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66 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 8 change. The number of hours required to be certified as a massage practitioner was increased, making education more expensive. A massage certification became more difficult to acquire. At the same time, however, massage was becoming more accepted within the public mainstream. Being a massage therapist became a viable professional option, and those supporting a family as a massage therapist seemed to be less likely to be able to volunteer with their already significant investment of time and resources to their profession. Secondly, corporate health care began to soar in the late 1990s, and privately run hospice organizations all across the United States became part of larger corporate identities. Hospice volunteer protocols started to change, making licensing of hands-on practitioners mandatory. This required many of the hospice massage volunteer programs to cultivate other models for offering massage (see box on page 67) as an integrative therapy to their clients. BORN IN VOLUNTEERISM— TO OUR DETRIMENT? For two decades, hospice massage was considered strictly a volunteer offering. Those serving in this field were praised more for their spiritual practice than for their professional skill. My identity, too, has been steeped in volunteerism. I am still praised for my volunteer service during the pioneering of this field in the early '80s and '90s. Although deeply honored to serve in this way, and profoundly honored with this recognition, I continue to be thought of as a massage volunteer within the community. The concept of "once a volunteer, always a volunteer" is one of the challenges that held the hospice massage field back from its due professional recognition for so many years. This field was born in volunteerism and it has been hard to cultivate a professional image for hospice massage within the industry. Throughout the '80s and '90s, hospices all over the country developed massage volunteer programs. Then, in the late 1990s, two very important changes happened. First, massage licensing laws started to Due to the increasing number of hospice organizations in the United States and the current demand for complementary therapies in mainstream health care, the field of hospice massage has come into its own and is receiving long overdue attention. Massage is becoming the most requested integrative therapy in hospice and palliative care, but with this growth also come some growing pains. THE CHALLENGES AFFECTING US TODAY With the cultivation of various massage program models, and the mainstream corporate demand for the service putting practitioners in all types of health-care settings, the knowledge of what an MT needs in the way of education and support for this work is not clearly understood by the hospice organizations, the educational institutions, or the practitioners themselves. The health and integrity of the field of hospice massage is beginning to suffer, as well-defined challenges begin to appear. Health-Care Organizations Practitioners, excited to serve in this newly recognized professional option within the massage industry, may not have sufficient training to work with dying persons. These practitioners are being hired by program coordinators who may also have little to no knowledge of what training a hospice massage practitioner needs, or what is needed in terms of support to facilitate a safe massage program for both the client and the practitioner within the hospice dynamic.

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