My last article focused on keys to opening doors to eldercare and hospice. If you desire to work in these settings, my guess is you have wondered: 1) How do I get my foot in the door? 2) How do I generate a clientele? 3) How can I get paid? All very valid questions! A few months ago, Massage Today conducted a poll asking two questions: "Do you provide massage to people in eldercare or hospice? If so, do you provide this service as an employee, independent contractor or volunteer?" Here is what we learned from the 249 people who responded:

• 59 percent provide massage in eldercare facilities and 41 percent in hospice
  And:
• 14 percent are employees of the organization
• 51 percent work as independent contractors
• 35 percent volunteer their services

The good news is that long-term care and hospice organizations are including massage therapy services more than ever before. I'm honored to be a part of this trend and to assist folks like you along your path of service. I thought you might like to hear about therapists who are doing this rewarding work - and getting paid for it either as independent contractors or employees. I interviewed several massage therapists to find out how they are being compensated. Read on and learn from your peers what you might expect when working in this field. (To respect privacy, I have changed the names of the therapists and have not named the organizations.)

Independent Contractors

Jill, LMT, contracts part-time with a hospice. Hospices are structured as either for-profit or non-profit and this particular hospice is a non-profit organization. Funding for massage services come from grants and endowments. Jill receives referrals from either the nurse or social worker who obtains a doctor's order for massage therapy. Each patient is initially referred for an assessment session plus four visits. Jill can recommend continuation of services beyond the four visits. She has a consistent caseload of six clients and typically sees each client weekly; however, some are seen more often based on needs. Sessions last usually 30-40 minutes. Jill is paid $40/session, plus mileage. She educates the staff about her services by regularly presenting at staff meetings as well as sharing printed information. She reports that this has helped generate appropriate referrals and build relationships with other caregivers.

Doreen contracts with a 100-bed skilled nursing facility for 12 hours per month. The facility administrator acknowledges the value added by providing this amenity for her residents. The funds for massage come from a combination of general operations and marketing budgets. Doreen has permission to work with any elder in the facility. The medical director must approve of all resident activities and massage therapy is considered a resident activity in this facility. When Doreen arrives at the facility she checks in with the social services or nursing director who make referrals. Elders are selected based on needs such as pain, agitated behavior, social isolation, or newly admitted to long-term care. Sessions range from 15-45 minutes. Session documentation is kept in the activities department records. Doreen is compensated at a rate of $60/hour. She occasionally provides seated massage for staff upon request of the administrator for the same hourly rate.

Mary, LMT, contracts with a 60-bed skilled nursing facility. She has taken a creative approach. Like many facilities this one has a number of elders living there whose care is paid for by Medicaid. (Medicaid is the state-operated public assistance program that pays for health care for people with low income. Some states may have another name for it.) People who receive Medicaid benefits get a monthly personal needs allowance, which is a set amount of money each month for things like clothing, toiletries, recreation, snacks, etc. (For example, Missouri's allowance is $30/month.) Many people who receive this allowance don't use much of it and it builds up in an account. An individual must use the money or the benefit is reduced or discontinued. Mary is paid with money in the client's personal needs allowance account. The nursing home administrator refers residents who have money in their account. But the referral is not just based on the funds being available. People are referred based on needs. Mary has educated the administrator about the benefits of massage for frail elders and, together, they determine a plan of care. Reasons for referral include anxiety, depression, pain, dementia, social isolation because of lack of family. Massage sessions are scheduled either weekly, bi-weekly or monthly. Mary reports that sessions range from 15-45 minutes and she is paid a set fee per session. She consistently has a caseload of six clients.

Employees

Rita is a massage therapist employed by a for-profit hospice working part-time 20-25 hours/week. She is expected to actively participate in interdisciplinary team meetings where patient care plans are discussed. Her involvement in these meetings results in referrals. All patients and/or families are informed about complementary services and they often request massage upon admission. Rita's current caseload is about 23 sessions/week and each session lasts 40-50 minutes including documentation time. This hospice organization pays for massage services from the Medicare funds it receives to care for patient needs. Rita earns $24/hour plus mileage for travel. She also receives benefits for paid time off including vacation and holidays. She found this position through an online job search service at SimplyHired.com. She reports that because she had specialized training in massage for people in later-life stages was what secured the job. The massage program has been so successful that they have recently hired a second massage therapist!

Cindy, LMT, is employed full-time at a continuing care community that offers multiple levels of care including independent living, assisted living and skilled nursing. Cindy is considered a part of the rehabilitation/wellness department. She has a massage room within this department where she sees clients consisting of independent older adults and facility staff, as well as people from the community. Elders who are admitted to the facility for rehabilitation following an injury or illness benefit from massage therapy during recovery. She also sees elders in the assisted and skilled nursing facilities where clients are referred by staff and families. Clients pay the facility for massage which creates a revenue source for the organization. Cindy receives a salary of $45,000 plus paid time off and health insurance benefits.

A New Age of Care

In the last decade, massage therapy has gained recognition and acceptance. Hospice and long-term care facilities are recognizing the value of adding massage therapy services. Therapeutic massage is growing as a form of wellness care for older adults. Organizations that incorporate massage therapy as an ancillary service are on the leading edge of what will become standard in the future of care services and will meet customer expectations. Perhaps you will join me in ushering in this "new age" of care!