Suggestions for Musicians in Elder Care and Healing Arts Programs


     Please remember that one of the single most important duties you will have when entering any medical setting as a professional is that of confidentiality.  This confidentiality extends beyond the patients themselves to include their family and friends as well.   DO NOT discuss the people you encounter when outside of the medical setting.  It is advised that you do not approach people you may have met in these settings when you see them elsewhere; leave that opportunity to them, at which point you are free to talk to them about whatever they please concerning their own situation, but not that of others.

                                                                                  Colin Ross



Elder Care, Assisted Living, Skilled Nursing


          These locations are all united by having patient/client populations that for some medical reason cannot attend to their own activities of daily living (ADLís) and therefore require assistance and constant care.  There are a multitude of reasons for why people come to these environments, some of the most common being dementia, mental retardation, and significant physical disabilities without any cognitive problems.  Listed below are some guidelines to follow in these situations.


To start: Make a noticeable entrance.

You are a guest where they live.  So, even if you are carrying instruments or gear, put down your load and audibly greet whomever may be in the room.  Be sure to speak clearly, loudly and slowly.  Make eye contact if possible, and donít immediately be focused on setting up. Look sharp and make your visit an occasion.


Before entering, it helps to take a few minutes to focus your energy and remind yourself why you are doing what you are doing.  

Be animated and outgoing, regardless of your own mood or the mood in the room.  Do not react to anything that takes you off your agenda, such as people coming and going, or needing staff attention.   In memory care and assisted living situations, people can say and do seemingly random things quite frequently.


Always defer to the staff on audience management.   

As an example: If there is background music playing, or a TV is on, ask a staff member to turn it off and redirect peoples attention as opposed to taking care of it yourself.


The less one plugs in the better.

If you can be comfortable and audible, sing without a microphone.  Many old people are wary of sound systems and sometimes have hearing-aid problems with amplifier systems.


Interact with your audience as much as possible, for both you and them.

Move around the room during some numbers.  Approach individuals and sing and play directly to them. Donít be squeamish about approaching extremely disfigured or disabled people and singing and playing right to them.  Crouch or kneel in order to look straight across or up to people in wheel chairs and beds.  Some may have very limited range of vision, so find their individual field of focus and try to meet their eyes.  If their eyes are not aligned, as with many stroke victims, try to determine which eye is in focus and look into it as you play.  Many seemingly unresponsive individuals can become quite responsive with this technique.  Move from one person to another without losing track of the whole room.


Be easy and outgoing.

Talk about the music, talk about your day, or tell a story.  Many people in these facilities seem to miss ordinary non-clinical conversation and humor.  Be very careful with sarcasm, pop culture references, as they can be easily misconstrued.  Those with problems with dementia or brain injury, in particular, can have problems as they can have key parts of their brain damaged that work to process these kinds of more complicated human interactions.


Ending with a sing-along is very effective.

For seniors, songs such as Side By Side, You Are My Sunshine, Sentimental Journey, I Got Rhythm, This Land is Your Land, or America the Beautiful always seem to work.   There are many great songs to choose for this, but the best ones are old, mid-tempo, easy to sing, and donít cover too much vocal range.



Hospital or Rehab Room Visits


     The patients in these settings are likely to be much more acutely ill, usually with some kind of difficult cancer, or recovering from severe illness such as a heart attack (myocardial infarction, MI) or stroke.  They are going to be fatigued from both their illness and their treatments and procedures.  You may even be in a palliative care or hospice setting, where treatment has transitioned from intention to cure the disease to a complete focus on reducing the severity of symptoms and suffering in that stage of the disease.


    Dress cleanly but casually. 

 Look like a visitor, not to be confused with staff member or medical professional.  Wash your hands before going in hospital or rehab rooms, and always be aware of any safety precautions regarding contact, gloves, masks or gowns.  If you have any questions or concerns about a giving setting, ask a nurse at the nursesí station.


    Determine what the function is in each situation.

It may be to entertain, evoke memory, change mental focus, aid in sleep, provide guided meditation, or simply pass time and relieve stress.  The function may evolve throughout that visit or in the process of several visits.  It is not about your performance.  Music can be palliative without addressing symptoms, just as it provides relief in everyoneís life.


    When entering, take note of the patient.

 Consciously note their posture, physical attitude, rate of speech, vocal pitch, and rate of respiration.  Try to match their speed of breathe and speech before playing any music.  Do not talk more or faster than they do. Even if there are visitors or family member present, stay focused on the patient.

Do not inconvenience the staff in any way

Always remember there are very serious, expensive, life altering decisions and procedures going on around you.  Be careful how you set up, and donít impede the staff.  Try to bring as little baggage and extra volume of materials with you as possible, as hospitals are often quite short on space.  Be prepared to get out of the way and wait.  Be aware of volume, and be sure that audio bleed over does not bother patients or staff in adjacent areas.


Always talk to your audience.

Do not ask how people are, but be prepared to be told in great detail about grave conditions.  Have a compassionate response.  Sometimes people want to vent to someone anonymous.


Always breathe through your mouth and not your nose. 

Do not gag or show disgust.  Do not flinch or react to smells, sights, sounds, conditions or procedures. 


Leave quietly. 









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