Massage therapy is playing an integral role in the hospice and palliative care environments.
By Michelle Vallet, August 22, 2017
There’s no question that science is helping us live longer—and better. Advances in medicine have helped control, and in some cases cure, a variety of diseases that in the past may have proved fatal.
So, it’s no surprise that as the life span of people living in the United States increases, the number of people living with chronic, progressive, age-related diseases that require longer and more sustained care also increases.
For this reason, hospice and palliative care environments are also on the rise—and massage therapy is playing an integral role in these health care models. In the following, you’ll find out more about how massage therapy is integrated into hospice and palliative care, as well as what you can expect—and what’s expected of you—in these environments.
According to the National Hospice and Palliative Care Organization’s latest “Hospice Care in America: Facts and Figures” report, an estimated 1.6 million people received services from hospice in 2014, and that number has continued to steadily increase over the past several years. Patient demographics were about evenly split between men and women, with women making up roughly 54 percent of hospice patients to men’s 46 percent. Approximately 84 percent were 65 years of age or older, and just slightly more than 40 percent were 85 or older.
Additionally, although cancer patients were the largest patient demographic to receive hospice and palliative care when these care models were first getting started, cancer diagnoses represent less than half of all hospice admissions today, with non-cancer diagnoses accounting for approximately 63 percent of hospice and palliative care patients.
The one common thread running through both palliative care and hospice is that patients eligible for these services have received a terminal diagnosis. “Palliative care can begin as soon as someone receives a life-limiting diagnosis,” says Mary Cheers, a massage therapist and educator in Lebanon, Ohio. “Hospice care begins when the life expectancy is six months or less.”
Both hospice and palliative care emphasize quality of life, that is, comfort rather than cure. “It is not about helping people die as much as it is about helping people live until they die,” Cheers explains. “And live with the highest quality of life possible.”
Susan Adler, a massage therapist who works with hospice patients in New York, agrees. “Hospice enables people with life-limiting illnesses to have a better quality of life during their remaining time,” she explains. “They are well taken care of by the hospice staff, alleviating some of the burden on their families, which means they can spend more time together in a loving and supportive way without worrying about basic care.”
This model of care is holistic and depends on an interdisciplinary team that includes volunteers, nurses, physicians, therapists, home health aides, spiritual counselors and social workers. These patients often need care across multiple areas, like pain management and emotional and spiritual support. “Patients receive comfort and care physically, mentally, emotionally and spiritually,” Cheers says. “In other words, the whole person is addressed and the hospice interdisciplinary team approach offers many different modalities to accomplish this goal.”
Cheers cautions against the sometimes hurtful portrayal that hospice and palliative care patients have somehow given up. “Many people still think that if they or their loved one is admitted to hospice it means they are giving up,” she explains. “Hospice is about supporting and enhancing quality of life for as long as the person lives.”
As with most client populations, patients in hospice and palliative care settings are likely dealing with a variety of issues—some that are physical and some that are more emotional—and massage therapy can help manage many of them. “Massage has been shown to help decrease anxiety, agitation, pain and joint stiffness,” Cheers explains. “Massage therapy also impacts quality of life by increasing overall relaxation.”
There is research to back up these claims. A 2014 study focused on integrating massage therapy into palliative care found statistically significant changes in pain, anxiety, relaxation and inner peace of patients, decreasing both pain intensity and anxiety while increasing the patients’ sense of relaxation and inner peace.
In 2013, research published in Complementary Therapies in Clinical Practice showed that adults with rheumatoid arthritis may feel a decrease in pain, as well as greater range of motion in wrists and large upper joints, after receiving regular moderate pressure massage during a four-week period. Additionally, in a 2012 pilot study published in Military Medicine, veterans indicated significant reductions in ratings of anxiety, worry, depression and physical pain after massage.
More recently, a 2016 collaborative meta-analysis of research on massage therapy for pain—conducted by Samueli Institute and commissioned by the Massage Therapy Foundation with support from the American Massage Therapy Association—found that, based on the evidence, massage therapy shows promise for reducing pain intensity/severity, fatigue and anxiety in cancer populations when compared to active comparators.
Adler also believes hospice and palliative care patients benefit from the one-on-one attention massage therapists are able to give them. “The massage therapist gives undivided attention to the patient,” she says. “This supports the patient both physically and mentally, providing relief to sore muscles to someone who is confined in a wheelchair or hospital bed, for example, as well as relaxation for the mind as they come to grips with their own mortality.”
Massage, however, isn’t going to work the same in hospice and palliative care as other environments, such as a spa or your own practice. Massage with these clients, for example, will often be less focused on deep or even moderate pressure work.
“Presence and intention are most important with this population,” Cheers says. “Very slow, gentle and gently applied techniques are the most appropriate. Swedish techniques like passive touch and hypnotic stroking also work very well. Even kneading can be appropriate if applied very slowly and gently.”
There are also going to be times, according to Cheers, where the patient isn’t going to be able to tolerate massage therapy. “In most cases, patient intolerance can be addressed by allowing my hand to conform to the body part I am addressing, moving more slowly and lightening my touch,” she explains. “Often, toes and feet are very touch sensitive, but if I stop and gently hold, the patient is usually able to accept the massage.”
Adler encourages massage therapists to stop thinking in terms of specific massage protocols when working with these patients. “As each hospice patient is in a different place on their hospice journey, the most important thing is to remain flexible and creative,” she says. “Think of massage as a broad spectrum that can range from simply holding a hand all the way to a full-body massage. The overarching goal is to provide comfort without doing harm and, as with all massage, tailoring the massage to the individual.”
When working with these patients, it’s also important to remember that flexibility and adaptability are the name of the game. Most often, care will be provided in the patient’s home, but massage therapists might also be working in hospice centers, hospitals, nursing homes or other long-term care facilities.
Regardless, there are going to be a variety of things in all of these environments that massage therapists are not going to be able to control, like where the massage takes place, for example, or the
length of any given session, and you’re going to need to be able to adapt quickly.
Critical thinking skills, according to Adler, will also help a massage therapist be flexible. “The ability to think critically is necessary in order to appropriately modify a massage session, both in terms of comfort and safety,” she explains. “The pace, pressure, stroke selection, positioning and bolstering, for example, may all need to be adapted for the patient’s comfort.”
Massage therapists will also be working within a larger health care team that likely includes physicians, nurses, social workers and counselors, to name a few, so maintaining clear communication and professionalism are an absolute must when working with hospice and palliative care patients. For example, Cheers encourages massage therapists to coordinate schedules with other health care professionals who work with the patient to ensure massage therapy is happening at the optimum time. “You can coordinate for massage therapy to occur after the home health aide visit so the patient can rest after massage,” she explains.
Additionally, Cheers participates in the bimonthly interdisciplinary team meetings organized by the hospice she works with, which gives her a chance to meet other health care professionals working with the patient and get medical updates. “I am updated on any new changes with the patient, as well as any new issues or concerns,” she says. “I am also given the opportunity to provide appropriate input.”
As the U.S. population continues to age, more and more people are looking for ways to help manage the symptoms of chronic disease and diagnoses that prove life-limiting. For those patients in hospice and palliative care environments, massage therapy is proving to be beneficial in helping relieve some of the most debilitating physical and emotional symptoms—such as pain, anxiety and depression—and allowing patients to live the highest quality of life possible.
There is one sure thing when working with patients in a hospice and palliative care environment eventually, you’re going to lose every last one of them. And that can take a toll on massage therapists who often enter the profession because of their desire to help people.
Working with palliative care and hospice patients can be hugely rewarding work, but it’s also work that requires you to pay very close attention to your physical—and perhaps more importantly your emotional—well-being.
Following are some self-care tips to help you do the massage therapy work you love while still taking care of yourself.
Mary Cheers, a massage therapist and educator in Lebanon, Ohio, finds that exercise helps for both physical and emotional self-care. “Dance, yoga, walking,” she says. Also, most importantly for Cheers, she receives regular massage herself.
For Cheers, having a good understanding of her own issues, especially surrounding death and dying, are an essential aspect of self-care when working with hospice and palliative care patients. “I sometimes journal any intense thoughts or feelings that arise,” Cheers adds.
Some massage therapists might find that having a closing ritual can be helpful, whether it’s at the end of each session, at the end of the day or when caring for the patient comes to an end. “You might want to end your days with a hot bath and lavender candles,” Cheers explains. “Or perhaps you want to plant a flower or go to your client’s funeral.”
Massage therapists don’t have to bear the burden of this work alone. Don’t be afraid to seek supervision from hospice peers, Cheers encourages. “Or, go talk to a professional counselor if needed,” she adds. Here, be proactive. Don’t wait until you feel yourself slipping toward depression or burnout before getting the help you need.
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