Is It Safe to Do Outcall Massage Services?
By Tessa Crume, PhD, MSPH
(Note: From the beginning of the COVID-19 crisis, many ABMP members have been asking for guidance on doing outcall services at the client’s home. We have not found reliable guidance to follow on this, so we reached out to epidemiologist Tessa Crume, an associate professor in the Epidemiology Department at the Colorado School of Health at the University of Colorado Anschutz Medical Campus, to get her expert advice on this member’s question.)
Q: What are your thoughts on continuing outcall services with longtime clients who have their own equipment (table) and supplies in their homes, while making sure to conduct appropriate pre-session screening questions that would include others in the household, as well as the client?
A: If you are going to provide service in a client’s home, I would consider how you can maintain the same level of caution as outlined in the ABMP Back-to-Practice Guidelines.
It will be critical to perform a pre-session health intake that asks questions about recent fever, COVID-19 symptoms, and known contacts with someone diagnosed with COVID in the past 14 days, for both the client and anyone else in the household. (Note: You can find ABMP’s updated COVID-19 forms and printables here.)
Ask the client to prepare the room in which the service will occur ahead of time. Preparation should include cleaning and sanitizing all surfaces with EPA-approved products, including the table, bolsters, chairs, light switches, and doorknobs. Open a window and, if available, place a fan in the window pointed out so that the airflow is directed out of the room. Place clean sheets on the table. Ask the client to wear a face mask during the entire service.
Wash your hands before heading to the client’s home and, when you arrive, put on your mask before approaching the door. Keep your mask on the entire time and don’t touch it. If you do touch it, apply hand sanitizer, remove the mask, and put on a new one. Decide beforehand what type of personal protective equipment (PPE) you will wear during the session. If available, I would wear a mask, gloves, a gown, and eye protection. The ABMP Back-to-Practice Guidelines has a wonderful video on how to use PPE for massage therapists.
When you arrive, conduct the health intake interview and take the client’s temperature with a no-touch thermometer. Discuss your comfort level, and the client’s comfort level, with facial massage. It is completely reasonable to skip procedures that would require removal of face masks. Apply hand sanitizer before beginning the session, and follow the ABMP Back-to-Practice Guidelines for in-session protocols.
While this would be hard for me to follow, avoid handling their pets. No matter how cute or friendly or adorable they are, DO NOT touch their sweet, furry faces.
After the service, don’t remove your mask until you’ve left the house. If possible, use the client’s bathroom to wash your hands thoroughly with soap and water before leaving, and use hand sanitizer once you’ve left the home and removed your mask. If not possible to use the client’s bathroom, once you’ve left the house, remove your mask, use a hand-wipe product to remove oil and dirt from your hands, and then use hand sanitizer as directed.
Bring a paper bag with you and place the mask and any other items you brought into the client’s home into the bag to be cleaned later. Once you are at your home, wash your hands with soap and water. Change your clothes and wash them at the highest temperature recommended on the clothing label.
Dr. Tessa Crume is an associate professor in the Epidemiology Department at the Colorado School of Health at the University of Colorado Anschutz Medical Campus. Her research focuses on the development and utilization of public health surveillance systems to understand the burden of disease. She has been an academic researcher since 2011, before which she worked for a decade as an applied epidemiologist at the state and federal level, analyzing surveillance data and evaluating public health impact. She has taught the core epidemiology class at the Colorado School of Public Health for nine years.
Out calls for Special Needs in Group Homes
I would love some advice. My massage business is only outcalls, all my clients are Special Needs and most are in group homes. I am worried for them and me! I don't think it's a good idea for me to go back to work. Many of my clients have medical issues, and many are low functioning, so if they don't want to wear a mask they will just take it off. I live in Mass. Nobody has called me back yet.
Special Needs Massage
Linda, the work circumstances you describe are very risky. I don’t believe you could take enough precautions to safely perform outcall massage with your client base right now.
Even if you were wearing an N95 mask, you can’t protect yourself completely from virus exposure. Therefore, every client you work with in an incubation period (up to 2 weeks) is potentially exposed to each other through you. That’s a good enough reason to wait. But for those who don’t see that, the clients are in group living situations, which increases the potential spread. Furthermore, functioning may be impaired among the clients or their contacts, which means taking all reasonable precautions cannot be assumed.
I would be surprised if any of the group home operators allowed you to come in—but I’ve been surprised before. I wouldn't do this kind of massage while the coronavirus is circulating in your area.
To Control or Not To Control?
The key to doing outcall massage with longtime clients is trust. I have wonderful longtime clients I trust deeply on a personal level. But they haven’t been thinking about how to prevent the spread of coronavirus like a licensed massage therapist forging a safe path back into practice.
If this situation came up for me, I’d be asking myself:
Can I trust that this client is taking necessary precautions in daily life?
Can trust everyone who’s been in the household? Can I trust my client to remember?
Can I trust my client to recognize a potential leak in their circle of trust/safe bubble?
If my answer was an unqualified “yes” to all of these questions, I would consider it. But, when you go into someone else’s space, you’re relinquishing a lot of control. As a licensed professional, that’s the last thing I want to do right now.
I only do outcall/mobile massage and have not ever worked in a storefront setting. I have had a majority of my clients for 30 years and I am not going to go to their homes and become the vector that spreads covid-19 from one client to another. Even though I trust my clients it would be very hard for them to follow all of the cleaning protocols. Only some of my clients have their own massage table. I would still need to bring all of the necessary equipment into their homes, take it back to the car, and then potentially transmit anything from their homes into my car. I can't begin to imagine how much time each of these cleaning procedures will take, and I don't think any of my clients wants to cover the cost of these extra measures. It will be financially unrealsitic for me to go back to work until there is a vaccine, herd immunity, and probably both. This is going to change massage forever. Many people will not be willing to get vaccinated on top of every other challenge.
Thank you for providing the input and format for comments. Best wishes to everyone who feels comfortable going back as moble/outcall massage practitioners!
I am contemplating performing outdoor massage at clients' homes weather permitting, once we get the nod to reopen. Not entering a client's home or indoor environment seems the safest. The ABMP guidelines and protocols mentioned above would be followed, along with consideration of table orientation with head toward the prevailing breeze. If and outdoor spigot is not available for hand washing the hand sanitizer would be used until soap and water are available. Any feedback is appreciated. Is anyone else performing outdoor work? Thanks.
I've chosen to go back to work, however, I'm only working with select clientele who want weekly massages. This greatly limits the number of people and homes I come in contact with. I also require my out calls to provide their own linens and blankets so that I'm not transporting soiled linens (HUGE added bonus is a lot less laundry!) Best wishes to everyone during these crazy times!
Outcall work is a significant percentage of my practice, and as of now none of my clients provide their own tables. I would very much appreciate hearing if Dr Crume has any insight on further protocols for bringing a mobile table, or hearing why that would be too risky, since it was excluded from the article above. (I am planning on using a plastic covering under the linens that can be cleaned and sterilized, but I am curious about the rest of the table and the table bag.) Thank you so much!
OUTDOOR outcall massage
I am contemplating outdoor outcall massage, outside of a client's home weather permitting, once we are locally allowed to reopen. All the precautions and protocols listed in ABMP guidelines and best practices as listed above would be followed. Consideration of wind direction would be given when setting up, with the client's head directed toward the oncoming breeze. Client of course can opt for being fully clothed. There would be no need to enter the client's home. The only issue I can foresee is it not being optimal to use hand sanitizer before and after the session, unless an outdoor spigot is available for hand washing. Can I get any feedback on this as a possibility? Is anyone else doing this now?
When the pandemic hit, I had to close my office. Now I'm back to work, going to peoples homes. Most of my clients are long time regulars, though I bring all of my own equipment into their home. They know the protocol and follow it, or I don't go, plain and simple. I've had no problem cleaning, disinfecting or following the recommenced protocol for safe and clean visits. The handful of clients that are immunocompromised, I do not go to them at all. It's just not safe to expose more people if we don't have too. Clients are just happy to be able to get bodywork again and feel like themselves again. Truthfully, I would be more afraid going into mainstream salon/spas bc the likelyhood for definitely being clean and sanitary is more difficult to maintain. At least when going into peoples homes, you know your clean; they know their clean and the space is clean bc they clean it. I've have many clients say to me they think this is the safest way to continue bodywork sessions.