doctor and therapist consulting in health care environment

There I was, massaging the shoulders of a client I’ve been seeing two times a week for five years. A nurse on high alert said, “No! You have to wear gloves.” I asked her why. She told me that my client had ringworm and had been receiving medication for that for three weeks.


Lack of Understanding

I have been providing massage in this health care environment for seven years as an independent contractor, and have three clients whom I see there now. Most of the care providers are long-term, and I have seen them, as well, for years. Imagine my confusion at not being given this information.

All the nursing assistants knew the client had ringworm, and yet when I stopped massaging they wanted to know why I was refusing to massage the client. English not being the first language of most of the care providers, they never understood my concern or caution.

I told my client and the care providers that not knowing the extent of the condition, even with gloves I would not provide massage for fear of spreading the ringworm to other areas of my client’s body. The care providers had no precautionary information. They wear gloves for everything anyway. They didn’t understand that I should have been informed.

I alerted my client’s conservator and asked her to call the nurse coordinator of the community and put me on the list to be notified of any health changes or conditions pertaining to the client in question. One week later, this still had not been done.



Advocate for One’s Self

It was time for me to advocate for myself. I contacted the coordinator and explained that seeing multiple clients in her community I could have started a rapid spread of ringworm as well as risk taking it with me into other health care environments.

I gave her the names of my three clients; called the families of these clients and had them call the nurse coordinator to ask to put me on the list for health information. As a private contractor, I am not updated because of confidentiality guidelines stipulated by HIPAA. For the site coordinator to speak to me about my client’s health, the client or person in charge of the business for the client is required to submit written permission to the health care site. This written permission is attached to the HIPAA consent form for the client. This paperwork remains onsite where the client resides.

In addition, I will now add 30 minutes to the time allowed for this site to find the nurse and ask if there are updates on my client’s condition each time I have a scheduled appointment.


therapist and client

Do Not Assume

I cannot assume that the care providers have current information on my client’s condition—and even if they did, they might not understand the precautions I need to take for my safety and for the safety of my clients.


Irene SmithAbout the Author

Irene Smith began her journey as a massage therapist in 1974. She founded and directs Everflowing, an educational outreach program dedicated to teaching mindful touching as an integral component to end-of-life care. Smith is a member of the National Association of Massage Therapists, Hospice Volunteer Association and the San Francisco Bay Area End of Life Coalition.