Fire-proof Music Therapy: Starting and then making music therapy an integral part of skilled nursing facility interdisciplinary teams.

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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

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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!

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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

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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.
  Grandparents day, Peanut butter Lovers Day,
  etc.)
• Outings in Community
• Pet Therapy
• Sensory Stimulation
• See Critical Elements for Activities
• All regulations reflect what we do as MTs
  anyway!

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Marketing Tips and Ideas

• Calling Facilities Activity Directors
• Pro Bono Work
• Get on their Monthly Entertainment
  Schedulethen EDUCATE!
• Sell selfable to include 25 people in group
  music session and provide instruments for
  allinteractive!
• Not only entertaining but meeting goals on care
  plans, completing documentation, assessments
• DO NOT ask for anything 1st timeprovide own
  materials
• Make face contact with administrator 1st time
  come, invite to the next music session invite to
  see MT at other building

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1st Presentation to the Facility of choiceget
Hired!

• Make appointment with Administrator (Selling Pts)
• Know what theyre paying current Activity
  Director/Entertainers and show what theyre
  getting for the
• Show cost-effectivenessCompetitive Advantage
• Marketing toolMarginal 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 needscondense, provide
  bibliography

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Findings continued

• MT has shown decrease in depression in residents
  with Alzheimers 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).

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Continued

• Neglect abuseno sensory stimulation
• Studies showing brain activity For late stages of
  dementia
• Res facing wall, no TV considered neglectEDUCATE
  STAFF
• Difference from MT and high school students
• Age inappropriate activities
• Entertainment based/passive
• Unable to complete required documentation(most
  important to them)

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Job Description Activity vs. MT

• 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
  functioningsigns of depression, anxiety,
  hallucination, etc.

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Pros Cons of Full-time

• Pros
• Develop therapeutic relationship with residents
• Salary/benefits/ paid time off
• Daily educating staff/doctors of MT

• Cons
• Must perform Activity Director duties
• No control over schedule
• Risk of burn-out
• Often times only MT in building--lonely

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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
• Dont want to pay for assessment

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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, CNAs 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

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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

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Populations ServedShort-term Rehabilitation

• Generally
• Dont want to attend Groups
• Want to go home
• Get bored/depressed easily
• May have cognitive deficits/may not
• Care plan in alignment with therapy goalsinclude
  therapist

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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

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Long-term, low functioning

• Sensory Stimulation
• Examples/Studies
• Help staff know when appropriate to bring to
  activitiesexample of religious preferences
• Keep tabs on functioningnotify when decline
  occurs
• Example of program in process

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Hospice

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

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Running the Program
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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 interviewoffensive

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Budget (fundraisers)

• Typically around 300/month
• Depends on building/occupancy
• Bake Sales
• Art Galas
• Garage Sales

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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

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Volunteers

• Get on Volunteer Opportunity Listsprovide job
  description
• Community Colleges
• High Schools
• Girl/Boy Scouts
• Church Groups
• AA/Drug Rehab
• Make experience exciting/different
• Educate on MT

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Meetings

• Resident Care Conference
• Organized by SS (IDT)
• 1st 1-2 weeks in building
• Department Headdaily
• Department Meetings with Staff
• Resident Council

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Activity ideas

• 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 Quest4 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

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MDS 3.0

• Questions?
• Comments?

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Insurance Basics

• Medicare
• Medical
• GNP/Routine
• Medicare Part B3 day observation period
• HMO

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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

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Improvements

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

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Activities

• Geriatric Song Listrefer to JMT

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Miscellaneous

• Policies Procedures
• Questions?