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Music Therapy in a Hospice Setting

June 28, 2018


GraceHospiceLogo.pngWhen Mary Lord began thinking about how to connect the dots between her love of music and how to make a living, hospice work was not high on her list. Yet, the more she heard about music therapy and the possibilities in relation to hospice, the more intrigued she became.

As one of three full-time music therapists at Grace Hospice (formed in partnership between Augustana Care and Mount Olivet Careview Home), Mary knows music therapy is not entertainment. She does not perform for large groups; instead, shares to talents on a one-to-one relationship with people who are facing the end of life. Her audience knows time is limited and are listening to connect with each other and reflect on what is most important to them. 

We recently caught up with Mary and asked her to tell us more about music therapy in a hospice setting. 

As a board-certified music therapist, I have the privilege of helping people through music. As defined by the American Music Therapy Association, “Music therapy 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.” Music therapy interventions can be designed to promote wellness, manage stress, alleviate pain, express feelings, enhance memory and improve communication. In short, it is the use of music for non-musical goals.

Sometimes when I am facilitating a music therapy session, it may appear to the onlooker that I am simply “playing music” for the patient but I’m actually using music to address a very specific goal that has been identified and documented in the patient’s plan of care. Before giving specific examples of how goals are addressed I want to point out a core principle of music therapy. Research shows us that the effectiveness of music therapy hinges on the use of patient preferred music delivered by a trained clinician. When facilitating sessions, it is imperative to assess patient’s musical likes/dislikes and only use music that a person wants to hear. This assessment can be done directly with the patient themselves or through a caregiver or family member if the patient is unable to identify this for themselves. 

I am passionate about the way music can affect people and impact their hospice journey.  Because music has the power to change our human response and behavior, I have had the great privilege of witnessing some sacred moments that may not have happened otherwise. Some of the goal areas specific to hospice music therapy are: 

Symptom Management - Symptom management can include decreased perception of pain and discomfort, anxiety and stress reduction, decreased agitation, improved respiration, reduced heart rate and relaxed muscle tension. While the hospice nurse will be heavily involved in managing these often-distressing symptoms, music therapy is another way to address the goal of comfort and relaxation. For pain management and decreased anxiety, the music therapist will create individualized interventions to direct attention away from pain or anxiety by distracting the patient with comforting music. For changes to the patient’s breathing pattern, a musical stimulus will be provided to cue or entrain the patient’s breathing. Aural cues can be used to promote positive visual imagery which can lead to a deep relaxation response or change mood. While these interventions are patient focused, family and caregivers often report they they too experience the positive benefits of music when at the bedside. 

Family & Caregiver Support - I like to say that a music therapy session is a really good way for a lot of people to co-exist in a room without having to do anything! There are often many family members gathered around a patient during the end of life or “actively dying” phase. This is often a time and place of waiting. Waiting for the inevitable and wondering “How long?” can create tension and anxiety for those participating in the ancient ritual known as the “vigil”. Families welcome me into this sacred space and allow me to keep vigil alongside them and use music to enrich this time of waiting. Music therapy can provide a calming background where families can relax and be present with their loved one and not feel the need to constantly talk or do something. Music therapy can also create an emotionally supportive environment that is a safe space for families to share feelings and memories with their loved one and each other. There are often tears and laughter in this space. Sorrow and joy held simultaneously as family members recall life stories, the extraordinary and the mundane each holding more significance now as their loved one’s legacy is being shaped in this place.

Life Enrichment - Due to the nature of the disease process, many of our hospice patients have some type of dementia effecting their cognition. While considering a patient’s functional abilities and needs, a music therapist can create experiences allowing the patient to respond and engage in music when they would typically withdraw or disengage with the environment around them. Using patient preferred music in one-on-one sessions provides opportunity for memory recall leading to reminiscence and life enrichment as well as positive changes in mood or emotional states. This positive sensory stimulation leads to increased socialization and overall emotional comfort. When I see a patient with dementia demonstrate a positive response to music therapy, I like to notify their family members as this often brings a sense of comfort to them as well. Over time they have watched their loved one experience multiple losses related to disease progression and knowing that music therapy can create opportunities for positive engagement can make the family feel as though their loved one is “still in there” although at times they seem so far away. For me as a clinician, this also serves as a great reminder that that individual is still a person who deserves to be treated with respect and dignity. This allows me to live the mission of Grace Hospice every day.

Mary Lord, MM, MT-BC is a board-certified music therapist and holds a Bachelor of Music in Music Therapy from The University of Minnesota, Twin Cities and a Master of Music; Specialization in Music Therapy from Colorado State University. She has completed advanced training courses through The Center for Music Therapy in End of Life Care as well as The Academy of Neurologic Music Therapy. For over 12 years, Mary has been working with hospice patients and families in Colorado and Minnesota. With a passion for educating people about hospice music therapy, Mary has presented locally as well as at the American Music Therapy Association’s national conference.