Ep 4 – Conversations in Quarantine – Interview with Nathan Nordstrom

00:00 Speaker 1: As a way to give back to the profession during this challenging time of COVID-19, ABMP is offering non-members free access and CE to some courses in the ABMP Education Center each week for a limited time. Simply register online at abmp.com/ce for access. ABMP members earn free CE for all 200 plus courses in the ABMP Education Center, including the new Ruth Werner course, "Taking The Danger Out of Endangerment Sites."

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00:39 Darren Buford: Welcome to Conversations in Quarantine. My name is Darren Buford, and I'm the editor-in-chief of Massage & Bodywork magazine and Senior Director of Communications for ABMP. Our goal here is to speak with luminaries and experts in and around the massage profession to talk about the effects of COVID-19 on bodywork practitioners, the fears, the frustrations, and more importantly to discuss next steps towards safely reopening our doors when the time is right. How to pivot now, how to prepare for their future, and discussing what the new normal might be. My guest today is Nathan Nordstrom. Nathan became a massage therapist in 2001. He is licensed in several states and is a board-certified massage therapist. He has taught massage therapists since 2004 and is a nationally recognized continuing education provider. As a massage therapist, he has worked in many settings over the years. He teaches classes in the application of ethics in daily life, and advanced anatomy classes for massage therapists. He has served as a leader in many ways in the massage industry, and he is now the director of Massage Therapy for Hand & Stone Massage and Facial Spa. Welcome, friend.

01:49 Nathan Nordstrom: Thank you so much. It's great to be here.

01:51 DB: It's great to have you. Let me start by asking specifically about Hand & Stone, and what you've done since this began. Did all of Hand & Stone locations close for the virus? Are they all closed right now? Did they close? And when did they close if that is true, if they all closed?

02:12 NN: Perfect, yeah. That's several different questions. Let's take this piece by piece because, yes, currently all Hand & Stone locations are closed. That's 450 across the US and Canada. And when we started looking at this, when it first started, all the way from CEO all the way down was aware of it and taking things into consideration and being conscious about what are gonna be the best behaviors to make sure that everyone is safe. In middle of last month, middle of March, actually... Yeah, I think it was March 14th or 15th, we had a person who had come in to a Hand & Stone location who had COVID. And they didn't know it until they had already received their massage, and were already home and tested positive. And so they called the spa and said, "Hey, I just tested positive for this, and I had that cough while I was there." And so they instantly closed down, and they were the first spa to close down. And quickly after, over the next couple of weeks, they all started closing. And there was a point where the CEO went out and said, "Everybody, shut your doors. If your state doesn't have the cease and desist and stop, and everyone stay home order, let's look at this because we wanna make sure that everyone is safe."

03:28 DB: When that happened, when you... You're really lucky actually that the client called you. That's actually incredible. I'm sure there must have been a little bit of panic when that happened. Was the practitioner able to get tested? What were your next steps after that?

03:44 NN: Interestingly, I have to talk about the franchise world to answer that. Everyone thinks of massage therapy and then they think franchise world is a complete different beast. And to kind of give that answer, the first thing is, we don't know, because they're not our employee. Each spot is independently owned. And so that owner franchises the name of Hand & Stone onto their location. So, when you look at the employees that Hand & Stone franchise company has that are massage therapists, that's actually a very small number. However, if you look at all of the locations that are titled Hand & Stone, that are the franchisees of the brand, we have 6000 massage therapists across the US and Canada that are trained and practicing in the 450 spas.

04:37 NN: So, the quick answer is, we can't say, because we don't know. The solid answer is we actually do know and, yes, the massage therapist was checked, and has been watched and was quarantined for the days that needed be just to make sure that everyone was safe. And everyone in the spa, they said, "Okay, who had contact with this customer? Who were the... " The rest of the process. And, yeah, we went through to make sure that everything was taken care of there.

05:03 DB: That's good. When you made that decision, whether it was a rolling decision or one decision, to start to close the locations, how were you... Whether that's corporate or whether the owners, how were they speaking with their therapists, and in turn speaking with their clients about the closure?

05:23 NN: There are several different directions. The first piece really comes down from the corporate side down, and then the second piece is the employer to the employee. When corporate said, "You know what, let's look at this," every week our corporate head, our CEO, has been doing a webinar to the owners and talking to them about what does it mean to furlough, and what are some loans that you can have, and what are we doing to stabilize the industry, and how is the corporate head stable, and what are we doing on our side to make sure that we're not going to go under and they're going to have support. And those conversations really have been easy. It's been... Yes, it's hard sometimes to say things that are uncomfortable and are hard for people, especially with someone who believes in their spa and loves their massage therapists, to let them know, "You know what, you're still gonna have to be closed for another couple of weeks, you're still gonna have to be closed for this amount of time." We refer right back to that same old statement of, "You need to make sure that your governor or your mayor, your local community is at a stance where it is safe for you to open up before you can even think of opening up."

06:40 NN: Now, on the employee to employer side, that's a piece where each of the owners have had to either put their massage therapists on some furloughed unemployment and... One of my favorite statements are, when I hear from the massage therapists saying, "You know what, my owner said that it's going to be so much easier to collect unemployment if they do it through the paperwork than if I do." And that's true, and that's part of the benefit of being an employee. And that's what Hand & Stone really has, is an employee status. And so when things like this happen, the employer makes the call, makes the letter, makes the statement, puts all the people's contact information in, and sends it in to the local government. Local government looks at it, does the paperwork, and sends an email out to those employees, and they go through a small paperwork to get through to the unemployment outline.

07:35 NN: On the other side, if I'm gonna put myself in this boat, majority of my professional career I was self-employed. And so when a financial hit came, it was on me as a business person, not on me as an employee, because I didn't have that status. And so the employers have all been really supportive and making sure that their massage therapists are safe. There are several massage therapists who are still employed, and are taking lesser hours or a payment structure that's a little bit different, and they're doing different things. Our lead massage therapists, some of them, are definitely still on, but the owners and the massage therapists are doing really, really great work to stay connected and stay in a community effect and making sure that everyone else is okay.

08:27 DB: And with regards to the community effect, you're talking about practitioner to practitioner under Hand & Stone, correct?

08:34 NN: That and manager to massage therapists, manager to esthetician, esthetician to spa associate, and spa associates to massage therapists. There's a lot of Zoom conferencing going on, where the managers at the corporate office and is... I saw a great picture where someone took a selfie of them self and the screen, and it had 18 or 19 different faces on there, and they were all talking about things that are going on and how they're feeling and what they're excited about coming back to do, and what those new standards are that are being set and moving forward. So, there's a lot of big strength there.

09:14 DB: How are you handling the client management portion while your practices are closed right now?

09:20 NN: Client management is a great piece. And in my mind, it's always been owned by the therapist. When I look at myself as a self-employed massage therapist, I was always responsible for my clients. However, at Hand & Stone, because you have this structure and this system, we have massage Monday newsletters that go out to the customers. We have facial Fridays, an email that goes out on Fridays that goes out and talks about self-facials and things that you can do and how you can maintain. I did one on self-myofascial release that will be coming out next week to the customers, how they can really take care of them self. We did ones about stretching. We've done some about working at home and how many people are now sitting on a chair, like I am, with a laptop on their lap and what knots they can expect that they've never had before, and how to work those out. These are some of the stretching pieces that we really put into effect really quickly, because we knew that it was important.

10:28 NN: But on the other side, the owners are reaching out to their clients and saying, "You know what, we understand that, as a membership-based program, you're still paying on a monthly basis, but what does that give you?" And so we've looked at several of the benefits of, "You know what, our members who stay with us will get a perk on either being able to schedule first, or they'll be able to come in in the first month without anyone else coming in," so we won't have customers who aren't members. Or even a free gift card, you get an extra. And I love that, for Hand & Stone, if you don't get your massage this month, don't worry, you can get two next month. You can have a system where now you actually have a little bit of a bank, so when you come in, you'll be like, "Okay, let's deal with this stress." But then you'll have, "You know what, I just had a stressful week, I just had a stressful month, I can get that extra massage." And a lot of the clients who regularly come in are so grateful that they're being taken care of.

11:34 NN: I got a great message from a customer in Washington State, and it was a person said, "Hey, can I get a message to Allie from this spa because I wanna make sure she gets her tip that she's used to getting?" And it's like, "Oh, that is so sweet of you," that the clients recognize their massage therapists are out of work and recognize that their massage therapists are used to having a standard, and they're wanting to share and wanting to help. There's some joy there.

12:09 DB: That's great. I know the... I wanna transition to the question that I know most people are curious about, which is what is Hand & Stone doing to keep their therapists, their clients, their employees and owners safe moving forward? Can you share any of those protocols with us as you're preparing those right now?

12:26 NN: Absolutely. I've actually seen a lot of speculation and fear-based arguments and discussions going on YouTube about really opening any business. And I heard someone saying that people should wear different clothes for every client, and they should shower between every massage, and they should really test themselves between each massage to see if they're COVID-positive. And I'm like, "Guys, hold on, let's back up here," because fear doesn't help anyone. And so when we take it back a notch and say, "Wait a second, what are the tools, what are the pieces that we know?" Because we may learn something else tomorrow, but with the stuff that we know, what can we do? We're adding several things to our standard. For example, Hand & Stone and all of the franchises, pretty much, have been known for a 10-minute turnaround. And right now we're looking at that and saying, "There's no way you can sanitize and disinfect a treatment room in 10 minutes." And so it's going up to 75-minute sessions with a... A 50-minute massage with a 75-minute room time. So, that means that you have 25 minutes to do the disinfecting, the cleaning, and making sure that everything is processed.

13:51 DB: That's great.

13:52 NN: Yeah. The simple stuff that really most massage therapists are aware of is, yeah, you have to be able to take all of the sheets off and sanitize down to the barrier, whatever your protective barrier is. And we are ones who really do like our hot, heated table units, and our fuzzy cushions, but we have a vinyl cover that's over that. And so that's what gets sanitized down to between every session, the washing of the walls and the countertops and those types of things. We're looking at and working with a protocol right now that includes massage therapists wearing a face mask and making sure that that sanitation is taken care of. We wanna make sure that not only, if a therapist is sick, they're not getting their clients sick, but also if a client is showing symptoms, that they're not going to come in and give a massage and give any illness. Let it be the flu, let it be COVID-19, anything else. So, temperature, taking temperature of the therapists, you know what, yeah, we've got a protocol where we're like, "Okay, we're gonna be really processing this to make sure that the therapists are confident and comfortable."

15:10 NN: We had several massage therapy experts who a lot of my friends pulled up and said, "Yeah, we'd review your policy." And I was very excited to drop the policy into their hands and say, "Pick it apart." And they did. They effectively picked apart different pieces and added stuff. And I'm like, "Okay, let me add that in, let's add this in." And a lot of those things... One of the things that I didn't think of, with temperature, if you're taking the temperature of an employee, that's medical information, so that needs to be documented and secured in any appropriate place. In the massage therapist work file would be a valid place. On a counter, where you're signing in for the day, is not a safe place for that medical documentation to say, "Oh, 98.6, this is Tom's number for today." It has to be in a secure place.

16:08 DB: HIPAA-compliant, correct?

16:09 NN: Right. And we think of it when we're talking about our clients, but we don't think about it when we're talking about our employees. And so being conscious of that and being able to pull that extra information really reminded us, "Hey, you know what, we have some great experts in the field who are willing to ask the right question." Even if I don't think of it, we can all work together to think of it. And that's what, I think, a lot of these podcasts are really important for, is being able to say, "I can't think of that, but you know what, we should probably be thinking about something like that."

16:40 DB: Yeah, that was the purpose for ABMP and Massage and Bodywork starting this, we wanted to make sure that practitioners, whether they're practicing independently or with the franchise, that we're all sharing ideas here and the next steps moving forward. Because, yes, we want the profession to get up and moving, and, yes, we wanna be safe for our practitioners, but also our clients as well.

17:03 NN: Right. I told you just before this that Hand & Stone is very interested in making sure that everyone is safe, and we don't look at our safety standards as proprietary information. We expect that any massage therapist coming out of massage school, any massage therapist who's been in practice and is practicing in their own treatment room would be able to look at a safe standard, and be able to say, "Yeah, that makes sense, perfect. We're gonna implement that as well." We want people to be operating in safe, professional ways.

17:34 DB: You mentioned, I'm really curious, about taking, a practitioner coming to work, their temperature. Is that something you would do at the beginning of the shift or would it happen a couple of times during a shift?

17:44 NN: Right. Generally we're looking at that number right now, and it's set up at the beginning of the shift. Now, the other statements that we're saying is, do we know the symptoms of COVID-19? Do we know the symptoms of a cold, of a flu, of all of these things? If you start coming down with those symptoms, gosh, then it's time for you to pull back and maybe you won't be seeing the next client, because we want to... And then it might be, "Okay let's check your temperature, let's check these other things." If you're feeling the body aches, if you're filling the chills, if you're feeling this cough, this tickling, this dry tickling in the back of your throat, these other things, you can go, "Yeah, that's a problem." It's not just a temperature, because people can have a temperature for any number of reasons, but that is one tool to give us to say, "Ah, we've got some ideas that we can connect with, and let's see how we can support our therapists effectively by making sure that people aren't sick."

18:41 DB: Is it something... I don't know legally with this question, but is it something that is possible to do with clients as well, taking a temperature?

18:50 NN: Yes, the golden question. [laughter] When we look at it, is this within our scope of practice as a massage therapist to take a client's temperature, there's an argument here. And I don't know if I have the full answer, but I can give a little bit of light to why I believe we can. And that is, what is a temperature? Is a temperature a diagnosis? No, it's an assessment tool. And as massage therapists, we can assess our client's condition, we cannot diagnose our client. And so when you're looking at a postural analysis or a gait analysis, or you're looking at how they're standing or what they're doing... Even taking their blood pressure, I know people will question, "Can a massage therapist take blood pressure?" Are you trained to do it? And are you diagnosing them with high blood pressure, low blood pressure? No. You're taking a number and documenting it. Same thing with a temperature. By using a thermometer and doing a head scan, obviously, you're not gonna shove something in their mouth, but doing a temporal scanner, you should be able to get a number and use that as an assessment for if you should be able to see them, if you shouldn't be able to see them, or what other steps you might take.

20:13 DB: Do you think, in that same vein, I'm guessing that the right of refusal to work with a client is somewhere baked in this as well, right? If someone's presenting with symptoms... And that doesn't necessarily mean symptoms that are visible with COVID-19, because there are so many asymptomatic symptoms there. But this is with a cold, with a fever. Is this something that you've spoken about as well?

20:41 NN: Right. The ability to deny service doesn't just go there. I know several years ago I had a client who came in and they said, "Gosh, I have this cramping in the back of my knee, and it doesn't feel right because it's in a place that I don't know there's a muscle." And so I looked at it and I said, "You know what, I am concerned because, you're right, I can't think of a muscle that's back there, and I don't think we're gonna be able to stretch that out, but it has a possibility of being a circulatory issue. And I really do want you to quickly go see your doctor, because if that is something like a blood clot, that should be checked out very quickly and taken care of." Now, she went to the doctor. She got it checked out. She went to the urgent care, got it checked out, got everything confirmed, and I didn't see her for several months. And when I... I was working in a group office, and so there were other massage therapists. I saw that another massage therapist was seeing her, and I'm like, "Oh, good, she's alive." And glad to see that she came in a couple of weeks after, and the documentation was all valid and right there. You have the ability to deny people service because of their health circumstances, even if it is just a symptom or a concern even by any assessment, no matter what your assessment is, by saying, "You know what, I don't feel comfortable. I think there's another concern." That's a valid concern to say, "We won't be seeing you today."

22:17 DB: I'd like to thank Nathan Nordstrom for joining us today. We will continue our discussion in our next episode of Conversations in Quarantine, where we'll talk about Hand & Stone's plans and protocols for reopening their spas.

22:33 S1: Thank you for listening. If you haven't already done so, please subscribe to the ABMP podcast on iTunes, Google Play or wherever you find your favorite podcasts.