Vladana Zorjan-Stubb, MA, MT-BC, NMT and Marce Muller, MT-BC

1. 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, NMTand Marce Muller, MT-BC

2. 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!

3. 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

4. Understanding Title 22(Understanding Activity Department Requirements) • Daily activity requirements • 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!

5. 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

6. 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

7. 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).

8. 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)

9. Activity Director 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 them) 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. Job Description Activity vs. MT

10. 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 Full-time

11. 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 for assessment Pros & Cons of Contracted

12. 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

13. 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

14. Populations Served:Short-term Rehabilitation • Generally… • 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

15. Long-Term, High-Functioning • 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 • Resident Council President • Greeter • Store operator • Resident of the Month • Residents lead Bible Study

16. 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

17. Hospice • Comfort for staff, residents & families affected • Prepare for grieving residents • Refusal of family to do assessment

18. Running the Program

19. 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

20. Budget (fundraisers) • Typically around $300/month • Depends on building/occupancy • Bake Sales • Art Gala’s • Garage Sales

21. 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

22. Volunteers • Get on Volunteer Opportunity Lists—provide job description • Community Colleges • High Schools • Girl/Boy Scouts • Church Groups • AA/Drug Rehab • Make experience exciting/different • Educate on MT

23. Meetings • Resident Care Conference • Organized by SS (IDT) • 1st 1-2 weeks in building • Department Head—daily • Department Meetings with Staff • Resident Council

24. High Functioning 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 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 Activity ideas

25. MDS 3.0 • Questions? • Comments?

26. Insurance Basics • Medicare • Medical • GNP/Routine • Medicare Part B—3 day observation period • HMO

27. Starting Internship Program! • Develop Packet • Include administrator • Follow guidelines of AMTA • Represent at Internship Fair • Network with Alumni • Understand ALL requirements • Set forth very clear expectations

28. Improvements • Documentation • Getting back with Rehab • Sensory Group • Internship Development • Instruments • Personal/Professional Growth • Grad school, Spanish tutor

29. Activities • Geriatric Song List—refer to JMT

30. Miscellaneous • Policies & Procedures • Questions?