On a recent steamy afternoon, 81-year-old Kay Beal was playing it cool in her recliner at Narraguagus Bay Health Care, a 58-bed nursing home in the Down East town of Milbridge. As other residents dozed or daydreamed around her in the common room, Beal was all smiles and twinkly eye contact, tapping her toes and singing along loudly with the music coming through her headset from the iPod Shuffle in her hands.
Beal, who suffers from dementia, was unable to tell her visitors what she was listening to, but staff at the nursing home said her personalized playlist includes Tom Petty, Stevie Wonder, Fleetwood Mac, The Beatles and Garth Brooks, among many other artists.
Beal is one of 10 residents at the nursing home selected to participate in “Music and Memory,” a program for people with advanced dementia and other forms of cognitive loss. There are 40 facilities in Maine in the process of bringing the program on board thanks to a national effort to reduce the use of antipsychotic drugs in nursing homes and some grant funding from the federal Centers for Medicare and Medicaid Services.
“You can tell they’re taking in the music,” said Narraguagus administrator Matthew Trombley of his participating residents. “Some will sit and tap their feet to the music, and some will stand right up and dance around. We have one lady here who will serenade anyone who will listen.”
Music has been a strong component of the facility’s programming all along, he said, with a weekly schedule of live performances on site and recorded music often playing in the common room and at mealtimes. But Music and Memory takes it to the next level.
Developed over the early years of the 2000s and popularized by the 2014 documentary film “Alive Inside: A Story of Music and Memory,” the program aims to reconnect individuals with locked-away memories and emotions by exposing them to the music of their earlier lives. By providing training and technical support to nursing facilities such as Narraguagus Bay Health Care, Music and Memory promotes the use of music to unlock deep memories, stimulate personal interactions and solicit conversation, sometimes from individuals who have been essentially non-verbal for years.
“We’re interested in anything that improves the quality of life for residents,” said Brenda Gallant, Maine’s long-term care ombudsman, who represents the interests of nursing home residents and their families. She said the use of Music and Memory in Maine and elsewhere not only has enlivened the participating residents but also has proven rewarding for family members and empowering for staff.
“To see all the benefits of this program is just wonderful,” she said.
Nadine Grasso of the Maine Health Care Association said bringing Music and Memory to Maine nursing facilities is an outgrowth of a national initiative to cut down on the use of antipsychotic drugs among residents. Too often in the past, she said, physicians have prescribed the use of powerful medications designed to treat severe mental illnesses such as schizophrenia simply to quiet behaviors such as agitation and aggression in individuals with dementia.
This “off-label” prescribing, primarily to make residents less problematic to care for, can lead to over-sedation, disorientation, falls and other side effects. So since 2011, Centers for Medicare and Medicaid Services and industry groups have led a national initiative to reduce the use of such medications in nursing facilities.
Grasso said that through staff and prescriber training and other activities, Maine has met and surpassed the targeted national goal of a 30 percent reduction in the use of antipsychotic medications by the end of 2016. Already, nursing facilities in this state have achieved a 36 percent reduction, she said — the fifth highest in the nation — by encouraging the use of other interventions such as physical exercise, social engagement and distraction to derail escalating behaviors.
At Narraguagus Bay Health Care, Trombley said the change has been good for residents and staff alike. For example, one resident — a former office manager — who was on high doses of an antipsychotic medication was gradually weaned to a much lower dose, while staff have found ways to engage her more creatively with paperwork, stapling and other office-related tasks.
“It gives her a sense of purposeful activity and has reduced her wandering,” Trombley said.
In addition, the move away from sedating patients and toward more personal interaction with residents has made “a huge improvement in staff morale,” he said, resulting in an overall boost in the positive culture of the facility.
In nursing homes all across Maine, Grasso said the impacts of reducing the use of psychoactive drugs is similar — improved resident care, boosted staff morale and generated savings in medication spending.
“But the fact that we have met the federal goal is not enough,” she added.
In partnership with other professional groups, the Maine Health Care Association has continued to look for ways to change the culture of long-term care and improve the quality of life for residents.
Grasso said the Music and Memory program promises to further reduce the need for medications by promoting social interaction and countering depression and isolation. And apparently, Centers for Medicare and Medicaid Services agrees, since it recently issued a $83,000 grant to help bring the program to 40 Maine facilities and the residents they serve.
Participating facilities may enroll up to 10 residents. The grant pays for training and certification and a dedicated laptop computer for storing music files, which must be acquired in compliance with licensing and copyright rules. Facilities must pay for their own iPods and headsets; Trombley said it cost his facility about $80 apiece to outfit participating residents.
Before beginning the program, staff document each participant’s behaviors, moods, functional status, use of antipsychotic medications and other factors. Working with family members, friends and others, they develop a personalized playlist for each participant and build the listening activity into the resident’s care plan. Every three months, staff reassess the resident’s status to determine the impact, looking for improvement in social outlook and cognition and a reduction in the need for psychoactive medications.
It’s not all Elvis and Frank Sinatra, said Trombley.
“We’ve got a guy here who really likes old rock ‘n’ roll — Led Zeppelin, AC/DC, [Jimi] Hendrix,” he said. “He’ll start tapping his toes, and then he’s up dancing with the staff and other residents.”
Trombley hopes to expand the program over time at Narraguagus Bay Health Care, so more residents can benefit from Music and Memory.
Dr. Jabbar Fazeli, a Portland-based geriatrician who advises long-term care facilities and the medical directors who serve them, said there’s an important role for powerful antipsychotic medications in treating bona fide cases of schizophrenia, depression and other mental disorders.
“But we don’t want to use these drugs to make residents more amiable to care,” he said.
In addition to avoiding side effects and complications, Fazeli said the move away from using psychoactive drugs has helped nursing home staff to become more skilled at determining the cause of residents’ agitation and other behaviors, which may be related to treatable conditions such as pain, infection or simply the need to use the bathroom.
As for Music and Memory, Fazeli said it’s hard to argue with the appeal and apparent success of the program.
“It may be hard to prove it works, statistically,” he said, but common sense and observation bear out its positive effects.