Hospital-based massage for patients, like so many other medical services, has made the needed adjustments for infection control and is back to work.
Because of the global coronavirus (COVID-19) pandemic, the massage field has quickly established new protocols for the continued safety of clients and providers alike. Although some massage therapists are choosing, or needing, to pause their practices, most of the massage world has retooled and is holding steadfast to its mission of providing touch to relieve pain, stress and anxiety, and to promote health and well-being.
Given the complexity of and emerging information about a serious disease that has in fact claimed over 2.4 million lives around the world as of March 2021, one might think massage therapists going into the front lines of hospitals or other medical centers would be unlikely.
For those massage therapists who may be interested in entering the field of inpatient work, this article provides a picture of what the work looks like with new COVID-19 protocols.
A Typical Workday as a Hospital-Based Massage Therapist
If you are interested in this specialty, it can be helpful to visualize what a typical workday might look like. Generally, referrals, or orders, are placed by a patient’s medical team member such as the doctor, nurse practitioner or nurse. The massage provider will collect their list of patients (via the electronic health record or other system). The provider will review each patient’s medical chart to assess their condition, plan for appropriate adjustments and look for any contraindications, or reasons the patient should not receive massage at this time.
Once patient information is reviewed, the provider will contact the patient’s nurse to confirm it is appropriate to see the patient, complete any intake forms and ask any specific questions. If massage therapists do not have access to the medical chart, a complete intake with the patient’s nurse will provide the required assessments.
Once questions are addressed, the practitioner will gather materials such as lotion and towels, and follow handwashing protocols. Donning required personal protective equipment (PPE) happens just before entering the patient’s room.
Once the massage provider enters the room, the whole effort to get there is made well worth it. In the room, the practitioner has the opportunity to meet a new person and often their family. Patients may be in a physically challenging or stressful situation. They may be uncomfortable or in pain. The practitioner will create a safe space during the intake conversation that contributes to the healing process. Transitioning from information gathering, the provider makes the room safe to move around and positions the patient for comfort and support.
Hands-on work will be simple. It will be slow. Touch will intend the body to know it is safe to let go of stress and open to inner repair work. For those who prefer a more medical-based description, the massage aims to release the body into a parasympathetic nervous system response and away from the fight/flight/freeze of sympathetic nervous system activation.
The final aspect of hospital-based work that is unique is the closure. Often patients feel so safe and comfortable that they want to share more of their history and experiences after the session. At other times, the patient is left in a deep rest, which is often elusive in the hospital. In the vast majority of sessions, both the provider and the patient feel better for the interaction.
Massage for Patients: Adaptations During the COVID-19 Pandemic
When the pandemic first hit the U.S. and shelter-in-place orders were implemented, many in hospital-based massage work knew hospitals would be safer than most places of work. Likely, this is true because hospitals are built for tending the sick and making every effort to eliminate the spread of infection. In fact, infection control departments are embedded in each health care system.
In the COVID-19 era, hospital-based massage therapy has made the following changes:
• All staff are screened daily before entering the work setting; any symptoms of COVID-19, unless understood as from a pre-existing condition, mean the provider stays home. If symptoms indicate, the therapist will be advised to get a COVID-19 test before returning to work.
• Patients are screened with a COVID-19 test pre-admission whenever possible and often routinely during their admission.
• Known COVID-19 positive patients are contraindicated for massage.
• PPE used by massage therapists includes a mask, eye goggles or face shield, gown and gloves; therapists often wear scrubs or a uniform. (There is some variation among institutions; each team follows the directives of their center.)
All other protocols, such as handwashing, use of lotion, length of session, levels of pressure and site restrictions, and all the skills of a hospital-based massage therapist are the same as pre-pandemic. Another important aspect that is the same: the patients. Patients continue to deeply appreciate the gentle comfort and care that is uniquely provided by massage therapists. In the time of COVID-19, the need by patients for gentle, safe touch may be more than ever before.
One day at work, I went in to see VL, a 59-year-old woman on the HemeOnc unit. She seemed happy to see me, a familiar face. She explained that her husband has heart issues. So, because of COVID-19 he doesn’t come to the hospital like he did on previous admissions. After the session, when I asked how she was feeling, she smiled and simply said, “Bliss.”
Hospital-Based Massage for Patients: At a Glance
Every massage therapist has certainly learned massage school that the “art of rubbing” is an ancient form of medicine in virtually all cultures. So, whether you work at the bedside, in an ambulatory care center or an outpatient clinic, each setting is a natural home for massage therapy.
Many people completely avoid hospitals or any medical facility. However, for readers who are drawn to this environment, here are some things to know about a massage practice in a health care environment:
• Hospital-based massage generally refers to work either inpatient (at the bedside), or outpatient such as in an infusion center, radiation center or integrative medicine clinic.
• Hospice work is similar to hospital-based work but with some distinctions. It may be done in a hospice center or hospital unit or on an outcall basis in patients’ homes, skilled nursing facilities, or an assisted living center.
• Employment is usually per diem or contractor; few therapists are full-time employees.
• Some institutions still use volunteers; however, they may be less utilized because of increased privacy protections and perhaps recognition of the skills needed.
• Advanced education is highly recommended. Specific courses in hospital-based massage therapy are available in some massage schools. A few hospital systems have education programs that offer classroom training and hands-on experience.
• Training in oncology massage therapy is a good precursor to hospital work. The skills and knowledge learned in those trainings carry over into working with all medically complex people.
• Published research will familiarize practitioners with the efficacy of massage therapy among certain hospital patient groups.
How is Massage Paid For?
Hospitals and clinics that do not yet provide massage therapy may be interested to know about the economic side of a service. Massage therapy is a low-cost service relative to just about everything else provided in a hospital.
Unfortunately, Medicare sets the standards of which services qualify for insurance coverage and massage is not currently included on that list, except for a very few diagnoses. However, there are still many ways to find funding. In the past, philanthropic grants, dedicated fundraising and grateful patient donations have been common sources.
Research grants are another avenue for funding massage therapy services, at least temporarily. Its potential in the hospital setting is vast and has rarely been explored. Variables such as pain and anxiety are well-tested, but others, like sleep, nausea and constipation, which show promise, remain under-researched.
Given the current financial unknowns due to the pandemic, funding new programs might be difficult at this time; however, once this period is over, massage therapy as a valued service will once again grow and thrive.
This Crisis Will Pass
Much of the work in developing hospital-based massage therapy for safety and efficacy has been done, including adjustments for COVID-19. If a massage therapist feels a pull, a sense of excitement, a yes in response to the descriptions of this work, the world of patients needs their participation.
The efforts to make hospital-based massage more available are not insignificant. It is important to understand, too, that the pandemic has impacted the economics of health care in ways still unfolding. Creative answers are the way forward, along with knowing the current crisis will pass and life will renew. Being skilled and prepared, doing our part to advocate for patients’ benefit, and staying engaged with our communities’ health care systems are the best next steps.
While not limited to hospital-based work, research specific to post-COVID conditions is needed, as well as more studies that demonstrate the benefits of therapeutic touch for the inpatient as measured by patient satisfaction, length of stay, pain management and other factors.
Many hospitals are currently restricting visitors as a means to limit spread of infection. Visitors themselves may not feel comfortable spending time in hospitals because of their own health issues. Thus, the companionship of a massage therapist whose sole purpose is to provide gentle, caring, symptom-relieving touch is most often met with nothing but gratitude in the patient’s heart and palpable releases in their bodies.
About the author
Carolyn Tague, CMT, is program manager and lead instructor of the advanced training in hospital-based massage therapy program at the University of California, San Francisco, Osher Center for Integrative Medicine. She is the founder of Tague Consulting, which offers continuing education courses and consulting. She co-authored, with Gayle MacDonald, “Hands in Health Care: Massage Therapy for the Adult Hospital Patient” (Handspring Publishing, 2020). Gayle MacDonald contributed to this article.
As a special offer to MASSAGE Magazine readers, order Carolyn Tague’s and Gayle MacDonald’s newly published book “Hands in Health Care: Massage Therapy for the Adult Hospital Patient,” Second Edition, direct from Handspring Publishing and save 20% off the list price and get free shipping. Order direct at handspringpublishing.com and use discount code MMHC20. Offer expires July 31, 2021.