Kavan Peterson, EditorYesterday I had a conversation with a contact from a Quality Improvement Organization (QIO) in my home state of Montana who was seeking advice on how to drive dramatic changes in dementia care practices in the state’s nursing homes. (QIO’s are independent state organizations chartered by the Centers for Medicare and Medicaid to advocate for high quality health care by providers receiving federal funding.)
She had seen Alive Inside and heard about my connection to the film (my mother runs one of the larger nursing homes in the state and has helped boost the film). Like so many other culture change advocates she saw this film as a clarion call for action.
She called asking for advice about how best to leverage the film to get nursing homes to adopt new practices of dementia care that will help dramatically reduce the use of anti-psychotic prescriptions to treat Alzheimer’s and dementia statewide.
Alive Inside has made it powerfully clear that the least — THE LEAST — providers can do is adopt the Music and Memory program and provide personalized music to those they serve. I don’t see how you can watch that film and not conclude that it is a criminal civil rights abuse to deny people living with dementia access to music.
But music is just the beginning, the most basic, no-brainer approach. Beyond music there is an entire world of creative, arts-based and experiential models of dementia care and culture change that have potential to radically improve the wellbeing of people living with dementia, in nursing homes or any other environments.
I shared a few ideas with my new friend and she promised to send me some new programs and ideas she had been investigating. Below are my top three suggestions and I would LOVE to hear other suggestions from readers:
1) Connect with The Eden Alternative and begin trainings in Dr. Al Power’s Dementia Beyond Drugs. The QIO can’t do that alone, but I recommended she look into the CMP-funded statewide trainings The Eden Alternative recently provided in Kentucky, Tennessee and Mississippi.
2) There is no substitute for the organization-wide culture change outlined by Eden’s and Dr. Power’s approach, but there are some amazing programs that providers can easily implement with life-changing results. One of my favorites is Anne Basting’s Timeslips. It’s a simple story-telling activity that provides a radical paradigm shift for participants away from a focus on memory and towards a focus on imagination. Coincidentally, Anne is in the final days of a major IndieGogo fundraiser to expand Timeslips and I urge all of our readers to visit her fundraiser page and chip in.
3) Third, I suggested getting the community involved by visiting the I’m Still Here Foundation to learn about dozens of other innovative, community and arts-based movements nationwide providing non-pharmalogical approaches to living with dementia (including programs like this here in Seattle).
That’s just the tip of the iceberg. What other programs would you suggest?
Hi I am an AGNG 200 student at the Erickson School of Aging, and I just wanted to say I love this blog, and the ideas in it. I agree with this post because people in nursing homes always want to go straight to medication to help treat memory loss such as Alzheimer’s and dementia. I always knew there had to be other ways to treat this disease but I never further looked into it. In my AGNG 200 class we have talked a lot about aging and mental diseases. Alzheimer’s and Dementia are are most likely not avoidable and if we see early signs we need to find better treatments. Music therapy seems very homey, and I say this because sometimes when i’m sad or feeling any type of emotion I listen to music, and to deny people music is outrageous.
I love that we are finally talking about methods of helping those with dementia without having to use all the psychotropic drugs! I am currently working on various “Nature Based Activities” that also help to reach out to this population in various senior housing settings. I have personally seen the power of various nature based activities touch the lives of seniors in these settings. One I will never forget was when I was visiting a Memory Care ward that was a “locked unit” in a traditional nursing home. I was visiting with my registered Therapy Dog, Cooper, a beautiful male Golden Retriever that I had done extensive training with to do these kind of visits. When we walked into a older gentleman’s room on this locked ward he “lite up” and said plain a day: “I know there is a God in heaven when you and that dog walked through my door” Whoa! that blew me away. This gentleman was confused and not that verbal most of the time but he really enjoyed visiting and talking with us on our visits. It turned out that he was raised with many animals around him in his youth. I have also seen other seniors respond to other visiting animals such as cats or bunnies and even chickens! In addition to animals I have seen seniors with dementia really enjoy working in small garden boxes digging in the dirt and helping to plant flowers for the garden. Just getting the seniors outside in natural sunlight every day can help them get better quality sleep at night!
There are many ways to use our imaginations when it comes to Nature Based Activities!! We only need to be curious ourselves and take the time to help our seniors explore the many options!!
I wish this programs had begun when my mom was alive. But she and I developed our own. When I was home in California I would call everyday. Conversation was of course difficult, so I started singing with her. At the beginning she could still sing along, later I would pause at key words for her to fill in.. We did this for 5 years. We laughed really a lot.I have wonderful memories. We also had music (we hoped she loved) playing in her rooms. Thank you for such fine work.
Board-certified music therapist here. My preferred populations are hospice and end-of-life care, as well as other settings with older adults such as assisted living and memory care. I agree that basic access to recorded music is the bare minimum for individuals with dementia. Music, by itself is a powerful medium. When you put that medium in the hands of a certified allied health therapist who can use music specifically to work on functional goals such as socialization, mood elevation, family communication, spiritual support, catharsis, etc., it is easy to see why music therapy does SO much more than simple music listening programs. A useful comparison might be having residents watch an exercise video versus receiving treatment from a physical therapist. I love that Alive Inside is bringing attention to the potential for music to change the way we approach dementia care. I get quite distressed, however, when administrators mistake music listening for the services of an MT-BC. I would strongly encourage you to take a look at http://www.musictherapy.org for more information on this unique approach to using music in a clinical setting.
Aging does not affect the things that bring human beings joy and comfort. Of course music and art are beneficial to older adults. So is social engagement, unconditional love, dancing, singing, feeling wanted and needed. None of this is rocket science, and while I am supportive of the QIO’s, it shouldn’t take a QIO to tell us how to do what is so obviously the right thing. You just have to care. So for me the greater question is, how do we engage communities in caring about and investing in seniors?
I am all about quality improvement in nursing homes. But in reality, for some nursing home owners their goal is a high census and profit. Those who do care about the nursing home residents they serve are engaged in dementia care best practices. Other nursing home owners who only care about their margins obviously are not, and lest we forget….nursing homes are a business, and there is your problem.
Update for readers: Shortly after publishing this piece I had the opportunity to interview someone who has implemented the Music and Memory program in two small homes for people living with dementia. She would beg to differ with my characterization of implementing the program as “basic” and “no-brainer”. The training for Music and Memory is only about eight hours, but the process of setting up individualized play lists is quite demanding. She spent many weeks following up with families and compiling music before she could launch the program. The good news that there are efforts underway to crowdsource the music lists organizations are developing as they roll out Music and Memory. Stay tuned for details!
Terrific post! “The Brain Healthy Power of Music” has recently surpassed “This is Your Brain on Chocolate” as our most popular keynote topic and your focus hits that “just right” note. It seems the science world is finally catching up with music’s long-recognized powers.
Take your pick:
Music gives wings to the mind, flight to the imagination, and charm and gaiety to life and to everything. Plato
Where words fail, music speaks. Hans Christian Andersen
Music is the soundtrack of your life. Dick Clark
We hope and we expect that we will soon look back to game-changers (brain-changers) such as “Alive Inside” and Anne’s TimeSlips as “just the beginning” of multi-sensory cognitive interventions.