Guidance for members of the public, care home residents and family members

What is an alcohol or drug problem?

We use the terms ‘alcohol and drug problems’ to mean the use of alcohol or drugs (substance use) that lead to significant problems or distress for the individual.

Drugs include cannabis, heroin, cocaine or medicines such as methadone or benzodiazepines held without prescription. Harms include falls, alcohol poisoning, drug overdose, conflict with family, liver problems, mood swings, irritability, anxiety, depression, brain damage, hallucinations and risky behaviour such as drink or drug driving.

In our research, we are particularly concerned about people who are substance dependent (also known as ‘addicted’) because our previous research suggests that they are at increased risk of poor care in care homes. Signs of substance dependence include unsuccessful efforts to cut down or quit, lots of time spent using alcohol or drugs, intense craving for alcohol or drugs and having to use more alcohol or drugs to feel the same effects previously felt with a smaller amount. In our research, we include people who are no longer drinking or taking drugs but may still be experiencing craving.

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How can I find a suitable care home if I have an alcohol problem?

A care home provides accommodation and round-the-clock personal care for people who are unable to live independently. A nursing home is a type of care home where one or more qualified nurses is on duty to provide nursing care. You can find general information about finding a care home here.

If you have an alcohol problem, provided you are able to make your own decisions, you have a right to make decisions, even those that other people think are unwise. This includes continuing to drink alcohol if you have an alcohol problem and move into a care home. Even if a person is unable to decide about their drinking, they should be involved in the decision making process as much as is practicable and decisions should be made in their “best interests”.

While some care homes will accommodate people with alcohol problems, whether or not they intend to stop drinking, some care homes will only accommodate people if they stop drinking. Other homes will offer a trial period or have conditions of stay, for example, they might say the person can only drink in their room.

Care homes should carry out an assessment to find out whether they can care for a person safely and effectively. Even though people with an alcohol problem have a right to choose to continue drinking alcohol if they move into a care home, that doesn’t mean that an individual care home must accommodate them. If you have been assessed by your local authority (council) as needing a care home but you haven’t been able to find a home that will accommodate you, the local authority may be able to help you to find a suitable placement or alternative care options.

Some homes specifically advertise that they care for people with alcohol problems. You can search for these homes by going to www.cqc.org.uk/care-services/find-care-home and selecting ‘substance misuse’ in the list of specialisms. But our research raises questions about whether some of these homes can reasonably be described as providing specialist care. We suggest before you move into a care home you ask:

• Does the care home have an alcohol policy?
• Has at least one member of staff received education/training related to alcohol problems?
• How many people with alcohol problems has the home cared for?
• (If relevant) does the care home accommodate people with alcohol problems who are unable or unwilling to stop/greatly reduce their drinking?
• If someone with an alcohol problem moves into the care home and abstinence is not their goal right now, will there be any conditions (e.g. they can only drink in their room, they must supply their own alcohol).

You have the right to privacy and confidentiality and this includes information about your alcohol problem. However, it is important that care staff know about your alcohol problem before you move into a care home so that you receive the right care and support and avoid withdrawal symptoms which can be dangerous.

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How can I find a suitable care home if I’m using drugs?

People who use drugs have the same right to be cared for in a care home as everyone else provided a local authority assessment demonstrates they meet the criteria for a care home. However, that doesn’t mean that every care home must accommodate people who use drugs or allow drugs to be used or stored on the premises. We know that some homes work positively with people who use drugs, even if they are not ready to stop using drugs. For example, in one care home that took part in our research, a resident “occasionally liked a spliff”. The care home had purchased a safe storage box for the resident’s room to keep his drugs in, but he wasn’t allowed to smoke on the premises. This in keeping with the law relating to drug use in residential accommodation.

Some homes advertise that they care for people with alcohol or drug problems but, because alcohol and drugs are combined in one category, some may only care for people with alcohol problems. You can search for these homes by going to www.cqc.org.uk/care-services/find-care-home and selecting ‘substance misuse’ in the list of specialisms. These homes may be more understanding about drug use. But our research raises questions about whether some of these homes can reasonably be described as providing specialist care for people with drug problems and, during our recent survey, 63% said they would not accommodate people who were not ready to stop taking drugs.

Before you move into the care home you might like to ask the following questions. The relevance of each question depends on your individual circumstances, for example, what type of drugs you are using and whether abstinence is a goal for you right now.

• Does the care home accommodate people who use drugs?
• Does the care home have a drugs policy?
• If someone moves into the care home and is using drugs, will there be any conditions (e.g. they can’t use or store drugs on the premises)?
• Has at least one member of staff received education/training related to drug problems?
• How many people with drug problems has the home cared for?
• Does the care home accommodate people with drug problems for whom abstinence is not a goal?
• Does the care home have staff trained to administer naloxone in case someone overdoses on opioids like heroin or methadone?
• Can the care home provide injecting equipment?

Care homes must fulfil their health and safety obligations and meet their duty of care to residents, visitors and staff. They should carry out an assessment to find out whether they can care for the person safely and effectively. If you have been assessed by the local authority as needing a care home but you haven’t been able to find a home that will accommodate you, the local authority may be able to work with you to find a suitable placement or alternative care options.

We recommend you discuss your drug use with the care home and ask them about their drugs policy before you move in. Otherwise, you may be evicted if they find out you are using drugs. Being evicted could make it more difficult to find another home.

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What if I’m being prescribed methadone or buprenorphine?

If you move into a care home, the care home will support you to continue taking medication you are being prescribed, and this is likely to include methadone or buprenorphine. There are laws and professional standards that set out how medicines should be managed in care homes and special regulations for controlled drugs such as methadone or buprenorphine.

It is important for the independence of people living in care homes that they are involved as much as possible in taking their medicines including methadone or buprenorphine which are used to manage opioid dependence. People working in health and social care (practitioners) will carry out an assessment and this should involve the person who is living in the care home, care home staff and, if the person wishes, their family members. The person's GP, pharmacist or drug service may also be involved. The assessment might include questions like:

• discussing what the person would like
• checking whether there will be a risk to the person (or other residents, visitors and staff) if they are responsible for taking their own medicines
• checking how able the person is to take their own medicines
• determining how the medicines will be stored (this is usually in a lockable cupboard or drawer in the person's room).

In some cases, the person prescribing your methadone or buprenorphine may require that taking the medication is supervised, particularly at an early stage in your treatment. Supervised consumption helps confirm that you are taking the prescribed dose and checks that the dose is correct (i.e. neither too high nor too low). It also helps ensure that the prescribed dose is not being shared, swopped or sold.

Supervision of methadone can only be carried out by community pharmacists or healthcare professionals who have the necessary training or experience. Care home staff are not usually trained or experienced in the supervision of methadone or buprenorphine. However, care homes may be able to arrange for a qualified professional to come into the home to supervise your methadone or buprenorphine or support you to attend a community pharmacy that dispenses methadone or buprenorphine.

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What support should I receive if my goal is to stop or greatly reduce my drinking or drug use?

If you are dependent on alcohol or drugs and would like to stop or greatly reduce your drinking or drug use, you should have easy and timely access to a specialist alcohol and drug service in the community or equivalent specialist support in the care home. You should not try and do it on your own or without the input of a professional who has the correct expertise, especially if you drink heavily, because this can cause dangerous withdrawal symptoms. You have a right to be treated for any withdrawal symptoms you may experience. If necessary, the professional providing the specialist support should visit you in the care home.

If you feel you might benefit from attending a peer support group, the care home may be able to support you to access one online or in person.

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What if I don’t think I’m being treated with dignity and respect?

When people are being cared for in a care home, staff must treat them with dignity and respect at all times. This includes being treated in a caring and compassionate way. Staff must respect people's personal preferences, lifestyle and care choices, including alcohol and drug use, provided this can be done safely and within the law.

You can get free and independent advice about your rights from Care Rights UK.

• Telephone: 020 7359 8136
• Email: helpline@carerightsuk.org
• Website: https://www.carerightsuk.org/
• Monday to Friday - 9.30am-1pm
• Thursday evenings - 6pm-8pm

You can also provide feedback on your care to the Care Quality Commission: Give feedback on care - Care Quality Commission

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