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Various Writers • September 9, 2019

Music and Violence in Long-Term Care Homes

The occurrence of violence in long-term care homes, both resident-on-resident and towards care staff, is escalating at an alarming rate. The system is failing to provide a living and working environment that preserves the dignity, well-being, and safety of residents and care staff respectively.

The issue of violence in long-term care homes has recently been brought to media attention. On January 21, 2019, the Ontario Health Coalition released a report called Situation Critical: Planning, Access, Levels of Care and Violence in Ontario’s Long-Term Care. This report draws attention to the alarming statistics. Unfortunately, in the past five years, there have been 27 resident-on-resident homicides in Ontario long-term care homes. The root of this issue can largely be attributed to understaffing in long-term care homes across Ontario. Another key factor playing a role in these alarming statistics is the increase in the acuity of long-term care residents. Put simply, acuity is the measurement of the intensity of nursing care required by a patient. According to the Ontario Health Coalition, long-term care residents today are medically complex and frail, and therefore, require equally complex care. The understaffing, in combination with the increased acuity of long-term care patients, leaves care staff ill-equipped to properly care for all residents, especially those with severe cognitive impairments. When residents are left unattended and/or are not properly monitored, signs of agitation go unnoticed, and often manifest in violent behaviours.

So, how does music play a role in the issue of alleviating the issue of violence in Ontario long-term care homes? Music can be used as a tool to calm and relieve agitated behaviours before they manifest as violence. Moreover, it can be implemented in a way that requires minimal time and effort from care staff. For example, a study conducted by Jan Cioddaer and Ivo L. Abraham titled, Effects of Relaxing Music on Agitation During Meals Among Nursing Home Residents With Severe Cognitive Impairment, found that simply playing relaxing music during the main meal of the day helped significantly reduce agitation among residents with severe cognitive impairments. More importantly, it helped significantly reduce physically aggressive behaviours. Care staff are already stretched thin due to understaffing, however, as previously mentioned, playing prerecorded music requires minimal time and effort and could have some incredible positive implications moving forward in terms of reducing violence.

It is clear that in order to solve this horrifying healthcare issue, it is of the utmost important that policy changes are made, and fast. The Ontario Health Coalition, and various researchers such as Dr. James Brophy and Dr. Margaret Keith have done an amazing job bringing this issue to the forefront. But how long will it be until we see tangible changes? Aligning with the goals of Room 217, it is critical that music is seen as a primary approach to care. Music is something that can be implemented almost immediately, and by almost anyone in the long-term care setting. Moreover, it can be implemented in a way that requires minimal effort. Optimistically, music, in combination with policy changes, will be used to decrease violent behaviours in long-term care homes in order to provide a living and working environment that preserves the dignity, well-being, and safety of residents and care staff respectively.

This article was written by Mara Medeiros, and is part of a series provided by upper year health sciences students at McMaster University.

By Shelley Neal March 8, 2024
I initially trained with MUSIC CARE to work with Seniors in Long Term Care who were experiencing dementia and Alzheimer’s Disease. This is the path I travelled with my mom. My training with Music Care and Room 217 supported capacity building in selecting music that was played on my harp or chosen recorded music. The music centered on the care of the individual and their specific needs. My job was to determine the individual’s specific and select music to address these needs. The music selected helped to build community, support sleep, talk about life experiences, create a background landscape of sound, support connection to decrease isolation and loneliness, as well as coming alongside people dying. My training with Music Care helped me understand how to support people “where they were” physically, emotionally, and spiritually. Through using beat, tempo, melody, and timbre, I could cater the music and desired support required for individuals or small groups. My profession is teaching. I am a special education teacher and use music in my primary teaching as a method for learning, practicing language skills, transmitting information about science studies or math equations, as well as having fun and creating our own songs. My teacher toolkit married exceptionally well with the knowledge and skills provided by the Music Care Certification training. Recently, my work with students has involved individual programming for the medically fragile children and the palliative children. I use music (repeating the chorus several times) to engage and connect with the kiddos. We use music to "talk" about feelings (our communication is through eye gaze, eye blinks, and squeezing hands), and content material. I use music to enjoy our relationship of being together. At times, due to medication for seizures, my little ones can be very sleepy. I increase the tempo, engaging in tapping the beat on her hands and using silly action songs. The giggles and wiggles make it magical. I also use music to tell stories (my students have CVI, cortical vision impairment, so visual perception is difficult). This helps the child to engage in the story arch and adventures. Music is my conduit for reaching out and being with the students. Recently, I had the sacred journey of visiting one of my children in ICU at Sick Kids. I was invited to come to say "goodbye". A dear friend who was an ICU nurse in a different department told me (AKA, insisted) that I bring my harp with me. I wasn't sure if this would be appropriate for the family. However, with the permission of the mom, I bravely packed my harp up and took it to the Unit. It was a beautiful evening of talking with their mom and dad about how special their child was in my life. I played the kiddo's favorite songs and then ended with "The More We Get Together". The little one opened their eyes and stared at me. We hugged, and I left. They passed the next morning. I consider this time to be a sacred gift. Music Care Certification has given me the confidence and toolset to work alongside people and to journey together. It is a time a beautiful, difficult, or sacred time that I have been honoured to participate in.  Thank You
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This article was written by Julia Cara, and is part of a series provided by upper year Health Sciences students at McMaster University.
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