Both palliative and hospice care offer services that provide comfort and tend to those with ailments that can be chronic and debilitating. Palliative care is offered to those who may live for many years with disabling conditions, while hospice is restricted to those whose life has a predictable end. Massage therapists have the ability to render services to almost all individuals. By its very definition and restriction, it is an offering of palliative care.
Some hospitals have palliative care teams. They are lead by a specialist working with team members who communicate with each other, as well as family members and the patient or client receiving care. Depending on the facility and the desires and needs of the client, a massage therapist can be a vital part of that team. The degree of care will depend on the individual’s physical and psychological condition – and may vary greatly from person to person.
To be considered palliative there are certain criteria, including:
- It is care that provides relief from pain and/or symptoms without providing a cure.
- It may be made available concurrently with curative measures offered by various health care providers.
- The disease or chronic illness being treated may or may not be terminal.
- It can be provided on an outpatient basis or in a nursing home, hospital or hospice.
- It can be administered by doctors, nurses, social workers, psychologists,counselors, chaplains, dieticians, rehabilitation specialists, bodyworkers (such as massage therapists) and even family members or friends.
Massage therapy is considered to be palliative care. Within the terms of scope of practice, it offers neither cure nor treatment of a specific disease or ailment. The massage therapist strives to alleviate, through the use of appropriate touch, symptoms like muscle ache and joint pain. Massage therapy improves circulation of blood and lymph. It provides stress reduction and helps to quiet the sympathetic nervous system, while stimulating the parasympathetic system and encouraging the body to relax.
The word hospice has multiple meanings in today’s world. Originally it meant a shelter for travelers and has a similar, if not identical, correlation with the word hostel. When using the word hospice with regard to medical treatment, it refers to a facility used to offer comfort and care to those who are terminally ill. It is a concept that originated in England with the purpose being to have heavily sedating drugs legally available to keep terminal patients pain-free. It has expanded to address a person’s psychological and spiritual needs, as well as offering a myriad of other services geared to supporting the resident and family members.
To be considered for hospice care, a person must have a terminal illness and a prognosis of six months or less, and be receiving no curative treatment. Palliative care is an important component of hospice care, but hospice provides even more support to both the client and the family, including respite services for the caregivers and grief counseling.
Hospice care strives to provide comfort to the dying and also maximize the quality of life by offering not only pain medication, but psychological services, emotional support, creative therapies (such as art, music and writing) and spiritual sustenance, too.
Most of the time, hospice services are provided in the person’s home and paid for by insurance or offered on a voluntary basis. Every program has its own policy regarding cost and payment but, in general, services are provided on need rather than on ability to pay. Currently hospice care is covered by Medicare, Medicaid, the Department of Veterans Affairs as well as many private health insurers. Some hospices are also supported by donations from the community and local businesses or through grants.
With regard to palliative care, the insurance issues are cloudier. Services, such as massage therapy, are not usually covered, though there may be exceptions depending on the terms written into the policy. Unless hired as an employee of a palliative team or hospice organization, a massage therapist often does this type of work on a volunteer basis.
Massage for Medically Frail or Terminally Ill Clients
When a massage therapist works with medically frail clients or clients who are terminally ill, the work performed takes on a much different purpose when compared to a healthy client coming in for health maintenance purposes. Often the touch is much lighter and offered as much for psychological comfort as for easing physical pain. In many situations the only touch they have received has been either cold and clinical or painful. Simply being there and holding a person’s hand, or gently rubbing his or her back can soothe anxiety and increase comfort.
One of the benefits a massage therapist might consider is to teach family members how to offer comforting touch to the hospice patient and to each other. The massage therapist will not be at the client’s home or hospital bedside for hours on end, but family members might. Often they feel frustrated and helpless just sitting there. Being able to feel at ease touching a loved one with healing intent can go a long way in reducing the feelings of powerlessness in a life-altering situation.
Another important aspect in working with chronically ill or terminal clients is making sure the massage therapist has a thorough knowledge of treatment plans by other team members, which would include knowing they type of medications being given and the potential for massage either increasing or reducing their effects. This would be true in both a palliative care situation where light Swedish massage might be given to someone receiving chemotherapy, or in hospice care where even more passive massage might take place on someone with end stage kidney failure.
Providing massage to very ill clients or to those who are in the last months or weeks of life is much different than massage for those who are healthy or suffering from life’s daily aches and pains. Compassion and patience are the main tools – with warm, healing hands coming in a close second. The rewards are many and the emotions can be intense. Being well prepared for this important work is vital.