Touch, music, and imagery can relieve stress, anxiety, and pain, report says

Complementary therapy moves into home health

Home health is an area that can benefit from a variety of complementary and alternative medicine techniques. That’s one of the conclusions reached by a report issued in March 2002 by the White House Commission on Complementary and Alternative Medicine (CAM) Policy, according to James S. Gordon, MD, director of the Center for Mind-Body Medicine in Washington, DC, and chairman of the commission.

"During our 18 months of hearing testimony from different areas of health care, we heard from home health representatives, and it is clear that some complementary and alternative medicine approaches can fit the home-care setting," Gordon says. "Because home health patients are often isolated and overwhelmed by their situation, basic CAM techniques can help them with stress management and reduce their pain or anxiety," he adds.

Some of the key reasons that prevent health care providers from integrating CAM techniques include minimal research of the effects of CAM techniques; reluctance of payers to reimburse CAM services; questions about education, training, and licensure of CAM practitioners; and dissemination of information about CAM, Gordon says. "Our report addresses these areas with specific recommendations to improve research, reimbursement, and access to these techniques," he adds. (To see the commission’s final report, go to www.whccamp.hhs.gov.)

Aromatherapy, therapeutic touch, and guided imagery are a few of the techniques that have been taught to home heath and hospice nurses by Aurora S. Ocampo, RN, MSN, clinical nurse specialist at the Beth Israel Center for Health and Healing in New York City. "Most CAM modalities require only five minutes to be helpful to the patient," Ocampo says.

"The proper technique can help with pain management, relieve anxiety, and reduce stress," she explains. While therapeutic touch or aromatherapy won’t eliminate pain, patients have reported that pain medication works better after they have been taught breathing techniques that help them relax, Ocampo adds.

Music therapy has been an option for Haywood Medical Center Hospice patients in Clyde, NC, since 1997, says Jenny C. Lockhart, RN, MSN, CLNC, program manager.

"We present the therapy to patients and their family members upon admission, and if they are interested, we include it in the care plan for the physician to approve," she says. "Our music therapist assesses the patient’s goals such as to reduce anxiety, breathe more easily, reminisce, express feelings, or just be entertained. We’ve even had patients who want to learn to play a new instrument as a diversion."

While the music therapist is an employee, Haywood also has volunteers who provide massage therapy and pet therapy, Lockhart says. The massage therapist is available to patients or to caregivers, she explains.

"The volunteer also gives a massage to one employee each month." Massage therapy is a good way to help patients, caregivers, or employees relieve the physical and emotional stress they are feeling, she points out.

While there hasn’t been as great a demand for the pet therapist’s services, there is an excellent response when the need is there, Lockhart explains.

"We’ve found that most animal people’ have their pets, but we occasionally have some patients who have had to leave pets behind when they moved into a new home. They greatly appreciate the chance to hold an animal," she says.

Check training and certification

Even with volunteers who offer complementary therapies, it’s important to require that they have special training in the modalities and show proof of the training and any licenses they may have, Lockhart says. For music therapy, she insisted on the certification and training because it was important that the therapist be recognized as a therapist, not just a musician.

Licensing and accreditation is one of the tough areas with implementation of CAM because there is no consistent approach or requirement, Gordon says. "CAM is a process of evolution, and we are just at the beginning. Licensing is really a state issue, but the commission report recommends that the states be given guidelines and information that can be used to develop licensing requirements in the future."

Home health agencies can use accreditations or certifications that are offered by professional associations of different therapies or by schools as one way to assure that therapists are qualified, Ocampo suggests. Local health care organizations with integrated medicine programs may also be able to provide training or certification, she adds.

Her therapeutic touch students undergo classroom education as well as monitored patient treatments. "We also certify aromatherapists in the same way," she says.

Therapies such as massage, Reiki, and therapeutic touch rarely are reimbursed by payers, generally because there is little scientific data to prove safety and effectiveness, Gordon says. As more data become available and payers can see the benefits, the reimbursement picture should improve, he adds.

There are options for reimbursement, Lockhart says. "Our music therapy is covered under [the prospective payment system] as a visit," she explains. When she first started the program, however, she used a grant from the hospice foundation to underwrite the therapist’s salary. This grant gave her a chance to evaluate the reaction to music therapy and the benefit to the patients.

Ocampo also points out that if a nurse knows the technique, she can perform aromatherapy or therapeutic touch as a small part of the overall visit. She adds that not all nurses can be trained in complementary therapies and be effective. "You can teach the hand movements, but the real healing benefit comes from the practitioner’s compassion and ability to focus upon making the patient feel better."

[For more information about the use of complementary therapies in home health, contact:

  • Jenny C. Lockhart, RN, MSN, CLNC, Program Manager, Haywood Regional Medical Hospice Services, 560 Leroy George Drive, Clyde, NC 28721. Telephone: (828) 452-8760. Web site: www.haymed.org, click on hospice.
  • Aurora S. Ocampo, RN, MSN, Clinical Nurse Specialist, Beth Israel Center for Health and Healing, 245 Fifth Ave., Second Floor, New York, NY 10016. Telephone: (646) 935-2220.
  • James S. Gordon, MD, Director, The Center for Mind-Body Medicine, 2934 Macomb St., N.W., Washington, DC 20008. Telephone: (202) 966-7338. Web site: www.cmbm.org.]

CAM Resources

  • American Holistic Nurse Association, P.O. Box 2130, Flagstaff, AZ 86003-2130. Telephone: (800) 278-2462 or (928) 526-2196. Fax: (928) 526-2752. Web site: www.ahna.org. Web site offerings include conference information, holistic nursing certification program information, and a list of other certificate programs endorsed by the association.
  • American Music Therapy Association, 8455 Colesville Road, Suite 1000, Silver Spring, MD 20910. Telephone: (301) 589-3300. Fax: (301) 589-5175. Web site: www.musictherapy.org. The web site includes information about education and certification programs, and answers frequently asked questions.
  • Beth Israel Center for Health and Healing, 245 Fifth Ave., Second Floor, New York, NY 10016. Telephone: (646) 935-2220. Fax: (646) 935-2272. Web site: www.healthandhealingny.org. The web site includes a library of related web sites, books, audiotapes, and other educational material related to a variety of complementary therapies.
  • National Center for Complementary and Alternative Medicine (NCCAM), P.O. Box 7923, Gaithersburg, MD 20898. Telephone: (888) 644-6226 or (301) 519-3153. Fax: (866) 464-3616. Web site: www.nccam.nih.gov. Part of the National Institutes of Health, the center was established to research and evaluate complementary/alternative therapies in order to determine their effectiveness and safety and to communicate this information to the public and the health care community. The web site contains information about complementary/alternative medicine (CAM), news and events, FAQs, classification of CAM practices, fact sheets, consensus reports, clearinghouse, clinical trial awards data, and clinical trial opportunities.