WA State Governor Inslee has shut down the State of WA except for essential workers. Somehow, massage therapists are on his list of essential workers.

Health care providers and caregivers (e.g., physicians, dentists, psychologists, mid-level practitioners, nurses and assistants, infection control and quality assurance personnel, pharmacists, physical and occupational therapists and assistants, midwives and doulas attending facility-based or home-based births, alternative healthcare providers, social workers, speech pathologists and diagnostic and therapeutic technicians and technologists)

There is much confusion over this and many have called, emailed and contacted state representatives, the Board of Massage, the Department of Health and every answer is different.

Some have said that it is just for medically necessary massage and that spas should be closed. We don’t know how they are defining medically necessary massage, but the insurance carriers have definitions in their policies. My guess is that because we are credentialed with health insurance carriers that we are deemed essential because we work with people in pain and who have a loss of function in some area. Leaving people without massage could mean that they would go to hospitals which are working in limited capacity or turn to Opioids which is something the state does not want and is very aware of.

It seems that mainly massage therapists that work for chiropractors don’t have a choice because the chiropractors are also on the list of essential workers and don’t have a choice as to whether or not they should be working or not except to risk losing their job. Many self employed are also staying working until ordered to stop by someone for reasons unknown but most likely because they don’t have any financial backup.

Governor Insless Stay home- Stay healthy Order 20-25 (PDF) declares the formal shutdown with further directions:

3b.Essential businesses are prohibited from operating under this Proclamation unless they establish and implement social distancing and sanitation measures established by the United States Department of Labor’s Guidance on Preparing Workplaces for COVID-19 at https://www.osha.gov/Publications/OSHA3990.pdf and the Washington State Department of Health Workplace and Employer Resources & Recommendations at https://www.doh.wa.gov/Coronavirus/workpla

Of course massage therapists, chiroprators and acupuncturists cannot treat clients in a way that complies with the social distancing requirement.

Updated 04/03/2020 – I also just found this proclamation (PDF) from Governor Inslee telling doctors and other healthcare professionals that they cannot perform

WHEREAS, the health care personal protective equipment supply chain in Washington State has been severely disrupted by the significant increased use of such equipment worldwide, such that there are now critical shortages of this equipment for health care workers. To curtail the spread of the COVID-19 pandemic in Washington State and to protect our health care workers as they provide health care services, it is necessary to immediately prohibit all hospitals, ambulatory surgery centers, and dental, orthodontic and endodontic offices in Washington State from providing health care services, procedures and surgeries that require personal protective equipment, which if delayed, are not anticipated to cause harm to the patient within the next three months, except as provided herein; and

I hereby prohibit all hospitals, ambulatory surgical facilities, dental, orthodontic and endodontic offices in Washington State from providing health care services, procedures, and surgeries that, if delayed, are not anticipated to cause harm to the patient within the next three months, with exceptions and as provided below. This does not include outpatient visits delivered in hospital based clinics.Examples of procedures to delay include, but are not limited to: most joint replacements, most cataract and lens surgeries, non-urgent cardiac procedures, cosmetic procedures, some endoscopy, and some interventional radiology services.

It does not include massage therapists on the lists or chiropractors or acupuncturists but they are using PPE

This leaves many in a conudrum with no help from our massage associations, legislators or governor. Despite the thousands of emails, petitions and phone calls we are not being heard.

Homeland Securities define Essential Workers

Most other states massage therapists have been ordered to shut down by their city or state governments. ABMP has a list of the orders here.

Homeland Securities has a completely different definition and list of essential workers (PDF) and massage therapists are not on it:

Workers providing COVID-19 testing; Workers that perform critical clinical research needed for COVID-19response

•Caregivers (e.g., physicians, dentists, psychologists, mid-level practitioners, nurses and assistants, infection control and quality assurance personnel, pharmacists, physical and occupational therapists and assistants,social workers, speech pathologists and diagnostic and therapeutic technicians and technologists)

•Hospital and laboratory personnel (including accounting, administrative, admitting and discharge, engineering,epidemiological, source plasma and blood donation, food service, housekeeping, medical records, information technology and operational technology, nutritionists, sanitarians, respiratory therapists, etc.)

•Workers in other medical facilities (including Ambulatory Health and Surgical, Blood Banks, Clinics, Community Mental Health, Comprehensive Outpatient rehabilitation, End Stage Renal Disease, Health Departments, Home Health care, Hospices, Hospitals, Long Term Care, Organ Pharmacies, Procurement Organizations, Psychiatric Residential, Rural Health Clinics and Federally Qualified Health Centers)

•Manufacturers, technicians, logistics and warehouse operators, and distributors of medical equipment,personal protective equipment (PPE), medical gases, pharmaceuticals, blood and blood products, vaccines,testing materials, laboratory supplies, cleaning, sanitizing, disinfecting or sterilization supplies, and tissue and paper towel products

•Public health / community health workers, including those who compile, model, analyze and communicate public health information

•Blood and plasma donors and the employees of the organizations that operate and manage related activities

•Workers that manage health plans, billing, and health information, who cannot practically work remotely

•Workers who conduct community-based public health functions, conducting epidemiologic surveillance,compiling, analyzing and communicating public health information, who cannot practically work remotely

•Workers performing cybersecurity functions at healthcare and public health facilities, who cannot practically work remotely

•Workers conducting research critical to COVID-19 response•Workers performing security, incident management, and emergency operations functions at or on behalf of healthcare entities including healthcare coalitions,who cannot practically work remotely

•Workers who support food, shelter, and social services, and other necessities of life for economically disadvantaged or otherwise needy individuals, such as those residing in shelters

•Pharmacy employees necessary for filling prescriptions•Workers performing mortuary services,including funeral homes, crematoriums, and cemetery workers

•Workers who coordinate with other organizations to ensure the proper recovery, handling, identification,transportation, tracking, storage, and disposal of human remains and personal effects; certify cause of death;and facilitate access to mental/behavioral health services to the family members, responders, and survivors of an incident ‘

Essential workers are those needed to keep people fed and healthy and alive during this pandemic. No one ever died not getting a massage. I have heard some use the reasoning that their pain relief sessions are essential for many of their clients and their clients may be faced with having to go on Opioids or worse finding pain meds on the streets.

Ethics for Massage Therapists in the time of coronavirus

The lack of clarity in the Governors directive, the confusing answers from the Board of Massage and Department of health has created a major ethical dilemma for many massage therapists. I know it took me about a week and a half to struggle over whether or not to close. I wanted to keep working because I have some clients just out of joint replacement surgeries and some dealing with serious pain issues, but the risk of not knowing whether or not I was spreading the virus unknowingly caused me too much stress.

Many massage therapists who continue to work have jobs at chiropractors or spas that refuse to close. Some sole proprietors are still working too. My guess is that it is about money. People in this profession live paycheck to paycheck like many other people around the US and in the world. Massage therapists paychecks often come everyday making it even more challenging. A day without income can mean not eating or feeding the family let alone not paying the rent and finding oneself and family homeless.

The Governors Directive call for staying 6 feet away and using the required cleaning and using Personal Protective Equipment (PPE) which includes gloves, masks, and gowns to prevent the spread of the disease. Massage therapists can’t possibly work 6 feet away from their client/patient. I am guessing no one in the massage profession has been trained in how to use this PPE unless they work in other fields that the training is required.

Do No Harm is being said around the many Facebook groups. I am not sure where that is coming from since massage therapists do not take any Hippocratic oath where that phrase is found. I find that confusing because have you ever read a list of the side effects of medications or the things they make you sign when you have a surgery?

The dilemma created lies in many massage therapists financial state. They are risking working on clients (and possibly spreading the virus) because their families need them to or they are alone in all of this and have no other financial support. What would you do?

Physical therapists are moving to telemedicine and doctors are too. Dentists are closed except for emergency situations. Non essential surgeries are being cancelled along with some life saving cancer treatments. ABMP has recommended (but not demanded) that we close:

We strongly encourage you to suspend your practice on a short-term, temporary basis.

Here is what AMTA says on March 17, 2020 – 4:30pm :

AMTA does not have the authority to stop you from practicing massage, but firmly believes massage therapists should be part of the solution and do no harm. At this time, we believe the best way that therapists can contribute to the solution is by only practicing massage that is medically necessary and by supporting the recent federal guidelines as outlined in the 15 Days to Slow the Spread initiative thru at least March 31.

Without clear directives, massage therapists are still faced with dealing with a very difficult ethical dilemma. Help is coming in many forms now to hopefully help you make the decision to close.

Meanwhile, I find a disturbing sentence regarding unemployment benefits.

I was just looking at the info on collecting unemployment in WA and it says:

“We adopted a series of emergency rules to relieve the burden of temporary layoffs, isolation and quarantine for workers and businesses. Some of the most recent changes include:

If you are out of work as a result of the governor’s stay home order issued on March 23, you are eligible for unemployment benefits.
When you apply for benefits, you should select “laid off” as your reason for seperating from your employer. Choose “Company temporarily closed” from the secondary options.
This does not apply to employees who are considered essential critical infrastructure workers, as outlined by the governor.
As new information emerges, this is subject to change”

https://esd.wa.gov/newsroom/covid-19

What does that actually mean?

This does not apply to employees who are considered essential critical infrastructure workers, as outlined by the governor

Why is there so much confusion as to who we are and what we should be doing?

This is where our professional associations have failed us miserably. Many of us have been emailing legislators, the governor, the BOM, the DOH and we are getting nowhere. We do not have the ear of the governor and he has not been informed of who we are and what we do. Being included in the Every Category Law and allowing us to be credentialed provider is part of what has gotten on this list. The role of the massage therapists in emergency situations is not clear. My guess is that (and what are some massage therapists and chiropractors are saying) is that they are keeping people from having to go to the hospital. I hope that they are only working on people who are in that much pain. They are also saying they are working on people who have been in car accidents or hurt at work making their sessions essential for people to recover and to get back to work.

AMTA-WA has been in touch with their lobbyist to try to get this changed. ABMP and WSMTA have not reported being involved. The thing is that now in hindsight, we should have had some previous representation and communication with the Governor and BOM and DOH that could help us remedy this quickly.

If we are on the list of essential workers does that mean that technically we should not be getting unemployment? Does it mean that the are different rules for essential workers somewhere? Not sure what that even means.
*** updated 04/03/2020 – The unemployment office updated their chart (PDF) on who can receive unemployment benefits and it now says (#7)

Worker is following the advice of public health and government officials to self-quarantine and chooses not to go to work. (check mark under the emergency rule)

Call to Action

This section Updated — 04/05/2020. My first edition of this post included directions for taking action and contacting the governors office.

I now have much more insight into the issue and it is much more complicated than it appears on the surface.

It has to to with our long fought for and accepted role being a healthcare provider in WA State and our long fought for and upheld role under the Every Category Law that allows us to become credentialed providers with health insurance companies. With those roles comes more responsibilities.

If massage therapy could keep people who are in a great amount of pain out of the hospital and off of pain medications, then I could see that some massage therapist may want to still work under the essential workers guidelines. Also massage therapy in hospice units could be helpful at this time. Personally I wish there was a way to massage all of the doctors, nurses, hospital workers and EMT’s/Firefighters… that could be something to focus on when we do get back to work.

Meanwhile..stay home.

File for Unemployment

Look into Loans and other resources

Look into becoming a Solowebpreneur – my new website.

Join me on Massage Practice Builder to learn how to update your massage website, improve your website and get ready to reopen.

Sign up for Unemployment – Employment Security Department Be patient! They are catching up with the new requirements in the CARES Act.

Coronavirus Aid, Relief, and Economic Security Act (CARES Act) General overview:

• $1200 per adult, $2400 per couple, $500 per child coming to everyone making under $75,000. Based on 2019 taxes, or for individuals who haven’t filed, against their 2018 taxes or 2019 Social Security statements.
• State Unemployment insurance for employees AND self employed AND Independent contrator massage therapists PLUS and additional $600 per week depending on hours worked for everyone collecting unemployement.
• SBA loans – https://covid19relief.sba.gov/

CARES bill explained:

From Governor Inslees’ office (PDF) Coronavirus Aid, Relief, and Economic Security ActSection-by-section summary

ABMP – CARES Act Information and Analysis for Massage Therapists and Bodyworkers

AMTA – In the financial resources section: COVID-19 Federal Relief Package :What It Means for Massage Therapists 

WA State Resources

1. WA L&I – Paid Sick Leave Common Questions
2. Message from WA Governor Jay Inslee – March 6, 2020
3. WA State Resource List, including: From Governor Inslee
   • – Financial Assistance
   • – Employer and Worker Assistance
   • – Insurance Assistance
     
4. WA State Department of Health
   • – General Website
   • – Workplace and Employer Resources and Recommentations
   • – Business Information PDF
5. WA Department of Commerce
6. Emergency Management Division Business Preparedness Webpage
7. WA Small Business Development Center
   • – Resiliency Webinars
   • – Main Covid-19 Site
   • – Business Resiliency Toolkit
8. WA Paid Family and Medical Leave
9. WA Employment Security Dept.
   General Covid-19 Page
   Layoff Assistance
10. WA Department of Financial Institutions
11. Thurston County – https://thurstonedc.com/resources-for-small-businesses-impacted-by-coronavirus-covid-19/
12. WA State Department of Commerce (grants) – https://www.commerce.wa.gov/open-grants-loans/
13. Employment Security Division – https://esd.wa.gov/newsroom/covid-19
    Workers may receive unemployment benefits and employers may get relief of benefit charges if an employer needs to shut down operations temporarily because a worker becomes sick and other workers need to be isolated or quarantined as a result of COVID-19.
    Standby will be available for part-time workers as well as full-time workers, as long as they meet the minimum 680 hours.
    Workers that are asked to isolate or quarantine by a medical professional or public health official as a result of exposure to COVID-19 may receive unemployment benefits and work search requirements could be waived, so long as they have a return date with their employer. The return to work date can be the date the isolation or quarantine is lifted.
    If a worker falls seriously ill and is forced to quit, they cannot collect unemployment benefits while they are seriously ill but may be eligible once they recover and are able and available for work.”
14. Businesses.WA.gov
15. Department of Revenue – State taxes -Upon request, the Department will provide extensions for filing and paying tax returns (even if the request is after the due date).This only applies to returns that are due and not already paid during the state of emergency (Feb. 29, 2020, through the end of the state of emergency, yet to be determined).
    60 days for monthly returns (this applies to the February 2020 and March 2020 returns at this time)
    30 days for the Q1/2020 return
    30 days for the Annual 2019 return
16. Fund created by a coalition of businesses to support Seattle Businesses www.allinseattle.com

Seattle & King County:

1. Seattle – Grants – https://www.seattletimes.com/seattle-news/seattle-to-offer-grants-of-up-to-10k-to-small-businesses-impacted-by-novel-coronavirus-outbreak/
2. King County Department of Public Health
   • – Public Health Recommendations
   • – Coronavirus 2019
3. Seattle Office of Economic Development
   • – COVID-19 Business Resources
   • – COVID-19 Business and Worker Resources
   • – Resource Guide (PDF)
   • – Relief Grant Funds – Application
4. Seattle Mayors Page – http://www.seattle.gov/mayor/covid-19
   Seattle: Mayor Durkan Announces Initial Recovery Package
5. Seattle Office of Economic Development’s Small Business COVID-19 Response Weekly Webinars
6. Amazon Neighborhood Small Business Relief Fund
7. Nonprofit Funding Assistance through The Seattle Foundation
8. SBA- https://disasterloan.sba.gov/ela/
   

Federal Resources:

• Federal Bill – H.R.6201 – Families First Coronavirus Response Act
• US Small Business Administration (SBA)
  Disaster Loan Assistance – Application & Eligibility (WA, OR & ID)
  Information on applying for an SBA Disaster Relief Loan
  Contact your local SBA office
• Taxes – The Treasury Department and Internal Revenue Service announced today that the federal income tax filing due date is automatically extended from April 15, 2020, to July 15, 2020.
  IR-2020-58, Tax Day now July 15: Treasury, IRS extend filing deadline and federal tax payments regardless of amount
  IR-2020-57, Treasury, IRS and Labor announce plan to implement Coronavirus-related paid leave for workers and tax credits for small and midsize businesses to swiftly recover the cost of providing Coronavirus-related leaveTreasury News Release: Treasury and IRS Issue Guidance on Deferring Tax Payments Due to COVID-19 Outbreak
  IR-2020-54, IRS: High-deductible health plans can cover coronavirus costs