Expert Advice on working with elderly clients.

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Expert Advice

Q: “I’d like to work with elderly clients. Is there a special type of massage I need to learn? How can I get a job at a nursing home?”

Answer: 
The Day Break Geriatric Massage Institute is the original certified geriatric massage program, according to its director, Sharon Puszko, Ph.D. With a doctorate in biology and as a massage therapist of 15 years, Puszko came to geriatric massage via a very personal path.

While living in the Orient teaching biology for the International Diplomatic Corps, her elderly parents became ill. Upon returning stateside to care for a mother who died soon thereafter and a father with Alzheimer’s disease, Puszko read about Deitrich Miesler, the founder of Day Break. She wanted to learn more. She completed massage school and then became trained in Miesler’s methods.

“The massage certainly helped my father,” Puszko says, “and after he died Deitrich and I became professionally involved because he knew of my work as a teacher, and suddenly I had a strong interest to work with the elderly.”

Puszko now serves as director of continuing education, teacher and therapist for Day Break, and runs its home office in Indianapolis. According to Puszko, although Miesler is no longer practicing, he continues to publish in the area of geriatric massage, and his strong leadership since he started Day Break in 1986 permeates her own passion to teach this very specialized field of massage therapy. Puszko points out that geriatric massage is a very specialized field.

“We don’t teach that geriatric massage is just a lighter form of Swedish massage,” she says. “We teach our therapists specialized techniques [such as] massaging both sides of the client’s body at the same time without having to turn them on the table.”

Miesler also created a stroke called fluffing, a combination of effleurage and petrissage which promotes relaxation, Puszko says.

She says that older people who often suffer from respiratory, cardiac or joint difficulties can’t easily lie prone on a table and may not even be able to lie on their sides; in addition, challenging physical conditions may contraindicate the use of traditional Swedish massage.

“We teach our therapists to do the whole massage with the person supine and not to go beyond 30 minutes. To massage an older person any longer, they release too many toxins.” Puszko says. “It’s like passive exercise; anything more aggressive is too active for them. We don’t do any stripping strokes, to protect delicate muscles and so as not to tear the skin.”

Puszko says a special kind of massage therapist is drawn to this work. “People who take our classes – and we teach physical therapists, nurses and massage therapists – are usually between 40 and 60 years old and are more mature. This is not to say that we don’t get the occasional younger student who really likes working with the elderly, but most of our students have had a little more life experience; perhaps they’ve had a spouse or grandparent who has gone through an illness, and that will sometimes draw them to the work.”

According the Puszko, the three-day, 17-hour course, which is offered all over the United States, covers more than the physical techniques of geriatric massage.

“We teach the psychology and physiology of aging,” Puszko says. “That’s followed by the sociological aspects of aging, the psychological aspects of dealing with the aging population, paying attention to detail with the elderly, client assessment, precautions and contraindications.”

Students are also taught how to market themselves to nursing homes, extended care facilities and hospitals, and how to communicate with physicians about the need the geriatric population has for touch and massage.

There are two levels of Day Break training available, according to Puszko, with the more advanced level focusing on medical conditions most likely to strike the older population, such as Parkinson’s disease, diabetes and stroke. Also included in the advanced curriculum is instruction about the effects of medications, how to massage both wheelchair-bound and bedridden clients, and care of the dying. Students at this level have the opportunity to train in a facility with the elderly.

Puszko sees a growing demand for this form of massage as the U.S. population ages. “Most extended-care facilities or nursing homes have independent massage-therapy contractors,” she says. “[But] remember, as our population is living to be much older and the people who are aging are baby boomers who had massage much of their lives, they’re going to want [massage] as they age.”

Puszko makes a final point about geriatric massage and why aging massage therapists might consider the practice: “I’m over 60 years old and I’ve been practicing for 15 years. Although the key factor to this work is the joy of working with the elderly, it is attractive because of the diminished physical demands on the massage therapist’s body.”

Another geriatric-massage specialist is Cheryl Chapman, R.N., H.N.C. (Holistic Nurse Certified). Chapman was a burned-out nurse who embraced massage therapy 14 years ago. She now teaches an eight-hour geriatric massage workshop, “so massage therapists don’t have to say ‘no’ to an older person who wants a massage” simply because they lack the skills. Chapman believes there is a huge market for this modality.

“I teach the benefits of massage to the aging person, what the aging process does to the body, contraindications. I talk about the lymphatics and positioning. We discuss deep vein thrombosis, and then they get a lot of hands on. We also go into the different oils and lotions that can be used. I teach them how to market themselves if they really want to get into it.”

Chapman, who lives in Springfield, New Jersey, says she personally doesn’t like the term geriatric massage, “because it sounds like someone’s in a nursing home and not able to take care of themselves. I have clients in their 90s who are very active.” Chapman prefers to call this population ‘mature clients,’ and uses her 80-year-old mother as a prime example. “You call her ‘geriatric’ and she may have to use the skills she learned as a black belt in karate to change your wording,” Chapman says with a laugh.

Chapman veers slightly away from Day Break’s fluffing technique when talking about the modality she teaches. “We don’t use different strokes, just modifications of strokes most massage therapists have learned. Certainly with someone with osteoporosis, you’re not going to use shiatsu or deep pressure or a mechanical muscle vibrator. If your client is on an anticoagulant, you can’t apply pressure because they’ll bruise easily. There may be times when all you do is apply lotion to very dry skin, providing a loving touch that they need more than anything.”

Chapman believes another primary difference the therapist needs to be aware of in dealing with this population is that everything takes more time.

“If you’ve got someone who’s used to getting massage, they can get their clothes off and get up onto the table OK. But usually you have to allow for a much longer time for them to move to the table, get undressed (sometimes layers and layers of clothes have to come off); you have to help them up onto the table and sometimes even escort them out to their car afterwards. As a therapist, you’ve got to slow way down. This isn’t sports massage.”

Chapman stresses finding out exactly what the client needs during the intake, exactly where their pain or discomfort is, what medications they are taking, how those medications might affect their skin integrity or the massage, helping them fill out the intake form and doing everything you can to deliver what they want.

“One thing about seniors,” Chapman says, “if you don’t give them what they want, they’re outta there. And they’ll tell their entire community. If you hurt them, they won’t be back.”

As far as getting your foot into the door of this community, Chapman says there are some brass tacks of business you need to understand first.

“Nursing homes aren’t in a financial situation to hire massage therapists. I’d suggest you present your credentials to a nursing director at an extended-care facility or nursing home; create a brochure, a poster. Go in and volunteer at first and offer foot or hand massage. Let the families of the residents know that you are offering massage. A lot of times, they’ll buy a massage gift certificate from you rather than buy their mom another night gown that will just sit in the drawer.”

Senior residences are also a fertile marketing ground, according to Chapman.

“Go in, volunteer, get to be known. Then pass out brochures. Find out who their doctors are and then market your skills to the doctors who are taking care of this population,” she says.

Chapman also suggests volunteering to speak at seniors’ social clubs or organizations regarding the benefits of massage. “Let them know that massage doesn’t mean they will be ‘pummeled to death by Helga from the old country,'” she says. “And remember, many [seniors] have lived through very tight times and are on a limited budget, so no young whipper-snapper is going to convince them they need a massage. It’s not for everyone, but as we live longer and age better, there will be a desperate need. A lot of elderly are depressed and have a fear of dying. A massage therapist can help alleviate that fear or at least soften it. You can help these people feel connected again.”

The final ‘expert’ interviewed for this topic is 94-year-old Marion Melander, of Springfield, New Jersey, who receives regular massages from Chapman. She is very nearly deaf – but what she lacks in hearing she makes up in vitality. When this interviewer got her on the phone at her home and introduced herself as from Massage Magazine, Melander promptly yelled, “I don’t want any!” and hung up the phone. When contact was finally made, she had strong opinions about massage.

“I broke my hip. My doctor ordered massage. It helped me get better. Then I broke the other hip; he did it again. It makes a difference. Tell everyone to get a massage. I feel great. Tell ’em all they need it!”

Therapists interested in geriatric massage training may contact The Day Break Geriatric Massage Project at www.daybreak-massage.com, or contact Puszko directly via e-mail at spuszko@juno.com or (317) 722-9896.

For more information on Cheryl Chapman’s workshops, e-mail her at Touch2RN@aol.com.

 – Charlotte Michael Versagi, L.M.T., N.C.T.M.B., is a journalist, a lymphedema therapist who also sees cancer patients, and a science instructor in a massage-therapy program at The Carnegie Institute in Troy, Michigan.

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