Elders surrounded by family sharing wine and toasting special events seems to have a curative power. The eyes light up, conversations flow easily, and pictures seem to take years off the senior’s life.
Alcohol may have repercussions for people of all ages. For seniors, alcohol can present unique problems. At some point in one’s elderhood, the body’s tolerance for alcohol changes. The amount a person was accustomed to consume daily is now more intoxicating. Too much alcohol can lead to depression, falls, accidents, and a myriad of illnesses all become more likely. Interactions with medications is an issue to monitor.
Key coincidental issues with alcohol that cause families to intervene in a senior’s living situation are unhealthy isolation, self-neglect, and physical deterioration. Other issues causing concern include the fear of the senior driving or doing something complex while impaired or at worst familial abuse.
Generally, families have no legal right to control a senior’s drinking, whether at home or in a Senior Living community. As in most states, in Texas there is a Resident’s Bill of Rights which gives seniors living in Assisted Living communities all the same rights as anyone else under the Constitution: drinking is effectively a constitutionally protected right. For seniors in a Senior Living community, there can be challenges in obtaining alcohol by the very nature of the health care infrastructure, but there is no legal barrier. Of course not all drinkers are alcoholics, nor is all drinking problematic. But when there is a question of improper drinking, what are the realities in each type of senior living? We examine them one at a time.
Alcohol and Independent Living (and 55+ too) In Independent Living, families will have zero chance of controlling their senior’s access to alcohol. By definition there are not caregivers who can report or limit access to alcohol. Many residents can drive their own cars to liquor stores, and for those that can’t, the community provides transportation to grocery stores and drug stores in shopping centers where there are liquor stores. The community itself will often provide free happy hours, and even wine with dinner on a daily basis. And finally, there is always a crowd in any independent living that hosts their own happy hours. Drinkers find other drinkers. It’s just the way it goes. I had one client who convinced her mother to go to three weeks of in-patient alcohol rehab, and straight from there to an Independent Living facility. Within weeks the mother had hooked up with the happy hour crowd, and eventually moved in with another alcoholic in the Independent Living community: the unofficial leader of the happy hours. Independent Living communities won’t stop anyone from drinking if they want to drink. The only potential upside for a problem drinker in an Independent Living community is that because of social interaction, drinkers sometimes won’t consume to such excess as they might have done while isolated at home. And drunk driving is much more infrequent.
Alcohol and Assisted Living There is far less drinking in Assisted Living than in Independent Living. Studies have been published showing as many as a third of Assisted Living Residents may drink daily. In my experience this seems quite high, and I question the methodology and parameters of the study. Let’s parse some factors at play here. First let’s discuss Large Assisted Living communities, which in Texas have a minimum of 17 apartments and average 82 apartments. When I see community-sponsored happy hours, there are generally fewer than a dozen residents in attendance. Usually these happy hours are held only weekly. Maybe two thirds of large assisted livings will serve wine with dinner, but there never seem to be many people with wine when I’m there. So community-sponsored drinking in Large Assisted Living communities doesn’t seem to be much abused.
A problem drinker will sometimes refuse to go to—or remain in—an Assisted Living setting if they can’t have access to alcohol. Consequently there are times where the community, in consultation with the family, will prepare a care plan for a resident that includes up to two ounces of liquor dispensed nightly from the medication cart. This is a good solution for many alcoholics who want the dignity of drinking, but need help to control alcohol abuse and can’t be allowed unlimited access to alcohol. However there will always be alcoholics who find a source for alcohol. This could be a liquor store delivery service, another resident who somehow has access to liquor, or a friend on the outside. As mentioned, the Assisted Living community has no right to restrict a resident’s alcohol access or drinking. In theory, even if a resident is demonstrably drinking himself to death, the AL can’t intervene, nor discharge him for that reason. In practice the community would consult with the family, would try to restrict his access to alcohol, or would probably send him out to the hospital when he is passed out, and then try to find a reason to keep him from coming back to the community.
In Small Assisted Living communities of 16 beds or under there is generally little drinking. The smaller environment is generally much more tightly controlled by caregivers as compared to the larger communities. Physically the residents usually require more help from staff, and dementia is more prevalent. Alcohol is rare in Small Assisted Living communities.
Alcohol and Memory Care I have never seen a Memory Care community have any difficulty limiting access to alcohol. This is because of the very nature of a secure facility and the increased control management has over the environment. But some Memory Care communities include alcohol in special events, and try to include it as part of an effort to maintain the illusion of normalcy. I know of at least one Memory Care community that used to stock its community refrigerators with beer, seeking consistency with a “normal” home environment. Unfortunately there is always at least one resident that would abuse that privilege, so that practice was quietly stopped. Often the wine and beer served in Memory Care events is now alcohol free, and nobody seems to notice or mind.
Alcohol and Skilled Nursing As in Memory Care, alcohol in Skilled Nursing Facilities (SNFs) is rare. There are multiple reasons for that. First, the SNF environment is overwhelmingly oriented toward medical needs, not hospitality preferences. So the SNF itself almost never serves beer or wine. Second the population doesn’t lend itself to drinking. Short term Medicare residents, generally about 20% of a typical SNF’s population, are there for only around three weeks, and are focused on recovery. So drinking isn’t at the top of their priorities. Long term residents paid for by Medicaid (50% of residents) don’t have money for alcohol, as they only get a $60 per month allowance. And long term residents paying privately (30%) generally have complex medical needs and also aren’t focused on alcohol. Finally, a very large percentage of a SNF’s long term residents have dementia, and their confusion doesn’t lend itself to drinking either. Having said all that, in theory a SNF resident has the right to drink if they so choose. Access is a major limiting factor.