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Massage Today
October, 2011, Vol. 11, Issue 10

Hospice Massage Programs Provide Visionary Care

By Ann Catlin, LMT, NCTMB, OTR

Ten years ago, when I began teaching others about end-of-life care, I heard a lot of massage therapists say that they wanted to volunteer with hospice and realized they needed some additional knowledge and skills.

Today, even more therapists I train say they want to work in hospice or develop a hospice massage program. The chances for them to do that are much better than a decade ago and I'm blessed to be a part of the expansion of holistic end-of-life care.

Understanding Hospice

Rather than a place of care, hospice is a philosophy focused on comfort and support of people facing a life-limiting illness that no longer responds to curative treatment. The goal of hospice is to improve quality of life by easing the physical, emotional and spiritual burden of the patient and his or her family. Pain and other symptom management is a special area of expertise hospice offers. Eighty percent of hospice care is provided in the patient's home. "Home" is defined as wherever the patient is living at the time. It might be a family member's home or a nursing home. There are even hospice services provided in some prisons. The United States Medical Center for Federal Prisoners happens to be where I live in Springfield, Mo. The first prison-based hospice program was developed there in 1988. I once heard moving accounts by several prisoners who were trained as hospice volunteers and served at the bedsides of fellow inmates.  They talked about the profound impact the experience had on them as they learned to care for a dying friend. I recall one man saying it was the first time he felt compassion for another human being and that it was making him a better person.

Hospice Massage Programs - Copyright – Stock Photo / Register Mark It might surprise you to know that hospice is a relatively new area of health care. The first hospice, St. Christopher's Hospice in London, was formed in 1967 by Dame Cicley Saunders, a nurse and physician who saw the need for more compassionate care of the dying. While lecturing at Yale University, she met Florence Wald who, at the time, was Dean of the Yale School of Nursing. Five years later Wald moved to London to work alongside Saunders at St. Christopher's Hospice. Meanwhile, Elisabeth Kubler-Ross published her landmark bestselling book, On Death and Dying, establishing her as an advocate for dignified home care of the dying. In 1974, Florence Wald founded Connecticut Hospice in New Haven, the first hospice in the United States. It's important to note that in 1982, Medicare Hospice Benefit legislation was passed, demonstrating that the federal government supported quality end-of-life care and was willing to pay for it with Medicare funds. Today, there are more than 5000 hospice organizations in the U.S. alone.

The Hospice Team — Where Does Massage Fit?

Every hospice patient has access to an interdisciplinary team depending on individual needs and choices. The patient and his or her family are central to the team. Each team also includes a nurse, physician, social worker, home health aide, spiritual and bereavement counselor, occupational, speech and physical therapist and volunteer. Not every patient requires help from every team member, but the hospice organization must have these services available. In fact, Medicare demands this standard of care in order to qualify for funding. I realize you didn't read "massage therapy" in that list of required services. So where do we fit in to the team?

The past ten years has seen remarkable growth in hospice massage programs in spite of the fact that there is no standard for how these programs are created, managed or funded. Since my own work includes training and preparing massage therapists to serve people in hospice, the question of how it's working is important to me. I'd like to give you a peek into what's happening at this point in time. I found one 2009 study published in the American Journal of Hospice and Palliative Medicine that surveyed hospices in the state of Washington to find out about complementary therapy use. Survey results revealed that 86 percent offered at least one complementary therapy. The three most common were massage therapy (87 percent); music therapy (74 percent); and energy healing (65 percent). A fairly significant number of hospice patients received complementary care, averaging 35 percent of all patients. So, if massage therapy was so widespread, how was it funded? Well, the good news is that hospices more than ever before are finding ways to compensate massage therapists for their service. The not so good news is that there still are a lot of hospice massage programs that rely on volunteer service. Of the 58 percent of hospices that paid massage therapists, funds came from donations, special funds and grants, direct pay from patients, and other hospice funds. Most hospices relied on a combination of paid and volunteer services. The authors concluded, "According to the results of this survey, the use of complementary and alternative medicine in Washington state hospices is so extensive that the official inclusion of CAM providers as part of hospice staff seems warranted (and these) providers should be considered health care professionals, and as such, be submitted to the same rule and benefits other health care professionals receive." I couldn't agree more! I'm happy to say there are some hospices that are doing just that.

Alternative Hospice in the St. Louis area is a great example. I interviewed Mary Magill, RN, Founder and Executive Director, to find out about their program. The most significant difference is that massage therapy is included in their standard of care, not just an adjunct to core care. From its inception in 2005, the use of complementary services has been central. In fact, it's in their mission: "Alternative Hospice provides holistic end-of-life healthcare by integrating complementary care with conventional medicine." Mary shared that her nursing background included work in long-term care facilities. She observed the profound impact of seniors living with the loneliness of touch deficit and wanted to alleviate that kind of suffering. Alternative Hospice currently employs four part-time massage therapists who work out of two offices, one in metropolitan St. Louis and one in a rural area. Besides wages, therapists earn paid time off and are covered by the company's liability insurance. Massage services are funded primarily by donated funds. Therapists not only care for patients and their family caregivers, but also other hospice staff. I asked Mary what special skills she looks for in the massage therapists she hires. She responded, "Love for elderly people; a compassionate heart; specialized training that includes not only clinical skills." Therapists are expected to function as a professional member of the interdisciplinary team and have sound documentation skills. Alternative Hospice benefits from the complementary care it provides in several ways, most notably, increased patient and staff referrals. Mary cited decreased staff turnover as a huge benefit. Personally, she is rewarded by witnessing the greater quality of life in their patients. "I know we are doing a great job and our families appreciate it."

I believe we will see continued growth in quality hospice massage programs as public interest in using complementary therapies increases, along with emerging evidence of the value of massage in end-of-life care. And those of us who feel drawn to serve this special population will have the joy of being a part of something that makes our world a better place.


"You matter because you are you. You matter to the last moment of your life and we will do all we can not only to help you die peacefully, but also to live until you die." – Dame Cicely Saunders, Founder of the Hospice Movement


  1. National Hospice Foundation,
  2. National Hospice and Palliative Care Organization Facts and Figures: Hospice Care in America, 2010 Edition,
  3. Kozak, Leila, et. al., "Use of Complementary and Alternative Medicine by Washington State Hospices," American Journal of Hospice and Palliative Medicine, Vol. 25 Number 6, December/ January 2009.
  4. Alternative Hospice, 1749 Gilsinn Lane, Fenton, MO 63026,

Click here for previous articles by Ann Catlin, LMT, NCTMB, OTR.


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