Available on Netflix, Michael Rossato-Bennett’s Alive Inside movingly captures non-profit Music & Memory’s mission and a selection of beautiful success stories. Winner of 2014’s Audience Award: US Documentary at Sundance, the film introduces the organization’s founder, Dan Cohen, and touches on the science and magic behind music’s potential to brighten the lives of nursing home residents. Cohen and I recently spoke about Music & Memory’s beginning, its impact, and how you can help. For more visit musicandmemory.org, watch the film, then go toss a few band names on your health care proxy.
I watched Alive Inside again before we spoke and was just as moved as the first time I saw it. What can you tell me about Music & Memory’s start?
It started really in 2006. I was listening to the radio and they were talking about how iPods were so ubiquitous and I thought, “Well, all of the kids have them and adults, but nursing homes from what I’ve seen don’t seem to. If I’m ever in a nursing home am I going to have access to my favorite ’60s music?” So I Googled “iPods in nursing homes” and even though there are over 16,000 nursing homes in the US I couldn’t find one that was using iPods with the residents. So I called up my nearby facility and I said, “I know music’s already your #1 recreational activity—you have live music, you have a lot of staff doing music—but could we see if there’s any added value if we were to totally personalize music?” They said sure and I went in with my laptop and a few iPods; it was a hit with the residents. I’d volunteer, even though I’m an MSW, and would come back every couple of weeks and just give them music that I thought they liked or what they said they liked. I’d say, “Ok, now, let’s get rid of the music that’s so-so. We’re used to listening to whatever plays so let’s get rid of the so-so music and just have the stuff that really moves you.”
So after two or three months of honing the list every couple of weeks, they ended up with a list of a hundred, 200, 300 songs which did just that. Either it got them going or it helped to calm them down. I did that for 18 months as a volunteer then I came across the Rubin Foundation in New York City. Don Rubin’s Mom had died from Alzheimer’s but music at home (where she had 24-hour care) was the only thing that helped change her mood for the better. He wanted to fund something around music and health. That enabled me to roll this out to 200 people across four New York City nursing homes to see if this really worked. Does it scale? How well does this flood of iPods in a facility integrate in a nursing home which is very structured?
Also, people would say to me, “Dan you can’t do this. You’re going to isolate people even more. They’re going to put headphones on them and leave them in a corner.” But, we found with the 200 people that just the opposite happened. No reports of people being more isolated, but of being more social. “You gotta hear this music.” Or, “This reminds me of my husband.” Or, “Do you remember the Andrews Sisters?” People that never even spoke to each other started to talk.
And there must be an added benefit for the staff as well. Meaning, music can connect people so quickly so, I’d imagine, once a staff member learns what kind of music a resident likes, that humanizes the resident a great deal for that employee.
Well said. This is really becoming clearer over time and is having multiple impacts. There’s a ripple effect from this. So yes, on the one hand, if you’re a nurse and have been working with someone for months and years and you love this person then they’re in a better mood and are more talkative with you, your day is better. And when you have to do things like wound care or feed them, get them out of bed, or get them bathed, or they’re agitated, now they’re in a better mood because of music and your day’s better. So that’s #1.
#2, from when they first rolled this out in Wisconsin to 100 nursing homes and 1,500 residents with dementia, what they found is that, gee, the results were so good that the Secretary of Health, Kitty Rhoades, said, “We’re not waiting for the end of this 18-month study. We see the results are clear and we’re going to do another 1,500 residents in another 150 nursing homes.” What they’re going to track in the second round is the impact on staff morale and, interestingly, if people are calmer they’re less likely to injure each other. When people are agitated they might injure a staff person or resident-to-resident injury. People get ticked off. So they see this rate going down. Also, the whole thing of chair alarms and different ways to manage people which are sort of not best practice, they’re seeing that music helps and if somebody is engaged they’re not going to be trying to get up or get out.
So all of these things, yes, are in terms of humanizing and sort of knowing your resident. For staff, people may be known by their diagnosis and room number but they don’t know a thing about them. What happens is sometimes people die at a nursing home and at their service, they might bring in their music and play it from their iPod. But they’ll also say, “Yes, Mrs. Smith, she flew a transport plane in World War II.” And people say, “Holy mackerel! I didn’t know she was a pilot!” They don’t know! My thing is, don’t wait ‘til they die to love them. So when they have the music they’re more likely to be talking and sharing and reminiscing. That gives staff something to talk about with them, not just, “Good morning. How are you today?”
Another major point is with antipsychotic use, which is really huge. The Chief of Psychiatry in New York City is speaking out on geriatric meds. Using the Music & Memory approach, according to the Chief of Psychiatry, they’ve reduced antipsychotic use from 38% to 13%. In Wisconsin they’ve also dramatically measured the first 100 nursing homes using this against the 300 that were not and have graphed the rate of decline of antipsychotic use. It’s much accelerated compared to the homes that didn’t have the iPods. Now the other homes are getting them also.
Every nursing home in every state in the country is tracked every 90 days on how much they’re drugging people with nasty drugs that are really inappropriate. The federal government has asked that these people are taken off of these drugs, reduced by 25%, by the end of 2015 and Wisconsin is moving to the head of the pack. In terms of antipsychotic use, unless someone has a psychiatric diagnosis, these people should most likely not be on these drugs. Very often people don’t want to take residents off of these drugs because they think they’ll become more agitated.
The point is, half the time at least, the music will be a replacement to the drug. To me the key here is to have this become a statewide project the way it is in Wisconsin and Ohio and Utah. It’s a replicable kind of thing. There’s no reason New Jersey shouldn’t do it either. It would be all positives for the state’s elders, and for all of us.
Tell me a little about the importance of a personalized playlist and how will the program change as music has changed over the years?
Well I think from the point of view of cognitive impairment it won’t change at all. Whatever young people are listening to today, if they happen to get some form of dementia, it will be the music from their youth that will resonate with them and won’t be affected by the short-term memory failure. It’s about which music holds personal meaning. When we’re coming of age, a first kiss, or hanging out with friends at the beach, whatever it was that was at the same time that you’re listening to this music somehow imprints on our brain. Because music is all over the brain, as it shows in the movie, there are parts of the brain that don’t lose that. It’s our emotional system which is not really failing in the way our cognition is. It’s our emotions that are responding. When we love music it’s not our cognition saying, “Oh, I love this song!” No, it’s feelings. So that’s why this thing works. Basically it doesn’t matter what cognition is saying. People have their feelings and that’s why it works.
I don’t want to say the type of music is irrelevant, but—
I would say it is irrelevant. It’s whatever music holds personal meaning. I have people that do well with Gregorian chants and have people that just want Led Zeppelin. But it has to be personal and that’s the challenge sometimes. Half of the people never get a visitor. Just because they’re 83 doesn’t mean you can play big band and be successful.
With someone that really can’t communicate or doesn’t have family, how do you develop a meaningful playlist?
What Yvonne will do (Yvonne is with Henry in the film), she’ll sit down with six residents with advanced dementia. She’ll get her pad of paper and put six columns, with each person’s name at the top of each column. Based on each person’s date of birth or religious background, she’ll just start guessing music and playing for the six of them. “Oh, John, he loved that one. Mary and Joan, they loved this one.” She’ll build this list organically.
Your website gives a lot of information on the program, documentary, and work still to be done. How can people help?
People can print out a postage paid envelope and send in an iPod and we’ll have it set up with someone within 30 days. Used iPods are fine. Doesn’t matter how old. All of them. iPhones, iPads. We’ll use them all. It’s easy too because people can just go online to Target or Walmart, buy it, and ship it to Music & Memory. Certainly everybody should make sure all of their elders and families have their own iPods. Get those playlists going. Even if they’re healthy and not so old, enjoy it now, and when they enter the healthcare system—which you never know when someone will—they’ll have the music and it will escort them wherever they bounce around. That will improve their time and the time of their family and professional caregivers. People can also adopt a nursing home as a group, religious organization, or business, and run an iPod drive. They did this in California where they showed the movie and inside of a week they raised $17,000 and now they have seven of the city’s nursing homes up and running. They said, “Ok, all of our elders in our community are going to have this. They’re not going to be sitting around, doing nothing all day.”
For more information on Music & Memory, go to musicandmemory.org, and for more details on Alive Inside, go to aliveinside.us.