By Jon L. Sullivan
Originally published in Massage & Bodywork magazine, June/July 2003.
Through my observations and personal experience, residents in multi-level care facilities require caring, skilled massage. They often have a dizzying array of diagnoses that the best rehab centers in the country have difficulty caring for. Day after day staff struggle just to meet the basic needs of residents, with little or no time to provide the gentle touch they so deserve.
My participation in a volunteer massage program has — through contact with the residents and on-site staff of an Austin, Texas, nursing facility — convinced me massage is more than a modality. Each week residents of Austin Nursing Center are seen for brief tune-up massages by practitioners, including myself, who spend two hours or more donating their time. This intervention is informal and incredibly valuable, illuminating the need for therapeutic massage in long-term care settings.
Bridging the Gap
Before I began working at Austin Nursing Center, no massage had been performed there for some time due to an in-house corporate contract. The residents of the home, however, often reminisced about the “nice folks” who once came occasionally to rub their necks and shoulders. The director of nurses also recalled when massage was frequently given to combat the effects of poor circulation in residents with skin breakdown. Unfortunately the nurses no longer had the time to spend with the people needing it most. Out of necessity, a program was born.
The massage school I had graduated from needed someone to teach students about the geriatric population and specialty massage, and the nursing home needed skilled touch. I stepped forward to bridge the gap for these communities.
Each of my lectures to the first semester classes began with an invitation to the students to meet some “old” friends of mine. Soon, students began to attend the scheduled volunteer massage days to hear me lecture and to get tips on dealing with elders and their care, and then to work with them in their nursing facility environment. Some began to fill volunteer slots to teach the elders yoga, tai chi and stretching during activity periods, and then to assist with trips outside the facility. One even took a part-time job with the home to help the activities department on a regular basis. A few residents were even able to make trips to the community pool, where massage therapists helped to make the task safer and more therapeutic for the folks with traumatic brain injury, Parkinson’s and arthritis.
Today, each resident participant receives about 15 minutes of general, clothed, non-invasive, light circulatory “feel good” massage tailored to their needs. Most participants are regular weekly consumers of this service and state repeatedly how massage works to alleviate their pain, stiffness and general discomfort while elevating their mood and providing a vital social opportunity — a very functional activity — so they can remain independent longer. Overall, the majority of residents show great improvements in self-care functioning, decreased irritable moods and withdrawn behavior.
Incorporating “Geri” Work
Though self-employment is now my primary focus, it has afforded me the ability to give back to this special population. My private practice as a massage therapist has been deeply rooted in occupational therapy (OT) ideals of a holism and principles of therapeutic use of self. My OT clinical experience has been successful through a hands-on approach and a finely tuned level of palpation that comes from having studied from a therapeutic massage perspective, and incorporating those components into practice. For several years I’ve also helped to take these techniques to the public through a local access television program called the Bodyworker. My clientele has grown diverse as I now work with clients of every age and dysfunction. My approaches include craniosacral therapy, Swedish massage, myofascial release, neuromuscular methods, deep tissue massage and aquatic therapy, to name a few.
Recently, I sponsored a level-one geriatric certification course from the Day-Break Geriatric Massage Institute, a first for Austin and Texas. The Day-Break instructor was thorough and led the class through two-and-a-half days of exploring the needs of the elderly, discussing contraindications and transferring Dietrich Meisler’s body of knowledge to eager students. The last day was a joy. The paired practical hands-on clinic with elder volunteers brought joy and relaxation to a married couple in their 80s and a septagenarian minister, among others.
With this learning, new and experienced therapists were given tools to promote their work with the geriatric population. Particularly valuable was the Day-Break recipe which involves attending to both sides of the body in a short amount of time. This makes a lot of sense to me. This method is creeping into my other, non-elder treatment sessions, and is well-received by even my long-standing clients who comment on how much they like the techniques I’ve learned. I usually don’t use the “geri” word when I mention my recent workshop experience, as some people are sensitive about their age. The greatest benefit of the weekend was hearing and seeing the therapists’ confidence. They had a renewed sense of mission to serve the elder population in their private practices.
My own practice has been bolstered as I take on new private pay clients in assisted living and nursing centers. Though the clients are appreciative, the lack of touch in these facilities is mind-boggling. Many under-serviced homes are full of people starving for touch, whose well-being is spiraling down without it.
Therapeutic massage continues to constantly demonstrate itself as a desirable, if not essential, component of any long-term care, medical or rehab setting. But chances are your insurance company follows Medicare’s lead and won’t cover massage therapy. And now since Medicare is about to cap therapy services for OT at $1,500, and physical therapy and speech therapy at a combined $1,500, our aged have little hope for the touch they so desperately need.
Our society is generally in denial regarding end-of-life and care issues, and death is the ultimate taboo topic. Most families don’t talk about it until someone gets sick or dies. So most people have no idea what to do when it comes time to care for an elder dealing with their own processes of grief. If you are lucky enough to grow long in the tooth but unexpectedly find yourself at one of these nursing facilities, where the staff are ill-equipped to handle the burgeoning needs, may you have gentle attendants and access to professional bodywork.
Circle of Life
Through an awareness built from working with this special population and recognizing the need is larger than the potential supplied by one mere mortal, I continue to speak in public settings about the reward of volunteering with the elderly. I feel more joyful surprises can be had in one 10-minute encounter with a 90-year-old person than subsequent hours spent with a roomful of 30-somethings. When a frail body answers that her first job was welding pieces of battleship together, or another gentleman who previously was asleep in his chair wakes to your touch and recalls how his family of 10 struggled during the Great Depression but always had unconditional love shown through family massage time, one begins to appreciate the full circle of life.
Until recently, I thought my view of being present to this population was pretty complete. As I have held the hand of many as they shrugged off this mortal coil, including my own father at age 50, I was aware of the importance of bringing a caring presence to people at the end of their lives.
This idea of a full circle of life was recently driven home when during the morning of my last birthday I was able to utilize my massage skills in the drug-free and scream-free labor and delivery of my friend’s baby girl. The very next morning I was back to volunteering with the nursing facility residents whose eyes were wide as I described my birthday surprise.