Care homes and alcohol: finding the right balance

“Ultimately, it's still his decision to drink that amount.”

That was how one senior manager described supporting a care home resident who drank a bottle of red wine each night.

Staff were worried. They could see the risks: worsening health, increased chances of falls or accidents, and changes in mood.

But the resident had mental capacity, meaning he could understand, retain, and weigh the information about whether or not to drink, and how much; and could communicate his choice.

As the manager explained:

“Our team naturally want to care for somebody. And sometimes you have to kind of reinforce that, you know, he is making these decisions. And although we may perceive it as an unwise decision, ultimately, it's still his decision to drink that amount.”

This tension sits at the heart of new research we commissioned, carried out for us by research consultancy Practice Solutions.

We asked them to explore a seemingly straightforward, but important, question: how do care homes in Wales balance residents’ right to choose to drink with the need to keep them safe?

The researchers conducted a survey, and spoke with care home staff and managers, sector leaders, and care home residents across Wales. What they heard was thoughtful, honest and sometimes challenging.

First and foremost, care homes are people’s homes. Moving into residential care does not mean losing your rights. Many residents still want to enjoy a drink. For some, it helps them feel normal and helps them to feel at home.

As one resident told the research team:

“The thought of being able to have a drink, it makes it more homely. You're not restricted.”

Another said:

“If you have a drink, of whatever you want, it's like you've had a good treat, and psychologically, it can work that way.”

Alcohol can be social too. As one manager explained:

“Three ladies have a glass of Baileys, a couple of times a week, chatting. It gets them out of their rooms.”

Clearly, for many people, alcohol is linked to identity, routine and connection. But alcohol, of course, can also cause harm.

As we get older, our bodies change. We break down alcohol more slowly. We may take more medication. We may be more likely to fall. And alcohol can increase the associated risks.

This was a snapshot study, based on a sample of participating homes. We cannot claim it represents the experiences of every care home in Wales. But it provides a window into the kinds of situations staff are navigating, and where more support may be needed.

Almost half of survey respondents said they had supported residents with alcohol dependence. Yet fewer than one in five had received alcohol-related training.

Staff told the researchers that supporting residents sometimes means managing difficult situations. For example, one manager described a crisis involving a resident experiencing alcohol dependency and mental health issues:

“What happens, and did happen in this case with this gentleman, [is] it became a crisis. Always on a weekend! He wanted to leave. He was absolutely not staying, and it was an unfortunate situation that we ended up in. And there was no support.”

When staff tried to get help, they struggled:

“We can’t get any support. We've tried the crisis team. We’ve tried everybody. We've tried this. We’ve tried that...I think it was eleven agencies they rang. So many people! [The] mental health team. Just for some support. Nobody was available.”

Whilst this is only one illustration, and we can’t say that there are similar experiences in every care home in Wales, it does suggest how potentially exposed care homes staff can feel when alcohol use becomes complex.

There are also challenges when one person’s drinking affects other residents. As one senior manager put it:

“When it impacts on the wellbeing of the person living next door, it's a different kettle of fish, isn't it? So, it's about managing the impact.”

Supporting one person’s rights must not harm another person’s wellbeing, but that balance is not always easy.

As an alcohol charity, our aim is to reduce harm. We want people to have dignity and autonomy, while also reducing preventable harm.

That means ensuring staff are equipped with the tools and confidence they need.

The research team suggest several practical steps, including that:

Alcohol in care homes, then, raises tricky questions. How do we respect choice while keeping people safe? How do we allow enjoyment without causing harm?

If we want to reduce alcohol-related problems in Wales, older people must of course be included in the discussion. And care homes, it would seem, would benefit from support to enable them offer alcohol in ways that are both safe and respectful.