The Challenges and Rewards of
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.
When 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 formulation.
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 details.
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," she says.
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," she says.
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 financial stability.
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 life."
Stress-reduction through massage helps patients deal with these important issues.
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.