Alcohol in Care Homes: How Wales Is Balancing Risk and Rights

Alcohol in care homes sits at the heart of one of the most quietly difficult balancing acts in Welsh social care. When a frail resident, close to the end of her life, asked staff to take her to the supermarket to buy cider, they made it happen. Her wish was clear. “When residents have wishes, we do what we can to enable those wishes to happen,” a staff member told researchers. A new study published in March 2026, commissioned by Alcohol Change UK and carried out by Practice Solutions and Age Cymru, examines how care homes across Wales manage alcohol use in residential care for older people and what still needs to change.

Why Alcohol in Care Homes Still Matters

For many older people, a drink is not just a drink. It is part of who they are. A glass of red wine with dinner. A Baileys with friends on a Tuesday afternoon. A beer while the rugby is on. These habits connect people to their past, their social lives, and a sense of normality.

“The thought of being able to have a drink, it makes it more homely. You’re not restricted,” one resident told the research team.

Another put it simply: “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.”

Staff echoed the point. One described three ladies who meet a couple of times a week, Baileys in hand, chatting. “It gets them out of their rooms,” she said. Another manager spoke about residents enjoying a beer during the rugby. “It is part of a natural thing that people did or do, isn’t it?”

Alcohol use in residential care, for many residents, is tied to identity, community, and quality of life. Moving into a care home does not erase that. But alcohol in care homes is not straightforward either. As people age, the body processes alcohol more slowly. Medications interact with it. Falls become more likely. And when someone lacks mental capacity, questions around choice and consent grow legally and ethically complicated.

The Numbers Behind Alcohol Use in Residential Care

The study gathered responses from 37 care home professionals across Wales, conducted site visits to seven homes, and interviewed senior managers and social care leaders at the National Social Care Conference.

What it found was a sector driven by genuine, person-centred values but operating without the structures to match.

Nearly six in ten respondents (59%) said their primary goal when managing alcohol in care homes is to promote resident autonomy and choice. At the National Social Care Conference, 88% of social care leaders affirmed that residents have the same right to drink, in some capacity, as they would at home.

Yet only 46% of responding homes have a written alcohol policy in place. More than half either lack formal guidance or have staff who are unaware of it.

The training picture is more striking still. Just 30% of respondents said their staff receive any training on alcohol-related issues. Only 19% have been trained specifically on supporting residents with alcohol dependency. And yet 43% of those surveyed had already supported at least one resident with alcohol dependence, meaning almost half of homes are navigating one of the most demanding areas of care practice without the training to do so with confidence.

Public Health Wales data from 2025 adds wider context: alcohol-specific deaths among people aged 50 and over rose by 15.6% in a single year, reaching 562 in 2023. Older adults now account for two thirds of all alcohol-related hospital admissions in Wales. These are not abstract figures. They will, increasingly, arrive at the doors of care homes.

When Alcohol in Care Homes Reaches a Crisis Point

Most of the time, care homes find a way to manage. Staff draw on experience, judgement, and a genuine commitment to residents. But the research includes accounts of situations that pushed everyone involved to the edge.

One senior manager described supporting a gentleman who drank a bottle of red wine every night. Staff were worried about his health, his safety, his risk of falls. But he had full mental capacity and the legal right to make that choice.

“Our team naturally want to care for somebody,” the manager said. “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.”

Another account described a crisis involving a resident with both alcohol dependency and mental health difficulties. The situation escalated over a weekend. Staff contacted agency after agency, eleven in total, without securing any support.

“They felt very vulnerable,” said the senior manager recounting the experience, “because they weren’t skilled enough to deal with that situation.”

This is not a picture of failure. It is a picture of a workforce trying to do right by its residents, without adequate backup when alcohol in care homes turns complex.

One of the more nuanced findings in the report concerns the use of non-alcoholic drinks as a substitute for alcohol, sometimes without residents being fully aware of the difference.

Some staff described offering residents a glass of wine without specifying whether it was alcoholic. Others described giving residents with dementia non-alcoholic wine to manage fall risks, allowing them to enjoy the ritual without the physical danger.

“It is amazing the placebo effect when residents think they are drinking alcohol, but they are not,” one staff member explained.

The practice divides opinion among those working in alcohol use in residential care settings. When asked, 47% of social care leaders at the National Social Care Conference said honesty is required and rejected substitution outright. A further 18% would permit it if clinically justified, and 18% only where a formal best interests decision had been recorded.

For residents with capacity, offering a drink without disclosing whether it contains alcohol raises clear questions about informed consent. For those without capacity, the picture is more complicated still. The report calls for clearer ethical and legal guidance on this practice across the sector.

The research also looks ahead, and what it sees should give the sector pause.

Several homes reported a rise in younger residents presenting with alcohol-related brain damage, particularly Korsakoff’s syndrome. One manager described a new referral for a 59-year-old woman with Korsakoff’s, alongside two other men already in the unit with alcohol-related dementia. “Since Covid, we have seen an increase,” she said. “Staff need to understand how best to care and support these people.”

These residents create a particular difficulty. They are often younger and more physically able than the typical care home resident, placed in units alongside people in their 80s and 90s. The picture of alcohol in care homes is shifting, and some managers are already calling for specialist provision to reflect that.

Meanwhile, those currently working in the sector are rethinking what future residents will expect. One senior manager, aged 66, was candid: “I like a glass of wine on the weekend. Those are things that are becoming normal patterns of life for us. And that’s going to shift our provision.”

The conversation around alcohol use in residential care is not static. The population entering care homes in the coming decade will bring different drinking habits, different expectations, and in some cases, experience of other substances alongside alcohol.

What Needs to Change for Alcohol in Care Homes

The report sets out seven recommendations spanning care home providers, Care Inspectorate Wales, Area Planning Boards, placement commissioners, and the Welsh Government.

For providers, the report recommends developing specific alcohol in care homes policies covering storage, care planning integration, guidance on supporting dependency, and escalation pathways when situations exceed in-house capability. It also calls for alcohol awareness training covering medication interactions, the Mental Capacity Act, signs of withdrawal, and how to hold difficult conversations with residents and families.

For Care Inspectorate Wales, the report suggests inspection activity should more consistently examine whether homes have proportionate arrangements for alcohol-related risk in place.

For the Welsh Government, the recommendation is care-home-specific operational guidance to support implementation of the 2021 Alcohol-Related Brain Damage Treatment Framework, alongside a review of whether commissioning arrangements are keeping pace with rising demand.

One recommendation stands out as particularly pressing: Area Planning Boards should review the availability of specialist alcohol support for care homes, including crisis support outside office hours. The account of eleven agencies contacted on a weekend without result is not a data point that can be left without a response.

A Sector That Deserves Better Support

It would be easy to read this report as a critique. It is better understood as an invitation.

The care home sector in Wales is genuinely committed to treating older residents with dignity and respect. Homes are working hard to enable alcohol use in residential care in ways that honour individual choice. The gap is not one of intention. It is one of infrastructure: clearer policies, better training, and more accessible support when alcohol in care homes becomes difficult to manage.

As one manager put it: “We are more than happy to support people. We want to give people the right support. But we also need the right support to enable that to happen too.”

That is not an unreasonable ask.

Source: dbrecoveryresources