An Examination of Policies Addressing Resident Smoking in Nursing Homes

Objectives: To report findings of a nationwide project that examined nursing homes' tobacco policies for residents. Design: A random selection procedure was used to sample nursing homes proportional to the geographic distribution of nursing homes in the United States. Rubrics were developed to objectively describe and compare policies. Setting: Policies were obtained from 4 types of facilities: (1) facilities that allow smoking indoors and outdoors (I/O-SFs), (2) facilities that allow residents to smoke outdoors only (O-SFs), (3) facilities that do not allow residents to smoke indoors or out of doors (NSFs), and (4) facilities in transition (TFs) from a smoking facility to an NSF. Measures: Rubrics used to score policies had common categories: administrative/authority issues, notification, resident smoking, safety, cessation assistance/encouragement, and smoking areas. Criteria within each category varied to reflect the smoking regulations of each type of facility (eg, policies of facilities that do not allow smoking indoors were not examined for inclusion of issues related to ventilation). Results: Facilities' policies from geographically diverse facilities are described. Across all facilities, mean percentages reflecting policies' overall comprehensiveness were low, and when examining specific components of the policies, few areas were consistently addressed across facilities. Conclusions: Considerable gaps were found in written policies regarding smoking. Although nursing homes may in fact have practices that are more extensive than their policies portray, creating policies that guide practice can assist these long-term care facilities to promote an environment that aligns with their goals and desired practices to protect the health of residents and staff.