No other type of massage specialty is as rewarding, or as emotionally wrenching, as this.  The article below will give you some insights about what's involved.

By Dawn Nelson

A decade ago, when I attended social events, and was asked the inevitable question, "What kind of work do you do?" I would answer, "I do gentle touch massage with the ill and the dying."

The questioner would usually stare at me blankly, quickly change the subject or suddenly remember some forgotten errand. People were not interested in hearing about my day or listening to my stories about touching hospice patients. Today, with death and dying slowly coming "out of the closet," many people, especially those over 50, consider such a line of work more fascinating than morbid, and are sometimes eager for more information.

In recent years, people are speaking out more about death, and about compassionate care for the dying. At the same time, the ancient healing modality of massage has been recollected and recognized as a viable resource in palliative care, as well as in health care.

The author is administering gentle touch to the abdominal area of a hospice patient, being careful to avoid contact with narcotic patches.

What Is A Hospice?
In medieval times the word "hospice" referred to a way station where travelers could be refreshed and cared for. Today, a hospice has evolved into a care program that attempts to provide for the physical, emotional, psychological and spiritual needs of those approaching death. A hospice has become a strong force in the search for a more unified approach to death that combines medical technology with compassionate care of the whole person.

The basic purpose of a hospice is to enhance quality of life, regardless of the expected duration of that life. According to National Hospice Organization literature, the primary goal of a hospice is to help individuals who are coping with diseases considered to be terminal or incurable to live as fully and comfortably as possible, in familiar surroundings, and in the company of family and friends.

Those who apply for admittance into a hospice program are required to have an opinion from a medical professional that their disease is likely to lead to death in six months or less. I have known patients who have remained in the program much longer, and even a few who have "graduated" from hospice care when their diseases reached a plateau or unexpectedly went into remission.

Some hospice programs are community-based, relying on grants and donations for their existence. Some are privately funded, and others are part of medical centers. Sometimes, hospice care is provided in a specific location or designated residential unit. Zen hospice in San Francisco, which gained national recognition through the Bill Moyers television program a few years ago, is such an example. The majority of hospice programs in America today, however, offer in-home care and support.

Many hospice patients have some form of primary cancer that has metastasized (spread) to other parts of the body. Others may be nearing death from respiratory conditions, cardiac disease, neuromuscular conditions (such as Parkinson's or Lou Gehrig's disease [ALS]), Alzheimer's disease or AIDS. People of all ages are admitted to hospice programs. I have worked with patients ranging from 5 to 95 years old.

With an emphasis on holistic care, hospice programs frequently provide benefits that are not available in traditional health-care settings. Specially trained volunteers are an integral part of all hospice programs; they provide companionship, respite for caregivers, and social and emotional support to patients and families. In addition to nursing care, many hospice programs offer a variety of psychosocial services, as well as spiritual counseling. Other hospice services may include:

• Massage therapy;
• Art therapy;
• Music therapy;
• Pet therapy;
• Bereavement support.

A person nearing death may be too weak to move at all, so the practitioner must adapt in order to meet the needs of the patient.

A Model Program For Massage In Hospice Care
I was associated for some years with a home-based hospice program that was part of a large, nationwide HMO. Services were available to any member of the HMO at no additional charge. A six-bed, inpatient unit in the hospital provided emergency procedures and respite care. The massage therapy program began when I became a hospice volunteer. Within a year, I was seeing several patients a week under an independent contract agreement. Due to the ever-growing number of requests for massage, more practitioners were brought in, and within five years, four specially trained massage therapists working part time under independent contract were part of this particular hospice team, which also included a music therapist and an art therapist.

Payment to the service providers came from donations, as these "alternative" therapies were not included in the allocated budget. Practitioners were paid a flat-fee rate, regardless of how long the session took or how much travel time was involved. Massage support to family caregivers was offered, if appropriate, as part of the home or hospital visit.

Upon admission to the program, all patients (or their caregivers) were given a packet of materials that included information about the massage therapy program. Massage was offered on a priority basis, according to assessed need and availability of a therapist. Each session was individualized, with special consideration given to the unique situation and needs of the hospice patient.

Case Example 2 As I was bathing a patient, her mother was holding her, and she died in her mother's arms. Her mother said, "I held her as a baby when she came into the world, and I'm holding her now as she leaves the world." It was extraordinary to witness that. --Dorothy Chaknova

Once a request was made for massage services, any team member could fill out a referral form. Sometimes, the request was made for a one-time visit to teach some simple techniques to a caregiver, or to help calm a family member who was particularly overwhelmed or distressed. Usually, however, once the referral was made and a massage therapist contacted the patient and family, visits were continued on a weekly or bimonthly basis until the patient's death.

A record of the massage session was completed by the massage practitioner after each home or hospital visit. The form was then placed in the patient file for reference by other team members. Any problems or questions that arose during the session were passed on to the patient care coordinator, or the appropriate team member, for attention.

Benefits Of Massage And Attentive Touch In Hospice Care
Therapeutic massage is well known for its ability to relieve pain, improve circulation and induce a relaxation response. Other benefits of massage, applicable to hospice patients, as well as to the general population, include:

• Softening contracted or tight muscles;

• Promoting faster healing from injury/trauma;

• Reducing joint stiffness;

• Reducing anxiety;

• Improving circulation, which can ease breathing, induce more restful sleep, help improve digestion and elimination, and temporarily improve mental clarity.

Physical Benefits Specific To Hospices
With the influx of advanced medical technology and the great variety of drugs available, we tend to forget that the simple, careful touch of the human hand is one of the most ancient and effective means for relieving discomfort in the body. Pain control is often a primary concern for hospice patients, and massage is an excellent nonpharmacological modality for reducing or alleviating pain, and thus reducing the need for narcotic painkillers.

Massage has been proven useful as a primary or adjunct therapy for any condition that includes a stress component, and being diagnosed with a life-threatening disease is high on any list of stress-producing events.

Acupressure techniques are being used by the author to relieve tension in the trapezius muscle of a lung cancer patient.

Massage has proven to be extremely useful for some hospice patients in managing stress and alleviating pain, which can reduce the need for psychotropic and narcotic medications, all of which have their own negative side effects.

A primary benefit of massage for those who are less mobile or bedridden is its use in helping to prevent pressure sores. Once referred to as "bed sores," these skin ulcerations are most likely to occur over bony areas of the body, such as the tailbone, buttocks, elbows, shoulders and heels, that are in constant contact with a mattress.

Massaging areas of the body that have been most recently under pressure--thus stimulating circulation at the susceptible points, along with encouraging the patient to change positions frequently--has long been recommended in nursing manuals as an aid in preventing pressure sores. The massage therapist can also be on the lookout for reddened, thinning or "hot" areas, and give that area immediate attention.

Most hospice patients reach a point where massage is no longer desired, tolerated or appropriate, yet maintaining contact is essential.