Legal marijuana and nursing homes

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Carlo Calma

Marijuana usage among the elderly has become a growing trend, as more and more states decriminalize the use of the substance — creating a delicate situation for many skilled nursing facilities (SNFs) and senior living providers.

To date, 29 states, including Washington, D.C., have legalized the medical use of marijuana, and California recently joined a smaller group of states that allow the recreational sale and consumption of the drug.

In terms of the growth in usage among the older adult demographic, findings by researchers from the New York University School of Medicine and Columbia University indicated a 250% relative increase of cannabis usage by adults age 65 and older.

With medical usage on the rise among the elderly — particularly for those who take the drug to manage pain — SNFs and senior living providers must work hard to not only comply with state and federal laws, but to also combat the stigma associated with marijuana, according to Dr. Zachary Palace, chief medical officer at Hebrew Home at Riverdale.

Based in the Bronx, New York, Hebrew Home at Riverdale is a SNF owned and managed by New York-based RiverSpring Health.

“Looking at medical cannabis as a recreational drug can limit people’s objectivity of the real benefits it can have when it’s used as a pharmacological agent [and] to treat specific diagnoses,” Palace told Skilled Nursing News. “The stigma associated with it, due to its … abuse recreationally — we need to try to remove that stigma.”

State and federal laws

Removing the stigma attached to marijuana can be a difficult undertaking, as each state has its own individual laws mandating the medical use of the drug.

In New York, for example, patients must first be certified by a physician to obtain the drug. Afterwards, they must apply with the New York Department of Health to obtain a registry identification card.

At Hebrew Home at Riverdale, the only two formats in which patients can take the drug is either in tincture form — an oil-based solution that is administered under the patient’s tongue — or in oil-filled capsule form, Palace explained.

But in addition to complying with state laws, Hebrew Home at Riverdale must also navigate through strict federal laws.

“As a SNF, we are required to follow federal guidelines in order to be able to accept Medicare and Medicaid funds for providing services for our patients, so we are held to the federal guidelines for which cannabis is a Schedule-I substance,” Palace said. “As such, having a Schedule-I [substance] in our facility’s possession would be in violation of the federal law, as well as the facility administering medicinal cannabis.”

To circumvent these federal concerns, the facility had to address how the substance was stored, and how it was administered, Palace explained.

“Our policies and procedures provide that for patients who qualify for medicinal cannabis, that they are required to maintain it in an area that is deemed to be their own personal property,” Palace said.

These patients are provided with a lockbox in their room to which only they have the key, making the storage unit their own personal possession.

With respect to administering the controlled substance, the facility requires that the patient self-administer the medical cannabis.

“If they’re not capable of self-administering the medical cannabis, then they are, by New York State law, allowed to designate up to two caregivers who would administer it for them,” Palace said.

These designated caregivers can be a family member or friend, who must also register with the New York Department of Health.

Managing and tracking

Because patients at Hebrew Home at Riverdale are self-administering the drug, the facility does not monitor the patient as they consume the controlled substance. However, staff are trained to make assessments, according to Palace.

“We do follow-up with the patient in terms of how they perceive they’re doing, if they feel a benefit from it, whether they want to continue with it or not, and their own subject to feeling of medicinal benefit,” he said.

To prevent abuse, staff are also trained to spot unusual behavior among patients who use the drug.

“If nurses observe anything out of the ordinary … that would be reported to the physician on the floor,” Palace said.

At Balfour Senior Living, medical marijuana is administered by nursing staff following a doctor’s order for the treatment.

There, staffers track usage through medication administration records (MAR), and the substance is stored and locked in medical carts at nurses’ stations, according to Eric Meyer.

Meyer serves as the executive director for the Louisville, Colo.-based  operator of continuing care retirement communities (CCRCs).

“The MAR indicates how to administer [and] how much to administer to that resident,” Meyer told SNN. “The nurse administers [the substance] and then documents how much is given to the resident, so it’s pretty much measured out.”

Providing tools similar to MARs is one of the services PDI Medical provides to patients and nursing staff. The Buffalo Grove, Ill.-based medical marijuana dispensary has become a supplier for senior care providers, and continues to make partnerships within the industry.

“I have a medication flow sheet that gets filled out and orders for products … how it’s given, and how often it’s dosed for the nurses to adhere to — very similar to a medication flow sheet for any kind of medication that gets administered,” Joseph Friedman, chief operations officer at PDI Medical, told SNN. “We do that and then we also have all of the necessary processes in place for patients and caregivers to become registered with the state.”

A furious outcry

For Friedman, education is key to combatting the stigma that persists with the usage of marijuana in the medical setting. This is especially true as U.S. Attorney General Jeff Sessions has doubled down on the Trump administration’s opposition to recreational use of the drug, and as the Rohrbacher-Blumenauer Amendment — a provision protecting medical marijuana programs in states from federal interference — is set to expire on January 19.

“If [the government] rescinds [the amendment] and removes protections for these 70-year-old ladies that are walking into my dispensary, or moms that have these kids whose seizures are being controlled with medical cannabis, I think that’s going to create a great, furious outcry from [those who] are getting a benefit,” Friedman said.

However, the medical and long-term care industries realize the medicinal benefits of the drug, as a study published in the Journal of Post-Acute and Long-Term Care Medicine suggests that legal access to cannabis may reduce the use of multiple classes of dangerous prescription medications.

“I think there’s a lot of validity to the use of medical cannabis for its indicated diagnoses,” Palace said. “Any medication can be abused, and medical cannabis is clearly no different. But when it’s prescribed for its approved indication, it can be a very effective alternative.”

Written by Carlo Calma

Flowers, fresh ideas are in bloom

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The Dementia Caregiver's Little Book of Hope [Kindle Edition]

Here is an idea for your facility or home

By VICTORIA DUGGER, Sentinel-Tribune Editor

For residents and staff of Wood Haven, everything's coming up roses. And petunias. And zinnias. And geraniums.

That's because a concerted effort to beautify the grounds and involve residents came into bloom this spring. The KaBloom program, thought up through a group effort by programming staff and administrators, saw well over 300 flowers and vegetable plants planted at the care facility, 1965 E. Gypsy Lane Road, Bowling Green.

"It's been known that gardening has been able to lower blood pressure and increase brain activities and give a good general feel to whoever is doing it. We are doing all kinds of different activities. The KaBloom program pretty much came out of getting the residents outside on nice days in May and to get the employees involved and the families involved," said Jeff Orlowski, Wood Haven's administrator. "We're completely different than we were three years ago at Wood Haven. We wanted to get more colors outside and show this is an inviting place and wanted everybody to take pride in living here, working here and visiting here."

The residents continue to take care of the plants that have been installed, and some tend to elevated beds that eliminate the need to stoop and kneel when they garden. Orlowski said some of the raised beds contain herbs and vegetables that the residents can take care of and eat. KaBloom is also spurring more activities beyond planting and tending, and some residents are making garden stones to be placed throughout the grounds.

"The whole focus of these activities, and this is our overall goal at Wood Haven, is providing an outstanding experience, and activities are so much a part of that," Orlowski said. "We brainstormed with a bunch of ideas and kind of used the inspiration of a cruise ship. On a cruise ship, there are nonstop activities for all ages to enjoy, and we kind of wanted to use that as a guideline. We asked, 'what can we do to get more people involved, to have more activities' and so forth."

Many staff members and numerous residents and their families were involved in the initial effort this spring. The plants that can be seen around Wood Haven include mock roses, petunias, geraniums, zinnias, daisies, impatiens, basil, lavender, thyme, chives, parsley, tomatoes, green peppers and sunflowers, "for Bob," Orlowski said.

Community Relations Director Chris Stearns notes resident Bob Boyer is very involved in the KaBloom program and he also requested hollyhocks to add an additional punch of color.

"He's very into the courtyard, the flowers and the vegetables out there," Stearns said, "He told them he wanted hollyhocks out there. I haven't seen any flowers yet, but they did plant some hollyhocks out there for him."

Stearns said the plants, which are a mix of perennials and annuals, were obtained from Joseph's Greenhouse for a discount. Orlowski said the KaBloom program will be repeated annually.

"We'll invite families, staff and community to come out and get their thumbs dirty," he said.

The flowers and vegetables are just part of what's currently blooming at Wood Haven, which has been in existence in its current location since 1971.

Orlowski said that a host of renovations to update the facility are underway, and they are in phase three of five phases.

"We are scheduled to be completed in September. They are currently working on phase three. Phase three and four involves redoing the hallways and phase five will be the main lobby. We are doing the main lobby, the hallways, the dining room and we have already painted the residents' rooms," he said. He has a long history with Wood Haven, as he used to volunteer at the center while attending Bowling Green State University in the mid-90s, and noted the building needed updates.

"We've updated the residents' rooms," Stearns said. "It's more modernized."

One feature that Orlowski is particularly excited about is the upcoming transformation of the facility's dining room. In an effort to give residents more choices, the dining room will become two restaurants.

"We're actually going to be turning our dining room into two restaurants. One will be called the Wood Haven Grille where you can get traditional meals and the other one is going to be called Le Cafe Au Bois, which is going to be a French cafe concept. That will be open for breakfast and lunch, and on nice days, residents can eat on the cafe's patio outside, which I think is a first in this area," Orlowski said. Families and visitors will be able to eat meals with their loved ones at the restaurants with residents.

Orlowski notes the support of the Wood County commissioners as being a key help in bringing the updated vision of Wood Haven to fruition.

"It's great that the commissioners are 100 percent pushing this and supportive of this. We are very fortunate that they really care about the residents here at Wood Haven and making it a success," Orlowski said.

Wood Haven is a skilled and intermediate nursing facility that offers both long-term care and short-term rehabilitation. The 95-bed facility is both Medicare and Medicaid certified and accepts most private insurance. Wood Haven Health Care is owned and operated under the Board of Wood County Commissioners.

It's history in the community is long. In 1868, the Wood County Board of Infirmary Directors purchased a 200-acre farm on which to build a three-story building to house the county infirmary. Additions in 1892 included a barn, staff quarters and a new resident wing. In 1913, the governing powers were transferred to the county commissioners, and the Infirmary became the Wood County Home in 1919.

In 1971, the county home was relocated and replaced with a modern 125-bed, single-story brick building and dedicated as the Wood County Nursing Home. The original building and acreage was turned over to the Wood County Historical Society in 1973 and currently houses the Wood County Historical Society and Museum.

The Importance of Nursing Home Activities

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Activities directors, caregivers, and healthcare professionals,here is an article
that should interest you



by Sarah Matthews
Many people think a nursing home is a nasty, soul-less place where residents either lie in bed or sit endlessly in a rocking chair, waiting out their days until the inevitable happens. The reality – at least in a good nursing home – is far from that. Many people enter a nursing facility when they have lots of life in them yet, and look forward to years of fun and companionship, with daily activities to keep both their bodies and brains active

In fact, studies have shown that regular stimulating activities help half a decline in depression among nursing home residents, staving off dementia and keeping their spirits as well as their bodies alive. Activities are vital to keeping up residents’ mental and physical wellbeing, and even staff and visiting family and friends can take part – willingly – in the activities a good nursing home provides.

If you are looking to find a nursing home for a loved one who’s still capable of loving life, it’s important that you discover what types of activities are on offer – and how often they are available. In fact, nursing homes that take Medicare or Medicaid patients have to have a designated activities director to get the proper funding. But how well they carry out their job is something you will have to assess yourself…

“I think the residents I talk to who tell me there is nothing for them to do but sleep, eat and read the paper are looking for purpose to get up every morning,” writes Vicki30CNA on the allnurses.com website. “They do not look forward to the next day as they all run together. And our residents that are not as able get little to no stimulation besides toileting and shower. A few fold bibs every AM and see it as their ‘job’, but that job takes them a half hour. Then what, they tell me. I hate to see their last years months days so empty and without purpose. “

If you want to avoid this from happening to someone you love, read on. A wide variety of activities should be on offer at every nursing home, so make sure this is the case when considering a nursing home. Some residents may enjoy going out for lunch several times a week, shopping or visiting the local art gallery or cinema. Others will prefer on-site activities that stimulate their hearts and minds.

It might be a good idea to have a chat with the nursing home activities director to see what’s available. Here is just a handful of activities that a good nursing home should willingly provide…

Self-Starting Activities

Great as they require little preparation and can be planned by the residents themselves. They include:

Gardening. Depending on residents’ scope of mobility and interest, gardening can be as rigorous or as gentle as they want it to be. If there is a real garden that’s fantastic, if not then hanging baskets, small pots of herbs and indoor cactus or orchid collections can still keep the interest going.
Arts and crafts. Even older residents enjoy making something – especially when they feel it’s going to a good cause. Knitting blankets, making baby clothes or entering art or photographic contests can keep people busy and help them make a contribution to society at the same time.
Games. You might think bingo is the most popular nursing home game – and you’re right. But there’s more to competitive games than just bingo. How about bridge, mah-jong, canasta or chess – the sky’s the limit. One-on-one games are great for encouraging closer relationships among residents, and group games are also good for fostering a sense of community.
Musical-based activities. Don’t limit the fun to sing-alongs – you may even have professional musicians among the residents, or you may discover some hidden talents…

Volunteer-led Activities

Nail care, Bible study, hair salon day – all you need is a volunteer with a skill – and the time to make a difference in someone’s life…

School groups. It may sound cliched, but young people have a lot to learn from oldsters. This can take the form of Granny teaching little Albertine to knit, or visiting a school once a week and reading to the little ones. Many schools, in fact, encourage people from the outside – assuming they have been police-checked – to help kids who need a little bit extra with one-to-one reading or math exercises.
Local community groups. People who have a special talent often enjoy visiting nursing homes on a regular basis and sharing their skills. This can be giving residents massages or reflexology sessions, teaching them a special aspect about gardening, or giving a talk about growing orchids.
Scout groups. Often, scout troops visit nursing homes – gathering together to do something fun such as bake chocolate-chop cookies or build a birdhouse. The two groups can learn from each other and make use of each other’s skills and talents.
Local charities. People from charities often give their time to older people, whether that means preparing outings or having a Pet Therapy day when the local vet or employees from the animal shelter bring animals to visit.
Nursing Home-Led Activities

Themed events, such as birthdays or religious celebrations. Some creative residents get together with staff to plan events such as Hawaiian nights, Chinese New Year celebrations or Halloween or Thanksgiving festivities. Friends and family can be invited to join in – perhaps even residents of neighboring nursing homes as well.
Outdoor activities such as barbecues, picnics or a stroll through a park or garden center. In some cases volunteers may be called on to help residents with mobility issues.
A bit of culture. Going to the theatre, opera, museum or cinema can take some planning, but its worth it. Again, volunteer helpers and drivers may be necessary.
Alternative therapies. Everyone can benefit – as long as they’re not too invasive. Massage, yoga or Tai Chi can help residents have fun, get fit and relax.
Keeping people as happy and healthy as possible for as long as possible. both physically and mentally, should be the goal of every nursing home. Activities should be varied and interesting, suited to the different abilities, needs and interests of the residents. They should be not only fun but worthwhile, enabling residents to form new relationships, develop new skills, and keep up their fitness levels.

“We have a ’senior prom’ in May, where the local single Marines escort our residents (wheelchairs and all) for dancing and food, writes CoachCathy on the allnurses.com site. “We have gowns and suits donated by the local thrift stores. Local hair parlors come and do the hair and nails. Everyone has a blast.

“And we had a Winter wonderland theme last December – we made snowmen with diaper boxes painted white – and had a snowman decorating contest. The residents had an indoor snowball fight (with cotton balls). It was so much fun!”

Nursing homes of the future

Business Innovation Factory
Here is an interesting article about nursing homes of the future

Volunteers are important

If you live in the Tampa, Florida area, make sure to check out this article.
Making the World a Better Place

Want volunteers visiting your nursing home?

Saturday, Oct. 25, marks the 18th annual Make a Difference Day, a national event sponsored by USA Weekend magazine.

Millions of Americans are expected to take part by volunteering for a host of activities to enrich their neighborhoods and communities.

Whether by knitting sweaters for the poor, entertaining nursing-home patients..

Contact your local paper or city hall to let them know that your facility would like volunteers to visit your residents

click here to read the whole story

How are you celebrating Residents' Rights Week?

Hopefully all activities directors throughout the country will be showcasing their long term care facility click here for a must read article