Article by guest author Alexis Baker, MT-BC, CDP, owner of Bridgetown Music Therapy Did you know that music activates every area of the brain? It's true, scientific researchers have observed that listening to music and engagement in music-based activities can involve all areas of the brain. Music activates the “feel-good centers” of the brain, and it can even help create new neural pathways. The benefits of music are abundant and far-reaching! The music therapy process involves assessment, treatment planning, implementation, documentation, and evaluation...based on a therapeutic relationship... What is Music Therapy?![]() As a music therapist, one of the questions I am asked all the time is “What exactly is music therapy?” The formal definition of music therapy as defined by the American Music Therapy Association is: “The clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” (AMTA, 2019) This definition can be broken into two parts:
To break these parts down further, evidence-based interventions are simply music-oriented experiences or activities such as singing, playing an instrument, moving to music, and songwriting, all of which have been studied and shown to be effective in promoting health and improving quality of life. Next, music therapy is always goal oriented. The focus is using music to achieve specific, measurable goals and objectives. A few examples of general goal areas include improving communication abilities, increasing range of motion, reducing stress/anxiety, and promoting social connection. The music therapy process involves assessment, treatment planning, implementation, documentation, and evaluation. Finally, music therapy is based on a therapeutic relationship which implies there’s an established relational bond involving rapport and consistency. This person is a professional board-certified music therapist. As a side note: According to the Certification Board for Music Therapists, there are currently only 10,000 board-certified music therapists in the U.S. Music therapists go through rigorous training to enter the field as a certified and highly-trained professional. They complete a specialized bachelor’s degree in music therapy which is like a double major. Coursework covers a wide variety of areas including music theory, ear training, music history, psychology and human behavior, human anatomy, and therapeutic applications. Music therapists are required to be competent on four instruments: guitar, piano, voice, and percussion. Training also includes 1,200 clinical training hours. Following completion of all coursework and hours, they must take and pass a national board exam to earn the credentials MT-BC (Music Therapist-Board Certified). Recertification is every five years which requires the completion of 100 CMTE (Continuing Music Therapy Education) credits. Music therapists can work with any age, all the way from babies in the womb or preemies in the neonatal intensive care unit (NICU) to older adults and end of life/hospice. Music therapists work in many kinds of settings including adult day programs, childcare programs, long term care, hospitals, schools, rehabilitative facilities, community health centers, hospice care, and private practice. Music therapists serve a wide variety of populations in these settings including but not limited to people with developmental disabilities, physical disabilities, mental health conditions, issues associated with aging, dementia and various other diagnoses, disabilities, or diseases. What Music Therapy Isn’t It’s exciting to hear about what music therapy is, but many people struggle to recognize it as a clearly defined practice. They see anything music-related and want to call it ‘music therapy.’ It’s true, music can function therapeutically in a myriad of ways, but the formal practice of music therapy is specific and limited, so let’s talk about what music therapy is not. To put it simply, music therapy is not music education or music entertainment. It can involve aspects of education and entertainment. It can even sometimes look like education and entertainment, but music therapy is different from these two fields. Music education fosters creativity and cultural understanding by introducing students to a variety of musical genres and traditions from around the world. What is Music Education?Music education is the structured teaching and learning of music theory, practice, and appreciation. It involves more than just learning to play instruments or sing—it encompasses a wide array of skills and knowledge, including reading music, understanding rhythm, harmony, and composition, and exploring music history. Music education fosters creativity and cultural understanding by introducing students to a variety of musical genres and traditions from around the world. At its core, music education helps develop essential cognitive and motor skills. Studies have shown that learning music enhances memory, improves problem-solving abilities, and sharpens attention to detail. It also boosts emotional intelligence by providing an outlet for self-expression and understanding the emotions conveyed through music. For learners of any age, music education often starts with basic concepts like rhythm and melody and gradually progresses to more advanced topics such as composition and performance. In academic settings, it is commonly taught through choir, band, or orchestra programs, allowing students to collaborate and learn teamwork. Beyond the classroom, music education is accessible through private lessons, community programs, and online courses, making it available to people of all ages. Whether someone aspires to become a professional musician or simply wants to enjoy the personal and social benefits of music, education in music nurtures a lifelong appreciation for this art form while enhancing overall personal development. Music education plays a vital role in shaping well-rounded individuals, enriching both their academic and emotional lives. Musicians and performers create experiences through their music that can evoke emotions, tell stories, or simply provide a fun atmosphere. What is Music Entertainment?Music entertainment, on the other hand, is more of a receptive experience. It’s enjoying music for the value of being entertained. Music entertainment is the broad field of performances, events, and productions centered around music as a source of enjoyment for audiences. It encompasses everything from live concerts, festivals, and DJ sets to recorded music, streaming services, and music videos. Whether experienced in person or through media platforms, music entertainment is a universal form of enjoyment that transcends language and cultural barriers. At the heart of music entertainment is the connection between artists and audiences. Musicians and performers create experiences through their music that can evoke emotions, tell stories, or simply provide a fun atmosphere. These performances might be intimate acoustic sets or massive stadium concerts, where production elements such as lighting, sound effects, and visuals further enhance the experience. In today’s digital age, music entertainment has expanded beyond live events to include various digital formats. Streaming platforms like Spotify and YouTube allow people to access vast libraries of music from artists worldwide, while social media enables fans to interact with their favorite musicians directly. Music videos, television shows, and films that feature or are centered around music have become key parts of the entertainment industry. Ultimately, music entertainment is about creating memorable, emotional, and engaging experiences. It serves as a means of relaxation, celebration, and connection, providing joy and excitement for individuals and communities alike. From the casual listener to the devoted fan, music entertainment touches lives by bringing people together through the power of sound. Music engagement is participating in music-based activities for the benefit of participating in music-based activities. What is Music Engagement?![]() We are now aware there’s music therapy, music education, and music entertainment. All of these are important, and each serves various purposes. But what if something doesn’t fit the definition of formal music therapy? Or it’s not quite pure music entertainment, or it doesn’t fall under ‘music education’? There is one more term to introduce you to: ‘music engagement’. Engagement is somewhat of a buzzword recently. Music engagement doesn’t have a formal definition, but it does offer a helpful description for things other than pure music therapy, entertainment, and education. Music engagement can incorporate elements of all three of the above. Music engagement is participating in music-based activities for the benefit of participating in music-based activities. As a board-certified music therapist, I’m a huge supporter of music therapy services; however, having been in the field for the past 10+ years, I know that music therapy services can often be expensive and inaccessible. There just aren’t enough music therapists to serve all needs everywhere, especially within senior care. It can also be cost-prohibitive or difficult to access geographically. For example, what about rural areas? This presents several problems for which I wanted to find a solution. I created our virtual music engagement program for many reasons. At the center of it all is my passion and mission in life to use music to make a difference in older adults living with dementia. Second, this program was created in response to Covid. It started out as an alternative when the pandemic was limiting activities. It can still function in this way. Beyond Covid, however:
Finally, I created it as a music engagement program, for individuals and groups to ENGAGE with music for the purpose and benefits of engaging with music! For more information about Bridgetown Music Therapy and our virtual music engagement program for care homes, click here.
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We want to continue to highlight the work of our amazing adult foster care home providers in Oregon. Matt Gannon spent some time talking with Provider Cherie Bray, owner of Country Comfort Adult Foster Home in Lane County. Please read below to learn more about Cherie. How long have you worked in the adult care home business? ![]() I've worked in the business since July of 2015. I was a career hairstylist and was looking for something new, so I enrolled in Lane Community College's Women in Transitions (LCC WIT) Program. My co-worker from the salon later referred me to a caregiver job at Country Comfort Adult Foster Home in Veneta, Oregon. Country Comfort was established in 1999 and is a class 2 home. I ended up taking the caregiving job and after thirty days I knew this was exactly what I wanted to be doing, so I quit my other career. For the next three years, I was groomed and mentored by the provider of the adult foster home. I then became a co-licensee of Country Comfort in February of 2018. Then, in May of 2018, I took over the business completely when the previous provider retired. For about the first ninety days, I was the only caregiver and worked full-time doing everything to completely wrap my arms around the responsibility I took on, and to get my bearings. Opportunities for staffing support presented itself, and once I had that support and partnership, I was really underway. What do you believe makes adult foster care homes special? The adult foster home model is designed to enable people to live independently in a family home environment, but it is much more than that. Too many people become isolated in later life. The adult foster home gives them more of an opportunity for new connections, sustaining old connections, and supporting traditions and life experiences. We don’t want people to feel isolated at the end of their lives, and so we give them a place to feel like this transition and the experience of us all being together in the home is another positive chapter in their life. My journey from career hairstylist to caregiver opened a path to service for me that is so much more profound... What do you love most about the work you do? This career came to me as my youngest child was going to college, so I was going through the empty nesting stage which is a big change. The adult foster home allows me to continue to care for others. Being the provider of the home has afforded me so much healing in my own life through caring for others, and it distracts me from any of my own issues. This healing began to happen immediately when I took my first job and began serving others in this special way, and it continues to do so. My journey from career hairstylist to caregiver opened a path to service for me that is so much more profound than just helping someone look pretty. There was a woman living in the home early on in my caregiving career, Mrs. H., who was nonverbal and a full assist with ADLs (activities of daily living). We meet people in this stage at times, and you of course never knew them before they required the level of support you must give, even though they’ve lived a very full life up until you become a part of their life. Something special happened. I realized she would respond to my touch, and if I gently put my arms around her, she would then begin to lean into me and want me to hold her. I realized I made a difference to her with this act alone, in this world - in her world, I made a difference through my presence and through my touch. She was also the first resident I cared for who passed away. I realize still to this day, what I do as a provider, I do for her and the gift she gave me. It is successful work when you are being told that your presence and what you do makes a difference in their lives - this is what it is all about for me. What do you believe makes someone’s work successful? Positively impacting the lives of others; providing a safe home for the residents and protecting them in some of the darkest days they've ever had. It is successful work when you are being told that your presence and what you do makes a difference in their lives - this is what it is all about for me. Since taking over as sole provider, I’ve also incorporated hospice care through a community partnership. This partnership has allowed me to also be there for my residents until the very end. It makes me feel triumphant in my work of service knowing I was able to serve them the whole way home. Anything else you’d like us to know about you? I do not do this work alone. My best friend is my live-in substitute caregiver. My daughter and her husband are my backup caregivers. With the pandemic, getting staff has been the greatest challenge I have ever faced in this line of work. My husband does all of our finances and shopping so we don’t have to worry about more exposure issues. Without them, the team, I could never do this at the level I do. The residents' families also become family to us. There are residents who’ve passed away, and their families still remain in touch with us as time goes on because they value the ongoing connection. It helps them feel closer to their loved ones, I believe. Being an adult foster home provider has given me the extended family I’ve always wanted. I make sure everyone hears from me just how important they are to me. This is key. We invest in everyone's self care in different ways because it matters to us that everyone has the balance in life to be happy and not rundown. And, I know you cannot give what you haven't got, so it starts with me. Visit Country Comfort Adult Foster Home on Facebook.
Article originally published March 2019. Updated December 2021. When I was an elder abuse investigator several years ago, I investigated a challenging case. Miriam*, who was 87, had eloped from her adult care home the previous day. She had managed to leave out the one door that was not alarmed. She had fairly advanced Alzheimer’s disease, and though her memory and judgement were both strongly affected, she was physically able to maneuver with little issue. This is often the case with individuals who have Alzheimer’s disease. My stomach sank, though, as I continued reading the report. Miriam was still missing. I investigated and hoped for a good outcome, but unfortunately there was no positive outcome for Miriam in this case. I found out a few days later that local law enforcement found Miriam deceased, not far from her care home. This story highlights an extreme outcome of wandering and elopement. Fortunately, most cases end with the resident safely back at home. Still, this story reinforces the importance of not becoming complacent. This situation could have happened to any care home provider. It’s an unfortunate story that illustrates the importance of managing wandering and preventing elopement in adult care homes. Wandering vs. Elopement The terms wandering and elopement are often used interchangeably; however, they are not exactly the same. Wandering is pacing or aimless walking. This generally takes place inside the home or facility, though it can also take place outside. These are the individuals you see who pace up and down the hallway, seemingly without direction. Elopement, on the other hand, is the unplanned exiting of the home or facility. It commonly includes “exit-seeking behavior.” This exit-seeking behavior and elopement from the home puts residents at great risk of harm, as Miriam's story tragically illustrated. According to the Alzheimer’s Association, 60% of people living with dementia will wander at least once. Who is at Risk? According to the Alzheimer’s Association, 60% of people living with dementia will wander at least once. Additionally, according to adult foster home surveys conducted by the Portland State University Institute on Aging, 45% of residents in adult foster homes in Oregon have some type of dementia. Who is most at risk?
Assessing for Elopement Risk What can you do to recognize and reduce the risk of elopement? Your screening process is the first step. It is important to conduct a thorough screening to find out if your potential resident is at risk for elopement and if you have elopement prevention options in place. During your screening interviews, ask if the individual has ever displayed exit-seeking behavior or wandered outside the home or facility. Additionally, if the individual is currently in a facility, review their narratives, care plan, and any incident reports to find out if there is a concern about wandering and/or elopement. Also, be sure to assess for elopement risk both during screening or after the resident has moved to the care home when their condition has changed. It is important to understand, even if you’ve conducted a thorough screening, or the resident has no prior history of wandering or elopement, they could still elope from your home after admission. In these instances, it's vital to put interventions in place and care plan to reduce further risk of elopement. 9 Tips for Keeping Residents Safe How do you keep residents with wandering or exit-seeking behaviors safe? Below are several tips and evidence-informed interventions for keeping residents safe. This is not an exhaustive list, as each resident’s needs and situation are unique, but it is a place to start. Tip 1: Care plan around wandering Recognize and document when a resident is most likely to be at risk, and what possibly triggers their wandering or elopement. Increase the level of observation. Tip 2: Meet the holistic needs of the resident If a resident is confused about where he or she is and insists he or she needs to “go home,” or “go to work,” use non-pharmacological interventions to address his or her underlying feelings and needs. Could she be bored? Might he be lonely? Tip 3: Keep residents active during the day Provide person-centered, meaningful activities and tailor the activities to the cognitive abilities of the resident. Tip 4: Install door alarms on exterior doors of the home Make sure to install alarms on all exterior doors and keep them turned on at all times. Tip 5: Consider using an ID bracelet An example of an ID bracelet is the Alzheimer’s Association Medic Alert + Safe Return® bracelet. Tip 6: Enroll the individual in a local safe return program Ask the resident's legal representative to contact your local sheriff's office or police precinct to find out if they have a registry for individuals at risk, like the Washington County Sheriff’s Office Help Me Home Program. Tip 7: Make changes in the home environment Paint exterior doors a similar color as the wall or consider a mural. Make the home environment comfortable, as well. Tip 8: Provide a space for residents to wander safely inside or outside Residents can wander safely with advanced planning. If a resident wants to walk outside, plan for a caregiver to go with him or her. Tip 9: Include the resident's care team Involve the resident's family and/or legal representative and others to help problem-solve around concerning, exit-seeking behavior. You don't have to do this alone. Awareness, Prevention & Intervention Sometimes you can do everything within your power to keep residents safe, and things will still happen. It is important, then, to recognize the point at which an adult care home may no longer be the safest placement for a resident with exit-seeking behavior who is an elopement risk. Fortunately, what happened to Miriam is a rare outcome in situations when a resident elopes from the home. With awareness, prevention, and intervention, you can keep residents who wander safe. *name and details have been changed
Article by Matt Gannon Life is fundamentally about relationships and our connections to others. Humans operate to gain and maintain control (in varying degrees) within relationships: to ourselves, with others, to our environment, spiritually, and to our place in the larger world around us. This is like a balancing act we operate throughout our lives. We ascribe meaning and purpose to the different relationships. Many relationships will shift and change over time, while others remain relatively the same. Within our relationships we have choices and we maintain control of our time, effort, participation level and, the interests being served - all of which shape who we are, our characters, and our identities. ![]() The Dementia Experience Dementia is progressive. Over time dementia demands a different type of communication to find and keep positive connections in relationships. Dementia creates a loss. For the people living with dementia, there is a progressive loss in abilities and independence. When we attempt to understand the dementia experience, what can become more understood is how a person living with dementia is losing a sense of control in their lives. One thing I have come to know well in my time of caring for people living with dementia is how life for them tends to become less about content and detail - and more about feelings. I also know people living with dementia do not lose their ability to feel, understand and recognize the emotion they are having when feeling it. They may not be able to understand and express fully why they are feeling what they are, but the feeling itself is familiar. Emotional memories are very deep-rooted memories and are still often more accessible and familiar (especially when utilizing the senses). The emotional experiences of a person living with dementia can be broken down into two categories: positive & negative. They may be feeling one way or another, or a combination of both at times, but how they are feeling and what they are feeling matters when it comes to providing care. Over time dementia demands a different type of communication to find and keep positive connections in relationships. What is Person-Centered Language? When providing person-centered care and communicating with a person living with dementia, it is important to do all we can as providers so the person ultimately feels more of a sense of control - this becomes our goal in each moment. It starts with an acknowledgment and validation to the moment you share, and to what emotion you sense is being felt. This can be done by communicating with feelings, both verbally and non-verbally. What is person-centered language and why is it important when caring for people who are living with dementia? It is about respecting the individual in our care approach at all times. Once we know the person we are caring for, we can plan and deliver care to them based on our knowledge of who they are as a unique person who also happens to be living with dementia. As you read the phrases below, ask yourself how does it feel to switch from one phase to another? I have a dementia resident.......
![]() When we move to using person-centered terms, our approach, attitude, tone, body language, and empathy can change. It will benefit both us and the person living with dementia because what we do and say can have a significant effect on how they are feeling. If we carry the right mindset, the right attitude, and the right outlook then we are ready in our right care approach. Less is often more when choosing the words we say as we communicate to a person living with dementia. Show more, talk less is generally a good formula. We pursue short, brief, and repeated words and sentences as many times as necessary. We strive to create words together that become familiar between us and familiar to whatever activity we may be doing within our routines, we can identify the words and use them repeatedly as they become mutually understood. We can look to use words the person living with dementia tends to use or respond best to, or phrases that mean something to them. It is up to us to learn what those important words and phrases are, and when we do, to share those words with anyone else who provides care to that person. When we move to using person-centered terms, our approach, attitude, tone, body language, and empathy can change. Insert positively-charged words into statements, such as “ah, that’s a good thing, that’s a good one isn’t it, I like that, I love that, that feels good, doesn’t that feel good? that looks good, and thank you”. A positive way of communication can be to offer suggestions over telling or directing what one needs to do. When assisting a person in any way, from pushing their chair in for them to buckling their seat belt, or helping to get a jacket sleeve on, it is important to seek their sense of satisfaction or approval before moving on to the next thing/task. This can be done by simply asking, “Ok then? Are you happy with that? Does that feel good? Is that a good one?” Or even doing the thumbs-up gesture and awaiting their response before moving on, as this communicates respect and how you see them and care enough to ensure they are satisfied with what you’ve done to assist, before another task or agenda takes over. This is person-centered language. ![]() Why is this important? How much or how little we know about a person we are caring for makes a big difference. A person living with dementia is still the “person” they have always been and in many ways will continue to be. But they are also changing and different in some ways now. What they need from us the most is to SEE them for who they are and to know what makes them unique. By doing this we are reaching the center of a person and can care for them in a way that charts their personal care course - providing a feeling of control, not taking more away. Person-centered language is part of how we communicate to people living with dementia who depend on us to understand, and to be able to connect in the most respectful ways possible. Respect matters in all of our relationships, but for the person who is living with progressive dementia that is affecting their brain, we must ensure our approach and the language of our care is received in the way our residents living with dementia require - to have the strongest relationships we possibly can. What they need from us the most is to SEE them for who they are and to know what makes them unique. By doing this we are reaching the center of a person...
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