Fire-proof Music Therapy:
Starting and then making music therapy
an integral part of skilled nursing facility
interdisciplinary teams.
Vladana Zorjan-Stubb, MA, MT-BC,
NMT and Marce Muller, MT-BC
What do you think?
• What is skilled nursing?
• What population is being
served?
• What are their specific needs?
• What role can an MT play?
• Are there regulations for daily
living act?
• Tell us what you know!
Understanding Skilled
Nursing?
(from MT clinical perspective)
• Identifying needs of facilities
• Short-term Rehab
• Desire to go home no act involvement
• Youngest Res. 32 years old
• Long-term Care
• Desire to do something interesting;
not be bored
• Hospice
• Young adults & older adults
Understanding Title 22
(Understanding Activity Department Requirements)
• Daily activity requirements
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Exercise
Current Events
Socializing (“Coffee Socials”)
Evening Groups
Religious Services
Intergenerational Program
Special Events
Minimum of 5 “Special Days” a month (i.e.
Grandparent’s day, Peanut butter Lover’s Day, etc.)
Outings in Community
Pet Therapy
Sensory Stimulation
See “Critical Elements for Activities”
All regulations reflect what we do as MT’s anyway!
Marketing Tips and
Ideas
• Calling Facilities Activity Directors
• Pro Bono Work
• Get on their Monthly “Entertainment”
Schedule—then EDUCATE!
• Sell self—able to include 25+ people in
group music session and provide
instruments for all—interactive!
• Not only entertaining but meeting goals on
care plans, completing documentation,
assessments
• DO NOT ask for anything 1st time—provide
own materials
• Make face contact with administrator 1st
time come, invite to the next music
session; invite to see MT at other building
1st Presentation to the
Facility of choice—get Hired!
• Make appointment with Administrator
(Selling Pts)
• Know what they’re paying current Activity
Director/Entertainers and show what they’re
getting for the $
• Show cost-effectiveness—”Competitive
Advantage”
• Marketing tool—”Marginal Difference”-extra pts
will pay for MT in building
• More professional way to engage residents
• Therapy for 2 hours/day, what about other 22
hours?
• Focus sell on Short-term Rehab (revenue)
• Find studies to support needs—condense,
provide bibliography
Findings continued…
• MT has shown decrease in depression in
residents with Alzheimer’s type
dementia
• Study showed increased cognitive
functioning from day to day in dementia
patients who participated in MT (JMT,
Winter 2007)
• Showed significant increase in positive
social behavior and decrease in negative
bx (i.e. agitation) with stimulating music
in background (JMT, Winter 2007).
Continued…
• Neglect & abuse—no sensory
stimulation
• Studies showing brain activity For
late stages of dementia
• Res facing wall, no TV considered
neglect—EDUCATE STAFF
• Difference from MT and high
school students
• Age inappropriate activities
• Entertainment based/passive
• Unable to complete required
documentation—(most important to them)
Job Description
Activity vs. MT
• Activity Director
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Party Planner
Weekend certificate
High school diploma
Entertainment
Coordinator
Outing Coordinator
Games/Movies
(Bingo!)
Unfamiliar with
mental illness
Uneducated in
engaging residents
(doing activities for
• Music Therapist
• therapeutic
approach for
traditional activities
(Bingo)
• Completes required
documentation
• Meets
needs/prevents
future
problems/declines in
functioning—signs
of depression,
anxiety,
hallucination, etc.
Pros & Cons of Full-time
• Pro’s
• Develop
therapeutic
relationship with
residents
• Salary/benefits/
paid time off
• Daily educating
staff/doctors of
MT
• Con’s
• Must perform
“Activity
Director” duties
• No control over
schedule
• Risk of burn-out
• Often times only
MT in building-lonely
Pros & Cons of
Contracted
• Pros—
• May get paid
more per hr
• In control of
schedule
• Planning &
Charting on own
time (not paid)
• Clear cut MT
goals/care plan
• Cons—
• Less time to
build
relationship
• Exhaustion of
traveling
• Poor support of
Activity Director
(not implementing
goals)
• Less time with
families
• Don’t want to pay
You are an
Interdisciplinary Team
Member!
• Care Plans
• Care plan must reflect other areas that may
affect activity involvement (i.e. dietary, rehab,
wound management, etc.)
• If resident prefers activities at 8am, CNA’s
must have resident ready (Personal
Preference)
• Part B (Medicare)
• Help identify decline of functioning in residents
for nursing & Rehab
• Social Services
• Communicate residents who would benefit visits
with psychologist
Starting the Music
Therapy Program
• Department Goals! (long term and
short term)
• Identify areas of improvement
• Create plan of action (include
administrator if appropriate)
• In-services
• Build relationship with DSD
• Pick 1 issue/topic and focus on it
• Implement staff reward
system/training tool
Populations Served:
Short-term Rehabilitation
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Don’t want to attend Groups
Want to go home
Get bored/depressed easily
May have cognitive deficits/may
not
• Care plan in alignment with
therapy goals—include therapist
Long-Term, HighFunctioning
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Use experience from resident Y.K.
Feelings of loss of control
Easily depressed/bored
Resistive to some activities
(example Dr. B.)
• Give a job in facility
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Resident Council President
Greeter
Store operator
Resident of the Month
Residents lead Bible Study
Long-term, low
functioning
• Sensory Stimulation
• Examples/Studies
• Help staff know when
appropriate to bring to
activities—example of religious
preferences
• Keep tabs on functioning—notify
when decline occurs
• Example of program in process
Hospice
• Comfort for staff, residents &
families affected
• Prepare for grieving residents
• Refusal of family to do
assessment
Running the Program
Assessments
• Initial, quarterly, annual, COC
• MDS nurse give calendar of due
dates
• Generally 5 days to complete
• Must match care plan
• Include if veteran, voting,
religion, occupation, name
preference
• MDS 3.0 interview—offensive
Budget (fundraisers)
• Typically around $300/month
• Depends on building/occupancy
• Bake Sales
• Art Gala’s
• Garage Sales
CALENDAR!
• Monthly calendar
• Different activity daily
• Special events
• High & low functioning activities
reflected
• Religious/Spiritual
• Exercise
• Socials
• Evening Groups
• Regulation of # of act per day
• Give ways to “get around” it
• Revisit Title 22
Volunteers
• Get on Volunteer Opportunity
Lists—provide job description
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Community Colleges
High Schools
Girl/Boy Scouts
Church Groups
AA/Drug Rehab
• Make experience
exciting/different
• Educate on MT
Meetings
• Resident Care Conference
• Organized by SS (IDT)
• 1st 1-2 weeks in building
• Department Head—daily
• Department Meetings with Staff
• Resident Council
Activity ideas
• High Functioning
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Around the World
Music via Centuries
Each Century Music
Music & Art
Musical Styles
Pictionary
Computers
Evening Groups
Yoga
Tai Chi/Chi Gong
Brain Quest—4
weeks
• High/Low Functioning
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Name that Tune
Interesting Geography
Music of the World
Learn an Instrument
Improvisation
Geography/History/
Trivia/
Massage
Singo
Relaxation
Emotional Ball
Getting to Know You
Alphabet Soup
MDS 3.0
• Questions?
• Comments?
Insurance Basics
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Medicare
Medical
GNP/Routine
Medicare Part B—3 day
observation period
• HMO
Starting Internship
Program!
• Develop Packet
• Include administrator
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Follow guidelines of AMTA
Represent at Internship Fair
Network with Alumni
Understand ALL requirements
Set forth very clear
expectations
Improvements
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Documentation
Getting back with Rehab
Sensory Group
Internship Development
Instruments
Personal/Professional Growth
• Grad school, Spanish tutor
Activities
• Geriatric Song List—refer to
JMT
Miscellaneous
• Policies & Procedures
• Questions?