Alcohol Consumption Policies in Nursing Homes Need to Balance Public Health, Resident Rights, and Legal Issues
Nearly half (43.9%) of people aged 65 and older in the United States consume alcohol. It’s not unusual for many individuals to want to continue drinking in some capacity after they enter a nursing home (NH). But this can become complicated with the many potentially conflicting considerations that come into play in this setting. A new study in the January issue of JAMDA suggests that alcohol policies in nursing homes should incorporate elements of public health, human rights, and legal frameworks.
The authors of Determinants for the Use of Alcohol in Long-Term Care Settings: A Comparative Analysis of Personal Choice, Public Health Advice, and the Law, noted that there are many potential dilemmas involving alcohol consumption that make total prohibition both unrealistic and difficult to enforce. This also can lead to other problems. For instance, a resident may offer sexual favors in return for alcohol from another resident; or a person may pressure staff to provide them with spirits. At the same time, NHs can’t allow unlimited alcohol consumption. The authors observed, “A more nuanced approach is required that balances the older person’s right to exercise choice with the safety of other residents and NH staff.”
Three frameworks, the authors said, are useful for analyzing the risks involved in a NH resident’s choice to drink alcohol:
- The public health framework promotes the elimination of risk, as it removes the possibility of health-related harm and improves population health, which is perceived to be for the public good. Making a decision about alcohol consumption under this framework requires consideration of individual risks and benefits associated with consuming alcoholic beverages.
- The human rights framework considers the social and psychological harm experienced by the older person when something important or pleasurable—such as the choice to consume alcohol—is removed, including social isolation, loss of culture, and the frustration at loss of control.
- The legal framework involves legal mechanisms, in the form of legislation, regulations, and common law, which govern a resident’s decision to consume alcohol. These include regulations outlining residents’ rights. The framework also addresses decision-making capacity, that is, the resident’s cognitive ability to make informed decisions about alcohol consumption.
The authors concluded, “As the global population continues to age, the need for robust, comprehensive, and transparent decision-making policies surrounding alcohol consumption in NHs will become increasingly urgent.” They added, “A holistic approach must be taken to ensure the complexities and controversies surrounding NH alcohol consumption are adequately addressed. This is best achieved through consideration of a public health, legal, and human rights framework.”
This study was conducted by researchers at Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.