Serving Alcohol in Facilities

This is a very heated topic. I want to start with a Resident Right:  

#(17) The right to consume a reasonable amount of alcoholic beverages at the resident’s own expense, unless not medically advisable as documented in the resident’s medical record by the attending physician or unless contradictory to written admission policies;

There are no specific requirements or regulations that facilities must follow in developing policies in regard to alcohol being served to residents. It actually comes down to each facility policy.  There are facilities out there that are religiously based and prohibit the serving of alcohol. Some facilities don’t want to deal with the issues that comes with allowing residents to drink.  One issue could be having an alcoholic in your facility and not being able to serve them alcohol, but them watching others drink.

I have worked in both environments. One where it was not allowed and another facility that had Happy Hour every Friday. I did some searching on this topic and came across many differing opinions.  Nursinghomehelp.org had an article called Dave’s Memo. He stated “Essentially it is a resident’s choice if they want to have an alcoholic beverage and this choice should be considered an activity, therefore, a policy or a physician’s order is NOT needed.” He also says that the medications they are taking and diagnosis’ should be taken into consideration. If they still request to have a drink, it should then be discussed with their doctor and their pharmacist.  They need to be given the ramifications of drinking, but in the end it is their decision and their choice should be documented in their clinical record.  He stated that it would be good to add their choice to care plan as well.

So often people associate going to a facility with going to prison. Although I do not agree with this, I can understand why they would think this. I worked in a facility that told the residents when they were getting up and when they had to go to bed. One of my ladies had a routine of going to bed at 8pm every night.  I was told it was her preference.  I went to put her to bed at 8pm. There was a movie coming on that she wanted to watch. Again, I was told it was her preference.  I was 16 years old and had been taught that I had to obey my elders. She said to me I really wish I could stay up and watch this movie. I said you sure can, I can come back at 10 and put you to bed.  She said, “but I will get in trouble if I stay up past 8.”  This was my first job as an Aide.  I told her I would shut her door and come back at 10.  This is when I learned that it really was NOT her preference it was the aides.  They wanted everyone in bed so they could sit and do their documentation. I started paying attention to what others wanted and realized they had no choices.

I later became an activity director.  One thing that I wanted to do was give the residents choices. I was determined to not tell them no.  I hated being told no. My biggest challenge came with alcohol. I need to tell you a little be about me before I continue.  I saw personally what damage alcohol did to families and to kids. My family did not drink, but I was around those that did.  I also saw what it did to some of the kids I went to school with. The Captain of the Football team was killed after going out celebrating a victory and then driving. He rolled his car and was killed instantly.  I swore at a young age I would never touch the stuff. I joined the military and really got an education.  This only strengthened my resolve to stay away from all of it. Now back to alcohol in facilities. Everyone I worked with knew how I felt about drinking. I would even refuse to go to company parties because alcohol was involved. But, when I read resident rights, I had taken an oath to uphold those. I was supposed to provide quality of life for my residents. I also knew I could not force my convictions on others.

I came across several articles that address this issue.

 Decisive alcohol consumption policies needed in nursing homes, safety experts contend by: Alicia Lasek January 26, 2021, https://www.mcknights.com/news/decisive-alcohol-consumption-policies-needed-in-nursing-homes-safety-experts-contend/

Nursing Home Alcohol Policy: Can Residents Drink Alcohol? By Nayyer Khakzad July 8, 2024. www.humanhealthmag.com/nursing-home-alcohol-policy/

Alcohol use in Long-Term Care Communities: Juggling Choice and Safety, By Joanne Kaldy, January/February 2023 https://www.caringfortheages.com/article/S1526-4114(22)00486-3/pdf

All three of these articles have very thought-provoking information. As I was reviewing them a few things stood out to me. One: it comes down to knowing the resident and the reason behind the drink.  Two: how does providing this choice impact quality of life.  Three: where is the line between keeping them safe and violating their rights? We live in a society that celebrates life’s accomplishments with a drink. I watched this with Nascar, toasts at weddings, promotions with a job, anniversary celebrations, holidays, New Years Eve Parties, Religious ceremonies, and even for health reasons. My senior year, my German club went to Germany. The drinking age was 16 in Germany.  My parents had to sign a permission slip stating whether I was allowed to drink or not. They left that decision up to me.  I knew how they felt about the topic and I knew what my conviction was.  I chose not to drink anything. This could be a huge issue for a resident who was raised in this environment.

I saw what taking the alcohol away from my residents did to them. For some of them, it was a way of life. We think we know best, but do we really?  This is when I came across a few verses in my Bible that helped me to truly understand how I should handle this issue professionally.  Proverbs 31:6-7 “6 – Give strong drink unto him that is ready to perish, and wine unto those that be of heavy hearts. 7 – Let him drink, and forget his poverty, and remember his misery no more.”

I want to leave you with this story. I truly felt these verses should always drive my decision to fight for what my residents needed. Yes, needed, this wasn’t a want, but it was needed for them to have quality of life.  We had a new admission one day.  He was a bum; the local authorities had found him passed out on a city sidewalk.  He was sent to the hospital and once they were done with their assessment, they determined he was not appropriate to go home.  He had no home, he had nothing and he was dying.  They had given him less than 6 months to live.  Why? Cirrhosis of the liver. He had been drinking since he was 17.  He was now in his late 60’s. He was combative, aggressive, refused medications and cussed staff out.  He threw his food and water at the staff. His chart said he was a Vietnam vet.  They came to me and said you have to go talk to him. I guess they figured a Navy vet could help get him to comply. To top that off, the facility physician told me he wanted me to get him involved in activities. I knew exactly what I was walking into.  I had 2 Uncles in the service during Vietnam.  They were spit on and called baby killers. I walked down to his room and introduced myself as a Navy Vet. He stuck out his hand and said nice to meet you. After a few exchanges of what we did in the service, I realized that he was NEVER coming to any of my activities and he wanted NO part of the government assistance being offered to him.  The Government shunned him when he came home so he didn’t need their help now.  He started drinking to help deal with all he had seen and done. He had been drinking a 24 pack of beer a day for years. It was while I was sitting on his bed speaking with him that those verses in Proverbs came back to me. I asked him what I could do to help give him some quality in life while he stayed with us. He looked me up and down and very carefully said, “Give me a beer every day.”  I said “Done”. He asked me if I even had the authority to do that. I assured him I would take care of it. His next question was “How are you going to do that on the Weekends” I again assured him that I had nursing friends over the age of 21.

We just happened to be having our Quality Assurance meeting the next day. Our facility doctor was not very happy with me.  I knew I had to make him understand. To be honest, I had a feeling I could be jeopardizing my job. I explained why I was doing what I was doing.  I explained what it was like to be in Vietnam.  I explained that he only had a few months to live and what could one beer a day do to him?  He was used to drinking way more.  I had also looked up the information on what taking away alcohol could do to him as well. Thankfully the Doctor looked at me and said he had never thought of that.  I was prepared to purchase that beer out of my own money. Once the doctor signed off on the plan of care, I was allowed to use my budget to purchase the beer. He stopped being mean and cussing out the staff and throwing things at them. He got his beer every day till the day he died.

This is not the only story I have, but it is one that has left a lasting impression on my life. Yes, military association opened the door to a conversation, but it was the honoring of his quality of life that made all the difference.  We need to be very careful drawing a line in the sand on the issue of alcohol use in facilities. We need to use our assessments to get to know those we take care of. There is always a reason behind what they do and it is our job to search that out. I truly believe there is no set standard, policy or rule that will fit every situation. This is where we come in, just because there is a policy doesn’t mean we can’t help make change to fit the needs of those we serve to help give them quality of life.

Tammy Point NAAP Leadership Team 2025