‘Wet’ eldercare facilities: three strategies on the use of alcohol and illicit substances

Abstract

Wet eldercare facilities constitute a type of harm reduction arrangements where goals of abstinence are abandoned in favour of goals of increased wellbeing for older people with long-term substance use disorder. The fact that residents are acknowledged as being active in their substance use results in challenges; harmful activities are witnessed by the staff in a context that has actually been created by a social service agency. The aim of this article was to explore what professionals in wet eldercare facilities considered problematic in relation to residents' consumption of alcohol and illicit substances and what strategies they used to address these 'problems'. Particular attention was paid to approaches and strategies that addressed the challenge of being present at a facility where destructive behaviour and consumption of alcohol and illicit substances were part of everyday life. Data for the study consists of 12 interviews with managers and staff at five eldercare facilities with different sizes, organizational styles, and approaches. Qualitative content analysis was used to identify strategies that were used to handle the presence of alcohol and drugs under a 'cap of acceptance' deemed to be necessary for a wet eldercare facility. Three main strategies were identified and referred to as a) looking away, b) intervention and prohibition and c) intervention and distribution. In the final analysis, findings were brought into a typology for strategies, based on the two variables of acceptance and control, and the use of different strategies was critically discussed.

Out of the ordinary: Media reports on wet eldercare facilities

“…Representatives of social service organisations have argued that for older people with long-term alcohol problems, treatment is usually a waste of money ( Palm, 2009 ). Studies on the everyday reality of wet eldercare facilities associated with problems that could be described in terms of ethical dilemmas – acceptance of trouble and misery being weighed against a higher threshold that excludes people in need of care ( Harnett & Jönson, 2018 ; Lindgren, 2008 ). Positive reports on wet eldercare facilities, we would argue, provide the public and decision makers with a comfortable solution to a problem: older people with long-term alcohol problems living in misery – and being visible as homeless people in city centres.…”

“…Wet eldercare facilities constitute housing options for older persons with long-term alcohol problems and provide care but not treatment. Residents are accepted as being active users of alcohol, and staff members report that some also use illicit drugs such as amphetamine and hashish ( Harnett & Jönson, 2018 ). In Sweden, the City of Gothenburg has been at the forefront of arranging wet eldercare facilities for people above the age of 50 years with severe alcohol problems.…”

Finding a fair deal: Policies on alcohol and drugs at “wet” eldercare facilities

“…The facilities have a low threshold, meaning that it is accepted that residents will be active users of alcohol and drugs-hence the term "wet" facilities (McCann, Wadd, & Crofts, 2017). Some facilities allow residents to consume alcohol in their rooms or apartments but not in common areas; some accept residents returning home drunk, but prohibit the use of alcohol in the building; some purchase alcohol for residents and allow its consumption during social activities (Harnett & Jönson, 2020). Wet eldercare facilities usually have a "for-life approach".…”

“…Known tradeoffs include an acceptance of drug use and drug dealing, the consumption of alcohol in no-designated areas, fighting and threatening behavior (McCann et al, 2017;Vossius, Testad, Berge, & Nesvåg, 2011). Despite the concern with dignity and self-determination, residents may perceive attempts to regulate the use of alcohol and drugs (whether directly through bans or indirectly through the provision of pocket money) as paternalistic and humiliating (Harnett & Jönson, 2020;McCann et al, 2017;Thiesen, 2007). Real reduced consumption has also been a matter of debate.…”

Enabling positive framings of stigmatised settings: a neglected responsibility for social work

“…Wet care facilities exist in several European countries and constitute a form of harm reduction for older people with long-term substance abuse (Harnett & Jönson, 2020;Thiesen, 2007). Goals include increased dignity and well-being and residents typically live there until they die.…”