Crafting marijuana policies in senior housing is tricky, but it’s becoming more important with each passing year.
There’s a good chance of at least some marijuana or cannabis product use among any senior housing resident population, according to Dr. Cari Levy, a professor of medicine at the University of Colorado Health Sciences Center and president of AMDA – The Society for Post-Acute and Long-Term Care Medicine Board of Directors.
“It has become much less stigmatized. Seniors talk to their peers, and they say, I got relief when I used this on my shoulder or my knee,” Levy said during a Senior Housing News webinar on the topic. “I would say probably 2 in 10 have used some formulation [of marijuana or cannabis products].”
As more states allow pot use, the chances of resident use will only go up. Today, 10 states — Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont and Washington — have legalized both medical and recreational marijuana, as has Washington, D.C. On top of that, 33 states have made medical marijuana legal.
And yet, there are many senior living providers that simply don’t know where to start. After all, marijuana use is a complex subject, and one that isn’t always talked about in the open due to its murky legal status. But, providers can’t ignore the issue for much longer.
“Don’t be afraid to tackle this issue,” said Gabriela Sanchez, a shareholder and co-chair with the senior living and long-term care team at Seattle-based law firm Lane Powell PC. “Whether you’re going to allow marijuana or not, medicinal or recreational, it’s really important that you have robust policies that talk about how you’re going to manage it in your communities.”
It’s for that reason SHN hosted a webinar about navigating the ins and outs of a successful pot policy. Here are some of the top takeaways from that webinar:
1. ‘No smoking’ is OK
One of the hang-ups providers sometimes cite surrounding pot use is that they don’t want to allow smoking on their campus. But providers can allow pot use without also allowing smoking or vaporizing, according to Angelia Brigance, senior vice president of operations at Chateau Retirement Communities. Based in Bothell, Washington, Chateau has three communities in the state.
“We do not allow any smoking or vaping of marijuana or cigarettes on the property. We just draw a really strong line on that,” Brigance said during October’s webinar.
With the wide availability of many different types of marijuana products these days, disallowing pot smoking is not only possible, but even logical on smoke-free senior living campuses.
“If they want to use marijuana, they can use edibles, they can use tinctures, they can use teas, they can cook with it. They just can’t smoke it,” Brigance said. “If somebody is smoking in their room and opens their door, that smoke gets into the hall. It’s about air quality.”
2. Storage and administration policies are vitally important
One of the most important rules regarding marijuana use at Chateau is this: Employees may not assist residents in taking marijuana, under any circumstances. The provider also doesn’t keep marijuana under lock and key for its residents.
“We don’t obtain anything for them, we don’t store it and we don’t help them consume it,” Brigance said. “We want to make sure we have clear lines in the use of marijuana at the communities. This is the bottom line.”
Chateau residents also can’t display marijuana in public areas, nor can they grow it on the premises. The reason for such a strong bottom-line policy has to do, in part, with that fact that while some states have legalized and decriminalized marijuana, it is still technically a schedule 1 drug under the Controlled Substances Act (CSA). Other schedule 1 drugs include LSD, heroin and cocaine.
Chateau worked with Lane Powell to craft its pot policies and help reduce its legal exposure.
“They made things much easier and clearer for us so that we can make sure we’re on the being alert and staying on the leading edge of what’s going on in our country today,” Brigance said. “And in meeting the needs of our residents, but still protecting us legally under the laws and regulations.”
3. Document, document, document
Even if a senior living provider isn’t helping residents use marijuana, they should generally know who is using it and adjust those residents’ care plans accordingly.
At Chateau, every new resident receives a pamphlet regarding marijuana policies at the community, and what the guidelines are for the state of Washington. Residents who say they want to use marijuana are also asked about their personal history with the drug, whether they’re taking it for medical or recreational reasons, whether they can self-administer it and how they plan to store it. That way, the community knows exactly who’s using what, and when.
“We’re addressing it from the first moment we meet someone,” Brigance said. “We want to make sure that we’re open to discussion, and that it’s not a judgement call.”
Chateau has different policies for residents who reside in independent living, assisted living and memory care settings.
“If they’re unable to administer or make decisions about administering it, we want to have that health care power of attorney be the one to determine if they’re going to use it, especially in memory care,” Brigance added.
For residents who want to use marijuana but also might be at risk of falls or other accidents, Sanchez suggests drawing up a negotiated risk agreement. The idea is to think of every unpleasant possibility, just in case something happens.
“You want to make sure you care plan around this, and don’t just stick your head in the sand and say everything will be okay,” she explained.
4. Parallels to alcohol
Most senior living providers already allow residents to use a controversial drug with side effects and health risks, and a growing number of them even help administer it in on campus. But that drug isn’t marijuana, it’s alcohol.
“I think there are a lot of parallels between alcohol consumption and the consumption of recreational marijuana,” Sanchez explained. “You can get intoxicated with both, both require some form of care planning to make sure the resident doesn’t get hurt, you can have addiction issues, and they both interfere with medication or care.”
Her point is this: many of the safeguards providers already have in place for alcohol can be used for recreational marijuana use, with perhaps a few tweaks here and there. For example, extra care must be given to residents who are on medications that could interact with other substances. Similarly, staffers must closely monitor residents who imbibe and then use motorized mobility devices such as electric scooters and wheelchairs.
5. Marijuana use isn’t without risk
Pot is trendy these days, and it can be tempting to throw caution to the wind as though full federal legalization is right around the corner. But even if this comes to pass sooner rather than later, it’s a good idea in the meantime to fully weigh the risks of allowing on-campus pot use.
“If residents are possessing in your communities, that could potentially open you up for some risk of law enforcement,” Sanchez said. “The penalties can be pretty intense and severe … and range from criminal prosecution to forfeiture of cars, assets, equipment.”
Allowing marijuana use also imperils facilities from getting federal or state funding such as Medicare or Medicaid dollars. Letting residents use marijuana on the premises could even cause some providers to run afoul of loan or lease covenants, or trigger litigation if an accident occurs.
So far, things have been quiet on the law enforcement and litigation side of marijuana use in senior housing. But that could change as more states move toward legalization.
“Right now, we don’t see a lot of this. It’s not as prevalent,” Sanchez said. “But, I think with more states coming online, you’ll see more of these issues in the future.”
When in doubt, Sanchez suggests getting guidance from your state government, or local industry groups that might have experience with marijuana policies.
Written by Tim Regan