Nursing-home residents fuming over smoking rules

Longtime smoker Sherwin Williams wants to keep his cigarettes in his Auburn nursing-home room and light up anytime in a place that's safe and poses no danger to other residents.

"I think it's my First Amendment rights. The right to the pursuit of happiness," says Williams, 54, who is recovering at North Auburn Rehabilitation & Health Center from problems caused by congestive heart failure.

But that violates a strict, new smoking policy at the Auburn nursing home and 14 others across the state. It was put in place last November by the owner, Extendicare, a national long-term-care corporation.

Now residents must keep their cigarettes and other smoking products in a secure place, such as the nursing station. And they can smoke only with staff supervision in a designated outside area at scheduled times. Residents or a responsible party are asked to sign a waiver promising to abide by the policy.

Williams, who has a two-pack-a-day habit, refused to surrender his smokes. The staff threatened to throw him out, he says. So he filed a complaint with the state long-term-care ombudsman — one of several such complaints from smokers in Extendicare homes.

The ombudsman's office, which advocates for resident rights guaranteed by state and federal law, agrees that the policy goes too far and has taken up the cause.

Extendicare says it's just trying to satisfy state nursing-home inspectors, who found the company's old policy unacceptable.

How the issue gets resolved probably will resonate with nursing homes across the state, since Extendicare's policy is not unique. The controversy also highlights a widespread and growing dilemma: How do long-term-care providers balance residents' legal right to smoke with the responsibility to protect residents' health and safety?

"It's a huge issue because fire can affect more than the person who started it," says Linda Ronco, nursing-home-enforcement officer in the state's Department of Social and Health Services.

In Washington, at least three people have died in smoking-related incidents at nursing homes since 2001, Ronco says. Residents who smoke have started a number of fires in garbage cans and bedding.

Even so, Extendicare's new policy is being contested by the state's long-term-care ombudsman for violating residents' rights.

"We've been working on the issue of smoking for a couple of years," says ombudsman Kary Hyre. "It's a very difficult issue for a whole variety of reasons."

The ombudsman program has received 142 complaints in the past 16 months about residents' rights to smoke in long-term-care facilities.

On the one hand, smoking is an unhealthy habit that may contribute to a person going into a nursing home. There's also the effect of second-hand smoke on nonsmoking residents.

Yet, for a segment of the nursing-home population smoking is a routine, even comforting, part of life. Lighting up that cigarette may be a last piece of independence, says Louise Ryan, assistant state long-term-care ombudsman.

"They've lost their home. They no longer work. They don't drive a car anymore. It's symbolic for a lot of people," Ryan says.

In response to a lengthy complaint from the ombudsman, DSHS is investigating smoking policies at all Extendicare facilities. Two facilities already have been cited for inflicting significant emotional distress on residents over their smoking.

The ombudsman's complaint says Extendicare's one-size-fits-all policy doesn't recognize the needs, preferences and capabilities of residents who are independent, mentally able and can take care of their own smoking supplies, the complaint says.

Residents also have the right to keep and use personal possessions, which can be locked in special storage space in their rooms, the complaint says. And no facility can require or request a resident to sign a waiver of any resident right. Nor can a resident be discharged for exercising their rights.

"Extendicare has discharged and threatened discharge," the complaint states.

Extendicare used to be more lenient about smoking, says Scott Edwards, area vice president for the corporation. But it got tough to satisfy DSHS inspectors, who sanctioned its nursing home in Edmonds last fall after a resident got burned smoking.

"They felt we weren't appropriately safeguarding all our residents," Edwards says. "Our company is trying to resolve this so we do what's right for our broader base of residents and we want to do what's right for smokers. We're trying to find the proper balance here."

Ronco, the state nursing-home-enforcement officer, says Extendicare went too far in some cases. A smoking policy should balance the rights of smokers and the safety of other residents, she says.

State officials and the company were expected to meet today to hash out the matter.

But the smoking issue isn't likely to go away.

Ann Ellett, who lives at Bethany at Pacific in Everett, a nursing home that isn't owned by Extendicare, also is fighting for the right to keep cigarettes in her room and to smoke freely, without supervision, in a designated area.

Just this week, she says, a staff person threatened her with discharge "if I don't turn my cigarettes in."

She called the ombudsman because "they're taking away my privileged rights." And assigning staff to watch her while she smokes takes away care from other residents, says Ellett, who is 70.

The policy she lambastes — similar to Extendicare's — was mandated by the company's liability-insurance carrier, says a Bethany official.

The insurance company checks up to make sure the nursing home complies, says Tom Gray, executive director of the nursing home's nonprofit parent corporation, Bethany of the Northwest.

Many nursing homes are trying to solve the issue by simply banning smoking. But even nonsmoking facilities must accommodate residents who smoke, the ombudsman says, by at least allowing smoking on the property outside.

Outside is where Williams and some other residents puff away these days — but just across the property line from their Auburn nursing home. That's because they want to smoke any time without supervision.

"You have to smoke at their convenience and not your own convenience," he says. "I pose no safety hazard whatsoever to anyone."

Williams expects to move out soon because his health is so much better. But he has no plans to give up cigarettes.

"I'll smoke to my dying day," he says with a grin. "I love to smoke."

Marsha King: 206-464-2232 or mking@seattletimes.com