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By Martha Brown Menard, PhD, CMT & Cynthia Piltch, PhD, CMT
With the aging of American “baby boomers,” our society
has a critical need to develop more effective care for
supporting people with chronic health conditions and
especially at the end of life. As part of that effort, massage
therapists need to be well trained to deal with the
special needs of the frail elderly. For more on this see the CE course “Serving Older Adults,”
by Ann Catlin, on page 111 of this issue.
One consequence of a nation with an increasingly
large segment of frail elders will be a greater call for palliative
care, which focuses on services that are oriented
toward “caring” rather than “curing.”
One element of palliative care needs to be focused
on making the end-of-life experience more comfortable
for people who are dying, as well as for their families.
Yet, because we live in a death-denying culture, many
health professionals, as well as the general public, tend
to regard death as a failure of the medical system rather
than a natural stage of life. This denial is made easier by
the fact that most people are completely removed from
the death process, since their loved ones die in hospitals
and nursing facilities rather than at home.
Despite our national tendency to avoid thinking of or
planning for end-of-life care, the hospice movement has
gained steady support over the last three decades since
massage at end of life
the first American hospice, Connecticut Hospice Inc.,
initiated in-home services in 1974. Since then, there
has been steady growth of demand for these services,
which are covered by Medicare as well as Medicaid in
46 states and the District of Columbia. The services
covered by Medicare include medical care (i.e., services
provided by doctors, nurses, physical and occupational,
social work services) as well as medications and equipment
needs (e.g., wheel chairs, catheters).
Since massage is not yet covered by Medicare, it is not
generally available as part of hospice or other end-of-life
care in hospitals. However, an increasing number of entities
are developing programs to provide palliative care
that includes massage to people who are chronically ill
or dying. For example, the Planetree Alliance, which
was founded in 1978 as a nonprofit organization of hospitals
and other health care entities, focuses on providing
patient-oriented services that include a 10-point list
of components that combine conventional medical services
with enhanced human interaction, architectural
design, nutrition and forms of touch therapy.
Hospitals that are part of the Planetree Alliance—currently
100 in this country—must commit substantial
financial resources ($20,000 to $30,000) and agree to
operate within the Planetree guidelines.1
The Metta Institute is another entity that gives attention
to improving the palliative care given to people at
the end of life. The institute established its End-of-Life
Care Practitioner Program in 2002, which is a year-long
training to develop “midwives to the dying” and to create
a national network of educators and advocates for
people facing life-threatening illness. Metta also provides
workshops, presentations and retreats to help individuals
and institutions become more equipped to provide
care to the dying.2
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American Massage Therapy Association®
