HCBS: Alcohol and Tobacco Use

Oregon Department of Human Services (ODHS) released a provider alert on April 25, 2024, that provides guidance to home and community-based services (HCBS) licensed providers regarding resident use of alcohol and tobacco. View a summary of this information below, or view the original alert here.

Providers of Home and Community-Based Services (HCBS) licensed by the Oregon Department of Human Services, Office of Aging and People with Disabilities (APD) may have residents who drink alcohol and/or use tobacco. APD has developed two documents to assist providers with these situations, as follows:

1. Flowchart on Alcohol/Tobacco Use in Residency Agreements
2. Guidance for Providers on Alcohol/Tobacco Use in Residency Agreements

Both documents are available on Oregon’s HCBS website, under the APD Program. Scroll down to “Provider Specific” then “Residency Contract.”

As always, providers may contact their Policy Analyst with specific questions:
CBC: cbc.team@odhsoha.oregon.gov.

Guidance for APD Providers on Residency Agreements (RA)

This document is meant to provide guidance to Home and Community-Based Services (HCBS) Providers licensed by the Office of Aging and People with Disabilities with the direction they give in their RAs on the use of tobacco and/or alcohol by their residents.

TOBACCO: For settings that have language in their RA on tobacco, consistent with Oregon Indoor Clean Air Act

• Prior to move in and at regular intervals, the provider must assess the individual’s needs and wants.
• From the assessment, the provider discovers if the individual needs support to do their preferred activities safely.
  • No: Individual enjoys their preferred activities.
  • Yes: Provider determines if an Individually-Based Limitation (IBL) is needed (i.e., if there is a moderate risk to individual/others’ health/safety).
    • No: Individual enjoys their preferred activities with reasonable help from provider.
    • Yes: Provider requests IBL for “control of own activities” and addresses how to mitigate health/safety risk.
      • Is IBL in place?
        • No: Individual refuses to consent or revokes consent to IBL, resulting in possible move out.
        • Yes: Provider reviews IBL regularly to ensure provider’s and individual’s needs are being met.

See also: APD HCBS Residency Agreement Flowchart (Tobacco)

Note: Scenarios that do not fit this model will need to be determined on a case-by-case basis.

ALCOHOL: For settings that have language in their Residency Agreement on Alcohol

• Prior to move in and at regular intervals, the provider must assess all aspects of the individual’s needs and wants.
• From the assessment, the provider discovers if the individual needs support to do their preferred activities safely.
  • No: Individual enjoys their preferred activities.
  • Yes: Where will/does individual drink alcohol?
    • Areas allowed in Residency Agreement (e.g., own room): Individual enjoys their preferred activities with reasonable help from provider
    • Areas not allowed in Residency Agreement (e.g., common areas)
      • Provider determines if an IBL is needed (i.e., if there is a moderate risk to individual/others’ health safety)
        • No: Possible move out for individual
        • Yes: Provider requests IBL for “control of own activities
          and addresses how to mitigate health/safety risk
          • Is an IBL in place?
            • No: Individual refuses to consent or revokes consent to IBL, resulting in possible move out.
            • Yes: Provider reviews IBL regularly to ensure provider’s and individual’s needs are being met.

See also: APD HCBS Residency Agreement Flowchart (Alcohol)

NOTE: Scenarios that do not fit this model will need to be determined on a case-by-case basis.

 **Make sure to view the original provider alert here to view the flowcharts associated with each scenario. 

For HCBS questions, contact  

AFH-specific: apd.afhteam@odhsoha.oregon.gov
CBC-specific: cbc.team@odhsoha.oregon.gov
General questions: hcbs.oregon@odhsoha.oregon.gov
Medicaid Case-Specific: Contact the individual’s Medicaid Case Manager