Does massage therapy belong in the nursing home?

Nursing Homes, June, 1996 by Millie R. Hynes

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.