Should AINs be providing therapeutic massage to frail injured residents?

Assistants in nursing are being asked to massage elderly aged care residents, even those who are injured, according to a HelloCare reader.

The reader has told us that AINs are expected to massage residents for five minutes in the course of daily personal care, and for a total of 20 minutes each week. 

“This was unheard of when I first started (working in aged care),” our reader said. “Only a trained physio was allowed to massage the resident’s very fragile body.” 

AINs are expected to provide ‘therapeutic massages’ for residents with injuries, the reader said.

“If they have a sore shoulder, for example, we need to fill out the appropriate form of ‘Therapeutic Massage’,” she said.

Only qualified professionals should massage aged care residents

Vanessa Jessup is the chair of the Australian Physiotherapy Association’s gerontology physiotherapy group, and is an advocate for achieving the best health outcomes for aged care residents.

Ms Jessup told HelloCare that it’s not appropriate for AINs to massage elderly aged care residents.

“It is important that a qualified health professional, such as a physio, is engaged to provide massage to aged care residents,” she said. 

Physiotherapists can recognise co-morbidities 

“Physiotherapists are able to recognise and understand the multiple co-morbidities and modify and tailor the massage to the resident’s individual needs, to ensure safety and quality care,” Ms Jessup said.

Ms Jessup acknowledged that AINs play an important role in providing social and emotional support to aged care residents. 

“We know that touch can be healing, but not all touch and contact is the same,” she said.

Inappropriate massages can cause, or worsen, injuries

If older people are massaged inappropriately, there is the potential to worsen injuries or cause grave illness, Ms Jessup said.

“If an AIN provides treatment, it may result in inappropriate care, worsening the injury or function, and possibly causing unnecessary bruising or harm to the skin,” she said. 

“Furthermore, many older and frail people in RACFs are not able to walk and are at an increased risk of deep vein thrombosis or blood clots. 

“A painful calf for example, may be the result of a DVT (or blood clot) which, if massaged, can cause the clot to break away and be detrimental to health,” she cautioned.

Risk factors in the massage of older people

Ms Jessup said older people have a number of risk factors that need to be considered when being massaged, including:

  • Skin integrity – Generally older people have very delicate, thin skin. It is important that there is no bruising or skin lesions caused by direct contact.
  • Altered sensation, joint mobility and cognition – frail and older people in residential aged care will often have altered sensation, joint mobility and/or cognition, which may impact their ability to express how they are feeling or move their body into a particular safe position to receive a massage.
  • Fracture risk – We know that approximately 13% of men and 43% of women over the age of 70 years have osteoporosis. Frail and elderly people with osteoporosis are at an increased risk of fracture, especially from certain stressors on the bone, such as if pressure from massage is applied incorrectly.
  • Additional comorbidities – frail and elderly people are more likely to experience additional physical comorbidities, which may alter the risks associated with massage eg. risk of DVT for a resident with a sore calf.

Funding for physios is limited in aged care

Ms Jessup said unfortunately funding for physiotherapy in aged care is limited to ‘pain management’.

“At this time, physiotherapy services are only directly funded through ‘Pain Management’ in the Aged Care Funding Instrument – essentially Items 4a and 4b of Complex Health Care. 

“This definition greatly reduces the scope and opportunity for a physiotherapist to provide treatment that is appropriate, safe, high quality and focuses on consumer choice and control.”

Physios can not only recognise health issues for people living in residential aged care, and help to treat them, but they can provide exercise and activities to promote health and psychological well-being.

Ms Jessup said the APA would like to see exercise included as method of pain management, and for residents to be able to choose to have physiotherapy in aged care “to support wellness, independence and restorative care to enhance their quality of life”.

Physios can help older people in many ways 

The APA would like to see physiotherapists being able to provide the full breadth of their services into aged care, including:

  • assisting in the management of fatigue, 
  • mobility, 
  • optimising comfort, 
  • activities of daily living (including influences of cognitive impairment and responsive behaviours that are challenging), 
  • falls and falls prevention, 
  • pain, 
  • shortness of breath, 
  • exercise tolerance, 
  • exercise,
  • oedema, 
  • incontinence, 
  • deconditioning, 
  • frailty, 
  • contractures, 
  • sleep, 
  • rest, and 
  • skin integrity.

Physiotherapists also have the skills and knowledge to support people living with dementia with tailored activities and exercises, and to support people in palliative care, helping them and their family to maximise quality of life. 

Ms Jessup said there are many ways physiotherapists can improve the lives of those living in residential aged care, but their services all too often are not made available to residents.

Staff too busy to give massages

Our reader told us that AINs often complete paperwork to say they had massaged the resident, when in fact they hadn’t due to time shortages. This could create confusion when records are reviewed, and mean residents don’t receive care they could benefit from.

“I am sure the staff mostly fill it in even when they haven’t performed such tasks as they are so, so busy as it is,” she commented. 

AINs often criticised when things go wrong in aged care

Our reader says the extra work AINs are asked to do leaves her “fuming”, especially considering the fact that AINs are often criticised in the industry for failures of care.

“Most blame is focused on AINs when something goes wrong,” she wrote.

Having less qualified staff members perform massages for residents at a fraction of the cost of physios is not the answer to getting the beneficial services that physios can provide into aged care facilities. 

Not only does dropping massage into an AIN’s daily tasks add to their already overburdened workload, it may cause harm or injury to frail and elderly aged care residents.

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  1. During the last recession (IE., early 1990’s) when nobody had a job in a certain regional town a woman founded a disability support service to provide contracted care to people in the area. Workers (like me) had two hour shifts and were supposed to assist with showers, dressing and the application of topical creams including massage to lower limbs. In retrospect I should have refused to provide massage however the job was very insecure and exploitative. It seems that nothing much has changed in Aged Care over 30 years. I would recommend not doing massage without training or insurance but if you are being exploited you have little choice.

  2. As an AIN I totally agree that we should not be doing massage. But I was continually asked by RN’s to massage so I went and educated myself a have diploma in massage also looking at doing more education in the near future

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