Tag Archives: geriatric massage

Ummmmm, yeah, it’s like that.

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.

Don’t Fear the Reaper

Beyond being one of my favorite songs,  it is a sentiment I hold dear and feel the truth in.  

I have chosen to follow a path with my career in massage therapy that few are willing to endeavor into.  I work with the geratric population, and have for over 4 years. 

My husband has pointed out that many people go into caring for elders for the right reasons,  but few are able to stick with it. He also pointed out that often you see there are those working in nursing facilities because it’s a solid job,  not because that is their preferred choice, and those are always the first to take another line of work.
He told me just last night that it is a wonderful thing I do, because even though it is hard,  I continue to do the work because I recognize the need.   He’s not the first to tell me that.  In fact I’ve heard it thousands of times. Friends tell me, residents tell me I’m going to be so blessed because of what I do for them. Yet, I have trouble believeing it.

For me my work is just that:  providing a necessary service to a needy populace, of which I’m very skilled in providing and well  informed in handling aspects of their situation; mainly as a means to pay my bills.  It’s not physically demanding,  not mentally difficult,  and though it can be emotionally and energetically taxing- even draining at times – there are worse things in the world. I’m simply doing what I know I can and should do.  I don’t feel that makes me special. 

Beyond that,  there are days which I’d  rather not.  Be it I woke up already tired,  I am already slogging through my own emotional muck, or I know it’s a full moon and thus likely to be a horrendously difficult day,  I find myself saying: do I really need to go in today. 

Yet, I nearly always do. 

My days off have been few and far between.  I’ve taken 3 one week vacations for family in the 4 years, I took one month off for the birth of my son, and I can count my sick days using just my fingers. And I’m a contractor,  so there’s been no boss to enforce my attendance, no one to threaten the loss of a job for missing too much work. I simply know I need to do my work,  not just for my bills,  but for those that would miss their massages if I was gone. 

But there is something else that keeps me going,  keeps me helping.  I don’t know what to call it for certain.  I’ve had people reference being a Death Doula. I don’t know if I like that label.  I know that whatever it is, my mom had it too.

What am I taking about?  Well I have a sense of when someone is about to pass. My mom did too. She used to talk about how people acted and spoke before they passed away.  She’d said there were times that she swore she’d seen  a ghost visit someone and within days they’d pass.  There were hundreds of stories she’d told me growing up. She spent over 20 years working as an LPN in nursing homes, she had plenty of them. Most of her stories she knew that someone was within a week of passing, and a few stories she would tell,  people  were hours to a couple of days from passing  when she got the knowing. 

For me though,  it’s less reliable.  Maybe because I have less experience yet,  or because I see my residents less often (once a week, instead of daily). Regardless,  I still seem to have the sense. Though sometimes there’s a bit of a delayed reaction.

Often I find myself realizing after the fact that I’ve had what I’ve come to refer to as “the goodbye talk”, and usually anywhere from a few  days to 6 weeks after the talk, the resident passes.  I have numerous examples,  but some  come to mind more readily. Here’s a couple (for HIPPAA reg.s I’ve changed names):

My most memorable was a retired priest I’ll  call Fred. He never did want me to work with him.  Be it pride, or his training,  he just didn’t want a massage.  Every visit was accompanied by “go away” or “leave me alone” or fist shaking.  Once he actually made contact with my shoulder in the closest thing to a punch he could muster.  Most of the time he would eventually give in and let me work.  Finally one day after a good fist shake,  I sat down, and confession style told him essentially that I wasn’t going away.  I said that I  needed to pay my bills and I would give massages to him because it was requested.  Followed with “there’s only 2 ways out of getting my massages, and only one of them would be to move out of the building”. I didn’t finish the rest of the sentence,  because death was simply implied.

  One week later he passed away, the night before I was due to see him again.

Then there was Miss M. I had been seeing her  for 2 years,  unable to stand, unable to speak,  could not feed herself,  could not use a toilet,  every action was  provided to her. When I worked with her I had to rely on facial expressions to tell if I was using too much pressure,  and she could only take the lightest of touch.  I knew she was miserable. I always talked to her  when I worked.  Telling her what I was doing,  telling her about the weather,  small talk.  One day though I interjected  my perspective on her situation.  Telling her: I see you are always in pain,  & I’m hardly helping.  Your family will miss you dearly, but that’s inevitable.  Everyone greives when they loose family,  but it’s impossible to live forever.  If you’re in as much pain as I believe you are,  you should just let go.  You’re suffering will not make their greif any less later…. 

She passed away two weeks later.  

I think I’ve just had another talk like that.  Though I’m not certain.  My buddy Jim, I’ve worked with for a couple of years as well, and I’ve seen him twice a week for over a year now.  We usually talk about a lot of things including politics,  & I’ve done just about every other type of caregiver thing for him that’s possible. I see a lot of my Dad in Jim, and feel close to him like father-daughter. Well this week’s first visit was on a relatively good day when everything was going smoothly. Yet, when I got to him I suddenly felt the urge to go on a tangent politically.  Jim is a Republican but has said he doesn’t like Trump. Anyway,  I asked “Do you have a contingency plan for when everything goes to crap, because I don’t?” He said “What do you mean?”. I replied to the effect that both Trump & Hillary are out for money and that I highly doubted either one of them would do anything to help the American people,  but both would pass laws to help their businesses. I followed with that they would probably screw the financial system,  taxes, and medical system for the average joe because that would make them more money. & I explained that I knew people  thinking about heading to either Canada or South America & I had no idea what I’d do.  … He repeated several times “I’d never thought of it that way.” Then on Friday when I went to see him,  he was very low energy,  could hardly talk,  was saying he felt like he was dieing and couldn’t catch his breath.  Everything was hyper sensitive and he hurt everywhere.  It even appeared that he had blood in his urine when I helped him out of the restroom.  I spoke with the lead nurse and she explained they were aware of everything and doing everything they could,  and she reminded me that they were limited because he had a DNR on file.

Now, I don’t know for certain that he’s on  his way out.  What I do know is I’ve told him: “I’m not afraid of death.  I’m afraid of pain, suffering, lack of finances,  being homeless,  many things,  but not death.” I also know that I care for this person like my own dad,  and hate to see him in pain. I also know that the facility he’s in does have limitations in his care because of government regulations on pain medications and his own DNR.

 And with everything I  know I’d rather he find his way out/home as peacefully as possible, rather than continue to suffer. I hate more than anything to see another human being suffer. So it’s a bitter-sweet knowing that his transition is sooner than later.  

Does it mean I look forward to my job? 

– No.

Does it mean I hate my job? 

– No.

It simply is.  

Whether I’m Special or not.  Whether I’m different or not.  Whether I’m blessed or not (I have yet to see the blessings by the way). 

It just is.

I will continue to get up and go into my buildings multiple days a week,  weeks on end, years even,  until something spectacular changes my world and relieves me of my duties. I will continue to be there for those that need me, and say  goodbye to each of them in their time. It seems it’s just what I  do.

Blessed Be Each and Every One of Them.