For many elderly Australians, residential aged care is their home, a place where they expect to live with dignity and as much autonomy as possible.
Person-centred care, a cornerstone of the aged care sector, aims to respect individual preferences and needs. Yet, when it comes to residents who smoke, not all facilities are equipped to support this choice.
With no uniform requirement for designated smoking areas across Australian aged care homes, it raises a question: are providers doing enough to balance resident rights with practical and regulatory demands?
The Current Landscape
Smoking policies in aged care vary widely. Some facilities operate as entirely smoke-free environments, meaning residents must leave the premises to light up, while others designate outdoor areas for smoking.
State and territory laws set the baseline, banning smoking indoors and often within a certain distance of entrances, such as five metres in Queensland or four in Victoria.
Beyond that, individual providers decide how far they’ll go to accommodate smokers. A facility might offer a bench in the garden, but if it’s uncovered, residents are left exposed to rain, wind, or scorching heat.
For those with mobility issues or advanced dementia, even reaching these spaces can be a challenge, let alone using them comfortably.
Data on how many homes provide smoking areas is patchy, but it’s clear the provision isn’t universal.
Queensland Health, for instance, allows aged care facilities to designate ‘nominated smoking places’ outdoors, yet many opt for a blanket smoke-free policy instead. This inconsistency prompts a closer look at whether the sector is truly meeting the needs of all residents.
Smoking as Part of Person-Centred Care
For long-term smokers, a cigarette can be more than a habit; it’s a ritual tied to identity, relaxation, or social connection.
Imagine a resident who smoked daily at home, perhaps with a carer lighting their cigarette or family joining them on the porch. In aged care, that same person might find no staff willing to assist, particularly if they have dementia and can’t communicate their wishes.
Without support, they’re effectively forced to quit, a decision made for them rather than with them.
This shift can have real consequences. Abruptly stopping smoking, especially for someone who’s smoked for decades, may trigger withdrawal symptoms like irritability, anxiety, or sleep problems.
For elderly residents with frail health or cognitive decline, these effects can worsen existing conditions, adding stress to an already vulnerable time. While quitting has clear health benefits, the cold-turkey approach isn’t always the gentlest or most person-centred option.
Practical Challenges and Resident Rights
Providers face genuine hurdles in facilitating smoking. Fire safety is a top concern, particularly for residents with dementia who may not handle cigarettes safely.
Staff health and workload also come into play, as assisting with smoking isn’t a standard duty, and some employees may object to exposure to second-hand smoke. Then there’s the cost of creating sheltered, compliant smoking areas, which not all budgets can stretch to.
Yet, residents’ rights deserve equal weight. Aged care homes aren’t hospitals; they’re living spaces where people should feel at home. If a resident smoked with assistance before moving in, why should that stop?
Homes that do offer smoking areas often keep it basic, with a chair or two, no roof, and no heating. On a rainy day or chilly winter morning, that setup hardly invites use. It’s a makeshift solution, not a thoughtful one.
Striking a Balance
So, what could better accommodation look like? Designated areas with shelter, seating, and heating would be a start, ensuring smokers can enjoy a cigarette regardless of weather.
Staff training could help too, equipping carers to assist residents safely, especially those with dementia, without compromising their own well-being. Nicotine replacement therapies, like patches or gum, could also bridge the gap for those unable to smoke independently, though this assumes quitting is the goal, which it isn’t for everyone.
The Aged Care Quality Standards encourage providers to support residents’ ‘choice and control’. Smoking, for some, falls squarely in that category. While complete smoke-free policies align with health trends, they risk sidelining a minority whose preferences don’t fit the mould.
Research from Tobacco in Australia highlights that older smokers, particularly in care, often face reduced access to smoking without tailored support, a gap the sector could address.
A Question Worth Asking
Not every resident smokes, and not every facility can or should cater to it extensively. But for those who do, the current patchwork of policies feels inconsistent with the promise of person-centred care.
Are aged care homes doing enough to make smoking accessible, safe, and comfortable? Or are they leaning too heavily on smoke-free ideals at the expense of individual choice? For executives in the sector, it’s a question worth pondering. After all, if aged care is about creating a home, shouldn’t it feel like one for everyone?
We strive to accommodate smokers; however, despite risk assessments for that resident, we remain under scrutiny when the commission visits, and they are expected to wear a smoking vest; that feels awful, especially on a hot day and lacks dignity.
It’s all quite challenging; that’s why some providers prohibit it.
Hello
I was an RN employed at Anglicare SA for 16 years until I retired in 2019.
When we had resident smokers it was always a daily significant stress for carers to take them outside and stay with them for the duration of the time they had a cigarette ( most wanted 2)
Our Manager demanded that the majority be supervised as these days most residents have some degree of cognitive deficit. There was the occasional resident allowed indépendance
Myself and other RN’s reported to the Manager that other residents call bells were not being answered and they were not being toileted or other care attended due to carers extended times outside with smokers.
This would occur numerous times a day as the Manager would not put restrictions on residents requests
She was unreasonable and did not accept that other care was unable to be attended stating no tasks should be left undone but this was the reality every day.
In most Care Facilities it is totally unreasonable to expect staff to continually be present for residents smoking as why should others care be compromised?
A weather proof area should be allocated outside within view of common areas and the resident should have a fire proof ‘ smoke mat’ in place.
Even with this organised some are unable to light their cigarettes
I suggest the GP should discuss the risks with relatives and if the resident and the relatives insist on their rights they should agree to sign a ‘risk’ form where the liability is removed from staff.
It is too hard or a resident to give up smoking upon entering aged care if they have smoked for most of their lives.
We need to do as much as possible to accommodate them but having worked in aged care for decades, I also know it is difficult for staff to drop their duties to accompany the resident and most staff who do nor smoke themselves do not like second-hand smoke.
I really do not think smoking need be catered for. If it is well known that there is no smoking in such facilities. These residents will often have waited in a hosptal bed until a vacency occured and there would have been no smoking at the hospital and so they would have started the withdrawal with help. Also we have a duty to staff and other residents to be kept safe and it is well proven that other peoples smoke is just as injurous as actually smoking. To allow or facility smoking in aged care residential is a backward step. All assistance should be avialable to help the resident to quit.
Also begs the question, if staff are non smokers will they then be forced to assist smoking residents with their habits. No, of course not. So, perhaps they job then should fall on family friends etc to accommodate their smoking.
Another aspect of smoking in aged care is residents having to virtually beg staff for cigarettes. They are forced to stand around the nurses station, often being ignored waiting to get a cigarette.
Their families often expect staff to ration cigarettes because they want their family member to cut back or quit; this causes friction when staff tell residents they have had their ‘quota’
Residents cannot accept that they are unable to smoke as freely as they did in their own homes.
Often when asking residents about spirituality they will mention smoking and being outdoors in nature.
This is a very contentious issue for sure.
If Nursing home staff are not allowed to smoke or vape within 10 metres of the entrances, how are we able to enable residents to smoke closer?