Hiring a Music Therapist in Long-Term Care: One-on-One Visits

This is the second article in a series about hiring a music therapist in long-term care. For an introduction to the series and links to other posts, please click here. Many residents can be served most effectively in a group setting (which will be the topic of my next post!), but there are always residents whose needs are not met by the regular group activities in a nursing home. These folks might be appropriate for 1:1 music therapy visits. Of course, every resident is different, but do any of these residents sound familiar?

  • Jerry is on a ventilator and paralyzed from the neck down. He cannot comfortably participate in group activities in his bed, but he can communicate with one-on-one attention and enjoys music.
  • Maeve is usually cheerful around her peers but is confused due to dementia. She sometimes gets anxious, scared by her unfamiliar surroundings, and needs extra attention to help her calm down.
  • Roger, in his 50s, doesn’t really click with his older peers and is bored by activities geared towards people in their 80s and 90s. He usually opts to stay in his room watching TV talk shows.
  • Marilyn just moved to the facility and wants badly to move back home, although that seems unlikely. Since she’s not planning on staying, she turns down almost every group activity. She is becoming more depressed every day.
  • George has become withdrawn since his wife of 60+ years died. He used to be involved in anything music-related that the activities department had to offer, but now he won’t leave his room.
It is likely that if any of these people were living in your facility, they would probably already be receiving one-on-one visits from the activity staff. Sometimes, though, even with this special attention from staff, it can be difficult finding a way to connect with certain residents to ensure that they feel safe and comfortable, and are having the best quality of life the agency can provide. This is when a music therapist can be especially valuable. Here are some reasons why: Music therapists are skilled at building rapport through music. This is especially important with people who are having a difficult time connecting with the long-term care staff through other means. Through the medium of music, music therapists can help a resident to feel more secure, and to be open to building a relationship with the music therapist. Music therapists have a wide repertoire of music and a wide range of musical skills. Music therapists probably already know some music that can help build a relationship with younger residents, for example. Music therapists can also learn music quickly to meet the needs of residents. (Just in the past few weeks, I’ve been learning Russian folk songs for one of my clients!) We also have the skills to facilitate a wide variety of music experiences and to adapt those experiences in the moment to meet the needs of the resident. Music therapists have the counseling skills needed to work with residents experiencing difficulties. Because of our academic learning and clinical training, we know how interact with residents who are confused or agitated due to dementia, who are experiencing hallucinations, who are feeling depressed and unwilling to participate in small talk, or who are angry with their families or with staff. In other words, we know how to meet a resident in the moment, no matter what state of mind or mood that a resident is experiencing, and interact with them verbally and through music. Music therapists can extend the reach of the agency’s regular staff. When residents need more special attention than the regular staff has the time or energy to provide, the music therapist can help to meet that person’s needs. We can also make sure that that extra time is quality, relationship-building time. Music therapists can provide useful feedback to the agency’s regular staff. This is perhaps the most important point. Whether it’s by finding out the favorite songs that help a person calm down, the topics of conversation that really spark a person’s interest, or the kinds of things a resident needs but was afraid (or unable) to ask, a music therapist can help the agency’s staff figure out the best ways to connect with that resident, not only during a one-on-one music therapy visit, but throughout the regular day-to-day life in the home. Music therapists can do a lot to help you strengthen your one-on-one program and to ensure that residents experiencing special difficulties are getting the care they need. Please let me know if you have any questions about how music therapy works in one-on-one visits. Feel free to leave any comments below as well, especially to share success stories! The next post in this series will focus on music therapy groups, so stay tuned!]]>


  1. Natalie Mullis, MT-BC on February 15, 2011 at 1:43 pm

    I would love to get to talk to you more about this aspect of music therapy in long term care. I have found that every time I speak to a facility about adding music therapy to their services, no matter how much I stress the importance of 1:1 for clients like this, they always want group to save $.

    • soundscapemusictherapy on February 15, 2011 at 10:57 pm

      It is true that it costs more per person to have 1:1 music therapy. There’s no way to get around that. What I’ve found is that many facilities will start either with 1:1 sessions or with groups, then they add the other later on once they see how it’s working for the residents differently than other musical entertainers or other activity programming. I also love to talk about the fact that in facilities where I get to do both 1:1 visits and groups, I often can help people transition from needing the 1:1 program to being involved in the music therapy groups, then eventually (hopefully) the broader activity programming.

  2. Kat Fulton on February 17, 2011 at 11:29 am

    GREAT write-up, Rachelle! Finally, we have a written resource with good, concise examples to use for educating our clients and potential clients. This is *such* a helpful piece, Rachelle!

    About 1:1 versus group for cost-effectiveness: Several of my facilities need the 1:1 documentation in the charts to show when the state survey comes around. So, sometimes when I mention our ability to chart for 1:1 and how beneficial it is for the survey, they will agree to both 1:1 and a group – alternating or right after the other. I’m sure it’s different for every state.

    • soundscapemusictherapy on February 17, 2011 at 12:59 pm

      Thanks for your comment, Kat! YES, it is definitely beneficial for facilities when the music therapist documents 1:1 visits – this shows surveyors that the facility is focused on individual needs, not just putting together an activity calendar. This is a big part of the culture change movement in nursing homes. I know this is true for Missouri and Kansas, too. Excellent point!

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