In hospitals and nursing care facilities across the country, patients are systematically denied access to medical cannabis, even if they are located in states where it is legal. The reason behind this is simple. As long as the vast majority of these institutions rely on funding from Medicare and other federal sources, they opt not to put those funds at risk by allowing a Schedule 1 controlled substance onto their premises.
One courageous trailblazer, however, has challenged this status quo. The Hebrew Home of Riverdale, a 735-bed skilled nursing facility located outside of New York City, developed an ingenious program that enables senior residents to access medical cannabis under New York state law, while the institution itself remains compliant with federal law.
Equal rights for nursing home residents
In a conversation with Hebrew Home CEO, Dan Reingold, he explained that immediately upon New York’s legalization of medical cannabis, it became a priority for him to ensure that Hebrew Home residents could benefit from it. He had observed firsthand how cannabis provided relief to his father while he was suffering from terminal cancer, which convinced him of its efficacy.
According to Reingold, “The residents of the Hebrew Home are citizens of the state of New York, and are entitled to the benefits thereof. And one of those benefits is to be able to use medical cannabis in the same way that a citizen of New York would be able to if they didn’t live in the Hebrew Home. Why should we be discriminating against residents of the Hebrew Home because they live in a facility?”
And he continues: “I feel that we have an obligation to protect and enforce the rights of residents in long-term care. And this is one of those rights.”
Legally compliant best clinical practices
After obtaining the full support of his board, Reingold and Dr. Zachary Palace, Medical Director at the home, developed a set of policies and procedures to enable residents to legally obtain and use medical cannabis. The Hebrew Home’s model and experience are described in a recently published article: “Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life,” which appeared in the journal of the Society for Post-Acute and Long-Term Care Medicine.
In the article, Reingold and Palace emphasize that skilled nursing facilities need to focus on “…simplifying medication regimens, avoiding polypharmacy, and eliminating medicines with potentially harmful side effects.” Introducing medical cannabis, they conclude, is consistent with that goal.
To remain compliant with federal law, the institution cannot purchase or store medical cannabis, although the home provides residents with individualized lock boxes to store their cannabis medicine. Residents must purchase their cannabis medicine on their own from a state-certified dispensary. For those who cannot travel, the New York certified Vireo dispensary offers Skype consultations and free delivery.
Residents must also self-administer their medicine, or have it administered by a caregiver who is not on the Hebrew Home staff. Because the Hebrew Home is a non-smoking facility, only orally administered medications (capsules or tinctures) are permitted.
Early on, the Hebrew Home offered a medical cannabis educational program for residents to dispel myths and explain its role in an overall treatment plan. A fact sheet describing the framework of the medical cannabis program was circulated to residents and their families.
Published findings
The article describes 10 residents who participated in the medical cannabis program, ranging in age from 62 to 100. Six had chronic pain, two, Parkinson’s disease, one, Parkinson’s disease and chronic pain, and one, seizures. In follow-up interviews, the residents receiving cannabis for pain reported a sustained improvement in chronic pain severity which resulted in concurrent opioid dosage reduction and an improved sense of wellbeing. Those receiving cannabis for Parkinson’s disease reported mild improvement with rigidity complaints, and the patients with seizures experienced a reduction in seizure frequency from twice a week to 1-2 a month.
Dr. Palace also observed an improvement in some of the participants’ quality of life, increased socialization and improved appetite, in addition to pain relief. One of the 86-year-old participants who is using cannabis for pain told Hebrew Home staff, “I feel so good that I feel like I could get up and do the Lindy dance!”
The paper also notes that financial restraints forced three patients to withdraw from the program. Medical cannabis is a costly out-of-pocket expense not covered by insurers or Medicare Part D. Reingold notes that many of the residents live below the poverty line, so while they might be interested in trying medical cannabis, it is simply beyond their means.
Shaking up the system
Reingold stresses that the policies and procedures are not designed to circumvent federal law, but to make sure that medical cannabis is being used in a clinically appropriate and efficacious way, like any other medications used at the Hebrew Home.
When asked by colleagues if he wasn’t nervous about losing Medicare, Reingold responded: “I believe that the federal government has bigger things to worry about than taking medical cannabis away from older adults who, by the way, are getting off of opiates.”
“I like to say that, we as baby boomers have blown up every system we’ve been through, from schools in suburbia to colleges. Now it’s time to shake things up with long-term care, and think of new ways of taking care of older adults.”
