Advice for musicians and music therapists

For older people in care homes, as well as hospices, particularly those living with dementia, music can offer a unique way to engage, communicate and find routine, comfort and creativity in life. The potential benefits to their wellbeing and quality of life should not be overstated, and there is a clear underlying neurological basis for saying so.

Sadly, the vast majority of the UK’s 21,000 care homes do not yet offer their residents genuinely considered participative music opportunities – so, there is a clear role for musicians to play here. There can be great benefits for musicians who do this. As well as regular paid work, musicians report that working with older people can provide nourishment for their other creative, performance-based work, giving them unique insights into the emotional power that their music can have.

If you can hold your own in a care home, the stage of the Albert Hall or Wembley Arena won’t daunt you at all!

Toolkits

Singing and making music with residents in care homes can be challenging but it is always rewarding. Live Music Now have put together a toolkit which will help you start, whether you’re a professional musician, care home staff or an amateur singer (and there are tips for the more established, too.)

In order to do this important work well, musicians need to understand several things, including:

1. Engaging with care homes

  • Think and talk with care home managers and staff about incorporating and including music into the daily life of the care home and lives of their residents.
  • Talk with care staff about how they can be involved in the music making to support residents, visitors, others in the care setting when sessions are running. Encourage their creativity and involvement as your work is far more likely to ripple on when you’re not there if you enable staff to have the confidence and skills to do some musicking with residents in between sessions.
  • Think with them about how what you’re offering can fit with other musical activities. For example, if you’re offering interactive music making sessions, don’t schedule these to happen at the same time as the choir rehearsal.
  • Where possible, plan sessions in advance with the staff team – take time to find out about who will be present, their needs and personalities, as well as their medical needs. This will help to ensure that the most is got out of the sessions for all involved – residents and staff alike.
  • Take time, when possible, to reflect with staff on the session to help build in a culture around do, review, improve that can flow beyond the music sessions.

2. The working environment of care homes, and the different types of dementia.

  • Having an understanding and being aware of how to communicate appropriately and engage with people living with dementia. There is a wide range of training available around this e.g. music care training or dementia friends workshop.
  • Feel comfortable in talking and being with older people, particularly those living with dementia.

3. Deliver appropriate evidence-based music programmes which are tailored to the specific needs of the people in that particular environment at that particular time

  • Be aware of and know what the latest developments are with research and evidence. Are there ways of working which have been found to be particularly effective, which you could incorporate into your work? Keeping in touch with the evidence base, keeps your work fresh and stimulates your creativity, in turn helping you to provide the highest quality of your work.

4. Choose suitable repertoire, whilst retaining musical integrity

  • Find out about likes / dislikes / preferences. If a particular instrument / song / style is known to be a trigger for an individual, be mindful of this when planning and selecting repertoire.
  • Find a balance between familiar and new – the former is useful for creating trust, confidence, connections and expressing identity, whilst the latter is an important element in supporting people to have new experiences through a creative medium. New repertoire and improvised repertoire can support groups in developing a here and now identity.
  • Remember that all activities are to be offered to residents and not done to them. The opportunities to participate in music making or share in music making is one that should enable choice, agency and autonomy. If a resident chooses not to join in initially, be respectful of this whilst finding other ways in which they may want to participate in the group experience. This may also be an opportunity to think with staff about residents making choices and the importance of this and how this validates a person’s sense of confidence, self and autonomy.

5. Use percussion and other instruments appropriately

  • Having a selection of instruments available ensures choice and variety for participants. If you notice unhelpful use of instruments, don’t stop someone from playing, rather re-direct or talk with them about other ways in which they can be using instruments. Playing loudly doesn’t necessarily mean that that person is enjoying the experience more than someone who is playing gently. Make space for each person to be heard and acknowledged.
  • Always offer choice – if someone doesn’t want to play when invited to do so, don’t forget about them. Ask again later in the session, they may have changed their mind or been encouraged by watching and listening to someone else play.

6. Health and safety

  1. Before starting a session, talk with the care manager and / or staff about whether any residents have a hearing impairment or are use a hearing device. Are there instruments or sounds you should avoid which particularly distort sound through devices and may be aggravating?
  2. Similarly, talk with the manager and staff about whether any residents have a visual impairment. How can they be best supported to access the group? Are there particularly tactile instruments that they might enjoy exploring and playing?
  3. Are there any health needs / risks you need to know about before starting your session? For example, are there any individuals in your group at risk of a seizure and is there a member of staff going to be present who will support if this occurs? Do you know what the procedures are for any of the medical needs of the individuals in your sessions?
  4. Think about the environment you are trying to create – where are residents positioned, are they positioned in appropriate seating, are they sitting with their carer if they need this level of support? Where are the instruments positioned? Where are you going to be positioned – will you be static or mobile? Who is supporting you in running the session and do they have a full understanding of what you need them to do in their role?
  5. If using headphones, we would encourage everyone to have their own set. We would recommend the use of over-ear, padded, wipeable headphones as they can be easily cleaned with an antiseptic wipe before and after a session. There are lots of headphones available and we would advise people to try a few pairs to get the best comfort, lightness and fit.

7. Safeguarding

8. Training and Support

  • Keeping your skills up to date is both important for you and the people you are working with. There is an exciting range of CPD available for musicians, provided both locally and nationally, from conferences to workshops to online training. Remember your skill set isn’t just about your musicianship, it’s about your knowledge and understanding of the care sector, dementia and the role of music in care and health.
  • Working with people living with dementia can be hugely rewarding in many ways but it can also be highly impactful on many personal levels. If you are working as part of a team, try to make time for sharing and talking about you work or hold peer supervision sessions. If you are a loan worker, think about what support would be helpful for you if you haven’t already got support in place. The British Association for Music Therapy offers a UK wide register of Supervisors who can provide supervision and training. Please contact info@bamt.org for more information.

9. Insurance

  • Be up to date with your required insurance, such as public liability and professional indemnity. Talk with the Musicians Union about what you should have in place.

10. Knowing your own scope of practice

  • Particularly when starting out in this area of work, it’s important to be aware of and know what your skill set allows and enables you to do. In order to ensure the safety and wellbeing of the people you are working with and yourself, it’s important to know your scope of practice and when you need to signpost to other services or health, care or musical professionals / practitioners. This could be noticing that someone in your group is finding it difficult to manage the group experience and may need individual music therapy sessions. It could be that you’ve noticed that someone in the group complains of a pain in their arm each week and it would be helpful for you to highlight to the nurse or the physiotherapist. Know who is part of the team in the setting. Talk to them about their roles, find out about what they do and when it’s appropriate to be signposting to them.

Live Music Now has been training and supporting musicians throughout the UK to work in care homes for over 40 years. They have created a set of free online resources to help encourage more care homes and musicians to work together, with practical guidance (including videos) on all the above topics. Visit www.achoirineverycarehome.co.uk to access these.

For early-career professional musicians of all genres, you may wish to consider auditioning to join the Live Music Now scheme.


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