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When Your Massage Client Has Dementia  https://medium.com/@everflowing"


Providing massage for dying persons presents multi level challenges to me as a practitioner. One of these special challenges is working with persons experiencing dementia. One of the blog posts that has been archived earlier is titled The Lost Pause. https://medium.com/@everflowing" Please read that post as well, as it is the preparation for the following guidelines for working with clients with varying degrees of dementia.

The following guidelines will assist you in remaining sensitive in your communications:

*Always approach the person with dementia from the front and tell the person who you are. Communicate at eye level. This may indicate that you sit to say hello.

*Use short simple words and sentences.

*Speak slowly and clearly. Breathe between thoughts.

*Give one step directions. (Ex) “Hold my hand” rather than, “Reach over and take my hand.”

*Patiently wait for a response. Verbal response may be faster than body response. Allow time.

*If the body does not respond, repeat the request again exactly the same way as the first time. If there is no body response, add a touch cue. If action does not follow then say, “That’s ok” and state what you are going to do next. “I am going to hold your hand.”

*Be willing to repeat information or questions. Use the same words each time.

*Your client may forget who you are and what you are doing several times during a session. Be willing to repeat these very basic details as often as needed. This will require you to acquire permission over and over again in regards to touching your client. Permission and trust building are ongoing with the client experiencing dementia.

*The client may also suggest that you attend to an area of the body to which you have already attended. Be willing to touch the area again before moving on or simply repeat the actions.

*Clearly define what you are saying. (Ex) “I am using lotion,” instead of “I am using this.”

Cueing

*Cueing is talking the client through a request in specific terms. (Ex) Instead of asking a client to lift this leg, You will touch the area of the body affected, to guide the client through the action while giving the verbal instruction. You would say, “can you lift the leg that I am touching.” Once again you will touch the areas of the body affected by the request.

*Turn questions into answers. (Ex) “I am going to touch your shoulder” instead of, “Do you want me to start with your shoulder.”

Communicating with Family

Family members of those suffering with dementia are in a deep state of loss. They are watching their loved one lose every aspect of their identity in the world. They are in constant fear that their loved one will one day no longer know who they are. Family are many times relating to what they have lost rather than what is present. I learned this the hard way when I took a photo of one of my clients that I thought was radiant. He was beaming and so comfortable. I showed this photo to the family. It brought immediate pain to the mother who explained to me that the person in that photo was a mere shadow of who had been her son and never to do that to her again.

As a member of a health care team I have the opportunity to meet the person in the bed. I have no past experience to grieve. I only know who I see and feel in that moment. The full experience is much broader than that. I must stay gentle and aware of the larger picture. I have learned to hold my excitement and awe of my touch experiences and share them with the larger picture in mind and heart.

Don’t Take It Personally

*With short term memory loss there may be a sudden change in the relationship. You may be asked to leave or the client may simply say, “That’s enough.” Try and make each touch as complete as possible as the session may end at any time.

*Feedback and gratitude at the end of a session may not be possible with more advanced symptoms of dementia because the session is not retained consciously. Be alert to the feedback expressed through the body and in facial animation as you facilitate the session.

Over Stimulating

Stimulation is needed; however, overstimulation can be frustrating. Remember your client is integrating in slow motion. Perform bodywork for short periods of time. Work slowly so you can observe the body’s response. After the initial trust building and set up for your touch session, ten minutes of touching physically may be enough.

Remember that you will be returning the room to its previous arrangement. Rearranging the room is more stimulation and is still part of your touch session.

Reporting

Grandiose ideas such as having lunch in Paris or having intimate relations with the body worker may be a symptom of dementia. Always report any out of the ordinary behavior to a staff member on-site. Make written reports on your sessions and note any irregular behavior or accusations.

Always Remember Your Client’s Safety

Short-term memory loss and loss of motor control may indicate that your client can forget their physical limitations, such as not being able to walk. They may also not be able to clearly assess the edge of the bed. Stay alert to your client’s limitations, the equipment you are using, your surroundings, and the directions you are giving. Be alert, as well as compassionate.

Irene Smith www,everflowing.org

https://medium.com/@everflowing/beyond-massage-b27a3a73fc12

Reading the Massage Magazine special issue on pain relief I am reflected into how working with pain differs in my hospice massage practice from more traditional modalities.

A couple of months ago I was working with an intern at an inpatient hospice. We went into see a woman with cerebral palsy who was not on our list of referrals.

Sabrina had spent most of her life in hospital wards. Her body was a roadmap of surgeries and called out loudly for tenderness.

Sabrina spoke of her legs and back being in great pain. She continued to speak of her discomfort as I positioned myself sitting comfortably at the foot of her bed. As I slowly lifted the sheet to assess her right leg my heart shed a tear for the dwarfed limb that was exposed.

I cupped my hand around the thigh and softly spoke," I am honored to offer this limb some tenderness....I feel your leg loves the attention.... I’m so glad we’re here."

While gently holding and tenderly petting this leg Sabrina replied, "If someone had done that years ago I might still be at home."

I covered the leg as Sabrina asked me to touch her back. Although she was in a lot of pain she requested that a nurse position her onto her side so I could touch the exact spot.

After positioning was completed I sat comfortably behind Sabrina on her bed, uncovered her back and with Sabrina’s permission I came very close. With one hand slipped under her head pillow as to hold her, I simply laid my other hand on her back and said, "Oh I know you have been in pain for a long time. I'm so glad we’re here."

As I became comfortable, slowly exhaling, I felt Sabrina going to sleep. Her pain had been validated. She expressed her gratitude before the silence..

After a couple of minutes I slowly removed my hand from underneath her pillow and changed places with my intern.

The Everflowing intention is never to remove pain from someone’s body. The intention is to validate and honor the symptom ology that is being experienced, and to create an environment where the client’s anxiety about having pain can be eased.

We are in a culture that insists that pain is something we have to get rid of. We essentially make pain wrong therefore when pain appears we are afraid of it getting worse; we defend ourselves, hold ourselves tightly. We want the pain to go away. This directs a profound degree of energy to the pain, and creates anxiety.

As an Everflowing practitioner, I want to create a resting place as I walk into a room or up to someone’s bed; a place of stillness first, and then a place of very gentle movement like a breeze or a soft wave of water as the tactile relationship begins. A place where there is no resistance; a vulnerable place.

This is achieved through slow body movement, slow speech, slow audible breathing; and my willingness to find my own place of physical comfort; just being comfortable and breathing as I slowly speak to my client. I am just a witness.

This resting place, this alternative rhythm, eases a lot of tension in the room. There appears to be more empty space and the client might begin to find comfort as well.

If I can stay grounded and comfortable in body and mind then the static and resistance has been broken. The cycle has to reestablish itself.

This change in the pain cycle can cause a decrease in the pressure being experienced by the client and give the client an alternative strategy for coping with the pain.

Pain is multidimensional when someone is dying and may be my client’s most familiar response to his or her condition. I cannot assume that alleviating it is the kindest strategy. I feel I must validate the existing relationship and give models for reestablishing a more compassionate communication with ones self and one’s environment.

This is the Everflowing approach to pain. I look forward to your sharing your approaches and stories.

Blessings

Irene Smith www.everflowing.org

I have been concerned for a long time about the way the field of hospice massage is growing. As with any therapeutic intervention that becomes mainstream ,the integrity of the field is suffering.

Practitioners with the desire to serve ;however without sufficient training to work with dying persons, are being hired by program co ordinators that have no knowledge in what is needed to facilitate a safe massage program.

I am alerted to hospice programs taking on massage practitioners that have no training in adaptations from working with healthy people on a massage table to working with seriously symptomatic persons in beds.

Many hospice co ordinators are corporate administrators who believe that a massage certification is all a practitioner needs to massage hospice clients.

Although some schools have continuing education programs for working with the dying, massage schools do not teach working with dying persons in core training as a general rule. Sometimes the topic will be minimally addressed in a geriatric or oncology course.

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Twenty seven years in hospice massage gives me the experience to outline what have proven to be challenges in this field ,and areas of training needed for safe relationships between clients and practitioners, and organizations

If you are a massage program co ordinator, educational director for a massage school, or hospice massage practitioner these are a few of the areas that require knowledge in this field.
*Hands on precautions as pertains to massage not nursing.

*Modification of standard massage techniques to meet the needs of the physically and emotionally fragile client. This includes; intention, amount of pressure facilitated through the hands, the speed of technique delivery, and the duration of a session.

*How to adapt massage for working with people in beds and chairs; including body mechanics for the practitioner. Practitioners need to know how to comfortably reach the client to prevent injury to themselves.

*How to gather sufficient information for treatment assessment.

*How to work in a home setting. This involves working in a bed; being with family; communicating with other team members; reporting; setting limits ,and what to take as equipment.

*How to cope with the emotional impact of clients dying which includes personal coping strategies as well as support systems.

This is a specialized field of service that requires practitioners to have sufficient information, supervision and support for the safety of the client and the massage practitioner.

If you are an administrator , educational director or practitioner reading this please go to my website www.everflowing.org and check out the educational resources. Resources are available to give you the information you need. You may download articles for free that will serve you well. You may also ask questions on this site.. Go ahead use me!!!

Many times patients are so hungry for touching, and practitioners are so hungry to make a difference that they don"t recognize the difference in a safe and unsafe session. It’s up to the integrity of the schools, co ordinators and teachers in this field to see that wisdom prevails.

Blessings

Irene Smith www.everflowing.org