In some markets, more and more employees turning to alternative care

How one EHF reader incorporates alternative care to wellness program

From Time magazine to the New England Journal of Medicine, the national media are portraying alternative medicine as the next big boom in health care. But does this mean your employees are actively seeking out massage therapy or herbal medicine practitioners? An informal survey of Employee Health & Fitness readers has found that the answer to that question varies by market.

Some readers in areas where alternative care has caught on are adjusting their wellness programs to take this concern into account, but others are taking a wait-and-see approach.

"I get very few questions; this is a pretty rural area," notes Ann Feliu, MS, wellness director at Canton Potsdam (NY) Hospital. "Alternative medicine is methodically slow in getting here."

Lisa Capriotti, wellness coordinator for Greenville (SC) Hospital System, works within a similar environment. "We have 7,000 employees. I teach 500 classes a year in our wellness program, and in the year and a half I’ve been here I’ve never gotten a question out loud," she says. "But we sent out 700 surveys asking employees what they wanted to hear about. One employee mentioned herbs, and one mentioned comparing Western medicine with other types of medicine."

If the alternative medicine boom hasn’t hit your area yet, it may be coming. A 1993 New England Journal of Medicine study found that 34% of respondents had used some form of alternative treatments, the majority of which (79%) were accessed without consulting their regular doctor. The National Institutes of Health has since established an alternative medicine office, and health plans such as Oxford Health Plans and Blue Shield of California are selling products with alternative health coverage.

Take the experience of Elizabeth Click, ND, RN, manager of wellness training at Progressive Corp., a Cleveland-based auto insurance company. Click says she regularly receives employee requests "about various vitamins and herbs, and different types of body work like massage and acupressure." She says requests are growing because of recent on-site presentations about alternative medicine.

While responses to EHF’s informal survey showed a wide range of employee interest levels, several common themes emerged:

• Health promotion professionals believe that a holistic approach to medicine and health is a logical extension of the "body, mind, spirit" foundation of wellness

• Wellness coordinators should become more knowledgeable about alternative medicine

• Whether alternative therapies are covered by company benefits or not, some employees will insist on using them.

• Wellness professionals should urge employees to use caution when considering herbal remedies and other alternative therapies

A natural’ fit

Whether they currently provide programming on alternative medical practices or not, respondents to the survey agreed that a holistic approach to health makes good sense for wellness professionals. "Even in our mission statement we talk about focusing on the whole person, and promoting that holistic view of people," says Click.

Feliu agrees. "As a professional, I need to be familiar with and aware of what alternatives there are, and to stay as current as possible," she says. "I need to know how they may be used, and how they may benefit the individual."

"Yes, it is definitely an appropriate concern for the wellness coordinator," says Diane Stone, RN, employee wellness nurse at St. Mary’s Hospital, in Richmond, VA. "We are into the holistic approach, the whole mind-body-spirit concept, and regular medicine doesn’t necessarily prevent or treat all aspects. It mainly deals with the body."

Being knowledgeable of, or even enthusiastic about, alternative medicine does not mean you should recommend such therapies to your employees, warn the experts.

"By law, we can’t give out recommendations," notes Fran Scully, MA, ACSM, manager of the corporate wellness program at Applied Materials, a Santa Clara, CA-based semiconductor equipment manufacturing company. Although her company has extensive nontraditional offerings, and provides insurance coverage for acupuncture and chiropractic, "We try to take a pretty conservative approach. People are always looking for the magic pill, and there really isn’t one."

(Two respected sources recently weighed in on this subject, urging caution regarding dietary supplements and alternative, unregulated remedies. See the related article on p. 124.)

"Our role is not to make recommendations, but to provide as much information as possible available so the employee can make an informed decision," says Feliu, "I’m certainly in support of making more alternatives available to people."

"Being a wellness coordinator, I’m very conservative with the advice I give out," adds Capriotti. "If I don’t know something to be true, I’d rather say nothing. I would not be opposed to having an expert in the field do a seminar, as long as it wasn’t a [product] sales pitch."

Meeting employee needs

While reluctant to give advice, wellness professionals are eager to provide employees with information about alternative medicine, especially when it has been specifically requested.

Stone, for example, says her program is providing massage therapy in response to an employee survey. The hospital underwrites about half of the costs. "The employees are willing to [pay] even though it is not fully covered," she notes. "They say it helps reduce stress." The massage therapist comes to the hospital on assigned days, for a total of about four hours a week. Employees sign up in advance for their 15-minute session.

"We did our first holistic health presentation series last fall," says Click. "Over a period of six weeks, 254 people participated; it was very popular." Click conducted a survey before she planned the series, and based its content on the responses. This pre-planning helped ensure its success. "Afterwards, 65% indicated they would make some form of change in their lifestyle based on the series," she says.

Her company’s health services department incorporates alternative therapies in a number of ways, Click adds. In the primary care area, for example, nurse practitioners will recommend herbs and vitamins on a limited basis. The employee assistance program offers biofeedback.

"We have a very diverse population, so alternative kinds of programs work well here, particularly different forms of physical activity," says Scully. Her company has offered a karate program for years, and t’ai chi and yoga are both very popular. Now, the company is offering a new class in falun gong, a kind of t’ai chi movement. "A couple of employees are teaching that because it’s something they’re interested in — and the class has been full," she says. (For more information on some of the more esoteric forms of alternative medicine and health practices, see the glossary on p. 124.)

Scully’s program also includes an on-site massage therapist, and a clinical acupuncturist. "He’s very popular," she says. "Employees ask him questions about different kinds of herbal medicines."

Employees will find what they want

If you don’t provide programming on alternative medicine, employees interested in trying new therapies will do so nevertheless — even if they aren’t covered by company benefits. All the more reason, then, for wellness professionals to become well-informed.

"There’s a gentleman in the community who practices iridology; he analyzes your eye, looking at the iris to tell what parts of your body may be experiencing stress," says Feliu. "I know a couple of employees have been to see him."

"We have two health food markets with their own cafes, and they sell herbs," adds Capriotti. "Our employees are much more apt to go there and try them without asking our approval."

Feliu says that at least for some proven alternative therapies, such as massage, insurance coverage is important. "Right now, insurance doesn’t [cover massage] unless the employee has been referred by a provider, but I think it needs to be covered," she says. "Average incomes here are pretty low, and you’re looking at anywhere from $40 to $60 [per session]." She notes, however, that employees are buying gift certificates for single sessions and giving them to friends as gifts.

Even employees who have coverage may bypass the benefit to see the therapist they want, notes Scully. "A number of our employees will see a chiropractor or acupuncturist, or another person outside of the campus — even if they are not covered."

It seems clear that this employee thirst for new knowledge and health options is not going to go away; what are wellness professionals doing to keep up with the changing times?

"We sometimes rely on the Internet," says Click. "I’m also a member of the Holistic Nurses Association, in Flagstaff [AZ]. Some of my colleagues there gave me suggestions about resources."

The advice Scully’s staff give employees curious about nutritional supplements seems to apply equally to wellness professionals: "We refer them to the Internet, to reference books, and we tell them to check with their doctors and registered dietitians," she says. (See the list of Internet Web sites, inserted in this issue.)

SourceKit

Diane Stone, St. Mary’s Hospital, 5801 Bremo Road, Richmond, VA 23226. Telephone: (804) 281-8395. Fax: (804) 287-3507.

Elizabeth Click, Progressive Corp., 6300 Wilson Mills Road, Cleveland, OH 44143. Telephone: (440) 446-7443.

Lisa Capriotti, Greenville Hospital System, Greenville, SC 29605. Telephone: (864) 455-3136.

Ann Feliu, Canton Potsdam Hospital, 50 LeRoy St., Potsdam, NY 13676. Telephone: (315) 265-3300.

Fran Scully, Applied Materials, 3165 Kifer Road, Mailstop MS2811, Santa Clara, CA 95051. Telephone: (408) 235-6632. Fax: (408) 563-5653. E-mail fran_scully@amat.com.