Another intense day to round out the week. It was HOT- 97*, though it felt like more. They have estimated that it might break 100* this weekend. Blah. Otherwise it was beautiful: bright, sunny, cloudless sky. Pretty flowers in full bloom everywhere. It was a work day for me, so I spent the day driving through Johnson County with perfectly manicured lawns and gardens, trees and shrubs.
The energy and messages flowed greatly. I felt very connected today. It was darn near blissful at several points. I don’t really know how to describe it fully, as I feel it through my whole body. Blissful, orgasmic, and intense seem to be the best descriptors. Regardless, everything went very well, and I even got to meditate over lunch. Even my meditation was intensely wonderful today.
On my drive into work I replayed the conversation (from yesterday) I had with the therapist relinquishing a building to me. It’s the new work to be had shortly. Basically, she confessed that I was the only therapist that she was able to come up with that was familiar with elder care. She said that she used to know 2 other ladies that did elder massage, but that they had retired. I also said that I had only known of a couple of other therapists doing a significant amount of elder care, but never actually met them, so I guessed she might have been one of them. Her concern was finding someone that actually knew the environment, how to work with the residents and what to expect and look for. She essentially did a short phone interview with me to ensure that was the case. We talked about which buildings I go to, how I function, and what I charge. It was a good conversation.
Anyway, upon replay I realized that essentially what this conversation means is that when she has fully relinquished the building to me, I will have a monopoly on Elder Care in the Kansas City Metro Region. That is to say, I will be the only massage therapist that solely provides elder care massage as my whole business. I’m sure that there are a handful which see one or 2 people in the environment which I work, therapists always make exceptions for their favorite people. However, most therapists do those exceptions on the side as extra income above and beyond their “stable” office environment (be it chiro, spa, or stand alone).
Now, on one hand that’s awesome. At one point I commented to someone that it would be great if I had “all” of the buildings and was as busy as I could handle making a decent living. So this is literally a somewhat delayed manifestation of that.
On the other hand, “all of the buildings”, is not really all the buildings. There are many buildings that choose not to get involved in facilitating a connection between resident and therapist. You see, massage is still not considered medicine, and is barely gaining ground as Complimentary Alternative Medicine. So, it’s not covered, at all, hardly ever. Out of the approximately 30 well established buildings in the metro, there’s only 6 that have bothered to directly facilitate introducing therapists to the residents. There are only 2 of those that will actually intervene in the billing process, and only one of them for individual full weekly sessions. It’s just not worth their time, or at least as the corporate world perceives it. Furthermore, though insurance covering massage would dictate an exorbitant amount of paperwork, it would finally cause facilities to acknowledge it’s usefulness.
So, ultimately I end up contemplating the long term ramifications of this. It’s what I do. I see a work situation where there are 2 sides and I have to decide which side I want to invest time into.
So, I could take this building, add it to my schedule and proceed as she did, essentially just adding a few hours of work to my week, and call it done.
Or, I could pursue the aforementioned problem of buildings not dealing with massage and potentially create a situation where I would need to train others and figure out the logistics of sub-contractors (short-term) and/or employees (long-term). Depending on the building environment, if I was able to convince others to be more on board, I might even then need someone to do paperwork/invoicing/client files, or some data system to automate it.
Essentially, I would have to market to buildings again from the stand point of this is why you should facilitate massage- of which the list is great in elder care. I have plenty of reasons why it’s a good thing not just for the resident, but also for the building itself. I would be educating the buildings on things I’ve facilitated in the past, which might even open up opportunities to do Continuing Ed with the staff (I’d need to pay NCBTMB extra to be able to do that in an official capacity).
Then I would probably have to interface with all of the massage schools in the metro to see if their elder care course was up to snuff to produce valid candidates for sub-contracting/employment. PROBABLY NOT, I went to a great massage school in Iowa, and it still didn’t cover elder care massage adequately, their course was mostly about meds, diseases that typically are seen in elderly, and the 3 basics: no heat, ice, or deep pressure. That’s all good information, but I learned so many things on the job, it’s not even funny. For instance, carrying around my table lasted all of a week before I realized it was more of a liability than a benefit, and I have probably at least a hundred examples similar to that.
Though I like the ramifications of success that come with the latter scenario, there’s part of me that likes the more laid back, mellow, lower stress of the former. Either way, I’m appreciating in myself the credence, insight, awareness, and trustworthiness that I’ve gained working in the environment. Nathan too, pointed out that I am proficient at what I do, professional with everyone, and experienced, which gives people a sense of confidence in my abilities. That definitely goes a long ways. Essentially, I have mastered my current trade. I like acknowledging that I have mastered what I do. I also like knowing that I could potentially build what I do into a larger business with several staff members.
However, I’m not so sure that even on a larger scale that it would be profitable enough to make all the work worthwhile. Unfortunately, until people recognize all the myriad of benefits of massage as being very valid in a medical setting, and additionally eliminate the association between dollar and minute, massage will not be a very profitable endeavor. The only businesses that make money off of massage are paying their therapists like crap ($10-15/hr), and I refuse to do that, which means my profits would be slimmer. So I’d have a heavy labor intensive route to make a very little money. That is very counter to how I even got into elder care in the first place. I’ve not convinced myself it’s worth it yet.
However, I’ve not shut the door on that possibility either. I would love to see massage more widely accepted and less about dollar per minute, but to do that someone has to do the dirty work that I’ve described. In an ideal world I see massage billed to insurance just like a doctor or chiropractor. Fees based upon area(s) worked. A chiropractor bills insurance (or even cash visits) based upon how many adjustments were done, the more adjustments, the more expensive. There’s no reason a massage can’t be charged the same way.
There are residents I work with that I could do everything 10 times over and still not make an hours time because they are simply so frail and fragile that I can’t focus that intensely on their muscle tone. Those residents still get a full head to toe massage, they still get a full head to toe Reiki treatment, but I would be hard pressed to meet an hour. Additionally, they still benefit, their mood still shows improvement, their blood pressures stay lower, edema swelling is kept at bay, and they get enough movement to help stave off skin tears and bed sores. My job has been done, and done well, regardless if I’ve spent exactly 60 minutes rubbing them.
One the other hand I have had residents that an hour is simply not enough. Be it their particular health situation, perhaps their physical size, their mobility limitations necessitating extra help, and even situations involving anxiety or other mood disturbances. I once had a resident that I invested two and a half hours attempting to just get a fairly decent head to toe massage. At the end of that time I gave up with about 3/4 having been done, knowing that I would still only get paid for one hour.
For you see: massage is, even with elderly, defined as hands-on time only is paid by the hour. Whatever your rate is by the hour, is paid only based upon the time your had hands on the client. I have fought that very issue the whole 4+ years I’ve been in elder care. I don’t get paid for wandering a building trying to track people down. I don’t get paid waiting for Nurses’ Aids to accommodate someone’s mobility or restroom needs. I don’t get paid for redirecting their Dad’s/Grandpa’s verbal lapses and questionable activities. I don’t get paid for keeping loved ones from falling out of chairs or beds, or answering anxious cries for help. I don’t get paid for waiting for housekeeping, or the salon, or any one of several other therapy sessions to wrap up so that I can get my session in (being lowest on the totem pole), and I sure as heck don’t get paid for my drive time or expenses. Yet families still complain about my $40 whole visit or $20 half visit charge as being too vague because: grandma said she didn’t get all of her hour, or mom doesn’t even remember you coming, or that seems awfully pricey for such a short massage. Never mind, I travel to them, they never have to worry about expensive or inconvenient transportation scheduling. I schedule around ALL of their other needs, even playing bridge with the girls. I bend over backwards to make sure that they are as comfortable as possible, and I limit needing to adjust or re-position them as much as possible, which often means fetching blankets and pillows and navigating any one of a number of different automatic beds or recliners. I’ve combed hair, cleaned faces and hands, I’ve helped Aids do their jobs, and I have fetched things for residents thousands of times, including drinks and food.
Now, I don’t say this to just complain about those aspects. I say this to point out the elephant in the room. That massage is billed at the “expensive” rates that it is because there are always behind the scenes things that would otherwise be “working for free”. Or, overhead would be uncovered, and businesses would fail repeatedly. I actually have the lowest fees of anyone in the metro. Perhaps that is how I slowly gained the monopoly. And I did it by eliminating as much as possible, cutting corners on my side where I could, and otherwise just eating the bullet knowing that I put in 36 to 48 hours a week and usually actually see pay for roughly half that. If it weren’t for the trade I do for my tax accountant, I probably would have failed years ago. Her skills with my tax return have ensured that I always remain afloat, just to make sure that other peoples’ dear ones are well cared for. That is my mission in life.
I have said millions of times over, my goal is always that the person I’m working with feels better when I leave than when I walked in and I always do my best to make that happen. Sometimes it is futility in action, sometimes it is an ever so short span of relief, but if I can even provide a little relief from the discomforts of aging, then I have done my job well. Now, I can say that I know this to have been true for the last 4 years, because I am the only therapist left standing. I’m the only one that had the fortitude, the knowledge, the strength (mentally and emotionally), and the stamina to keep going and keep helping when the odds were stacked against me. I managed to keep my costs down to encourage as many people to get massage as possible. I managed to learn quickly, stay focused, and help educate families and staff on the importance of massage. I’ve given talks, I’ve done free events, I’ve shaken thousands of hands, and I’ve given helpful advice when and where I could. All of that work has finally paid off, if not financially, at least metaphorically. I am the standard of care in Elder Care massage for the Kansas City Metro area. I am the only one left to turn to for advice, counsel, or appointments. So, I have to decide if it will end with me when I retire from massage, or if I will attempt to grow a business that will potentially not only keep Elder Massage going, but possibly gain better footing for the field and create expansion.
And all when I thought I was going to have some miracle allow me to move to Colorado and build Atira. Could life get any more confusing? Don’t answer that Universe! Maybe there’s a both answer lying in there for me somewhere…. I always have liked BOTH answers.