Q:
What are best practices for developing a facility cannabis policy, and can staff administer medical marijuana to residents?
A:
As more states legalize medical and recreational cannabis, long-term care facilities are increasingly faced with questions about how to manage resident use while maintaining compliance with federal regulations. Because marijuana remains a Schedule I controlled substance under federal law, any facility receiving Medicare or Medicaid funds must proceed with caution.
When developing a cannabis policy, facilities should:
1. Begin with a comprehensive legal and regulatory review of both federal and state law. Clearly define the scope of permissible use, such as limiting use to residents with valid medical cannabis cards and prohibiting smoking or vaping on the premises.
2. Include storage and administration protocols, if state law permits resident use — specifying who may store cannabis, where it will be kept, and how it’s documented.
3. Outline staff roles and responsibilities, clarifying what staff can and cannot do under federal restrictions.
4. Ensure alignment with resident rights, infection control, and medication management policies.
5. Educate staff on nonjudgmental communication, documentation expectations, and professional boundaries.
Because cannabis remains federally illegal, facility staff cannot handle, store, or administer medical marijuana under policies governed by federal funding. However, some states allow self-administration by residents or administration by a designated caregiver, such as a family member. Policies should clearly state that staff involvement is limited to ensuring resident safety and compliance with facility procedures.
If a resident uses medical cannabis, the medical record should reflect:
- The resident is a state-registered cannabis user.
- The form of cannabis used (tincture, capsule, edible, etc.).
- That use is self-directed or managed by a representative, not staff.
Avoid documenting cannabis as a prescribed medication. Instead, document under resident self-directed use or alternative therapies, following legal and regulatory guidance.
Recreational use poses additional risk. Even in states where it’s legal, federal law prohibits it in federally regulated or funded facilities. Policies should explicitly state that recreational use is not permitted on facility property and outline procedures for addressing violations respectfully.
Facilities can acknowledge residents’ rights to pursue alternative therapies, but direct inclusion of cannabis in a pain management program is not recommended under current federal law. The interdisciplinary team should instead focus on person-centered discussions, safety, and documentation that reflect resident choice while maintaining compliance.
Need help developing or updating your facility’s cannabis policy? Proactive can help you navigate state-specific requirements, align with CMS regulations, and develop compliant documentation and staff training tools. Contact us today to schedule a compliance policy review.
Written By:
Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CPC, CLNC
Director of Regulatory Services
Proactive LTC Consulting
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