Does massage therapy belong in the nursing home?

It is low-cost, low-tech, and benefits residents and staff

In the interest of improving quality of life, can alternative medicine therapies such as massage be offered in retirement/nursing homes, especially since few insurance companies or Medicare pay for them? Yes, it can be done but only with the cooperative efforts of the therapist, administration, and staff.

I was fortunate to have an administrator who previously worked at a nursing home where a massage therapist came to the facility on a regular basis. He said, "I don't exactly know why, but I know people always seemed rejuvenated when they came out of the treatment room." I provided him with research articles about touch therapies and brought to his attention a growing number of corporations that include massage as an employee benefit to relieve stress in the workplace.

I worked as a nurse in this facility. When I explored the possibility of going to a year long massage therapy school, I became acquainted with Dietrich Meisler, founder of the Geriatric Massage Project, now a national organization. He told me, "With massage, we do not strive to add years to life but to add life to years." I became a member of the Nurse Massage Therapy Association and joined another 700 nurses nationally who incorporate massage into their nursing practices.

As I circulated around the nursing home, I became aware of how many residents were experiencing pain, depression, anxiety, immobility, and social isolation. I knew I could not change their chronic disease or aging process, but I suspected that massage therapy would be an important adjunct to the mission of the facility - nurturing those we serve by offering them the very best quality life.

Eighteen months ago, we began a massage therapy program in the facility, available to both residents and employees. Startup costs were minimal - less than $1,080 - because every effort was made to use items either donated or already in facility storage. My husband assembled the on-site chair from a kit, remodeled a physical therapy treatment table that had been discarded, and constructed a privacy screen for a fraction of the cost of buying one. The "tools" of massage therapy are not expensive, the principal ones being the hands of the practitioner.

The success of the program is reflected in anecdotal data from families, staff and physicians. Two physicians called me personally to express appreciation for the massage given to their patients, and I receive prescriptions from physicians as they become aware of the service. One family who lives at a distance called to report that they "heard a difference" in their mother's voice: "She sounds so much better. Whatever those treatments are, be sure she continues to receive them." This about a resident who told me on her first appointment, "I am only here because my granddaughter insisted and I know she thinks I won't do it." (She's missed only two appointments in the last 18 months.) Another woman, wheelchair-bound, often remarks after her massage, "My legs were dead and now they are alive!"

Massage is not a cure-all but implies a compassionate, caring respect for others, and it enables the body to respond so as to heal itself. Research supports that regular massage over a period of time increases red blood cell counts, serotonin levels and absorption of medications, and decreases post-surgical healing time.

Residents report decreased problems with constipation, insomnia, and appetite. Pain is reduced and stress relieved. One resident, a retired nurse with dementia, had been verbally abusive to other residents. As she came down the hall following her massage, she greeted a group from her floor with friendly salutations, prompting exclamations of, "What happened to her? Is that who we think it is?"

Often residents with dysphasia speak in complete and appropriate sentences after a massage. One woman who only muttered continually about "the man and the thing" said, as she got up from the massage table, "My back feels better but everything else feels funny." A complete sentence, a new sense of proprioception.

As Juhan writes, "Some of the most tangible and troublesome features of age itself are simply conditions of muscular activity, activities that bow the posture and rigidify the joints, that collapse the chest cavity, that put the squeeze on peripheral circulation, that create all kinds of limitations to movement and that waste precious vitality." Health maintenance and wellness programs like massage effect the frequency of falls, opportunistic infections, and contractures effecting the elderly's independence to perform tasks of daily living.

Geriatric Nursing (March/April 1995) featured an article entitled, Efficacy of Hand Massage in Decreasing Agitation Behaviors Associated with Care Activities in Persons with Dementia, reporting on a study that was done at the University of Minnesota. The author points out that "Although a number of articles propose interventions for managing agitation behaviors, few studies have systematically explored the efficacy of specific interventions to promote relaxation and to reduce agitation behavior in persons with dementia." To substantiate data, as this study did, is difficult, because the resident's behavior can be affected by the disease process, the time of day, the objectivity of the staff administering the massage, and many other factors. But what is clear is that massage supports comfort care, implies a compassionate regard, is non-intrusive, meets the unique needs of individuals, and encourages a relaxation response that causes a chain reaction of positive benefits.

What about its value to employees? Nursing assistants, of course, experience a disproportionate rate of back injury. In view of the fact that eight of ten Americans between the ages of 25 and 45 - even the most fitness-conscious - will experience a bout of back trouble at one time or another, it isn't surprising that the risk increases greatly with any activity that involves twisting, sudden movements and prolonged lifting. True, massage cannot take the place of exercise in strengthening muscles - but massage can increase flexibility, body awareness, nutrition of the tissues and softness of connective tissue.

Most importantly, touch provides a sensation of relaxation, of control over stress. Nursing assistants are under constant strain with work loads and time constraints. Also, they often enter their jobs each day with frustrations and conflicts in their personal lives. Massage can help.

Ron Burt, director of a wellness program for Providence Medical Center in Everett, Washington, created a successful wellness program awarding employees who participate in such a program a bonus of $250 to $325. Developed in 1991, the program achieved total savings of $369,416 for 1992, at a direct program cost of only $133,700 as a result of decreased health care usage, sick time, and worker's compensation.

I usually see frail residents for 30-minute appointments, and more robust folks for 45 minutes. At times I will also work on an employee, family member, or volunteer for a half-hour. I am unable to fit more than six or seven massages into my schedule daily due to my other duties, such as following up on referrals, documentation, and billing. The revenue from this service, based on residents' and staff's ability to pay, is $1,900 a month, and I am currently seeking grant monies, facility foundation funds, and other sources to supplement the revenue generated by the program.

Can you afford to have complementary therapies that reach out in compassion and empathy in your long-term care facilities? Can you afford not to?

Millie R. Hynes, LPN, LMP, is a licensed nurse massage practitioner based in Brighton, CO.