Songs of the soul

Laura Krell didn’t realize when she left her home in Pennsylvania to pursue a music degree at a small college in Indiana that her greatest lesson would come from a nursing home.

Krell ended up working in a long-term care (LTC) facility after college graduation, looking for a way to earn money and establish residency in the state where she wanted to attend graduate school. As the community’s activities assistant, Krell spent most of her time using her gifts of music and art to engage the residents. What started out as a fun way to entertain the residents—including songs at mealtime—soon became much more personal.

Over time, she adapted her music to meet the personal needs of specific residents. A maintenance worker put her keyboard on wheels so she could take her instruments to residents who were unable to leave their rooms. Krell discovered that by understanding the past of each resident, she could sing or play specific tunes or hymns that eventually would tap into that person’s inner soul.

The power of music didn’t fully registered with Krell until she went to the hospital to visit a resident who had suffered a stroke and lost her ability to speak. It was the Christmas season, and Krell recalls walking into the hospital room and seeing the patient frightened and alone.

“I started singing ‘Silent Night’ to her, and she really calmed down. Then all of a sudden she started singing the words with me,” Krell said. “That was a really special moment, maybe because of the way I remembered it. The room was so dark, she was so upset and crying and trying to talk. When I started singing, you could just see her demeanor change, and she calmed down.”

Today, Krell is in graduate school with hopes of receiving a doctorate in music. Still, she can’t forget what she learned in the nursing home, and her dissertation chair has suggested that she research her experience for her upcoming thesis.

The desire to understand music therapy’s effect on cognitively impaired individuals is not new. University researchers, Alzheimer’s advocates and others are investing time and money in discovering how our society can capitalize on music to unlock the hidden personalities of those isolated because of Alzheimer’s and dementia. As a result, LTC facilities increasingly are turning to music therapy as a frontline strategy for memory care residents.

Meanwhile, the growing use of technology helps make the therapy much more accessible, explained Jed Levine, executive vice president and director of program services at the New York City chapter of the Alzheimer’s Association. “This is a wonderful time to be doing this, because we are much more sophisticated in understanding what a person with dementia is experiencing, and we have many more tools to reach that person.”


Dr. Connie Tomaino has been a music therapist for 35 years and said it didn’t take her long to realize what an impact music could have on residents with memory loss. “My ‘aha moment’ was when I was assigned to the dementia unit and I saw people who technically—I was told—had no cognitive ability, were disoriented at times and had no awareness of other people,” Tomaino said. “But when I started singing a song that was relevant to their age, they would open their eyes and start singing.”

Tomaino’s discovery led her on a journey to research the extent of music therapy with mentally impaired individuals. In 1983, she and several others created the Institute for Music and Neurologic Function, an organization that acts as a bridge between clinical music therapy and neurological science. The institute’s research has explored some of music therapy’s biggest questions: Are parts of an individual’s life connected to music? If that music is played, does it help connect that person to others? Are individuals more aware and alert while listening to music and even after it has ended?

What Tomaino and her colleagues found is that music is capable of addressing very specific systems in the brain to allow people with neurologic deficits to enhance function and in many cases regain it. “Music works because it taps into so many basic systems within the brain,” Tomaino said. “All of our fundamental systems are aroused through patterns of sound, which is music. And when they get aroused, it is like jump-starting a car. The car may not be able to start, but if you give a shock to the batteries, everything starts to hum and become active again.”

Further research has shown that music therapy has a much greater effect on memory care residents than other activities such as scrapbooks or aromatherapy. And the therapy also helps residents in the early stages of cognitive decline hold on to information longer. In one of Tomaino’s studies, residents with dementia learned a made-up song and were able to repeat it over and over again.

The benefits of music therapy also extend beyond the therapy session, Tomaino said. “The fact is that those of us who have worked extensively in this environment for years and have worked consistently with the same patients actually see this carry over to other things,” she said. “Residents who have music therapy before lunch actually end up eating better.”


The belief that music therapy has the ability to transform memory care is what made Tomaino so excited when she met Dan Cohen, a former social worker turned businessman. Cohen’s connection to the LTC industry began with a simple question: Would he have access to technology like iPods when and if he ever entered a LTC community?

“In 2006, I read a story that said iPods were everywhere,” Cohen said. “And I thought well, kids have them, many adults have them, so if I were to enter a nursing home, would I be able to listen to my ’60s music?” But of the 16,000 nursing homes throughout the United States, Cohen couldn’t find one that offered residents the use of iPods back then. “Even though nursing homes have technology, their residents don’t have access to the same technology as the rest of us do,” he said.

Cohen began a quest to change that. At the time, his work had nothing to do with memory care, but as he met more people in the LTC industry, he slowly learned the amazing connection. Cohen—with the help of Tomaino and many others in the field—launched the Music and Memory Foundation. The foundation’s vision is to help LTC facilities implement music therapy through the use of donated iPods, which are equipped with personalized collections of songs for each resident.

Stacie Dawes, director of Pacifica Senior Living in Northridge, Calif., heard about Cohen’s work from a university professor who was helping her community with research on memory care. She liked what the Music and Memory Foundation had to offer, and now 10 of her employees are certified in Cohen’s program.

“We work with the family members and get personalized play lists for each resident so that when they get agitated or in a heightened state of confusion, we will put on the music they like—whether it be the Beatles, or we have one gentlemen who likes Led Zeppelin—and it reduces their state,” Dawes said. “And what is nice is that once the music therapy has stopped, it has a prolonged effect. You really have a sense that you are tapping into a part of the brain that has shut down.”

Pacifica was able to implement its music therapy program in less than a year and now has 17 iPods that are rotated among residents. Therapy is held at various times, but most often it is best used before a state of confusion or agitation reaches its peak. Residents who are in the midst of music therapy will become calmer, open their eyes, begin humming and even begin speaking. “There are wonderful medications out there to assist in combating this horrific disease,” Dawes said. “But music is an organic way of fighting it.”


Administrators wishing to implement music therapy programs will encounter plenty of myths, Tamaino said. Many in the LTC industry believe that music therapy is simply playing music in large settings, but it must be personalized for it to be effective. Music that is played in a large setting like meal times is nothing more than background noise to those suffering from memory issues. Likewise, soothing music played during family visits does nothing more than put visitors at ease, she added.

Tamaino suggests that LTC communities invest in hiring a music therapist from a local university to educate their staff. Training can help staff understand how music therapy works and also teach them how to best apply it. Therapists also can help assess the community’s environment and aid staff in creating autobiographical music for each resident.

It’s also important for the community to engage residents’ family members in the process. Family and loved ones can provide crucial information about what music will arouse positive feelings in a resident and what music may have the opposite effect.

Although the awareness of music therapy is growing, LTC communities still have a long way to go before harnessing its full potential. “If everyone was a pleasantly confused resident and didn’t demand any attention and just slept, then facilities wouldn’t be so worried. But it is the reduced interaction, the agitation, the pain, the aggressive behaviors–those are the things that become the challenges,” Tamaino said. “Music gives staff the ability to make connections to individuals and reduce so many of those behaviors.”

Topics: Activities , Alzheimer's/Dementia , Articles , Clinical , Executive Leadership