Hospice produces its own sing-along CD for dementia seniors

Patients respond with calmness & delight

The National Hospice & Palliative Care Organization of Alexandria, VA, is developing a diversity toolkit to assist hospices with their efforts to diversify their patient population.

The preview toolkit includes these suggestions of measures to increase the success of an agency's diversity plan:

1. Know your community. Who are the respected leaders? What are the community's strengths and needs? Go to the community for answers.

2. Be cautious in rolling out a mandatory cultural competence initiative. That could lead to resentment, poor adherence to policies and superficial responses by staff. Instead, gradually infuse cultural proficiency into the organization's culture.

3. Employ a manager of cultural proficiency to emphasize and help organize the commitment to diversity throughout the organization.

4. Establish a cultural diversity advisory board that includes representatives from the organization, as well as the community to help guide the delivery of culturally competent care.

A professional singer, who also is a hospice nurse practitioner, developed a CD of sing-along songs for dementia patients and found that it works wonders at curbing certain behaviors and stimulating their memories.

Maribeth Gallagher, RN, MS, NP, the dementia program psychiatric nurse practitioner/music consultant for the Hospice of the Valley Dementia Program in Phoenix, AZ, selected songs dementia care patients have heard repeatedly since their youth, and she recorded sing-along versions of the songs.

Sing-along recordings already available commercially tend to be too high-pitched and too fast for patients to keep up with, she notes.

For the dementia care CD, Gallagher sings in an almost nasal tone, without inflection, and much slower than she would sing normally.

"I wanted patients to hear the beginning of the words to cue their residual memories and have a successful sing-along experience," Gallagher says. "From what I've read, the patients' response doesn't have anything to do with the quality of the singing."

At first the hospice staff was reluctant to join in the singing, but as they saw their patients' positive responses, it moved them so deeply that now many of them will sing along with CD, Gallagher adds.

Hospice staff uses the CDs to calm patients during activities of daily living, the way new mothers croon to their infants to keep them calm.

"We find that if the hospice worker goes in and holds the person's hand and slowly sings, 'You are my sunshine,' there is something that happens where the patient interprets it that this person is singing to me, so I know this person will do me no harm," Gallagher says.

The sing-along CD also contains only the chorus of songs because most people haven't learned all of the verses, Gallagher notes.

The CD's songs include the following:

  • "You Are My Sunshine;"
  • "Take Me Out to the Ballgame;"
  • "Let me Call You Sweetheart;"
  • "Shine on Harvest Moon;"
  • "Bicycle Built for Two;"
  • "How Much is that Doggie in the Window?"
  • - "I've Been Working on the Railroad;"
  • "My Bonnie Lies Over the Ocean;"

Two additional selections that wouldn't be a music therapist's pick, are "Show Me the Way to Go Home" and "Side by Side," Gallagher says.

"Show Me the Way to Go Home" was a song that one generation of elders used to sing at parties, Gallagher says.

"One line is 'I'm tired and want to go to bed,' and when patients hear this they start laughing," she explains.

Likewise, "Side by Side" contains the verse, 'Oh, we ain't got a barrel of money, maybe we're traveling side by side,' and another line is '… what if the sky should fall, as long as we're together it doesn't matter at all.'

"I put that song on the CD for the wife to sing to the husband," Gallagher says.

"A lot of patients have a Christian tradition, so I included the chorus of "Amazing Grace," and put it at the end of the CD, so patients who wouldn't like a spiritual song wouldn't have to listen to it," Gallagher says.

Anecdotal evidence suggests the CD works precisely as hoped.

"We had an elderly couple who had been married for more than 60 years, and the husband was a war hero," Gallagher recalls. "He became increasingly restless, and she was taking care of him alone despite cardiac problems."

The husband's restlessness resulted in repeated calls to 911, but once the hospice gave the woman the CD to play for him, his behavior improved, Gallagher says.

"This man who looks incredibly vulnerable and frail sang out in this huge voice, and at the end of the song he would yell 'Yahhh' and start laughing," she adds.

The songs helped the man transcend his disease, and his wife could play him the CD when she needed to do household chores, and she knew he would be calm while he was singing along, Gallagher says.

During one visit with the couple, Gallagher discovered that the couple's wedding song was "Apple Blossom Time."

At her next visit, she brought words to the song and told the couple, "I'm so impressed by your devotion and love, and I would like to sing this for you," Gallagher says.

"So I started singing, 'I'll be with you in apple blossom time,' and the wife's reading the words with me, and the husband's eyes are filling up with tears and are beaming," Gallagher recalls. "She started choking up and crying in a good way, and then she stopped and I stopped singing, and her husband looked into her eyes, and it was one of those beautiful moments.

Later, the wife told Gallagher: 'It's like having my old Johnnie back.'

Building on the first CD's success, the hospice next had a cantor singer sing Jewish songs for patients who were Holocaust survivors, and the next project is to identify music for Mexican American elders and have these sung in Spanish, Gallagher says.

The CDs can help caregivers manage those difficult situations they encounter each day.

For example, if an Alzheimer's Disease patient becomes antsy while riding in the care to the medical center, the caregiver can put in the CD, creating a pleasurable environment and calming the patient, Gallagher says.