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Alcohol Policies in Care Facilities
In 1996, one hundred and sixty-seven care facilities across Canada answered a survey on their policies regarding residents' alcohol consumption. The study compared five regions: British Columbia, the Prairies, Ontario, Quebec, and the Atlantic. Here are some of the highlights:
75% of facilities across Canada permitted alcohol consumption by residents under certain circumstances. However, in many cases it was strictly controlled.
64% of Canadian care facilities required a physician's order before a resident is permitted to consume alcohol. This requirement ranges from a high of 85% in B.C. to a low of 9% in Quebec.
The "doctor's order" requirement was quite different from what happens in the community. In the community, a physician has little or no control over the matter of whether an adult drinks.
Quebec facilities are far more likely to permit residents to have alcohol in their rooms (91%), compared to 8% for Atlantic Canada; and 32% across Canada.
When Was Alcohol Permitted?
Across Canada, 50% of the facilities served alcohol on special occasions or at social events. This varied from a low of 19% in Atlantic Canada to a high of 81% in Quebec.
28% of the facilities across Canada had special events (such as pub nights) where alcohol is sold to residents. This practice is most common on the Prairies (48%) and in Ontario (47%). It is far less common in Quebec (10%) where residents commonly have alcohol in their own rooms.
Throughout the country, care facility staff tends to control who is served at social events, and the amount served. In Atlantic Canada the issue seldom arose, because alcohol was rarely available.
Somewhat surprisingly, there does not seem to be a relationship between how restrictive the alcohol policy was and the level of care a facility provided or the number of residents.
Below are some alcohol policy responses given by the administrators and directors of care for the facilities surveyed:
| - "Alcohol is
permitted by residents at social events and, if mentally competent, alcohol may
be kept in residents' rooms for personal use and/or social use. Residents who
have alcohol abuse tendencies must have physician's order for same. Appropriate
staff are made aware of this."
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| - "Alcohol is not permitted except by doctor's
order".
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| - "Residents who are able to leave the facility
are allowed to access alcohol if that is their wish. We have also had relatives
come and bring a bottle of beer for their loved one and sit and share a beer.
Our only request is that they inform nursing staff that the resident has had a
drink". (Saskatchewan, 28 residents, Level 3 & 4 - includes dementia
care).
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- "We do not have a no alcohol policy. If someone was to request having a bottle in their room, it would be allowed". (Saskatchewan)
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| - "Alcohol is not allowed in residents' rooms.
A physician's order is required for residents who are allowed alcoholic
beverages. Residents,
family and friends must discuss alcoholic needs of
family member(s) with the unit nurse and physician". (Ontario, long term
care and retirement care)
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| - "No alcohol in building unless prescribed by
doctor, and then for medicinal purposes at nursing station". (Ontario, 72
residents, nursing care)
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How Access to Alcohol is Controlled
| - "Residents are not permitted any medication
or alcohol in their rooms - most are not capable of acquiring it because of
their physical or mental condition."
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| - "If alcohol is brought in for a resident, it
is locked up with the medication." (Prince Edward Island, 28 residents)
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Other comments from respondents:
| - "In my years of nursing here we have had
several residents who loved to go to the pub daily - our request was to let us
know where they were going and we had a time frame in which they were to
return".
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| - "Unless a resident has problems with alcohol
or it is contra-indicated with the meds a resident is on, then we feel residents
should be allowed alcohol. Hopefully, this adds to "home-like"
atmosphere we try to maintain". (Ontario
facility, 116 residents, nursing home and retirement home)
Comment: What is interesting about this, the facility staff also note they always keep the alcohol under lock and key. Is that approach home like?
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Circumstances for Drinking
Care facilities will sometimes permit the consumption of alcohol under controlled circumstances. Typically, this is accomplished by the resident requesting a drink at the nursing station and the nurse dispensing it to the resident (similar to dispensing medication). In this study, the majority of facilities identified this as the routine.
This approach starkly contrasts with our community attitudes about the individual choice to consume alcohol, and personal responsibility about when or whether to drink. It is also contrary to any perceived beneficial effects associated with alcohol consumption and socialization.
British Columbia and the Maritimes have the most restrictive approaches of alcohol across Canada. Thus we have an apparent contradiction in British Columbia: the province tends to have quite restrictive policies in its care facilities, but a social acceptance and use of alcohol among older adults in the larger community
Reasons for the Policies
Two reasons were commonly cited behind more permissive approaches:
o Respecting the personal autonomy of the residents to decide for themselves.
o Most facilities explained the actual level of consumption was not high.
One of the reasons noted for the restrictive policies in British Columbia facility was the high percentage of their residents on psychoactive medications. The concern was the alcohol- drug interaction. No one seemed to question why there was a high rate of prescribing psychoactive medications in the first place.
Over one in four Canadian facilities do not have a specific policy on alcohol consumption. This suggests that the rules are not being developed in any reflective manner. The staff response to a resident who is drinking may reflect the personal assumptions, biases and values of staff or administration.
The Need for Carefully Considered Protocols
It is important to have stated protocols when the facility's policy is restrictive so that residents and family know what will be expected before admission. Developing protocols can also help staff and administration consider what are their personal attitudes about
drinking,
seniors drinking,
alcohol problems and how these develop.
The protocol also needs to be considered within and consistent with the broader mission statement of the facility, as well as what we mean by "health" of residents in the facility and how that is achieved, for the individual and the collective. It needs to be considered in the context of both resident autonomy and the safety of staff and other residents, looking at ways in which it able to meet both goals in the least intrusive manner.
Written by Charmaine Spencer, Gerontology Research Centre, Simon Fraser University, Vancouver, Canada.
Page last updated Wednesday June 23, 2004
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