by Darcey Trescone, RN, BSN
We grow up listening to music. It’s common to hear a song and have it trigger a memory or a feeling. Many self-medicate with music when we are happy, sad, angry, melancholy etc. Music plays in waiting rooms, elevators and even airports to distract, relax the mind and alleviate anxiety. In the world of medicine though our focus is typically pharmaceutical measures verses music as a therapeutic means.
Music therapy has been an accredited profession since the 1950's and, in the US, it is still considerably underutilized as a treatment. Even with research studies that support the use of music for both neurological and physical disorders, medicinally you hear little about utilizing it to treat the chronic conditions we see in the post-acute space.
In our world today, patient outcomes and value-based care are prominent topics impacting how and what we deliver as services. Fee for service is a thing of the past requiring "out of the box" thinking to achieve high quality results in less time to our patient populations.
Musical Health Technologies has combined the use of music and technology to deliver therapeutic benefits to a range of diagnoses, with their current focus being Alzheimer's and Dementia. The results and benefits they have achieved with this population alone are noteworthy and they are expanding their SingFit solution to treat additional chronic conditions, COPD being one example.
We caught up with Rachel Francine, Co-Founder and CEO of SingFit, in her London hotel room to learn more about how the use of technology and singing have a positive impact on chronic conditions in the post-acute space.
It's been interesting to watch the adoption of SingFit Prime (SingFit) in senior living communities as a therapy. Andy Tubman, Co-Founder and Chief of Therapeutics and Music, and I started the company together. In 2014 we were in 30 communities and now we are working with 450 communities in 35 states. 260 of those communities are with Sunrise Senior Living, the 3rd largest provider of senior care in the US. That type of nationwide adoption is not common in the senior living space, so it is a big deal for the industry at large. Officially we have trained over 1400 people how to use SingFit with Alzheimer’s and Dementia patients.
It is a good feeling to be part of extending the reach of therapeutic music in the US. In addition to senior living communities the SingFit solution is being adopted by rural hospitals. Niobara Community Hospital in Wyoming is a good example. Many rural areas don't have senior living communities that can care for someone with dementia, so the hospitals have dementia units. Niobara, being isolated, additionally does not have music therapists locally available. There is no way to get this form of therapy to their residents. SingFit has been a way for Niobara, and other rural providers to deliver therapy services through music to these populations.
As we grew, we realized the importance of facilitating easier methods of education and minimizing the cost of training caregivers to use SingFit. This lead us down the path of simplifying the delivery of training while maintaining the effective utilization of the solution. Niobara Community Hospital was the first to utilize our 3-hour online training with their dementia unit staff. It was both exciting and rewarding for the SingFit team to see Niobara achieve the savings and effectiveness we set out to provide with online training.
Music therapy as a profession has a variety of benefits for many different diagnoses. SingFit allows the music therapists to focus on the difficult patient cases and supervise others, while professional caregivers and loved ones use our technology solution to achieve therapeutic benefits with music. Our customers report that residents with dementia who participate in SingFit experience a 42% elevation in mood, decreased wandering and improved speech.
SingFit Prime is our group product. It works along the whole continuum of care and is being used in independent living, assisted living, and memory care. We are coming out with a home care product in 2020.
There are multiple components to all our SingFit solutions. For dementia, we know that between the ages of 14-23 years of age we begin to form our own musical tastes. The music we experience during these ages will stick with us and we often associate memories to these songs. The SingFit program utilizes the most popular songs during the "sticky years" to encourage mental, physical and emotional engagement.
We decided we were going to focus on dementia first. We went to a very well-known adult day program in Los Angeles and asked what their biggest issues were. What we learned was that when people get to a state in their dementia journeys where they can no longer participate in large group activities, they see more behavioral issues, social isolation and depression. With these patients they run smaller groups of about 10 people but getting true engagement/participation was still a challenge.
The SingFit program downloaded on a tablet device is run by the caregiver through speakers and prompts the lyrics to a song before the group sings them. The prompting is done by a soothing voice that is delivered through the application. Each session has a theme which helps increase focus and all the songs adhere to that theme. For example, the theme could be "from the oceans to the mountains". The songs associated with that theme might be "My Bonnie Lies Over the Ocean", "On Moonlight Bay" and "She’ll Be Coming Around the Mountain."
In addition, trivia and reminiscence questions in line with the theme are included which activates different parts of the brain. We find that responding to questions encourages members of the group to engage further. Physical body movements that cross the mid-line of the body create cross hemispheric brain activity which is especially important in delaying the onset and progression of dementia. The caregiver facilitating delivers the music from the application as well as these movements in line with the theme and trivia which encourages the group to participate.
Every quarter we create 12 themed playlists. Each playlist contains 10 songs, 4 levels of trivia and instructions on movements for the facilitator in book form. The caregivers facilitating are provided 3 hours of training which includes 2 hours of online asynchronous training and a 1-hour webinar with a certified music therapist. In addition to the training and 12 themed playlists, the customer receives speakers and a box full of scarves, shakers and additional tools programmed into the session with the group. The SingFit solution enables caregivers to run a robust, active music making group on a regular basis.
Like any therapy, consistency and regular group sessions 3-5 times a week stimulate and impact the participant attending. Serotonin, oxytocin, endorphins and dopamine are increased when we sing, and these are the chemicals that have been shown to be lower in people with dementia. SingFit customers provide this active intervention on a regular basis as opposed to having a singer or entertainer come in once or twice a month to provide a passive listening experience which is typical in senior living communities.
Some of our SingFit customers run the program twice a day in their memory care units. Once in the morning to create focus which has resulted in individuals participating in group activities throughout the day. They will also run the SingFit program late afternoon before sun-downing lessening the effects of agitation and the typical behaviors seen with sun-downing syndrome.
In California a SingFit customer that has both a social and medical model wanted to see if they could reduce the use of prn anxiolytics by 15%. Their current patient population is Veterans with high utilization of prn anti-anxiety medications. Upon implementing the SingFit program and tracking five residents they saw a 40% decrease in the use of prn anti-anxiety medications. It’s amazing what music and singing can do to affect the chemicals in the brain. It reanimates people and even patient’s that never participate start to engage over time.
SingFit Studio (SingFit 2.0) is like a swiss army knife. We wanted to launch a product that really showed off what singing could do. The platform can be used one on one, in groups and by individuals. We are starting with dementia in home care in 2020 and the program will have additional features specifically focused on improving ADL's for dementia patients. Add on modules for conditions such as COPD will be available as well. SingFit Studio can be used by professionals and non-professionals to improve the health and wellness of individuals.
We presently have home care partners that are testing SingFit Studio in the field with their caregivers and clients. In addition, families can utilize SingFit Studio with their loved ones and for themselves to reduce caregiver stress and improve communication.
We knew that the process of lyric prompting could work for a lot of different conditions. In addition, singing increases the good neurochemicals making it an obvious win for depression or anxiety. The research shows that singing has respiratory benefits and effects cortisol levels promoting heart health.
The program is different for someone with dementia than it would be for someone with chronic breathing disorders for example. The effects of COPD lead to anxiety, social isolation, depression and potential exacerbation of breathing issues. We also know that anxiety coupled with existing breathing difficulties can result in a lot of unnecessary hospital visits.
Singing is like yoga or exercise but with less of a barrier to entry. It’s hard to get someone with COPD off the couch to engage in activity that is taxing but how about a little Frank, Ella or Elvis. Music is an easier way to get people with chronic conditions participating and moving. Andy calls it "Getting on the song train." Once a patient is used to singing on a regular basis and they understand how the process can make them feel, they are more likely to employ singing as a coping mechanism when they are feeling anxious. Furthermore, because music is such a motivator, the process of singing will often enable the participant to be open to other types of therapeutic protocols and increase engagement in their own healing process.
The reluctance to back down in the face of challenges. A friend of mine once told me, "If you are not doing something that makes the world a better place then stop doing it and do something new." Introducing a new highly scalable, highly distributable, medical modality to the post-acute space in my mind accomplishes this. We are continually learning the downside of pharmaceuticals and after 120 years there has been no significant breakthrough in the treatment or prevention of dementia. The idea that music and singing can sit alongside pharmaceuticals and other medical interventions to improve patient outcomes, across the continuum of care delivery, is significant and amazing for the healthcare field.
©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org