part0008

S ome younger people can seem older and frailer than some seniors. I had a ninety-two-year-old neighbor who lived on his own and did his own chores, with help from family as needed. He was not infirm until his alcohol use reached a tipping point and Alzheimer’s disease set in.

I currently have a ninety-five-year-old client who has only recently started using a walker after a few falls. All his life he took care of himself. He took walks all the time, until his recent unsteadiness caused him injury. When caretakers and family became concerned about his frequent bouts of dizziness, he had to reluctantly relegate his cane to the closet. A new walker took its place.

I know younger seniors who live in pain and can’t hold themselves upright or walk properly, with a heel-to-toe gait. I know others, many with Alzheimer’s, who are not nearly as sharp as my ninety-five-year-old client. So, although senior or elderly status is defined by an arbitrary age, this does not define the individual seeking you out as a therapist. Also, their symptoms may not be due to age alone; don’t make that your automatic assumption.

Seniors are found in many living situations. I live in a fifty-five-plus community. Some will live with family members or friends. Retirement homes are a big business, as seventy million baby boomers begin to appear on the horizon. Anyone—from a healthy retiree to a person in need of skilled nursing care or even hospice—can be found there. I know of at least five facilities of various sizes now being built in my county alone.

Many skilled nursing facilities also exist to care for those with more medical needs. Hospices exist for those needing care at the end of life. Some seniors have hospice care come to them in their own homes, as my mother did. So, depending on needs, finances, and family decisions, seniors can be in their own homes, the homes of family members or friends, or in graduated care facilities.

As we get older, so too do friends and family. Losing those anchors that have helped give our life meaning causes emotional changes and, for many, depression. Deteriorating physical and mental health does much the same. We will discuss that more in- depth in the chapter on infirmity and identity. We are in the age of COVID-19 now, in which loss of life is a daily event. For now, just try to realize how much these losses can affect who we are.

Going from being the independent earner, giver, or caretaker to being dependent upon the help of others. and on the receiving end of other people’s efforts can be a difficult adjustment. It requires a redefinition of self. It requires acceptance of your current state. It’s not an easy task for most of us.

Given today’s economics, if a senior is relatively healthy, he or she may need to work longer than originally intended. Many are self-employed, as I am. Some are retired with a decent income, while others limp along on limited funds. There are even seniors living on the streets, hungry, forgotten, and alone. Hunger and lack of shelter are big issues for our elderly.

Aging can mean a variety of things to our seniors, and many baby boomers will not have the same type of retirement their parents had. I think there will be a big divide between those that can and cannot afford retirement homes when the time comes. My generation will probably have more aging in place at home.

Some common issues you’ll encounter when working with seniors include challenges with hearing and vision, stability, and activities of daily living, such as dressing. Many seniors wear hearing aids, and some take them out during massage work. This can become a problem when you need to communicate. Consider using gestures for questions and answers, like a thumbs up or down. Remember that if you both have trouble communicating, you both get frustrated.

If the client wants quiet, make sure to ask your questions ahead of time. If you remove the hearing aids, make sure to keep them separated. (If placed too close together, they make a high-pitched squeal until you separate them. It is also quite likely that you will be the only one to hear the squeal.) If the client proves to be a talker, have them keep the hearing aids in to avoid stressing either of you.

Emergency buttons strung around a client’s neck need to be removed when you work on a massage table. You don’t want to accidentally set one off when a client moves and hits the button. I have experienced this problem. As I had no idea how to turn it off, staff members had to leave what they were doing to show me how to quiet the device. If you are the staff, consider helping incoming therapists before this happens and disturbs everyone.

Loss of vision to one degree or another may make it necessary for you to slowly guide and possibly stabilize an individual as they move around. Don’t do more than you are comfortable doing and do nothing that compromises safety. Use staff, family, or anyone else around to help with the client’s needs. Their safety and yours are primary concerns.

Falls can be ugly and very damaging for the elderly. Stability problems have many causes that are rooted in a variety of issues. Be sure not to add preventable dangers. Wipe off excess oil on their feet before they leave therapy, especially if the floors are not carpeted. Slip-and-falls are just too easy.

In the past, I fell twice in the space of a year and a half. One fall was due to a large tree root that had upended chunks of sidewalk. I went down hard. Luckily, all I got was bruised ribs and a scare.

The second fall was due to rain. I was fine on the patio, but when I entered the laundry room, the water on my shoes against the linoleum caused me to slip. I landed on my right hip. Both times I didn’t move for a few moments, afraid I had broken a bone. Bones are something to worry about as we age. A break can be the end of mobility.

Helping to preserve your client’s mobility is a big deal. I used to work at a spa that sent me to a senior center nearby. I’d wheel over the grasshopper-style massage chair and set it up. That experience taught me how dangerous that style of chair could be. Clients often had difficulty getting on and, even more often, getting off the chair. One almost went down with me as I tried to steady the chair.

I don’t like using massage chairs for seniors, and it is sometimes difficult to get them on a table too. I use a tabletop face rest instead, as needed. With this tool, they can sit in a normal armless chair, positioned sideways to allow access to the back. Their head leans into the face rest, with their arms on the table. This is very safe and easy. The only issue I have found is that the table has to be a certain height to work well for short people, or you have to have a cushion for them to sit on to give them height. These headrests are light and easy to set up, making them kinder on your own body too. An internet search for “desktop or tabletop massage headrests” will find you plenty of options.

Aging often leads to medical procedures. Back, shoulder, knee, and hip surgeries are common. Surgeries and the resulting scar tissue, both inside and outside the body, can limit movement. Any past surgeries may cause present-day problems for the client, as scar tissue throughout the body is a big issue for seniors. People struggle with massage chairs often because of past surgeries or other problems; these chairs aren’t exactly senior-friendly. Too many potential accidents exist for me to feel comfortable using these chairs with many of my clients.

Dressing and undressing are often part of table work. Surgeries and limitations in range of motion can make dressing difficult or painful for many seniors. Sometimes helping is part of the mix. I help people put on socks and shoes, shirts, and coats.

You may face various obstacles while helping seniors, but they face daily challenges just to stay active and able. Be there to support them, if they wish it, but not to make them feel helpless. If we live long enough, we will all be in their shoes one day. It is important to let them do what they can on their own.

Caregivers want to feel needed, but seniors need to feel capable. Ask if they want assistance before rushing to take their independence away. Help if asked or help if they are struggling. There is a tricky balance here. Be mindful of your approach.

Health among seniors runs the gamut. Bone health is a common concern with aging adults and an issue for us all. A rounded back, the neck held forward on the spine, and stooped posture could all be signs of poor bone health. Poor bone health can also be a part of a bigger picture of health issues too.

As we age, we might lose our hearing, our vision, and our ability to talk, walk, and do things on our own. Our bodies have bumps and lumps, skin tags, scars, and moles. So many of our elders have dementia too. Just by making it to the status of senior, we have gone through many transitions. On the one hand, we are gaining so much in maturity and wisdom; on the other, many more things are taken away.

Losses come quickly, as our family and friends age also. In one two-year period, I lost both my parents, and my ex-husband lost a cousin and a few friends. Soon after, he lost several more who were dear to him. These people help us define ourselves and the world we know. Then one day they start to leave us. How one views and deals with these losses can make a tremendous difference in the quality of life going forward.

Our place in the world, our relevance, changes. What we can or cannot do changes. Finances and living situations change. Stress can build up with each shift in our lives. COVID-19 brought widespread stress to us all. Some people are resilient, some depressed, some angry, and some grumpy; pain alone can make one grumpy. More and more we see the devastation of Alzheimer’s or dementia, people living in fear and confusion. Some seniors use alcohol or drugs to deal with chronic pain or depression. But then there are also seniors who are grateful for what they have right here and now.

If you show your senior clients the compassion they deserve and truly care for them by offering them solid skills to address their aches and imbalances, you will rarely find a more thankfull client population. So, no matter what ailments land on your table or in your care, the relationships and rewards of making older bodies easier to live in brings joy to all concerned.

What we offer as therapists is focused attention on loving touch. Touch is vital to the heart and gives us feelings of acceptance and worth. Many elderly folks have little more than custodial care. Touch, that vital connection to other living beings, is missing. With touch we bring them a significant gift.

I have recently partnered with a local hospice. They understand the need for touch and care at the end of our respective roads. For the first session, I am hired as a gift to them. They can then choose to invite me back if they want to pay for future sessions. It is a goodwill service from the hospice, and I have the opportunity to gain a potential new client.

We may find ourselves working with vital elders, like an eighty-nine-year-old customer of mine, or we may also give comfort to those at the end of life; the angels in waiting. It is all important work. Find your comfort zone.

Time is a limited resource. Therapists can offer quality time, healing time, and one-on-one time. You offer seniors your acceptance, touch, companionship, and time to just be, without the constant demands of everyday life.

The pace of today’s world stresses us all. Imagine how it affects those who have trouble moving, speaking, hearing, or who just don’t feel well. The older you are, the harder it can be to keep up with the pace of the world. Energy is not what it once was. Try not rush your senior clients, to avoid contributing to their stress.

Therapists offer relief, a time-out from the relentless to-do lists we all have. And, yes, seniors have many daily tasks similar to yours. Bills don’t stop. There are those who try to con seniors out of their money with schemes and scams through the phone, computer, or snail mail. There are family problems—or maybe the family sees the elder as the problem. You offer your senior clients a time to just be still within themselves.

Pain may lessen or disappear with a massage. Sleep may improve. With your skills, circulation quickens, and muscles soften. If pain is less and sleep is better, the desire for social activities may increase, along with mood. With sound sleep comes an increase in energy levels too. Massage can elevate lives.

Little changes can ripple into bigger changes with regular massage. What you do raises someone’s quality of life, if done with proper training, continuing curiosity, kindness, presence, understanding, and a lot of love.

Know, too, that physical pain can also result from emotional or spiritual pain. But unless you have a degree in psychology or some sort of spiritual guidance expertise, you need to stick to what you know. Just listen if your clients choose to talk. Do not offer them advice. Instead, refer them to professional assistance when needed.

Imagine yourself in the body of your client, looking for relief from the symptoms of aging. Feel what they must feel—the pain, the emotions, the self-worth. What would you want? What would you need? What would bring you comfort? What could a massage therapist or caregiver offer you?

Now, with that perspective, offer all you have and all you know to best serve your clients. You will be rewarded in countless ways.

Besides protecting your clients, protecting yourself and your practice is a serious business. Although you may not expect problems, you are at risk with each and every client. A complaint, a lawsuit, an injury, an allergic reaction, a slip-and-fall: these are all real possibilities. We are not immune from harming someone or from being harmed ourselves.

Once, I got tired of everyone complaining about breathing problems when face down on the table, so I got smart and put a few drops of eucalyptus oil on the underside of the face cover. Wouldn’t you know, the next person who came in turned out to be allergic to eucalyptus. I usually inquired about clients’ allergies, but no one I had ever worked on had an allergy to eucalyptus, and I thought everybody was safe. Wrong. Be diligent. Protect yourself and your clients through knowledge and skill.

Membership in professional organizations like Associated Bodywork and Massage Professionals (ABMP) or the American Massage Therapy Association (AMTA) offers some insurance. In this case, I also didn’t understand that this type of insurance I had could still leave me vulnerable. As attorneys and insurance professionals explained it to me, those coverages are aggregate policies. That means there is a finite pool of money for claims. If there are too many claims before yours, the funds could be used up, leaving you uncovered. Make sure to get your policy clearly explained to you so you know what is covered and not covered and how it is covered.

You also need to know the legal requirements of your profession and how they impact your insurance coverage. If you are practicing in a rogue fashion, you could likely be leaving yourself legally vulnerable. In recruiting therapists for my business, I find that about one quarter of therapists here in California operate illegally without city licenses. Some think that California Massage Therapy Council, CAMTC, is a license, rather than a certificate, for the entire state and don’t understand its true purpose. Others just don’t want to go to the expense of getting city licenses, so they practice rogue. These rogue therapists make it harder for the profession as a whole to maintain legitimacy or be respected as a true therapy.

Private insurance is expensive but may be a valuable consideration. Having both an association policy and a private policy helps protect your business as well as the businesses of others you work with. Several retirement homes have asked for my insurance. Some places are only satisfied by private insurance because it offers the home and its residents better protection. Other businesspeople may even take you more seriously when you have dual insurance. See what is right for you.

I originally wrote this book eight years ago. Since that time, I am beginning to see a shift here in my area. Over fifteen years ago, I put together my company, Mac Dougall Consulting for Disabilities, LLC. I planned on growing the business, which would mean I would need to bring in more therapists as independent contractors. Because the facilities were afraid of their liability should something bad happen, growth potential was stymied. Liability fears overshadowed the good I could do at that time.

Now, some facilities incorporate spas into their communities. I network with new facilities as soon as I know they exist, and I try to build relationships with the places before they even open. I’m currently in talks with five that are still months away from completion. Once in a while, a community reaches out to me, just as the hospice did.

One thing I think has changed is that the facility management, of late, believes that if the client brings you in, the company cannot be held liable. An attorney and I disagree with that belief. I am still working on their property, with their clients and staff, under the conditions the facility provides. Sure, my insurance covers me, and if the homes are smart, it will cover them too. The companies are still the so-called deep pockets for any disaster. Check with your own attorney on this.

I am just happy they have begun to open the doors at long last. But here in California, the hurdle to growth now is the new independent contractor law, AB5, that virtually eliminates those jobs and hiring opportunities for us. For example, a veteran called me and wanted to use my services through a veterans’ program. Unfortunately, I received the typical governmental runaround: I had to be an approved provider to work through that program, which meant working for a chiropractor as an employee. Despite calls and emails, getting any further clarity on what I needed to do seemed improbable. Getting into their program would have meant a steady stream of disabled veterans and another way to expand the business to include other therapists. It could have also meant more liability for me.

There are increased risks working with elders and people with disabilities. Anything can happen so quickly, to them or to you. If you try to prevent an accident for someone, you can easily become part of it instead. Be proactive in avoiding dangers and liability before anything happens. Be prepared if it does.

Health among seniors runs the gamut. Bone health is a big problem for aging adults and a common issue to address with senior clients. Bone health is a factor in stooped postures—the rounded back with the neck held forward on the spine is a phenomenon seen so often in this client population.

We can find ourselves working with marathon runners and aged gym rats, or we can find ourselves at the other end of life, with the angels in waiting. They can all use our services, and you can choose whom you serve. You can also refer out if you get clients you would prefer not to handle, so network with other therapists who love seniors.

The attitudes of your patients will also vary widely. Through the years each of us goes through many transitions. Losses come quickly as relatives and friends age too. This can be rough, as it also signals to us that our time is nearing, our own mortality is calling. Thoughts like this frighten some and comfort others.

As seniors, we still have a need to feel important. What we can or cannot do changes, and that can change both who we are and our emotional state. Finances change, and that can affect how and where we live. Living situations change. Health is more tenuous. We may require protective undergarments and intimate personal care, and that can be embarrassing. We have come full circle. The world is leaving us behind, and we can feel it go, as everything around us becomes newer and better, but we do not.

Some seniors are resilient, despite the changes. Others are depressed and frightened. Some are angry and grumpy. Others are ready to leave this earth and wonder why they are still here. Then there are some actively thinking about suicide. Others are just grateful to be here and to have what they have. I am fortunate. My clients are mostly the grateful type.

Understanding seniors and where they are coming from is important to your ability to relate to them and their time of life. Even if you are young, you can find a way to relate if you bring empathy and understanding to the table. Put yourself in their shoes. Don’t negate their feelings because those feelings frighten you. Show a little compassion, not pity, and you may make their day.

I had a client with a rare disorder. Until relatively recently, he was whole and vital, an intellectual and an author. I would have loved to have known him before he had the disorder. In the end, it killed him.

I found him, as a client, to be grateful and eager for my massage. He tried to communicate. Sometimes that worked, but other times it failed completely. The disappointment on his face when I couldn’t understand his wishes saddened me. I asked questions that required a yes or no. I asked him to give me a noun and a verb that told me something about what he wanted. I asked him to slow down. When he got anxious, he spoke more quickly, which was harder to understand. I assured him that I wanted to understand his wishes. I did not dismiss him. Once in a while, a word or two was clear, and we both sighed with relief.

Remember that no matter who your client is, they are the boss. Do as much of what they want, provided it is legal, ethical, comfortable, and understandable. Even patients with severe Alzheimer’s can tell you that something is wrong. Watch behaviors and expressions, even if the words make no sense.

Working with these types of clients is not for everyone. I have the capacity to love them for who they are now. I didn’t know the personalities they once were. But I know some of the needs they now have. I can offer my kind of touch and as much kindness as I can. That’s enough.

Comfort is a wonderful gift to give to a body in pain. Aging individuals have more joint pain, circulation problems, digestive issues, structural misalignment, foot issues, scar tissue buildup, and on and on. Discomfort is all too common and often accepted as a part of aging. Comfort in your own skin is a gift that is highly prized when the body is no longer young.

Acceptance is also what loving touch offers. We are not as we once were. Beauty and good looks may have vanished or changed. Our shapes are often rounder. Our skin is thinner and drier, and spots of various kinds have made their home upon it. Poor digestion can cause intestinal gas, and gas release is common when our stomachs are compressed on a massage table. These and other potential embarrassments may concern the client, but the therapist can ease those concerns with acceptance and understanding.

Respect for the elderly needs to be given freely, no matter the conditions the client presents. We need to do the best we can for each individual. Respect may be much easier to give and get when our own idea of self is intact. But as the mind and body decline, it may be harder to keep self-respect or to expect respect from others. The caregiver’s attitude and support here can make a real difference in the lives of clients.

Protection from harm is something we try to offer the aging. While they are in our care, there is a responsibility. How can anyone feel comfortable, accepted, or respected if they don’t feel safe in our care? They can’t.

We may also find ourselves acting as their voice when they feel they are not being heard or are too afraid to mention their concerns to others. You are likely to run into many uncomfortable situations between staff and clients, institutions and clients, family and clients, outside agencies or people and clients. You will need to determine what, if any, role you play in each of them.

There are many kinds and degrees of elder abuse. We may or may not be able to affect the outcome, but we have to let our senior clients be heard. We are their voices when it is appropriate and necessary. Being an advocate is an important part of the job for all of us. Each time we are around the elderly and people with disabilities, our entire interaction is what we offer them. All too often they are ignored, invisible to many, used and abused by some. Give them sincerity, honesty, and compassion. We all want to be noticed and relevant to others.

I can feel when someone isn’t focused on their work with me. I can feel when there is just a routine response being offered, and my needs are ignored. I can feel when I am not cared about or for. The same is true of your senior clients. If you were in their place, as you will be someday, what would you want? Ask yourself this each time, until your caring behavior comes naturally. After all, you’re next.

Our world is geared toward the young and the new. Seniors are neither. They are generally more comfortable with older technologies. Computers and the internet can be intimidating. I don’t like reading on a computer, but more and more, the world requires it.

Don’t get me wrong. I have worked on computers since the 1980s and even learned some of the early programming languages. But I want the book or newspaper in its physical form. I want to write ideas on paper before entering them on the computer. In my youth, there were no home computers. We learned with books, pen, and paper.

Doing things in a familiar way is important and puts seniors at ease. Don’t expect that seniors will want to jump online to book a massage, though the younger the senior, the more likely they will be comfortable online, generally speaking. Phone calls or even emails will probably work better for older seniors. Texting may be difficult or unavailable for some.

A senior’s physical condition may mean that they cannot come to you. A while ago I pulled my back and strained the quadratus lumborum on the right side twice within ten days. Each time I was incapacitated for two days; just lifting my leg a few inches could send me into spasms. Driving to a doctor, had I been at all able, could have proven dangerous. Moving my foot from gas to brake could have caused an accident. As people age, mobile services become more than just a convenience—they are a necessity.

My practice is mobile. I don’t rely on seniors being able to get to me nor expect them to remember the appointment. I go to where the clients are, and I prefer that. From their home environment, I can see problems that might not be revealed if the client had come to me. You may be able to do a lot more for someone by observing them on their home territory.

Transportation can be difficult for a senior who no longer drives. To get to appointments, many have to hire private drivers, find and get to public transportation, or depend on senior shuttles. This could affect how you schedule or when you schedule a senior coming to your office. Their reliance on others to get them to their destination can exacerbate stress levels for both you and your client.

Last year I had surgery at age seventy-one. I made arrangements to stay with family during the recovery stage; we all assumed I would need assistance. I was shocked that I was up and walking the next day with no pain. I had no pain and therefore no need for the pain pills the doctor had me buy. Even the incisions caused me no pain. The surgery was done laparoscopically and robotically.

Now, I tell you this because I have a disabled senior friend whose roommate, our mutual friend, was going to bring her to see me. An hour after the time I had expected them, I called her. Her roommate had been called away on an emergency and couldn’t bring her to see me. Neither of us had previously checked into senior transportation options for just such occasions. Fast forward a few days, and I now have access, and I believe my friend will get it also.

That isn’t saying that either of us will be pleased by the service. I have heard far too many complaints from my days working with people with disabilities and, more recently, from seniors who use these services. Pickups must be scheduled twenty-four hours ahead, which may be, at first, difficult to remember. But both of us are willing to give it a try. When you need transportation, you do what you must to get to your destination.

I am glad that I got back to work soon and could drive again. Losing that independence to get around on my own would have hit me hard. At one point during my recovery, I needed to check on things at home and had to take an expensive Lyft ride there and back.

And there are problems beyond transportation. Stairs or inclines, loose rugs or rough surfaces, narrow doorways and hallways, uneven surfaces, table and counter height, etc. are other obstacles that can all pose difficulties for seniors—especially those with canes, walkers, or wheelchairs. Since special adaptations may be necessary in an office setting, the client may be better served at home. You could offer an evaluation of the situation in both places to find the best option.

As we age, these and other obstacles delay, frustrate us, and then isolate us more and more from an ever-changing world. And the speed of those changes is not friendly to the slowing pace of seniors.

Most seniors I work with prefer half-hour time blocks, but I suspect that is often ruled by the pocketbook more than a true preference. Medical conditions and medications, age, and client toleration can necessitate a shorter time of five to fifteen minutes. But I once had a woman in her nineties who would alternate half-hour and hour massages; we were able to work out many trigger points in our time together.

Your style of work may also determine how long someone wishes for your touch. Solicit some feedback. Clients of any age need to be heard. Too much pressure? Too little? Too much oil? Not enough focus on problem areas? As much as you can, ask questions, and do what the client wants. If you cannot, tell them why you can’t. Explain your actions as necessary.

I have had older clients want deep tissue. I had to tell them that they must get a bone scan so I know their bones can take deep pressure, or I must respectfully decline that request. Be the safety net for both of you.

Personally, I have had a therapist oil me up to the point where any pressure should have shot me off the table. It felt awful to be so slathered up. None of the work I wanted done could be attempted with this thick, slick layer on my skin. Even after the work, after rubbing it off, my skin felt slick and sticky. The whole experience was disgusting.

Had I known what my experience with her would be, I would not have made the appointment. By her not communicating with me beforehand about what I wanted, she lost a client who also knew the owner of the business where this therapist worked. People are often connected in ways you may not suspect.

I went to him later and let him know that this lady had used one third of a bottle of his oil on me. If other clients felt as I did, the therapist would not be getting many repeat customers, and his oil expenses would be higher than necessary.

Time frame is often determined by perceived need. Depending on the problem, the client may believe a longer massage would be helpful. If you disagree, explain your reasons. On the other hand, you may also offer to go beyond your assessed time limit, depending on the client’s and your own experience during your work. Always err on the side of safety.

Health issues and medications make a big difference in massage work and may alter your and your client’s assumed time frame. The more you know about these massage problems, the better you can guide the client to an appropriate time frame and realistic expectations. Client education is part of the job.

Clients with cancer who are undergoing therapy may be able to accept only five to ten minutes of any type of hands-on work. If you have certification in energy work and the client is willing, that may be an acceptable alternative. Partner with that client to find what styles work and how much massage time is tolerable before it brings on fatigue. This applies to other critically ill clients and many hospice patients.

Seniors will be happiest wherever they feel most comfortable. That could be in an office, if accessible, or a senior center, or their home. When I was new to the field, I used to work a bit in a senior center with a massage chair. It was quickly obvious that many of those who wanted my work had a lot of difficulty getting into and out of that chair safely.

Chair massage is doable if mobility and stability combine, but not otherwise. I have seen people nearly fall trying to get out of the chair. Getting into the chair can be a problem for people with joint issues. In both cases, the chair itself was unstable: it caught on body parts and almost tipped over. Of course, I would try to stabilize it, but adding my involvement could have made the situation worse. I, too, could have been hurt if we all went down.

Some people automatically think of chair massage as a way to maintain modesty, because they mistakenly think table massage is not a fully clothed option. But if there is a choice, give modest clients their pick of methods; either can be appropriate. I have offered both options fully clothed.

Depending on the location, I will also work on people in their own chair, their own bed, or even wheelchairs. Less mobile and less stable clients are often unable to make use of either chair or table. I try to meet them where they are or where they are most at ease. Access to the entire body can be limited with these clients, but it is a chance to be innovative.

Personal preference is important, but not when it competes with safety—yours and theirs. If you are in an assisted living facility, the staff should be helping the person into bed or wherever you need the client to be. Your job is massage, not to risk injury to yourself or your client while moving them.

Think also of the time frame of the massage. It is easier on you both to leave them in their own chair if the work is just for a few minutes. There are times when working on a person in a lounge chair can work out well, too, for longer periods.

So, offer your services in their home, in a therapy office, or any other setting where they are at ease and you can do your job safely. Keep stress on yourself and your client to a minimum. Offer as many choices as you can. Guide their choice by their abilities and by what you need to do in the session.

Older adults tend to cluster near community centers, where they have quick and easy access to stores, transportation, services, and medical support. More active seniors may come to you for massage services, but many cannot. Working with seniors can take you into their homes, their retirement communities, or the homes of relatives and friends.

In-home massage services allow your clients to stay where they feel comfortable and safe. For those who have difficulty going to and from, the home option is a blessing. More and more mobile services will emerge in the next few years to serve the growing elderly population. Be ready for that trend to grow.

In any of these settings, you may be asked for an identifying piece of paperwork. It might even be wise to offer a copy of your CAMTC or other organizational card, as well as a copy of your driver’s license, for your client or the facility to keep. This can provide a bit of security against fraud. If the facility is wise, you will be asked for more.

There is a town in my county that requires nothing to get a massage license. I challenged them when I found out I would not be asked to prove my training or expertise. In that town, anyone could go into any home under the guise of a therapist and present themselves fraudulently. I don’t think that has changed over the years, or I would have had to prove something to them. So far, nothing has been asked of me.

I know of people who would not provide this simple piece of identity for a clients’ security. Disappointment on both sides was the result. Trusting seniors want to trust you, but how would you feel if you asked a professional, who is coming into your home, to provide professional ID, and they refused?

Office massage is offered in a studio or spa, in physical therapy settings, in the workplace, or in a chiropractic setting, etc. I have even worked in a dental setting, where the company offers massage after surgery to help their clients heal faster. More recently, I have been working with a stroke victim in a skilled nursing facility, a place in real need of our work.

Seniors do better if access is easy, so a ground-floor office is best if there is no elevator service in the building. I have turned down studios with stairs, because I knew my clients who were older or in pain may find stairs difficult. Stairs might even have discouraged them completely.

Senior centers, retirement homes, skilled nursing centers, rehabilitation centers, and hospice settings can all offer therapy. Hospitals, too, sometimes use massage therapists. A wife who wanted to provide her husband comfort at the end of his life asked me to work with him in his hospital bed. There was no objection from the hospital, so I did.

We have our toes in all these doors, but there is so much more work and education to do to really throw open entry into these settings. And we must give and get much of the education ourselves, so that professionals in these fields understand our services and skills. It is all about making people feel comfortable with us and with how our skills can help them.

Here in California, with no statewide accepted training threshold, I often hear potential clients tell me that they feel a massage is “just a massage”. I believe this attitude comes from our state’s low expectations and licensing standards. Since I started writing this, some things have changed, but in my opinion, there is still a long way to go.

And now in California, independent contractors are seeing their positions eroding to the point of extinction through new laws. There is a push-back to AB5 coming to the ballot in November through proposition 22. Many businesses have suffered by having to have employees and many independent contractors want to stay independent. There are laws on the books that, if enforced, would serve the same purpose of tax collection and proposition 22 provides a middle-of-the-road solution to offer benefits to those who choose to stay independent.

Due to California’s lack of consistency in training requirements, many clients have most probably experienced lesser-trained therapists. These poor souls have been given minimum schooling and are then sent out into the world, unaware of the harm they can do when they attempt to work on someone with special needs. In my opinion these low standards are a crime against both therapists and our special-needs clients. A massage is not just a massage, nor is it a one-size-fits-all application.

And, as we will discuss later, there is so much more to working in the senior community besides schooling and experience. If that is all you have going into the field, you will not fit well with the institutions or the clients until you gain more skills.

Working with an aging clientele opens up reality. Seeing the ramifications of postural imbalances in your seniors will teach you a lot. If you see poor posture in a younger client, you can offer them insights of what that does over time, if left uncorrected.

You will see how surgeries help or hurt various people and problems. You may even be motivated to change things you do yourself to avoid some physical problems later. Just remember that you are the only one you can really change. Lead by example.

Patience is required, so take a deep breath. Elderly clients are often slow and often live with disabilities. Plan your appointments accordingly. Patience practiced with your older clients will bring rewards to your entire practice. No one likes to be rushed. Everyone likes to feel accommodated. Your attitude is everything. Referrals occur naturally in this atmosphere of respect.

Older clients need to be heard and paid attention to by those around them. It is part of feeling relevant. If they don’t feel heard and acknowledged, you may see them squabble with you over seemingly irrelevant things. If you see beyond the present issue, you may find someone looking to be heard and to feel valued again. This is important for our elderly, but you’ll find it’s true in younger customers too. We all need to feel important and needed.

Taking the long perspective, seeing life on its physical decline, can bring your heart more gratitude. You are still healthy enough to work, to be relevant to your community, to your family. You can still take care of yourself. Do what you can, while you can.

Gratitude for what you have today can change how you treat all your clients. Today is all we have, and maybe not all of that is ours. So here and now, we can be thankful for our clients, our work, and our health. Tomorrow holds no promises. Do what you can, while you can.

As you age, your body will change. Use those changes to learn from, to grow with, and to understand what your clients are going through. What you do for yourself when you are hurt, injured, or ill is seen by your clients. Lead by example. Lead by love for yourself and others.

There is peace brought to the soul when massaging elders. Whatever reality I may be dealing with, it is forgotten as I focus on the body’s terrain. I work to bring each of my elders the peace they give me daily. Their gift is not only to me, but a gift that goes forward through me to the rest of my practice. That same gift can be yours, and through you, your clients can be gifted too.

Judging our elders and people with disabilities as they struggle with their obstacles is easy. Until your body is in a similar state, how can you know how they feel or why they do what they do?

We can choose to judge or empathize. Offering empathy for the difficulties our elders encounter in their everyday tasks, which they must do at their own speed and in their own way in this fast-paced world, can help you bond. Be prepared to be patient, to listen, and to be flexible. Flexibility is a key component to a happy career with this community.

Self-care is vital when working with seniors. People for whom you have cared and with whom you have shared will get sick and die. You will have to be strong for others. Having a strong core of spirituality can help you move through these times with grace.

Death is sad but expected. I will soon start working with a hospice, where clients are usually expected to pass within a year or so. I have no problem helping these people experience more comfort and less anxiety in this final stage of life.

But if this isn’t within your comfort zone, don’t add your own anxiety to the lives of individuals who need as much peace as they can get. You should be there for them fully or not at all.

And though you may learn of someone’s passing, other clients will still expect your service. If you work in a retirement home setting, you may easily find yourself becoming an ear for others who are feeling the loss too. They will need you to be strong. Your work can ease their stress as well as your own.

Sometimes, a death can cause others to question how long they have left. And for some, death is preferred to an unexpected diagnosis of Alzheimer’s or cancer. After such a diagnosis, I have seen a person retreat fully and quickly from the world. Give them your strength and healing through touch and connection with others, if they will allow it.

Gratitude is a mindset of mending in life. Working with seniors will put you face-to-face with your emotions like no other group can. They will invite you to grow as a person, a caregiver, and as a therapist. Accept that invitation.

Gratitude will help you move gracefully through many situations and many emotions. Examine each situation for the good it has brought you and the teachings it has offered. Take those gifts of wisdom to your next situation. It has been said that life has no shortage of classrooms or teachers, just a shortage of willing students. Be that willing student.

If you can be flexible, open-hearted, and grateful, then working with seniors can be a viable path for your massage work. You will benefit from that choice in a myriad of ways. Choosing empathy instead of judgment is the right choice for a long career. If these are not your natural traits, you may not last long as a therapist or a caregiver.

Now that your business is protected, and you believe this market is the one you wish to serve, it is time to let potential senior clients know you exist. Marketing to seniors right now can be tough. Many in their eighties and above see massage as frivolous and have never tried it. A rare few have used massage throughout their lives. Others are afraid of being hurt. The older the senior, the less inclined they will be to use your services, generally. One very elderly person recently came to a talk I gave on massage for seniors. As she left, she made a point of telling me she had never had massage and really didn’t need it. That is a common attitude for her age group.

Money can be a roadblock too. Fixed incomes are difficult to live on; affording more than the basics of life can be next to impossible. But these folks often have family who can help with payment if their loved one asks. In a growing number of cases, it is the children who establish massage sessions for their parents.

Finding seniors is not that hard. We’ve already discussed where they are physically. It is getting them on our table that is the next task. I have done many demo massages. One elderly couple had stopped taking long trips out of town to get routine cortisone shots because of my massage work with them. He and his wife became loyal clients for years after I took away his back pain. They referred many seniors to me over their lifetimes.

Current clients can be a source of referrals for their elders too. They can recommend you to people they know well and sometimes can help educate them to try massage. Your midlife customers may have aging parents who may benefit from massage for aches and pains or more. Offer to sell them a gift certificate for that person. After your session, you may have a new client.

Also tell friends you appreciate referrals, and network to advertise your desire to work with seniors. Be proactive. If your business is a secret, you’ll just limp along. Don’t stop mining for new clients with the false impression that you are full and will always be booked. Nothing stays the same. If you work mostly with seniors, the reality is you will often have a need for new clients.

Help out at events through volunteering your talents. Share a booth with another vendor or get your own. You can also advertise to those who have tables at events. Get exposure for your skills. Writing articles in local papers and magazines or on websites or blogs can help build name and brand recognition. Even if seniors don’t read your articles, their children may be impressed enough to contact you. For some, social media postings and presence can be a customer draw. The hospice I will be working with found me on LinkedIn.

I have found the signage on my car to be an effective marketing strategy. Friends tell me they see me all over the county; it is hard to miss me when I am on the road. My car is a moving billboard for my brand, and I clearly state my target market and contact information. I am often seen right outside of facilities and get some inquiries that way.

Building a business and a brand takes years of continual work. Don’t let go of your dream too early. Work with the clients you have while constantly working toward your goal. No one said business building would be quick or easy. It seldom is.

Implementing this philosophy has taken me through many years of ups and downs in income. But recently things look like they will take off soon. I am working now with the local Economic Development Collaboration that works with small businesses to find the best way forward as my business needs more therapists. The 2020 California Dynamex law has forced me to alter my business plans. Time will tell.

(The previous paragraph was written before the Covid-19 crisis in March of 2020. Currently, I am not working and do not see a path back until sometime in 2021. In the meantime, I am working on getting this book republished, finding funding through the Small Business Administration’s Economic Injury Disaster Loan to ready myself for reopening, and working on policy and procedures for the post pandemic reality when I do reopen. It has been quite an adventure this year.)

Learning and growing as a caregiver or massage therapist should be a natural part of your love for this field of work. Seniors provide a rich tapestry of needs and conditions that will continue to challenge your skills. Even those with similar issues can have them for different reasons or require treatment with different medications and massage modalities.

To be competent and helpful, therapists will have to research and study to bring the best outcomes for their older clients. What you learn from this group will help you treat all your clients more effectively. Seniors will test your knowledge of conditions, medications, and other natural therapies and the interaction of massage techniques with those elements.

What you may be able to do with a younger client may not be possible or must be approached differently with an older one. Reactions to techniques, pressure, oils, and temperatures can all be more sensitive in many elders. You must learn caution and how to modify your practice for the safety of all clients.

Personally, I find older clients more grateful and more pleased to see me. Yes, there are testy clients, but providing a valuable service can turn that around. I have one client who can be negative and judgmental, but I have helped rid her of leg pain, so her face lights up for me, and she’ll joke a bit. At the end of our session, she always thanks me profusely. I am grateful for this outcome and our friendship.

From a business perspective, we baby boomers are arriving at senior status daily. There are around seventy million of us. And while our own parents may not believe in or have experience with the benefits of massage work, many of those in the boomer generation are more familiar with its therapeutic power. This generation will be a big part of the massage market for several decades. And the younger people who follow the boomers into old age will be even more informed. Both generations will have used massage frequently in their younger years. Massage is gaining popularity with these two generations.