Music therapy fills many needs
MT can aid clinical, emotional, and spiritual care
Hospice care addresses the holistic needs of terminally ill patients. To meet those needs, hospices must address medical, nursing, social work, and counseling issues. Music therapy touches on three of those four needs, yet remains largely overlooked.
"For every nurse in a hospice that delivers care, there should be a music therapist," says Pato Cogg, RN, referral director for Chicago-based Season’s Hospice. "What they do impacts care on many levels."
Cogg acknowledges the exaggeration is meant to drive home her point, but adds that music therapy aids nurses in pain and symptom management, counselors in dealing with complex family issues, and chaplains in addressing spiritual needs.
However, she notes a distinction must be made between music used as therapy and music used to entertain. The role of music therapy in the hospice setting is to help relieve pain and deal with emotional issues associated with the end-of-life.
Opening the past
Cogg uses the following case study from Season’s Hospice to illustrate the specific goals music therapists try to achieve:
Diagnosed with metastatic prostate cancer, Mr. N. was referred to hospice care in September 1994. After three months, the 78-year-old widower became increasingly depressed and was referred to a music therapist.
During the first visit, the music therapist asked the man to fill in the blanks to the sentences below. The patient’s responses are shown in italics:
• Music makes me . . . feel good.
• If I were to record an album, I would title the album . . . Lookin’ back over my life.
• Music is . . . the core of my life.
After talking more with the man, the music therapist learned that music played a prominent role in his life, including singing in his church choir for several years. Mr. N. requested that the therapist sing "Away in the Manger," which prompted him to cry and sing along softly. The therapist then asked if the song held special meaning.
As a result, the therapist learned that it reminded him of past Christmases with his family. The man began to express grief over no longer having family around for Christmas. Soon the man began to open up and discuss happy memories from Christmases past.
From this initial contact, the therapist developed the following goals for the patient:
• Validate life, through reminiscing.
• Identify and express emotions effectively.
• Develop adequate coping skills.
A care plan that included one music therapy visit per week for 45 minutes was developed. He also was given unlimited access to recorded music.
The next month, Mr. N requested music by Nat King Cole and Billie Holiday. As he reminisced about his high school sweetheart, going to nightclubs and sharing stories about his youth, he became more bright-eyed and laughed frequently.
The music therapist also engaged Mr. N. in lyric analysis that helped him express his thoughts and fears about death. As treatment continued, Mr. N. seemed to focus on church hymns and used the spirit and emotion of the songs to cope with the final stage of his life.
Applications for pain management
Proponents of music therapy suggest it may alter pain perception and increase patient relaxation. They argue that music intervention helps reduce anxiety, improve relaxation, and act as an adjunct to pain management drugs. In addition, music therapy enhances cognitive coping strategies in which the patient uses imagery to filter out and reduce perceptions of pain.
Seasons Hospice uses board certified, credentialed music therapists as an adjunct to pharmacological pain and symptom management, psychosocial counseling, and spiritual care.
"All of these hold a direct relationship in raising the quality of life, which is basic to the goal and purpose of hospice care," says Cogg. "This restoring and improving of the mental and physical can often create another level of healing."
Music therapy intervention techniques used at Seasons Hospice include:
• lyric analysis;
• guided imagery;
• sing-alongs;
• rhythm sessions;
• song choice;
• songs as life review stimulus;
• making musical plans in conjunction with memorials;
• improvised singing;
• instrumental improvisation;
• song writings;
• music composition;
• music and massage;
• use of nature/environmental sounds.
Hospice managers that use music therapy in end-of-life care sing its praises, but admit music interventions are not used often enough. For most hospices, money is an issue. The $85 per visit cost is often perceived as money that can be spent elsewhere. Traditionally, Medicare has not reimbursed music programs under fee-for-service arrangements.
The myth about reimbursement
"There is a cost-benefit," says Hugh Henderson, general manager of Odyssey Health Care, a hospice in Dunwoody, GA. "It fits in wonderfully with the hospice concept of attending to the whole person. But with the cost restraints that we’re up against, the chances of working it into our budget aren’t very good."
Many hospices use money from donations to fund music intervention.
"At our hospice, we’ve decided that music thanatology is beneficial and we’ve been able to manage so far with donations," says Teresa Warren, LGSW, director of Hand in Hand Hospice in Gainesville, GA. (See related story on music thanatology, p. 40.)
But Cogg says hospice managers that rely on their own general budget or donations to fund music programs are misunderstanding both Medicare and managed care reimbursement. Most hospices have moved to per diem rates and therapeutic music programs can be included.
Cogg says when per diem rates are negotiated, she includes music therapy in the list of services and ensures the rate is enough to cover visits by a music therapist. "Music therapy is considered counseling the same way chaplains and social workers are counseling."
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