In 1967 the first modern hospice program was founded in London,
England. It focused on maintaining dignity for the dying while
controlling pain and managing disease symptoms, with a strong
emphasis on emotions and spirituality. Today that mission remains
the same, although in some cases the approach has changed. In
addition to medical services, some hospice programs provide an
array of complementary therapies, including massage, to fulfill
the goal of caring for and comforting patients and their caregivers.
massage therapist Debra Murray, owner of Once in a Blue Moon Massage
and Yoga Therapy in Charlton, Massachusetts, graduated from a
local massage-therapy school three years ago, she wanted to build
a client base—but also felt the need to give something of
herself to the community. Her search for a meaningful outlet for
her newly acquired massage skills led her to a hospice program
managed by a nearby hospital.
Since that first experience—which, according to Murray,
provided the client with more spiritual healing than physical
therapy—she has given hundreds of massages to a variety
of clients. However, the impact of that initial hospice-massage
experience made a lasting impression, and she continues doing
hospice work to this day.
Unlike other types of therapy, hospice massage works in concert
with the client's disease and state, which changes rapidly, sometimes
within a few hours. Fragile conditions, including all types of
cancer, cardiopulmonary failure, amyotrophic lateral sclerosis,
and other debilitating diseases that often impact breathing, induce
significant physical stress and mental anxiety. Massage therapists
must adjust their thinking when ministering to hospice patients.
"We are not trying to fix anything," says massage
therapist June Bessette, who directs the massage component of
the hospice program at the University of Massachusetts Memorial
Medical Center (UMMC) in Worcester. "This type of massage
falls outside the standard rules and regulations for massage."
Before working with hospice patients, a massage therapist undergoes
program-specific training. Murray learned about the mission and
goals of hospice before taking a course on life-threatening illnesses
and associated symptoms.
She also received training in the grief process and the five stages
of dying as prescribed by Elisabeth Kübler-Ross. "Part
of my job as a massage therapist is understanding what the patient
is going through," she says.
Bessette points out that the length and intensity of a hospice
massage varies according to unique circumstances. "I have
to pay a great deal of attention to the patient's expressions,"
she says. "I don't always get to every inch of someone's
body." Patients may find reclining in a chair or lying in
bed on their side provides maximum comfort. Therapists need to
alter their methods to fit the physical environment.
Although oils, creams and lotions play an integral role in a
complete sensory experience, hospice massage often forgoes or
substitutes such amenities. Easily absorbed creams help lubricate
thin, dry skin but should be used with caution, as allergies and
other sensitivities might preclude the use of even the mildest
Catheters, intravenous lines, pain patches and other medical
devices also present a challenge. "The massage therapist
needs to be aware of what is on the patient's body and where you
need to avoid touch," Bessette says.
In hospice massage, the psychological benefits often outweigh
the physical advantages. Massage therapist Christine Moody, of
Mountain Area Hospice in Asheville, North Carolina, explains that
many hospice clients seek pain relief without the use of pharmacological
agents, which often cause confusion. Psychologically, patients
need to re-establish a link to their physical selves. "When
you are dying, you distance yourself from your body," she
says. "A massage puts you more in connection with your body."
Unlike the clinical touch of medical personnel, massage therapy
restores emotional balance and physical comfort.
"I feel so much better"
Like many hospice patients, Eleanor McCabe, 84, had to be sold
on the idea of massage. At the suggestion of her nurse, she decided
to give it a try. Suffering with chronic obstructive pulmonary
disease, McCabe sought relief from some of her physical symptoms
and allay anxiety. To her delight, the massage enhanced circulation
in her legs, by almost 80 percent. Other symptoms related to gastrointestinal
discomfort were also reduced. "When June [her massage therapist]
leaves, I feel so much better," she says. "I'd like
to do it every day." Her experience with massage has made
a significant difference in her physical stamina and mental outlook.
Nyria Acosta-Pearl, a massage therapist at Hospice of Cincinnati,
recounts the experience of a client with voice problems. "Through
therapeutic massage, the muscles in his neck stretched. His voice
is now stronger, and he can swallow better," she says. "Many
patients who have never had a massage are very enthused once they've
actually experienced it."
For Acosta-Pearl, hospice massage is about relationships. Unlike
a time-driven spa massage, the therapist can take time to provide
comfort to clients and their families by learning about the client's
likes and dislikes, hobbies, musical preferences and other personal
Moody believes that hospice massage offers reciprocal benefits.
Not only does the client feel more tranquil after a massage session,
the therapist often does too. "I always feel I've been given
a gift after I leave the patient," she says. "I am overwhelmingly
honored and blessed."
Caregivers, too, require consideration for the time and energy
they invest in the care of their terminally ill loved one. According
to Bessette, the person in the home provides around-the-clock,
hands-on attention. "They get tired, weary and are totally
absorbed in the care of their loved ones," she says. In many
cases, family members hesitate to take advantage of the offer
of massage, believing that all consideration should be focused
on the patient. However, with a little coaxing, some relent. Massage
applied to caregivers helps decrease stress in the home.
A growing field
Hospice of Cincinnati, under the direction of administrator
Pam VanHart, had offered holistic services since 1996 on a limited
basis. When VanHart saw firsthand the patient benefit of massage
administered by a nurse, she decided to initiate
a formal massage component in XXXX. Originally unsure how the
idea would be received, she has been heartened by its success.
As many as eight patients per day request massage services. VanHart
derives comfort knowing that the program is helping both patients
and families. "We were looking for ways to provide support,
as well as another modality besides the medical approach,"
Holy Redeemer Health System in Meadowbrook, Pennsylvania, added
massage to its hospice program in 2002. Before launching the program,
Vice President Terre Mirsch, R.N., expressed two concerns. "I
wondered whether or not there was a desire or need on the part
of our hospice patients and families for those services,"
she says. "I also had vague concerns about how it would be
integrated into the team."
Her fears were quickly put to rest with the addition of massage
therapist and nurse Valerie Hartman to the staff. "When she
joined the program she wanted to find out about the needs of our
program, our specific population, the people that we serve in
the different settings and how to slowly integrate her work into
that," says Mirsch. "She took the time to get to know
each staff member individually and how they practice hospice nursing
and social work, and how her role would enhance what they were
already doing with patients and families." Within six months,
Hartman's position changed from per diem to full time.
Funding for hospice-massage programs requires some creative
thinking. According to Florence LeClair, R.N., coordinator of
the hospice program at UMMC, a local charitable organization provided
a grant for the initial start-up costs. "Once we had a therapist
on the service, we made a budget position within the hospice budget,"
In addition to the paid position, the program also utilizes
the services of two volunteer massage therapists. "We emphasize
that people live until they die. Massage helps them feel like
a person. We focus on the positive things in their lives,"
says LeClair. She reports that from Oct. 1, 2003, to Oct. 1, 2004,
376 massage-therapy visits were made, to both patients and caregivers.
Mirsch says that the Holy Redeemer program's use of complementary
therapy has increased expenses, but, on the other hand, has replaced
or reduced the need for some other therapies.
"The patient requires less medication for anxiety or fear,
so you might have lower pharmacological costs associated with
your program," she says. By reducing anxiety with massage,
you might also prevent nighttime crises in the home, which in
turn decreases nurse or social-worker visits and expenses.
She advises hospice programs considering the addition of massage
to begin small and evaluate how the modality is received. "Once
you can actually see and feel the benefits, it becomes much easier
to get creative about how you grow the program," Mirsch says.
Her program applies for grants on a regular basis to maintain
Hospice seeks to ease the "fight or flight" response
that stems from fear, anxiety and worry, according to Hartman.
"When you think about the death process, there are three
things that people facing death are psychologically processing,"
she says. “Letting go of attachments in this life, trying
to move through the death process without loss of dignity, and
moving into the afterlife or whatever they perceive to come after
Stress-reduction through massage helps patients deal with these
And although massage will not cure terminal illness, it often
brings patients much-welcomed physical and psychological relief
from the ravages of their disease.
Phyllis Hanlon freelances from her home in Massachusetts.
Although she specializes in medical topics, she often writes articles
for college, family, religious and health magazines. She regularly
delights in the joys of massage.