State ponders smoking ban

Bill targeting health facilities has unexpected opponents

A proposed statewide ban on smoking inside long-term care facilities seems, at first glance, to be a common-sense measure aimed at protecting the health and safety of residents.

Under a bill that passed a House committee Wednesday, smoking would be outlawed inside the state's nursing homes, assisted living facilities, state psychiatric hospitals and other centers that house older people and those with disabilities.

But two statewide organizations that advocate for older people say they're not endorsing the bill.

They say it raises complicated issues of balancing personal freedom with safety and health concerns. For all the potential benefits of a smoking ban, public officials have to keep in mind that residents still have rights in places that are legally considered their homes, said a member of the policy committee of the nonprofit Friends of Residents in Long Term Care.

"From a public health perspective, we should do everything we can to get people to stop smoking," said Bob Konrad, a health services researcher at the Institute on Aging at UNC-Chapel Hill. "From the standpoint of, 'This if your life and this is your home,' we don't ask other people to stop smoking in their homes."

Friends of Residents in Long Term Care and the North Carolina chapter of AARP are both remaining neutral on the bill. Its sponsor wants to avoid tragedies such as a fire last month at an adult-care home in Davie County, where one person was killed and 21 others injured after a resident lit a cigarette near an oxygen tank.

Rep. Julia Howard, the bill's sponsor, is from Mocksville, where the March 12 fire occurred.

"We are just trying to protect the innocent lives of the people that are there," Howard told the House Aging Committee. "This shouldn't happen to anyone else again."

Bill gets support

The bill received only clarifying amendments in Wednesday's hearing and will appear next in a house judiciary committee. State government, long-term care industry and public health representatives said after the meeting that they either favor or won't oppose the legislation.

But the legislation is additionally controversial because of the increasingly diverse population of people who live in adult care homes. About one in four residents of long-term care in North Carolina is younger than 64; more than half of them have mental illness as a primary diagnosis, state records show. A UNC-Chapel Hill psychiatrist said facilities may have a tough time getting people with this diagnosis to cut back on smoking.

"People with severe mental illness, a very high percentage of them smoke ... for that group of people, that would be a real challenge," said Dr. Scott Stroup, who works with patients in long-term care.

Recent research adds to the confusion. One study suggests that young people who smoke have higher risks for developing depression and anxiety, although the role that cigarettes play is unknown. Another recent study by Yale University researchers found a link between nicotine and improved cognitive function among people with mental illness.

Dr. Jana Johnson, medical director at the state Tobacco Prevention and Control Branch, said she's heard concerns that trying to stop people with mental illness from smoking might make underlying conditions worse. Those fears have some justification, Johnson said, but she noted that a smoking ban in state prisons has gone smoothly since it began more than a year ago.

"There have not been some of the issues that people might fear in terms of backlash," Johnson said.

Safety measures

After last month's fire, the health and human services department urged nursing and adult care home operators to be vigilant about the risk of fires caused by smoking patients.

"Rules clearly state that smoking is not to occur in a resident's room, and approved smoking areas must be a safe distance from oxygen tanks," Jeff Horton, chief operating officer for the Division of Facility Services, said in a letter to facilities.

The bill calls for fines of up to $200 for each violation, to be paid by the owner, manager or operator of the center.