually we were advised to wait four hours and then give them their medication or skip a dose but there were some that could be given with alcohol.

Under no circumstances were we allowed to take alcohol away from anyone unless a deprivation of liberty order was in place. Ditto medication. If the resident was in charge of their own medication we could not take it away unless they were deemed as being an immediate danger to themselves and we could only do this with the say so of the crisis team.

If I took Alcoholic Bob on a shopping call and he decided he wanted to buy three bottles of gin I could not legally stop him. I could encourage him not to. I could contact his family and social worker but I could not deny him his choice to buy gin. He is an adult and they are always deemed as having the capacity to make their own choices unless a DOLs is in place.

It's the same with dementia and leaving the premises. We can encourage them not to leave, we can follow them, we can contact the police if we are worried for their immediate safety. We can contact their family and social worker but we cannot physically prevent them from leaving if they are adamant that they want to leave.

This was in a semi independent living complex. We sadly, had lots of people who could have benefitted from full nursing care in a secure dementia unit but could not secure the funding or had families who were blinkered to their detoriating mental state and wanted to protect their own inheritance. I have lost count of the number times I have chased someone with dementia down the road begging them to come back home. The majority of the time they happily comply when you offer them a cuppa and biscuit and promise to go out later and do whatever errand it was they thought they were running on their behalf.

Often they just wanted a wander in the hopes of finding someone to chat to.

I'm pretty shocked at the number of care homes mentioned on here who are overstepping the law. It is not legal to deny an adult the choice to drink, smoke or eat too much cake.

My alcoholic uncle is in a care home. I think it's a decent one. He is allowed to drink so long as he has it brought in.

If they were at home, what is stopping them from drinking? If they are able to make the decision and understand it may effect their meds then its up to them. You should always assume capacity even with labels such as dementia.

Phew! I’m so pleased to hear it.

I’m so confused about this. When I read the thread title my first thought was - well they’ll probably have a great time with each other. But then someone mentioned medication and now I’m confused. I’d so love people in a care home to smoke and drink and eat what they want if that’s what they’d like to do but what about their medication.

I also regularly take my residents to pubs/cafes etc. I'm even taking one to bongo bingo next weekend. Shes in her 70s but will absolutely love it. They should be seen and treated as adults with adult interests and hobbies.

Horrified at some of these care homes that are being so restrictive to their residents! I run a nursing home. We have a smoking room and outside areas available for smokers (fire risks have to ask for their lighters). They can have alcohol whenever they want it, mostly bought by themselves but we always provide a good selection for events/birthdays/Christmas. It is their home and they are human beings with rights.

I work in a care home. Smokers are taken outside for a cigarette. Maybe not as often as they want but a few times a day.
We don't provide alcohol but family can bring it in for residents if they want
To be honest most of the dementia residents are happy with the non alcoholic beer or wine .

After a while, she deteriorated and eventually forgot she was a smoker.

It is an amazing disease, unless you have lived close to it you can have no idea. My mum's husband's life was defined by alcohol. Now his physical body walks about but he has no awareness and apparently no craving for drink. I have heard about other heavy smokers that forgot they smoked by the time they had deteriorated sufficiently to require residential care. Dementia really does strip the person of every scrap of personhood and yet they remain 'alive'. It makes you question what being alive really means.

The staff at the care home appear to be full of common sense and compassion by the way, but I think it is hard to grasp how far gone some people in residential care can be. It is not about 'allowing' them to drink and smoke and have fun. Those concepts have gone completely for many people. Admittedly some may deteriorate slower and can have some quality of life, but it by no means a given.

thank goodness for such common sense and compassion.

My friend’s mum, heavy smoker, who had dementia went into a care home. The care staff use to take her out to the smoking shelters regularly. After a while, she deteriorated and eventually forgot she was a smoker.

in my Nans care home they had wine with the evening meal if the wanted it and a scotch or brandy after the meal, it a cafe home not a prison. I suspect they can smoke it their room but not in public spaces.

@AlaskaThunderfuckHiiiiiiiii I can only speak from my experience, through the lengthy downhill process prior to being admitted, the level of his drinking was known to his GP and consultant. When he was admitted the staff said he had a beer allowance, which mum was to supply but they would give him on request up to a certain amount. He went downhill so rapidly he stopped asking so I guess he was weaned off that way. So in my experience, there is an awareness that alcoholics need to drink a certain amount to remain stable and this needs to be tapered - your mum is far from the first drinker with dementia they will have dealt with, sadly it is all too common.

@HeadNorth this is the point I was trying to make, I’m unsure she would be allowed to drink to the levels she has been drinking therefore will need something to help wean her down

Yeah, alcoholics aren't generally happy and relaxed. They don't enjoy drinking, it is an addiction and a compulsion that has destroyed their relationships, their bodies and their brains. That being said, the care staff would give him tins of beer if asked, but he was a secret drinker so it is not in his nature to ask. Whether he drinks or not is an irrelevance now, in any case.

Gosh, what would be the point in putting a person through the pain of withdrawal at that age and stage of life? What's the worst that can happen? I'd rather die happy and relaxed.

My mum's husband (note, not my stepfather, vile man) went into a care home with alcohol related dementia. He had a beer allowance the carers were permitted to give him but he declined pretty quickly and now has no perception he used to drink, his brain is so addled. So he was effectively weaned off in the home and is now dry. It is such a strange illness, drinking was one of the last bits of him to go but it has gone. He is effectively a shell with no sense of who or where he is.

Note to DS when looking for my care home in the long distant future,hopefully please make sure I'll be allowed a glass of wine/gin and tonic in my twilight years.

I think when our generation is older ie the generation of uber eats and deliveroo it will be easier to maintain autonomy over what we eat and drink.

Carers and nurses cannot legally stop us from ubering as much gin and cake to our room as our hearts desire.

That's assuming any of us can still afford to eat and drink.

This is such a depressing post.
It should be enshrined in law that when you go into a care home you can smoke and drink and have as many takeaways as you like.
It is literally God's waiting room, they are waiting to die, why the fuck can't they do as they please.

Yes this is as bad as schools trying to force water only rules on children.
Are these rule makers failed Traffic Wardens, useless and interfering in trivia to avoid real work?

I agree with a PP they should really be allowed to indulge in whatever small pleasures they have left at that stage of life.

My DM was in a care home and had put on a lot of weight due to being fed properly and not moving much (used to chuck her meals on wheels on her lawn when she lived alone).

Her care home rang me one day to say they were not going to allow her to choose a cake from the afternoon trolley due to her weight increase … she was 92!! And she was paying over £1K a week in that place. I soon told them they absolutely wouldn’t be doing that …. it was the highlight of her day ffs.

I think a lot of this depends not on the care home's rules as such but on the individual's desires, needs and quite importantly, their capabilities.
If they're quite independent and able to express that they want a drink etc then most will still get it. If they get drunk and cause a danger to themselves, others or their surroundings then it's a situation that needs addressing and it would be something for the whole care team to sort out with the resident. That's the family, care home manager and staff, social workers, healthcare providers and of course, the resident themselves. The ex alcoholics I know were violent, aggressive drunks and now suffer from dementia so the choice to drink has long been assessed by their care team.
If residents are at the stage of needing assisting to eat and drink then alcohol would probably not be the first thing the carers are reaching for, holding a beaker and straw up to make sure they get their whisky with their breakfast but a nip of sherry or brandy in an evening is certainly a possibility.
Having to go into a care/nursing home is shit whatever way you look at it. It's even more shit when you lose the physical ability to take yourself out for a smoke whenever you want. It's shit that staff can't take you out immediately when you ask because they're busy with someone else. I think my residential home is lovely with great staff. Do I ever want to have to go into a home? Hell no. If I had a personal valet to assist me and only me whenever I want then fine but I'd rather stay independent until I shuffle off this mortal coil.

Although most of the post I'm about to quote is positive (and I'm sorry for your loss) this is also depressing

Dad was allowed a £25 ‘spends’ budget from his calculated ‘earnings’ that paid for his care, so he did have to reduce the amount he smoked (from 40+ to 4-5 a day).

I pray to a God I don't believe in that euthanasia is an option by the time I need a care home.

I absolutely agree about not stopping them doing what they want at this point in life, heck I would like a little tipple now and then. The big difference is that the OP says she thinks the dementia and brain problems stem from alcohol use so she must be drinking to excess which you wouldn’t be able to do in a care home bar I wouldn’t have though so her drinking will need to be cut down