Everyone knows the dangers of second-hand smoke. Employers around the country have moved to smoke free environments and in 2008, the Iowa Smokefree Air Act was passed, providing rules that smoking is not allowed in enclosed places of employment.

This law and cultural shift made working environments cleaner and safer for employees. But questions come up when employees are working off site, particularly for home-based service providers. Although not the office of the company, can home healthcare agencies implement a policy disallowing patients, family members, or others to smoke while staff are on premises providing care?

Yes, but following a documented process is important.  Home healthcare agencies can request that a patient or family members and visitors not smoke while staff is present providing care.  It is important that the agency have this discussion with the patient and any decision-maker to make clear its request and the reasoning for the request (the health and safety of its employees). 

If the patient and/or family and visitors will not comply, pursuant to DHS/DIA, this would be governed by SOM G448-468 and Iowa Code § 484.50(d)(5) which allows a patient to be discharged for “disruptive, abusive or uncooperative behavior in the delivery of care.” 

It is important for the home health agency, as indicated, to have a discussion with the patient and any decision-maker or family member first, document this discussion, provide formal notice and, only then, if there is non-compliance, determine that the patient can be discharged.