Abstract
Alcohol is one of the most widely available psychoactive substances globally. Many
accept the risks associated with alcohol consumption for reasons such as social engagement
and feelings of pleasure. Alcohol consumption in a nursing home (NH) setting highlights
the moral and logistical challenges of balancing the need for a safe living and working
environment with the dignity of risk (DoR) and personal autonomy of residents.
This analysis explores public health, human rights, and legal frameworks in their
approach to a NH resident's choice to drink alcohol. Key issues under the public health
framework include the medical risks associated with alcohol consumption, whether residents
with impaired cognitive functioning have the capacity to make a decision about alcohol
consumption, and the practical and ethical implications of supplying alcohol to residents.
Under a legal framework, NHs must consider the legal imperative to respect residents'
rights, the possibility of liability in negligence, duties owed to employees, the
existence of substitute decision-makers, and liquor licensing laws. Fundamental considerations
under the human rights framework include the damaging psychological effects of risk-avoidance
and the importance of inclusive risk assessment processes.
Alcohol policies should incorporate elements from all 3 frameworks. There is limited
data publicly available about alcohol policies in NHs. Further research is needed
to establish current practice and to evaluate the merits and disadvantages of different
policies. Establishing inclusive and thorough decision-making processes is key to
achieving better consumer-directed care.
Keywords
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Article info
Publication history
Published online: September 23, 2020
Footnotes
This work was supported by the Department of Health and Human Services, Seniors, Aging and Aged Care Branch, Health and Well-Being Division, Victoria, Australia and the Department of Forensic Medicine, Monash University. None of the funders influenced the design, methods, subject recruitment, data collection, analysis, or preparation of the paper.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any agency or departments of the Australian Federal Government, the State Government of Victoria, Monash University, the Victorian Institute of Forensic Medicine, or the Coroners Court of Victoria.
The authors are affiliated with or employed by the Department of Forensic Medicine, Monash University, which is also a funding source. The authors have no other potential financial or personal interests that may constitute a source of bias.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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