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Hands-On Care for Those in Later-Life Stages

By Ann Catlin, LMT, NCTMB, OTR

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Hospice Massage: Paid vs. Volunteer

For more than a decade I've had the honor of getting acquainted with massage therapists from around the world who touch the lives of hospice patients. Many say they feel "called" to do this amazing work and they tell stories of the personal rewards inherent in working with people facing the final days of their lives. True as this is, we also need to consider an important practical issue — if, and how, we're compensated. I want to help you understand what you might expect if considering this field of service.

If you explore hospice websites, many list massage therapy service. But what won't be apparent is if the massage therapists are being paid or if they're volunteering their time. While I'm a proponent of paid programs and believe that a skilled therapist should be fairly compensated, the fact is that some of you choose to volunteer your time with a local hospice and I respect that preference. And some hospice organizations still only include massage therapy on a volunteer basis, if at all. That said, paid programs are growing and I expect that trend to continue.

Paid Hospice Programs

I don't know of a better way to answer questions than to share feedback from your peers around the country who are working in hospice programs.

What motivates hospice organizations to hire a massage therapist? The answer here is two-fold. First, hospice providers are competitive. Patients and their families have control over which hospice company they use and hospices have a vested interest in appealing to the wishes of potential clients. Today, people want access to complementary therapies. In short, having a massage therapist on staff gives them a competitive edge. It's sometimes hard for therapists to understand that hospices are businesses because of the nature of what they do. Here is an excerpt from one hospice's website about their company that highlights both the patient care and business aspects.

hospice massage - Copyright – Stock Photo / Register Mark "[This] hospice is a service-driven organization relentlessly focused on patient care, customer service and compliance. We are privileged to provide end-of-life care. We are focused on increasing the number of patients we serve in our current markets and driven to expand our footprint."

Secondly, a hospice company may see massage therapy as a natural extension of their mission to provide comfort and quality of life for those with an advanced illness. Compassionate touch therapy helps ease symptoms, fostering physical, emotional and spiritual well-being and can be integrated into the interdisciplinary plan of care.

How are therapists getting started with hospice? We are still pioneering paid hospice massage programs and there are lots of ways therapists are finding their way into these jobs. Recently, I got a call from Lauren, who was contracted by a hospice group. She had been performing on-site massage for the hospice staff when the director mentioned they were looking for a therapist to work with patients. Evidently, they had a program in place but had trouble finding a therapist with the skills needed. Actually, this comment doesn't surprise me at all. It's not the first time I've heard about hospice programs failing because the therapists lacked proper training in working with this population. It's not the kind of work that basic massage therapy training prepares us for.

Michelle started working full-time for hospice only a few weeks ago. She had been providing massage as a volunteer and the hospice organization decided to convert her to a full-time employee position. She said, "I'm the guinea pig for the program, but I'm feeling good and it should be a great experience".

Anita reports that in starting the massage program almost six years ago, she was surprised at how well it was received. What started out as a part-time program blossomed to full-time in less than a month. Anita said, "I have come to believe it is not for every massage therapist. There is no prescribed method when working in this field. Flexibility and a willingness to expand your knowledge are the keys to success. There is also a different mindset required to do this. Sometimes massage therapists think they have to fix everything. The hospice model is more about healing and not curing."

Angela shares that, "I found out about the job by meeting a fellow massage therapist who was also a social worker for a local hospice company. From the very beginning, when this hospice was opened, a complementary/alternative medicine program was just as important to have available for the patients as the required positions (nursing, chaplains, social work, etc). They wanted, and continue to want, to offer alternatives to patients who prefer massage, acupuncture, or music over medication." It's becoming more common for hospice groups to advertise massage positions. Online listings can be found on job search sites such as Glassdoor.com, SimplyHired.com, and Indeed.com.

How does the company fund massage therapy services? Hospice care for most patients is paid by Medicare, although some people have private insurance coverage. I need to explain very briefly how Medicare payment works. Basically, Medicare pays hospice a flat, per-diem rate that covers all aspects of the patient's care, including all services delivered by the interdisciplinary team, drugs, medical equipment and supplies. Some hospice providers pay the massage therapist out of the Medicare per-diem funds. Others use money from another source, such as charitable donations or a foundation. A case in point is one hospice that has an annual fund raising event that raises funds for complementary therapies, including music, massage and pet therapy, as well as for the care of low-income patients and other services.

What are therapists' wages? Wages for LMT's hired as employees vary quite a bit. Therapists working full-time 40 hours per week report annual salaries of $33,000 to $45,000. Benefits vary, too. All include health and paid time off for full-time employees. Some companies also provide dental, vision, retirement fund, and tuition reimbursement. One therapist is a part-time employee, working about 20 hours per week and earns $25 per hour plus pro-rated benefits. Other therapists work part-time as independent contractors and reportedly earn from $45 to $75 per session, plus mileage reimbursement. Independent contractors are self-employed and do not receive benefits.

Hospice Volunteer Programs

Did you know that hospice providers must have volunteers in their program? It's a requirement for any hospice company receiving Medicare funds, which is nearly all of them. To comply with regulations, volunteers must provide day–to–day administrative and/or direct patient care services equaling a minimum of 5 percent of the total patient care hours of all paid hospice employees and contract staff. Hospice volunteers are made up of professional and lay persons and help with things such as household chores, shopping, transportation, pet care and companionship. Complementary therapies including massage, music, art and pet therapy may be part of a volunteer program. Volunteer services to patients and/or their families must be included in the hospice plan of care. As a hospice volunteer, you would be required to complete orientation training and submit documentation of patient visits, as well as mileage and travel time. Hospice companies have an incentive to seek your services on a voluntary basis as it helps them meet regulatory requirements, while at the same time providing something great for their patients.

Some therapists that volunteer have shared with me that their reason is to give back to a hospice for what it gave to their own family during a difficult time of loss. Others say they volunteer because it's the only option they have with local hospices. A word of advice about volunteering: be clear about your motivation and understand that rarely does a volunteer position become a paid one. If you really want to give your time and service, consider doing something other than your professional service. I have volunteered for hospice but instead of massage therapy, I served on a team that provided bedside vigil for dying people who didn't have family so that they would not have to die alone.

Setting aside the debate about paid vs. volunteer programs, I'm happy to say that massage in hospice is thriving and hospice patients have access to our service more than ever before. To those of you who reach out to people at such a vulnerable and important time of their lives, thank you.

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