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Smoking In Long-Term Care Facilities Debated

California already prohibits smoking inside hospital buildings, so Assembly member Wilmer Amina Carter (D-Rialto) thought it made good sense to extend that ban to long-term nursing facilities.

The often elderly, frail population at nursing facilities might need more protection from secondhand smoke than most people, Carter said at a Senate Committee on Health meeting yesterday.

“There is no safe level of exposure to tobacco smoke,” Carter said. “One lit cigarette inside a long-term health facility exposes non-smoking workers, non-smoking patients and those who visit these facilities to over 7,000 harmful chemicals, of which over 70 of these chemicals cause cancer.”

Mirie Levy, a health sciences professor at Cal State Sacramento who spoke at yesterday’s hearing on AB 217,  had a catchier way to put it:

 “Smoking is optional,” Levy said, “whereas breathing is not.”

Levy said the majority of patients in long-term health care facilities are immuno-compromised which, she said, makes them more vulnerable to secondhand smoke. She said cigarette smoke inside nursing facilities could exacerbate symptoms for those with asthma, bronchitis and other respiratory conditions.

“Why are unsafe working conditions tolerated in a profession that is supposed to help people stay healthy?” Levy asked. “Secondhand smoke makes healthy people sick, and sick people sicker.”

The problem is, according to those in opposition to the bill, many longtime smokers live in these nursing facilities, and are forced outside to smoke, even during extreme weather conditions — from heat waves to thunderstorms — and that can be hazardous to those residents.

Senate member Tom Harman (R-Huntington Beach) raised that issue, and posed a question: “What about the patient who is admitted as a lifelong smoker?” Harman said. “I know it’s a difficult habit to break, and it seems it’s difficult enough to be placed in a long-term facility and then go cold turkey in inclement weather. It could be raining for 10 days, and they can’t go outside for 10 days, what about then?”

Levy’s response: “A bad weather day is having to breathe in secondhand smoke,” she said.

That was a little much for committee member Joel Anderson (R-El Cajon). “I’m sorry,” Anderson said, “but we still don’t have an answer. I get your opinion. But the senator asked a question, and if we have an answer that’d be great.”

Carter broke in to explain that her staff is working with opponents on that particular concern.

Jennifer Snyder, legislative advocate for the California Association of Health Facilities, explained the concern: “We asked for some flexibility in times of extreme hot or extreme cold, for residents to smoke indoors, under very restrictive circumstances,” Snyder said.

The CAHF has an oppose-unless-amended position on the bill, Snyder said. “We greatly appreciate the Assembly member’s willingness to address most of our concerns,” she said. “But nursing facilities are caught between a rock and a hard place — where residents in nursing facilities are allowed a certain amount of self-determination. So, under Medicare rules, it puts many nursing facilities under a tough situation.”

 Anderson wanted to know if the legislation would include hospice facilities. “The idea is that people go into hospice and we’re trying to comfort them,” Anderson said. “I’m more interested in their comfort than in making some PH.D. happy.”

It was unclear whether or not the law would affect hospice buildings. Snyder said it was that uncertainty which concerns some people who run nursing facilities. “If this rule is in place,” Snyder said, “will it conflict with Medicare rules, or with patient rights that have been established? I don’t know. And the reasons we have concerns is that unknown [aspect].”

The Senate Committee on Health passed the measure on a 7-2 vote. It now moves on to the Senate Committee on Labor and Industrial Relations.

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