M-in- Law a heavy smoker; home carers can't come to a smoky house.

Discussion in 'I care for a person with dementia' started by Re Ma-in-law, Apr 7, 2016.

  1. Re Ma-in-law

    Re Ma-in-law Registered User

    Apr 7, 2016
    9
    My M-in-law has Alzheimer's which was diagnosed a year ago. She is 80 and still lives in her own home independently, but with increasing family support. She has smoked since she was 15. She now smokes around 20 a day as she forgets -though tries to keep track of -how many she is lighting.
    We were setting up domiciliary care support for my M-in-law with people from the Care home she will go to as a resident, when the time comes. M-in-law really needs increasing support, and we want her to get to know people from the Care home before she eventually goes there. The care manager has now told us that they cannot send care workers into the house with a heavy smoker.
    She lives a very-low tech life, no computer, no mobile phone, and looking at Vaping on the internet, I don't think there's any hope of her getting the hang of it. Patches have been tried and failed in the past - her Alzheimer's medication is in patch form, and she was very suspicious of them at the beginning because she thought they were nicotine patches! If she can't cut down - or at least not smoke when they visit, we are going to struggle -and so will she!
    We're hoping her GP can help, but has anybody any experience of getting their PWA to cut down/quit?
     
  2. BeckyJan

    BeckyJan Registered User

    Nov 28, 2005
    18,972
    Derbyshire
    Just coming in to say hello and wish I had helpful comments.
    It seems strange to me that there are not some carers (who smoke themselves) who are not prepared to help. If not then I wish I had some answer for you.

    It alarms me that someone with dementia is smoking and perhaps creating a fire risk. Can you use this as a reason for extra interest and care for your MIL?

    I hope others will be along soon with their own experiences and suggestions.
     
  3. Re Ma-in-law

    Re Ma-in-law Registered User

    Apr 7, 2016
    9
    Thankyou Jan.

    We've been told the smoking problem is a staff Health and Safety issue, which is fair enough - I hate it myself and I am with MIL for a while most days, coming home reeking. Much as I love her, I loathe the smoking. She generally spends more on cigarettes than food - is determined, and hard-wired in thrifty mode. She has recently been diagnosed with COPD too so maybe the GP can put some pressure on...
     
  4. Amy in the US

    Amy in the US Registered User

    Feb 28, 2015
    4,624
    USA
    I do have experience with this, I'm sorry to say, and am warning you that you may find our "solution" to this problem, and other parts of this story, distressing.

    My mother is 73 and has Alzheimer's and no short term memory. She had been a smoker since her early 20s and although she'd made some attempts to cut down, once the dementia took hold (at some point in the last 3-7 years although she was only diagnosed a year ago), like your MIL, she smoked more than ever. She was living alone at home with no carers or services and with me as her only support (only child 100 miles away).

    This is the part I'm ashamed to admit: my husband and I did not think to check her smoke detectors in her home and after she moved out, we discovered they were not functional. As she lived in a condo (a unit in a building with shared interior walls) if she had started a fire, it could have affected the seven other units in her building. There are children living in the unit immediately over my mother's, and a bedbound person in another upstairs unit. I still have nightmares about what could have happened.

    My mother was also spending a large part of her (fixed) income on cigarettes and it's a miracle she never started a fire. There was no discussing the subject with her and I didn't even try. Her GP would try, every time he saw her (which was sometimes3 or 4 times per month) but she would always say, "Dr Smith says my lungs are clear and that smoking hasn't negatively affected my health and I'm not going to stop." That is not, of course, what Dr Smith said to her!

    My mother went into hospital on the American version of what you call sectioning in the UK. She spent 12 days there and somehow understood that there was no smoking in hospital, and never asked me about cigarettes at all. They did, of course, put nicotine patches on her, but had to place them out of reach on her back as she would remove them otherwise (either because they itched and/or because of delusions about poisoning).

    From the hospital, my mother went to a care home where she has been for the past year. She has never said ONE WORD about smoking, cigarettes, that she used to smoke, that she wants to smoke, et cetera. The nursing staff at the hospital and at the care home watched her carefully for signs of nicotine withdrawal but saw none. They did taper her down very slowly as she had smoked for over fifty years.

    The same situation happened with my maternal grandmother, also a lifelong smoker who began smoking more heavily when her Alzheimer's got worse. She suffered a bad pelvic fracture and went to hospital, then rehab, then a care facility, and never smoked again. She, however, was cantankerous about it until the point where she became non-verbal.

    So I am not sure that's a happy story, even though it does demonstrate that it's possible to get someone with dementia to stop smoking. I have no idea what the nurses on the Geriatric Psychiatry ward (Senior Behavioural Health Unit) in hospital said to my mother, but they said they had no trouble with my mother.

    So I would make sure that your MIL's house has functional smoke detectors that your MIL cannot disable. I think that the fire department will come and do an inspection and help with this sort of issue and your MIL would likely be more amenable to doing what the nice young (and attractive) firefighter says, than if you tell her. (One of the best pieces of advice I've ever gotten is to consider not only the message, but the messenger, and that adult children are usually the worst person to deliver a message to an older person, with or without dementia.)

    I've seen stories here on TP about PWDs managing, in very creative ways, to break or otherwise disable the smoke detectors. Sometimes because the alarm goes off and they (understandably) are disturbed by the noise, sometimes because of the chirping "low battery" alarm, and sometimes because of delusions related to them.

    I doubt she could learn to vape/use electronic cigarettes but I suppose you could try.

    I am sure there must be others who have dealt with this situation in terms of getting carers to come into the house. I'm sorry I haven't better advice for you. Best wishes in dealing with a very difficult situation.
     
  5. Not so Rosy

    Not so Rosy Registered User

    Nov 30, 2013
    580
    Dad was a 40 - 60 a day man once he had AD and FTL dementia. He couldn't remember having just put a cigarette out so lit another one. To the best of my knowledge it wasn't an issue with the carers in fact they used to empty his ash trays into a metal bin each visit. Part of the second carer of the day's remit was to check he had enough cigs to last him, Social Worker put that in the care plan.

    Smoking only really became an issue when he went into a care home and not for the reasons you would expect. Every home he has been in has an outdoor smoking area usually hogged by the care home staff on their breaks. Last thing they wanted was to share the space with residents.

    Sorry, don't know what to suggest really. Maybe an air purifier and leaving a window open.
     
  6. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,958
    How does your M-in-Law light her cigarettes please? It just might be possible for all her matches to keep disappearing ...

    If she retains enough creativity to light her cigarette using the fire or oven, keeping the matches would be safer!

    If you think it might be possible to stop her being able to light her cigarettes, the reason why she has them in the house might also get forgotten. She could perhaps be "bought off" by children's "sweet sticks" given to her to chew.

    Everyone would have to be "on message" - carers, neighbours, family, friends.
     
  7. TrixieB

    TrixieB Registered User

    Jul 2, 2015
    20
    My MIL also forgot that she smoked after a spell in hospital with a broken hip and then moved into a care home. It's a really difficult one this, but there's only so much you can do to keep her safe. I'm sorry I can't suggest a solution for you.
     
  8. Toddleo

    Toddleo Registered User

    Oct 7, 2015
    412
    The same happened with us - thank goodness, eventhough she smoked since she was 13 (shes 82 now) she just seemed to forget! in the past she has said "I don't smoke do I?" and I just tell her that she gave that awful habit up many years ago! I would not have believed her habit could have ended so easily in the end, as she was a very enthusiastic smoker, certainly to the detriment of her food intake.
     
  9. arielsmelody

    arielsmelody Registered User

    Jul 16, 2015
    513
    My MIL is a heavy smoker - 10 or 20 per day. It has been raised as an issue by a fire safety officer, who insisted on smoke alarms and a fire-proof duvet because she smokes in bed (!) So far, it hasn't been a problem for the agency carers, who also do some overnight sleeps - in fact, she sends them out to buy her more when she runs out, which is very annoying because there would be no harm in her having to wait a bit before starting a new pack!

    Edited to say - the family is split between smokers and non-smokers, and the non-smokers hate having to spend time in her house just because of the smoke.
     
  10. cragmaid

    cragmaid Registered User

    Oct 18, 2010
    7,963
    North East England
    When my late Mum was assessed for home carers, it was part or the regulations that LA appointed carers were not permitted to come into a home where the patient( for want of a better word) smoked in their presence. They could smoke as much as they liked....but no smoking for the durationwhen unaccompanied. The Doctor's practice also has this system for Nunsing and Doctor home visits.
    I don't think this is unreasonable, even as an ex smoker, I find smoke offensive however I don't know how this can be policed unless the smoker is never alone when visits take place and can be prompted to stub it out.
     
  11. Shedrech

    Shedrech Volunteer Moderator

    Dec 15, 2012
    7,935
    Yorkshire
    Hi Re Ma-in-law
    I've never smoked so may not really understand ...
    I just noted that the Alzheimer's meds are administered by patch - and that Amy in the US says patches were put out of reach on the back
    so, could you now sneakily introduce nicotine patches alongside the meds patches?
    this might help with the nicotine 'fix' - so might reduce the number of cigarettes
    but I guess, if the lighting up is an ingrained habit in itself, this wouldn't help?
     
  12. geum123

    geum123 Registered User

    May 20, 2009
    4,604
    I've nothing helpful to contribute sorry. What a dilemma.:(
    What I wanted to say though was, be careful if you do introduce nicotine patches, and your M-in-law then continues to smoke (from just habit, rather than desire)
    because it could cause her to overdose on nicotine.:eek:
     
  13. southlucia

    southlucia Registered User

    Dec 19, 2011
    166
    I work as a charity support worker – doing cleaning, visiting, and shopping for elderly clients. One of my clients -who has dementia- smokes heavily. She spends most of the time in her bedroom, smoking. Certainly a concern for her safety, and her family worry about this. However, this isn't a problem with her care company, as she has three visits per day.

    I'd given up smoking a few months before I started to visit this lady, and believed that the smoking ban would surely mean that by law, I shouldn't be expected to work in a smoky environment. I discovered I was wrong. There is no law that states that anyone in their own home has to curb their smoking when they have anyone visit. Although, anyone has the right to refuse to work in a smoky home environment. I decided not to refuse, because this lady is fabulous. I can put up with two hours of smoke a week.

    As for nicotine patches; smoking is a combination of addiction to nicotine and a habit. It takes a logical mind to understand the concept of patches, that are designed to combat the cravings. The habit is, well, a habit. Harder to combat, until you decide to overcome it; or indeed forget.
     
  14. fizzie

    fizzie Registered User

    Jul 20, 2011
    2,740
    as an ex smoker i agree with ge above - I wouldn't use patches, there has to be some motivation involved in the use of patches. I don't think you stand a chance of reducing her smoking without making her very stressed and very unhappy. OH smoked valiantly through his lung cancer and had the last one 10 mins before he suffered a massive bleed. He wasn't motivated to stop. There are homes which will accommodate smokers and there are agencies who have willing carers, there are also private carers who dont mind but it does mean seeking them out. Good luck
     
  15. cragmaid

    cragmaid Registered User

    Oct 18, 2010
    7,963
    North East England
    20 years after my dad gave up smoking he died of lung cancer caused by Asbestosis contact (probably during the war). Until he died, his hand would go to his pocket, patting for the packet.
    Mum gave up when my sister did.....just before sis developed Leukaemia. She used the patches and would have started smoking again, had she not promised my sister.

    I gave up nearly 10 years ago due to a chest infection, and have stayed off using my willpower alone. I could kill for a fag sometimes!!!!!!

    We were all aware of the risks and, at the time, none of us had Dementia......I really pity anyone who has been a lifetime smoker and does not have the capacity to understand why they cannot/ must not smoke any more.
     
  16. Re Ma-in-law

    Re Ma-in-law Registered User

    Apr 7, 2016
    9
    A big Thankyou to everyone who has responded; I had a feeling we wouldn't be the only ones trying to find a way through the smoking problem.
    With some ideas from the GP and suggestions here we're going to try to persuade MiL to use disposable e-cigarettes when visitors are there.
    They seem to be the simplest option of the kind. The patches idea could work well later, when she is in a care setting and someone is applying daily medication, but at the moment she applies her own Medication patches - and surprisingly, seems to have grasped the daily 'peel and stick' - other medication (tablets) are much more problematic.
     
  17. dalmation lady

    dalmation lady Registered User

    Feb 3, 2014
    48
    As a care worker myself and also a non smoker I can honestly say I don't have a problem doing care calls in houses where people smoke.
    If they need the services of a care worker then they are obviously dealing with enough stress and trauma in their lives and that of their families to make the political correctness of the situation pale into insignificance. Just my opinion sorry if others disagree
     

Share This Page

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.