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There are a host of complementary therapies available to hospices, ranging from common art therapy to not-so-common dolphin therapy. As the needs of patients become more diverse, hospices may feel compelled to expand their stable of complementary therapies. The question then becomes: Which therapies are best suited for your hospice?
"We checked out a number of therapies," says Heather Kantor, assistant director of foundation and complementary therapy administrator for Nathan Adelson Hospice in Las Vegas.
As late as 1999, Nathan Adelson employed no complementary therapies; now it uses seven and is planning to add more. "It’s better to have a lot rather than a few," says Kantor. "We’re always looking into other therapies."
For hospices with one or two complementary therapies to offer patients, Kantor suggests they consider adding more to broaden their ability to manage pain and stress.
Kantor says hospices starting from scratch as Nathan Adelson did should start slow and build upon the success of one or two therapies at the start. After considering a number of therapies, Nathan Adelson started the Comfort Care Program with pet therapy and has since added six more, including aromatherapy, music therapy, water therapy, reminiscence therapy, massage therapy, and therapeutic touch.
Pet therapy, also known as "visiting pets," "therapy dogs," and "animal-assisted therapy," holds that by simply petting animals, patients and family members will experience lower blood pressure.
Nathan Adelson uses volunteers who handle certified therapy dogs. The therapy can involve formal care plans or can occur as informal visits. The handler and the hospice nurse may consult on specific goals to be accomplished and plan how to accomplish those goals. The preferred use, however, is for more informal activities.
An animal visit can offer entertainment or a welcome distraction from pain and infirmity. Visiting with animals can help people feel less lonely and depressed; for instance, people often talk to the dogs and share thoughts, feelings, and memories with them. Many people in hospitals or group homes have had to give up pet ownership, and they miss the unconditional acceptance a pet gives them. The pet also makes it easier for two strangers to talk, because it gives people a common interest and provides a focus for conversation. Patients become more active and responsive during the visit, and this change often lasts for some time after the visit is over.
Music therapy is the specialized use of music to improve or maintain functioning in the following areas: motor, physiological, social/emotional, sensory, communicative, and cognitive functioning. The purpose of music therapy is to help individuals attain and maintain their maximum levels of functioning. This is achieved by addressing the client’s needs and problems through music. The following three professional credentials are recognized by the Silver Spring, MD-based American Music Therapy Association: MT-BC (music therapist-board certified), RMT (registered music therapist), and CMT (certified music therapist).
At Nathan Adelson, each inpatient unit facility offers a library of music, videotapes, and books on tape. Musicians also come to inpatient units to play for patients and their families. Music is used in conjunction with medications to alleviate pain, elevate the patient’s mood, counteract depression, induce sleep, decrease fear, and lessen tension, Kantor says.
The Colorado Association for Music Therapy in Fort Collins provides the following information about music therapy provided by certified therapists:
Aromatherapy is a treatment based on the application of essential oils obtained from plants. In aromatherapy, trained nurses and volunteers use essential oils and aromatic diffusers to make a difference in the quality of life for patients. For instance, aromatherapy can help a patient sleep, assist in memory recall, or help with depression.
The therapeutic properties of plant oils have been studied for thousands of years. All the great ancient civilizations — Persian, Egyptian, Greek, and Roman — used plant oils for their healing properties. It was French chemist Rene Gattefosse who first coined the term "aromatherapie" in the early part of the 20th century. Gattefosse accidentally burned himself one day while working in the family perfume business. In pain, he plunged his hand into a container of lavender oil, and found that his hand healed quickly and with minimal scarring.
The use of essential plant oils has been popular simply as a beauty treatment, but with the increasing recognition of its therapeutic aromatic qualities by the medical establishment, it is now a vital complementary therapy in many health care units.
The main benefits of aromatherapy in palliative care are:
Nathan Adelson Hospice gives patients the opportunity to share their memories, special messages, or thoughts or feelings with and about those they love. The patient’s thoughts are recorded, written, or videotaped for patients’ family or friends or for the hospice’s web site. Hospice social workers or volunteers meet with patients to reminisce about their lives and share important messages.
Reminiscing allows patients and families to overcome negative emotions surrounding the patient’s impending death, says Howard Thorsheim, PhD, professor of psychology at St. Olaf College in Northfield, MN, and co-author of I Remember When, a book on how to employ reminiscing as a therapy.
Thorsheim says story-telling is a valuable therapy for patients who are near death because it creates an opportunity for social support from family and friends. Thorsheim’s research showed that as people get older, they have fewer opportunities to feel supported by family and friends. The same can be said for the dying, who often feel isolated and angry.
As a result, self-esteem is affected due to the lack of support. Self-esteem is even more dramatically affected in dying elderly patients. The authors noted that men of retirement age experience drops in self-esteem because they feel their life has lost meaning. If a terminal illness is thrown into the mix, the patient’s ability to have a meaningful death can be hindered by her perception that her life has lost meaning and by her perception of diminished support from friends and family.
The goal of hospice workers is to help patients wade out of the sea of negative emotions and get them to a place where they begin addressing their social and spiritual needs. According to Thorsheim, story-telling provides four elements that promote life affirmation and help patients along the road:
At Nathan Adelson Hospice, massage therapy is used to bring stress relief, ease aches and pains, and bring general comfort to patients. According to Kantor, massage relieves stress, headaches, backaches, anxiety, fatigue, and sleeplessness.
"Massage therapy is very compatible with hospice care," says Adela Basayne, LMT, a private practice massage therapist in Portland, OR. "Massage therapists aren’t looking to change the health status of hospice patients. Instead, their goal is to treat symptoms."
The role massage plays in pain reduction is not well-understood, says Basayne. But experts have theorized that massage promotes relaxation and relaxation reduces anxiety. This reduction in anxiety in turn lowers pain intensity.