Live Concerts Break Through Resident Isolation

The author's company brings residents and musicians together, up close and personal

By Susan E. Mazer

Note: This article originally appeared in the September 2003 issue of Nursing Homes Long Term Care Management, www.nursinghomesmagazine.com)

Musician Vince Guaraldi once said, “When I walk into a room, I make a noise so that I won’t feel alone.” Although for most of us, sounds may cut through the momentary loneliness imposed by silence, isolation caused by age, illness, hearing and visual impairment and other diminished capacities, is not so easily rectified. Although described, documented and acknowledged as a risk factor, involuntary solitude remains pandemic among the elderly. For the institutionally confined elder, the visits of the postman or UPS driver, seeing long-term neighborhood acquaintances, enjoying fellowship at church and other activities that bring people together contribute to a quality of life that is no longer available.

Despite media rhetoric addressing the needs of the aging population, long-term care residents and the facilities in which they reside are subjected to individual and collective isolation. The community at large, preoccupied by the busy-ness of living, marginalizes population segments who are unable to fend for themselves. Important to improving the quality of life for the confined elder is a sense of community beyond that contained within the walls of a long-term care residence. Within the facilities themselves, individuals meeting for the first time under stressed circumstances live (and die) under one roof, eat in the same dining room night after night, and experience publicly their frailties, habits and daily struggles. While residents may become united in the progression of the aging process, the inevitable changes are seldom positive. Residents stay until either they become acutely ill and transfer to another facility, or they die. In either case, progressive loss is ongoing and probably expected. Without a community presence relieving the isolation, the culture of illness and debilitation overtakes a culture of living.

One of the many benefits of music is to bring people together and act as a socializing force—a way to change isolated individuals into a group of people whose commonality is created in the moment by a shared experience. Furthermore, the relationship between a musician and audience adds another component of social and personal enrichment. A musician coming into their “home” to perform is seen by residents as a sincere form of intention and attention.

Research studies and anecdotal reports have verified the profound value of live performance, and studies in the field of gerontology and music therapy have shown that, among other physiological outcomes, appropriate music can alleviate depression, reduce agitation, increase cognition and stimulate memory. Furthermore, the music also benefits family members who may be present, and the professional caregiver’s day-to-day work life is likewise enhanced.

Integrating live music into the culture of long-term care also invites, if not creates, other rituals that optimize the experience. These may include snacks (before or after), social activities around the event, an opportunity to dress for the occasion, programs to further introduce the event, and preparation on the part of both the musicians and the facilities.

Performers in Facilities
Throughout the country, many organizations provide entertainment for the elderly. For example, Bread and Roses, a nonprofit organization in San Francisco, has been providing concerts for the institutionally confined (including hospitals, correctional facilities, and others) since 1974. Music Therapy Association of British Columbia has active resources to support music for the elderly. Major musical performers, such as Wynton Marsalis and Bobby McFerrin, have made performing at hospitals and long-term care facilities part of their professional mission. Other volunteer groups and musicians in numerous communities across the U.S. provide music for the ill and elderly. All of these events are most effective, most generously provided, and much needed.

The Elder-Care Concert Series
Recognizing the need for and benefits of live music for the elderly, Healing HealthCare Systems, a company that produces environmental programming for patient television, funded the first Elder-Care Concert series in its community of Reno, Nevada. With administrative assistance from the Sierra Arts Foundation, Healing HealthCare Systems’ goal was to bring artist and audience together, specifically to enrich quality of life by providing live music for the confined elder. This was not to be a one-time event, but to be provided on a regular basis, so that the music became part of the culture of each facility, and equally part of the lives of each resident. Achieving the goal was expected to provide long-term benefits, rather than short-term gains. It was also hoped that staff members would then be able to use the events to further enhance their ability to serve the psychosocial needs of residents and families.

The initial seed funding from Healing HealthCare Systems was $5,000, which drew matching funds from the City of Reno Cultural Arts Commission. The administrative costs of managing the series—$2,200—covered scheduling performances, contracting for facilities and musicians, collecting data, and attending each event to ensure quality. Fees for the musicians are $90 for a soloist or ensemble leader and $60 for each ensemble memberWith the average cost of $50 per event for administration, the total expense for each event is approximately $140-270, based on how many musicians performed and a local performance payment scale established by the Musician’s Union. The first year, which took a full six months to set up, provided 27 concerts to six facilities, each event serving 15-30 residents. Recently funded for a second year, with continuing support from the Reno Cultural Arts Commission, the Elder Care Concert Series is provided at no charge to the facilities.

As with any project, there are various people involved, all with different needs, responsibilities, and expectations. We believed that the best way to accelerate optimal benefits in this situation was to meet with both facility staff and musician-volunteers to orient both to the program.

Orienting Musicians
Healing HealthCare Services developed an orientation session for the musicians, and attendance was required. While many musicians had already performed in this setting, their experiences had been mixed. None of them had ever fully addressed why this audience was distinct from other audiences, what was reasonable to expect from the facility, and what kind of adjustments they needed to make their performances most effective. It is clear that the skills needed for a musician to perform for an audience of individuals whose ability to respond is unpredictable and determined by their physical condition is beyond those typically expected of musical expertise and talent.

Invitations were sent out to known artists who had already qualified by past experience, and others who had been recommended by the musician community. The orientation meetings were set up in the late afternoon (3 p.m.) to avoid any conflict with evening performances or, for teachers, school hours. These one hour discussion-meetings focused on the objectives of this series, the importance of their performances to each resident, and the various challenges that are common to this setting. Guidelines were offered relating to such matters as being on time, keeping the sound level moderate rather than loud, not taking residents’ sleeping or wandering away as personal criticism, mixing old and new (but all recognizable) repertoire, and paying attention to staff requests and directions.

During these orientations, musicians shared experiences from past performances that they had found very gratifying, and others in which they had been left alone to perform for a small group of residents, in some cases of which residents had exhibited uncontrolled behavior reflecting their level of acuity, but for which the musicians had been unprepared to respond. Musicians need to be prepared, and staff members for their part need to be available to manage residents who wander, to protect musical and sound equipment from harm, and to ensure in general that the event is as beneficial as possible.

Earlier the topic of musicians’ fees was mentioned as one of the costs of these events. Although many musicians are willing to volunteer their time, providing them with compensation, however nominal, creates an authentic relationship between the facility and artist and acknowledges the professional value of the services provided. This does not diminish the generosity expressed by the musician—the fees paid in these situations seldom equal other professional engagement fees, and do not compensate fully for the benefits rendered to residents, families and caregivers.

Orienting Staff
Staff have their own guidelines—among them, making sure that musicians’ equipment, sound systems, etc. don’t get in residents’ way and vice-versa, reducing glare from windows or strong ceiling lights, working to acclimate the musician to the setting and helping with the loading and unloading of instruments and their safekeeping. Creating a “ritual” around the concerts is also beneficial, in that residents can look forward to it, socialize with each other afterwards, and maintain the excitement for the next several hours or days.

Evaluations
Even the best-written evaluations fall far short of fully describing the impact of a musical event on an appreciative audience. It is worth noting, however, that in over 50 concerts in some six-to-eight nursing homes, both staff and musicians stated unanimously that they found the events to be a valuable and quality experience, and that they each would like to do it again. Musicians described the participation of residents to varying degrees, ranging from attentiveness, to tapping feet, to singing along, to standing and singing. Musicians also found the experience to be personally enriching. They said it was very different from a normal “gig,” where music is often secondary to the food or taken for granted. Also, these performances were different from those in which success is measured by a specific kind of audience response. Here there were no standing ovations, no loud, lengthy applause; the response was quieter, the feeling more profound. Audience participation in these events was not an entertainment ploy, but expressed the audience’s full re-engagement in life.

Facilities also expressed appreciation for the roster of musicians, who, while diverse, were all of the highest quality, and for the Sierra Arts Foundation, whose role in administering the series was found to be invaluable. Without its administrative support, the Elder Care Concert Series could have easily become just one more burden to manage for the activities therapists or facility directors.

Aging-Related Issues
Without a doubt, the issues of aging-related hearing and visual impairment pose daily challenges for residents and caregivers. However, in the concert setting, where only one event is occurring and the visual and auditory focus is clear, and distractions are minimal, these issues seldom arise. Live music does “get through” and, in fact, research on music therapy has shown that patients suffering from the ravages of stroke and dementia may well be able to sing when they cannot otherwise speak, to understand and enjoy music when they cannot conduct normal conversations.

One anecdote will illustrate: In the first of the 27 performances conducted during the first year of the concert series, Irish folk singer Tommy Sands performed at an Alterra Residence Center. Patients at this facility had a wide span of acuity. One was brought in a wheelchair, his head drooping in a semi-sleeping state. He had not come out of his room for days, although he had asked to attend. When Tommy asked if there were any requests, this gentleman barely lifted his head but, in an almost full voice, requested “When Irish Eyes are Smiling.” Almost everyone joined in the singing, even those who, under other circumstances, may not have been able to participate in other social activities.

Presenting concerts in nursing homes or hospitals is not a new idea. However, an elder care concert series, the specific intention of which is to enrich the culture of the facility and enhance quality of life for residents, has far more comprehensive impact than a one-time or occasional event. Moreover, he quality of life within any community-at-large is measured by its consideration of the full chronology of life—from birth through death, for infants, children, adults, and elders. The HHS Elder Care Concert Series is but one example of a community caring for its own. Expressing collective respect for life in all its stages enriches life for all generations in the community.