As an LMT providing massage in a hospice setting can be equally emotionally rewarding and challenging. This article can help you better understand massage therapy and the end of life. Part of providing support to the client, the family, other caregivers, and members of the hospice or medical team, will be learning to recognize the signs that death may be imminent. There are several characteristic indications that death is 48 hours away or less.
Withdrawal is one of the first signs; the client begins to turn inward, focusing less on the physical body and more on the internal spirit. At this stage, active massage is not necessary; instead, you may choose to simply sit with the client, holding hands, if that is comfortable, and provide a gentle reminder that you are there, and they are not alone.
Metabolic changes and decreased oxygen intake may cause the client to become disoriented, anxious, or restless. Palliative massage can help ease “terminal restlessness,” a syndrome common in the last days of life. Breathing can become noisy and irregular as a person nears death. Respiration may increase in some cases, though generally as we die, the breathing slows down, as do the rest of our bodily functions. The client may experience apnea, or cessation of breathing, characterized by breathing at intervals of 10-40 seconds, also seen in clients who snore or have chronic sinus or respiratory problems. The practitioner may want to elevate the client’s head to ease breathing.
Typically, as a person nears death, he will stop eating and drinking, sleep more and more, and become less responsive. Individuals nearing death, like individuals in a coma, can often hear clearly, so it is appropriate to continue to speak in a comforting way to the client.
Clients with spiritual beliefs may benefit from visits with clergy or spiritual advisors. Changes in skin temperature can also be a sign that death is imminent. As we near death, circulation of blood to our extremities is reduced, preserving blood and oxygen flow for the vital last function of breathing. Thus, someone who is nearing death may have extremely cold hands, feet, and legs. Additionally, they may be clammy or damp from decreased blood flow. Blankets or light coverings can make the client feel more comfortable during this time.
Some clients nearing death experience what we might think of as hallucinations; seeing people who other people do not see, or feeling that a dead relative or loved one visited them during the night. In many cases, these images or feelings comfort the individual, but sometimes they can be frightening. The practitioner may want to ask the client if he or she would like to talk about the experience.
The practitioner may choose to remind the family and loved ones that they may want to say goodbye, to let the dying person know that those left behind will be all right. The opportunity to provide final reassurance to loved ones and remember their presence in our lives can be tremendously important and beneficial, for the individual who is dying as well as his/her family members and friends.
Death occurs with the client’s last breath and when the heart stops beating. If the massage practitioner is present at the time of death, it is appropriate to ask the family if they want you to stay, or if you can help them in any way. Offering to make phone calls or provide some type of assistance to the family can help them adjust to the death. It is important to be supportive of the family’s needs during that time. The family should be allowed to spend as much time as they feel necessary with their loved one after the death; there need be no rush to call the hospice nurse or the funeral home.
Many families will choose to sit with their loved one or invite other friends and family members to sit with them before taking the body away. The family may wish to bathe or dress their loved one for their funeral services.
Many families ask that the practitioner or other members of a hospice team attend the funeral or memorial services for their loved ones. This ritual can be of great value to the practitioner, helping him or her resolve and put closure on their experiences with a particular client, and offers the therapist a final period of time with the family, where they can share their compassion and deep connection to the client.