Interesting post differentiating reversible and chronic dementia
Dementia - More Than Just Memory Loss

Has anyone recently experienced a change in how they are being asked to work with hospice patients. Let me explain:

I worked as an independent contractor for a small, privately owned hospice for about eight years. About three months ago, I was told that I could no longer work as an independent contractor, that I would have to become an employee of the hospice. It was explained that the Medicare Conditions of Participation NOW required that ALL therapists be employees. I searched the COP's extensively and found that Massage Therapists were NOT specifically named (as were Speach Therapists, Physical Therapists, etc who were specificaly named) as needing to be employees. The COP's have provisions for a hospice using an independent contractor, but those conditions do require extra monitoring of those contractors activities. I asked the hospice where in the COP's MT's were required to become employees and was told, "well, they're not in the COP's but in the "Interpretations." When given the option of becomming an employee I asked for a few days to think it over and offered to continue to work with my patients on a "volunteer basis." I also added that if I chose not to become an employee, I would continue to work with these folks on a volunteer basis until they all made their transitions. I was told that the COP's did not allow for massage therapists to work as volunteers.

In as much as the hospice work comprised 80 to 85% of the work I was doing, becoming an employee would have seriously jeopardized my status as a "business owner" and therefore all the business write-offs come tax time. This and a number of other changes in the way we were going to be allowed to work with patients prompted me to severe my relationship with this organization.

I was charging, basically a dollar minute for the time my hands were actually on a patient or caregiver. I charged mileage, but not for any of the time going to or from a client's home, for the time I did paperwork or for any time in conversation/counselling apart from when I actually had my hands on a client. Actually, I did keep track of that time and donated it to the hospice as "volunteer hours" to help them meet their Medicare volunteer component. I explain all of this only to say that the overall economic impact to the hospice by making this change would not have been significant because, as an employee, I would have been paid for all of this additional time even though the overall hourly rate would have been less.

Hospice work has been extremely satisfying and I have been told on many occassions by family and other hospice staff that the work I did really made a difference. I would like to continue to do hospice work, but am discouraged in doing so because I'm afraid that this has become the rule and other hospices I may approach will require me to become an employee?

So, I'm curious if anyone else has been confronted with the same interpretation of the Medicare Conditions of Participation and if so, what relationship they have taken to the change?

John,

I am oging to send your comments to a colleague at the Hospice of the FL Suncoast-who may be able to shed some light-I will get back to you here-also please consider posting on the Compassionate Touch facebook page-perhaps others may have some ideas as well.

I checked with my colleagues at the Hospice and here is what they said: Do hospices have to “employ” all therapists? "He/She can certainly do volunteer work. All Core staff must be employees… thus physician (who can also be contracted), nursing, social work, counselors (including bereavement and dietary) and spiritual care. Just because they are employees doesn’t mean that they must be full time or even part time. We will also offer free 15 minute consultations if anyone would like to contact us. Our number is 1-877-523-4144 Please feel free to call to schedule a consultation call or contact us via our website at www.SuncoastInstitute.org
Hope this helps!
Lisa

Medicare DOES NOT reimburse for massage therapy. If a hospice has a 'paid for' as opposed to 'volunteer' MT, they are paying for the work out of the hospice budget/bottom line. I repeat. There is NO medicare reimbursement for massage therapy.

There is now the issue in the hospice world regarding 'volunteer' mt's and the potentiality of possible damage being done to fragile clients thru lack of training. Basic mt training and a weekend or video/online intro to medically fragile work is beginning to be questioned by hospices. I suggest that anyone interested in doing this work get nationally certified (if not already) & gather up CEU's in advanced trainings with the likes of Tracey Walton, Gayle MacDonald, Isabelle Atkins, Guenter Klose to name a few of those who take the work beyond a weekend intro.
As this work goes mainstream, MT's are going to have to meet the criteria of the medical world, and it is NOT going to be what one gets in basic massage school or most of the so called feel good trainings that are out there right now for this particular work.
College level A & P is a great place to start. Having the ability to 'talk' the language of care, attend IDT as an intelligent member of the care team and being able to write appropriate session notes are all an integral part of this work.
Anything less is going to be falling to the wayside as no longer appropriate.
Best to begin preparing now. Blessings on the work and all who do it.

I am NCTMB and do massage remission cancer clients in the spa where I work. I am the only one on staff that does. I am also the only one that is insured by ABMP. I have been looking for advanced training to work with Hospice more closely. I have been massaging for over 26 yrs but went back to school to become certified rather than be grandfathered in. My years of experience have given me insight and knowledge sometimes not appreciated by the medical circle. I am not deterred.

I emphatically agree with the need for advanced training to work with the special population of those in later life stages.
I would also add the 55 hour Compassionate Touch Certified Practitioner training. I have been working with industry expert Ann Catlin for 2 1/2 years and she has so much to share with therapists and other caregivers for successfully integrating massage into these special settings. There are also 2 great blogs on the Massage Magazine site, one by Ann Touching Lives and one by Irene Smith of Everflowing, another pioneer in the work for massage for frail clients.

New article on New Guidelines for Incorporating Spirituality in End-of-Life Care

I have been doing 1/2 hour massages at a retirement home now for 1 year .
I would really like to see myself grow and reach out to many others in this building who have not tried massage.
I am considering doing a demonstration on massage, using a table, also having someone sitting in a chair receiving lower leg and reflexogy on their feet. I think this would help me grow,showing the seniors examples of what happens.
Could you give me any suggestions on speaking and or demoing massage to promote massage?
The benefits that are exchanged through this work with the seniors are soul touching for me.
what are your thoughts on giving Seniors lower leg with foot reflexlogy? They all seemed to love it.
Thank you .Namaste
Noreen

My 91yr old Dad has moved in with me. He uses a wheel chair and a walker. Each time I massage his legs he moves better. I have had to stop putting him on my massage table because getting up caused him to get dizzy. He does fine when I massage him in is bed or while sitting in the wheelchair. I live in Houston Tex and am looking for to Ann's classes in Texas. I saw it on the schedule and called but no one returned my call about where in Texas. Does anyone know?

Noreen, you can have people put their name in a drawing to see who is interested. Maybe give one free one any they can be your advertisement Also give B-day discounts.
Peggy

Thanks Peggy. I like the Birthday discount idea.
I do volunteer once a month there ,doing complimentary hand massages.

How nice, I bet you are the most looked for person in the Building! When I visited my Dad in the Rehab/Nursing Home, All the people were searching for attention from whoever. I made a point to talk to or help all of them, they began asking me to do things for them whenever they saw me, and I did. Since my Dad is here now my going is limited. I am interested in the classes that Ann is giving. I hope to go in March.

Noreen how long have you been a Massage Therapist?

I received my license in 1988.

I have been a massage therapist now for 10 years.
after losing my mom, is when I entered in with other seniors,That has been 2 years.

Would it be say to say. that a very gentle & soft massage on the elders lower legs and feet would be safe . I do this along with always ending with some lymph drainage toward the heart.
any contraindications on this?

It's fair to say that knowing a bit about the health history of your patient is very useful and in most cases very necessary. They may have some sort of blood clot that could be forced upward and eventually be fatal or could cause a stroke. I always ask just to make sure. You should be aware of the signs of a myocardial infarction as well as stroke. Being able to read those signs can be very helpful in avoiding life threatening situations to your patients. Keep up the good work.

Thanks Rudy. Most of them do fill out a history intake form,but not all.

I have been a hospice volunteer for 5 years. I got into it because I specialize in pain and ROM issues. I have worked on about 100 clients so far. I also work on caregivers because taking care of others is an emotional drain and can aggravate of cause physical problems.

In my private practice I specialize on working with the elderly and people for whom that medical profession cannot help. What I love about hospice is that the focus shifts from what is the right ting in medical terms to what is best for the patient. The egos are gone.

I am a “muscle whisperer” a medical intuitive so when I feel pain of problems, I have to be careful to feel the issues in them and not take it on. I have to focus in the fact that I am improving the last days of their lives not that they are dying.

My regular work is focused on helping people heal themselves and through a dialog of touch, help their tissues heal themselves. Being able to communicate through touch helps me work with people who cannot communicate such as dementia or ALS.

Dear muscle whisper(love that)
Thank you for your insight.
I have to agree with you so much. Even at 90 plus years old.It all comes down to a tender,loving touch filled with good intentions.
I like to look at myself as a isolator to help the client to find their way to healing. I don't call myself a healer.I feel I am more like a channel or a vessel to be used from your higher self to direct healing and In The moment peace.
yes ,it is important not to take on the pain but to only desire it gone. Not to take it on yourself.
I
Have only had the privilege to be with three hospice patients to date. One being my mother. The second one ,would be considered my other mother.(life long friends mother). a very profound time to share with someone.
I mainly work on the average age of 90 years. I Love to see their face brighten when they see me.and the after session expressions

I am looking to find a nice lotion or cream that has a warming affect on the body.
does anyone know of one?

sorry facilitator not isolator

Just join this group and so glad to see it here! I've been doing hospice work for a short time and was really glad to see Jagruti's comments regarding concerns of volunteer's education in this area. The Heart Touch Project has a fantastic training, as well as Gayle MacDonald's book! Any hoo... I'll be here lurking and possibly making comments in the future. ;)

There are traiinings out there apparently that are teaching volunteers, chaplains, social workers et al of the hospice care team to give massage therapy to patients.
I have a really hard time with this as what does that do for the licensed/certified MT's and especially the patients? Sort of makes training pointless it seems and this is one of the populations that needs excellence in training for MT's.
This comment may stir things up on this board, but I feel healthy conversation/communication is always good...and after all, the first priority for all of us are our patients, not running touch trainings for the general public right?

2010, one of the largest national hospice companies will be requiring ALL MT's who touch end of life patients to be nationally certified, have specific training for the population and ONLY MT's will be allowed to do the work. This is as it should be, especially if we wish to be more accepted/recognized by allopathic medicine as capable/trained care providers.

I agree that anyone that is "massaging" a patient (semantics might get in the way of this one!) should be a MT, but simply holding a hand (this is considered touch therapy) is a blessing and a benefit to the patient.

Jagruti, I think the training for MTs is inappropriate for hospice work. There is some overlap but much of what is taught does not apply including the basic attitudes that go with Swedish massage and there is training that is certainly missing for working with the elderly, infirm and doing palliative work.

The allopathic community is very different in that the focus shifts form what is proper medicine to what is best for the patient. I think we need different training. There is no traditional Swedish strokes, draping and the body mechanics are wrong. You don’t do deep tissue or sports medicine. You can’t rely on a person with dementia to communicate properly. It is not like the dance of Swedish and the focus of how you interact with clients is different. You work with people in hospital beds, wheel chairs any rarely use tables. You are not there to fix but to serve. It is a totally different attitude. If you are mot properly trained you can seriously hurt yourself or you patients. And there is the hospice training. You also need to be able to psychologically take on the job and learn to help clients and not burn out yourself.

The training does have some things in common such as anatomy but even there the focus is different. The techniques are different and the psychology is different and I have heard from some trainers that it is easier in most cases to start with a non-MT.

Thank you Carl! I am in total agreement with your analysis of the difference between Sweedish Massage and what is required to do palliative work.

After 8 years or more of working with hospice patients and elderly clients, I am, and have been, really conflicted about what qualifications one needs to work with this segment of the population. On the one hand, no one needs a massage education to provide caring touch. On the other hand, those allowed to exercise the responsibility of providing massage for hospice patients need to have enough understanding of the human body and the elements of massage to know when they may be doing harm or causing unintentional discomfort to their patients. However, the notion that a massage therapist has to be "Nationally Certified" to do hospice work is absurd! The national certification requirement by some hospice organizations is purely a hedge against liability in a litiginous society and by some hospice workers in our profession an attempt at bureaucratic birth control. If you think that certification enhances your ability to provide caring touch to those in need, I say "go for it." But to require certification just limits the number of patients that can and will receive real benefit/healing from being touched by another. Working from a stance of scarcity reaps scarcity. Working from a stance of abundance reaps abundance. "Nuf said!

What my basic massage education did provide me with are those red flags that get raised when I am just not sure if a particular technique is appropriate or helpful. That, and of course, the most basic precept drilled into us throughout our time in massage school; "When in Doubt, Don't" is essential to doing the work safely. All that lies in the background any time I begin to work with someone whose health is compromised. I also have to remind myself that the goal is Healing and not Curing. As you know, the two are very different! Some of the healthiest folks I have ever met met have been amongst the hospice patients I've worked with whose bodies were falling apart and shutting down around them.

Thank you again, Carl, for your ongoing insights on hospice/palliative massage. You are far more eloquent then I and probably a whole lot more politically correct. I will continue to look forward to your posts on this subject.

Greetings all,
I've followed this conversation with interest and appreciate the various perspectives. While it's true that anyone can provide caring and conscious touch that is beneficial to those in hospice or palliative care, I believe that there is good reason for hospice organizations to require massage therapists to be licensed or certifiied. As our profession gains a place in the health care settings of eldercare and hospice we are expected to uphold standards of practice similar to other healthcare professionals. I recently talked with the director of a hospice in Iowa that has massage therapists on staff. She shared with me that they have had some therapists who didn't work out because they did not have the specialized skilles required to provide the quality service they expected. As an educator I support the unique role that massage therapists play in hospice care. I also provide training for other hospice caregivers in the use of skilled touch. I agree that there is a huge difference between therapeutic massage (as well as other skills offered by a properly trained massage therapist ) and the simple use of focused touch in caregiving. I think there is a place for both to occur side by side and if a caregiver uses focused touch it does not pose a threat to the use of a massage therapist's service. I've found that it actually builds awareness to the value we bring to the hospice patient. Thanks again-- I look forward to our continued conversation.
Ann

Read Ann's new article in Massage Today, The Art of Authentic Listening.

I am thinking about looking into Hospice work and massage. can you share the avenge that I should take? Also, do you get any kind of certification from this?

Thank you Lisa for the direction with Anne's article on Listening. It was wonderfully written. I printed it out so as I can review it again and share it with others. I visit a couple retirement homes weekly,so I find this very helpful and compassion information to use.
Thanks again.
I hope one day I will meet Ann in person.Hopefully in a workshop.

I look forward to meeting you too, Noreen! I'm glad the article has served you well. I'm glad to hear of your interest in offering your services to hospice. You asked about what approach you should take. Well, that's a very big question and the answer is a bit complex. I can tell you that it matters to hopice directors that the therapists they bring on board can demonstrate that they have the right skill sets. Massage therapy in hospice is growing as our value becomes recognized. You asked about certification. I'm thinking that you are referring to training. Yes, Compassionate Touch offer a certification. If you would like specific information feel free to email me directly. And keep an eye out for those articles!

Hello everyone...my name is Laurie. I work at at a Hospice in Las Vegas, NV. I was wondering if anyone knows of any online CEU's for hospice massage or elderly massage. It is a wonderful yet heartbreaking job. I would love to swap stories or talk with anyone who does or would like to do hospice massage.

Laurie check out compassionate touch and Daybreak geritric massage. I do not know if they offer on line ceu's. let me know what you find out,though.
I just filled out paperwork for Munson Hospital,up here in my area to voluteer to work in Hospice.Or anyway to gather more info on this.
How long have you been working in hospice and what can you share?
I have been voluneeting and working in two diiferent retirement homes (and assited) for 2 1/2 years now. I am very content tand passionate about being with this population. I truely enjoy it.I am looking forward to adding addition knowledge and experience with them
looking forward to hearing from you.

Laurie,
Glad to lend a hand to you. I would love to hear how you came to work in hospice! These are some on-line resouces that I've contributed to our body of information for working with this special population. I hope you find interesting and useful.
Bright blessings, Ann

(All courses are 2 CE credits)

1. Massage and Compassionate Touch® in Managing Challenging Behaviors in Dementia Care (2008) www.care2learn.com

2. Massage and Compassionate Touch®: Non-pharmacological Pain Relief for Elders in Long Term Care (2008) www.care2learn.com

3. Massage in Hospice and Palliative Care: Ethical Considerations (2009) www.yourCEplace.com

4. Meeting the Needs of Older Adult Clients (2009) www.yourCEplace.com

Hi ann
Thanks for the info for the on-line CE. I am thinking about purchasing one or two right away. which ones do you highly recommen?
I was looking at the yourCEplace.com

ok i just checked out the descript on Non-pharmacol. course. i like the sounds on this one

Noreen, Glad the on-line course will serve you well! I'd love to have your feedback.
Ann

Hi Ann
Is there room in your calendar to teach a course in Michigan this year?
I was also wondering aboutIndian head massage. are you familiar with it and do you teach it? seems like this would be wondeful for the seniors. I have been massaging many of my c linets heads who may be sitting up in a chair that day. They love it. i do have a tape on it,but thinking the course would be a benefit.

Check out Ann's new post on the impact of the healthcare legislation!

At this time we don't have a course scheduled in the great state of Michigan. The year is young! It would be great if you could join me in Chicago in April. I'm somewhat familiar with Indian head massage. The beauty of Compassionate Touch is that we each bring our gifts and talents to the work. Take good care, Ann

Ann's new post on Massage Magazine Touch- A Link to Emotional Memory for People with Alzheimer’s disease.

I know this isn't anywhere near Michigan but I took a wonderful course in Santa Monica CA, The Heart Touch Project (http://www.hearttouch.org) Wonderful people! I work as a LMT volunteer in hospice and haven't had a Alzheimer's client as yet but want to learn more. I will be sure to keep reading the info here! Thank you!

Thanks for the link Heather! Actually-I am in beautiful Cape Cod in MA and Ann lives in MO! It looks like a wonderful organization. I look forward to learning more.

Join us Monday 6/28 at 8pmEST for another complimentary Inspire U webinar-this one featuring Grace Terry, MSW. Grace will present on Effective Grief Support in a Death Denying Culture and how we can uplift with our awareness.

I s anyone firmiliar with this info. ~An Everflowing Resource by Irene Smith
Includes Book, DVD and 2-CD Set
Purchase directly from Natural Touch Marketing

I've just joined, and am still a student. I have a nursing home directly across the street, and don't know what I don't know. What should I expect, hire in as an employee/contract with my own business, how much to charge, and is it difficult to collect money from them/how do they typically pay?

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Massage in Eldercare & Hospice - An idea whose time has come!

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