Home Care Providers Shape Policies Around Conflicting Marijuana Laws

As the nation undergoes a changing marijuana regulatory landscape, rife with opposing state and federal statutes, home health care providers are left to determine their own policies on the Schedule 1 drug as it gains approval in more and more states.

In Arizona, passage of the Arizona Medical Marijuana Act in 2010 encouraged some providers to implement their own medical marijuana policies based on the state’s legislation.

Comprehensive Hospice and Palliative Care offers an in-house doctor who will recommend marijuana for patients who qualify under state law.

To avoid trouble with Medicare, which often pays the bills for 99% of the hospice care provider’s patients, the hospice requires the patient or someone else to send the recommendation to the state Department of Health Services for final approval, and to pay the fees, says CEO Charlotte Igo, adding that hospice care providers have all approached the legislation differently.

“Like meatloaf, everyone has a recipe and does it a little differently,” Igo says, adding that the provider just added medical marijuana certification to its programming June 1.

So far, 20% of clients have expressed interest, she says. Comprehensive Hospice and Palliative Care has an average of 140 clients.

The distinction between the drug’s illegality at the federal and state levels, in states where applicable, is key, says healthcare attorney Fred Miles, of Denver, Colo.-based law firm Miles & Peters. In Colorado, the first state to make marijuana legal for both medical and recreational purposes, senior living providers have chosen different ways to approach the state’s marijuana laws as well.

Providers that utilize Medicare, Medicaid or other federal funds run a risk of losing federal funding should they create policies that condone usage of something federally classified as illegal, Miles says.

And while those who lobby in favor of medical marijuana laws say federal action against senior living providers who align with state laws is highly unlikely, Miles says even publishing procedures on the issue can engage a “slippery slope.”

Miles visits local and national long-term facilities to discuss the issue through his presentation “Are Nursing Homes Going to Pot?” and says a growing number of providers, and residents, have questions about marijuana use.

Many argue that marijuana helps in the management of chronic pain and other ailments, which are common health concerns for seniors receiving home health care.

Last year, 44% of Americans aged 50 to 64 and 17% of those 65 and older had tried marijuana, according to a Gallup poll. That’s more than double the amount of seniors who had tried marijuana in 1999 — 22% and 3% by age group, respectively.
And as the senior population is expected to double by 2025 as baby boomers age, marijuana activists say they expect marijuana use by seniors to grow.

“As more people who are comfortable and/or experienced with marijuana use enter senior living communities, it will require administrators to develop new policies for how, when and where residents may consume marijuana,” says Marijuana Policy Project Communications Manager Morgan Fox.

Many providers implement a “Don’t ask, don’t tell” policy, Miles says, adding that it’s much easier to look the other way than address the issue head on.

“Until the federal government takes an active role, facilities are left to fend for themselves,” he says.

Igo points to the health and cost benefits of medical marijuana when explaining why the hospice provider offers access to the drug.

“If [marijuana] is half as good as it is presented to be, it will alleviate half of the symptoms alone or in conjunction with other medicines that our clients have,” she says, adding that the drug is low cost, especially when compared to other drugs like morphine, and marijuana be ingested a number of ways.

“One of the last things a hospice patient can enjoy is food — if we can help terminal patients enjoy a hot fudge sunday we should do everything we can to help them enjoy it,” she says, noting that marijuana is known to help increase appetite. “If it increases enjoyment of food and decreases anxiety, why wouldn’t we offer that?”

In Massachusetts, senior living providers are asking similar questions with the recent passage of The Massachusetts Act for the Humanitarian Medical Use of Marijuana, which took effect Jan. 1 of last year.

Because facets of the acts have yet to be implemented, such as dispensaries or an ID card system, many potential consumers don’t have a safe way to access marijuana for medicinal purposes, says Matthew Allen, executive director with Massachusetts Patient Advocacy Alliance.

But, many in the senior living industry are expressing interest as the new regulation unfolds, Allen says.

“We’ve had a lot of interest from assisted living and hospice organizations,” he says. “Providers are interested to learn about existing cases where seniors found benefits from medical marijuana, and we know from clinical studies that for folks with severe pain medical marijuana can help increase quality of life.”

Written by Cassandra Dowell