Bev Foster • May 9, 2025

Key Change Series Part 6 – Overcoming Barriers to Change

One important step in the process of change and change management is figuring out what roadblocks you might experience along the way. Barriers are things that interrupt the goal of lasting change, and by identifying them ahead of time, disappointment and curve balls may be mitigated.

 

In the 3-year research project that provided the operational process and evidence behind MUSIC CARE CERTIFY, the enablers and barriers within 27 long-term care homes implementing musical integration were collected and evaluated. We found 4 key factors that became predictors of success or readiness factors. We called them factors because in some cases, the indicator was a barrier and in other cases the exact same issue, handled differently was an enabler. We call these 4 factors, predictors of success: integration, core staff, processes, and delivery.

 

Integration refers to what it takes to incorporate music into the care setting. Strong, decisive leadership, oversight, and advocacy for music care from the top and from the music care site team leader is critical. When music is perceived as holistic, integral, fun and pleasurable, then it is a huge enabler. When musical care is valued, then there is ongoing financial investment in training and programming. Care recipients need to be involved in making decisions about what happens around music so that music is not done ‘to’ them, rather ‘with’ them. Having a certified music therapist as the site team lead, or on the music care site team is advantageous for musical and clinical expertise. Musical care coaching and mentorship through training and ongoing support through organizations like Room 217 gives caregivers the confidence to use music effectively and responsibly.

 

Core staff means that there is a group of staff members responsible for music care delivery, and they are all using music as care. Using a relational, person-centred approach, staff is aware of care recipient needs, and knows when music is most appropriate to meet those needs. The workplace culture is predominantly a growth mindset where staff are encouraged to learn, try new things, and think outside the box. There is a drive towards continuous improvement, where evaluation is a best practice, including professional reflective practice. Staff is adaptable and can easily flex and adapt to a changing environment and care recipient needs.

 

Processes comprise the internal operational procedures that impact music care delivery. When recruiting care recipients for music care, residents are prioritized based on their needs. Music care planning has sequential steps and determined accountabilities with resources such as physical space, technology, and musical instruments available for music care. The plans and processes are well communicated and mobilized with the team. Music care tracking and training are well in place and are regularly reported on.

 

Delivery of music care is reflected by flexibility. Is the music care program or strategy adaptable to language for example, or group size? Having the confidence to deliver music as care does not depend necessarily on your perceived musical talent. Being confident in the process of what you are delivering is most important. When musical care is delivered with social bonding in mind, then inclusivity, whether that is about ethnicity, or socioeconomics, becomes a necessity. Frequency of music care programming or strategy may be an important indicator for success. Delivering music care with a cohesive team approach is optimal.

 

When music is used as an agent of change, particularly as a change management system like MUSIC CARE CERTIFY, the organization benefits in a number of ways. There are business wins such as differentiation from competitors, strengthening unique sector strategies, showcasing the achievement of your team, boosting morale. There are staff gains. Staff feels supported with new learning, access to music care tools, strategies, training and ongoing support. Staff may feel more resilient by building some personal musical self-care strategies. And we’ve shown some of the measurable changes that music can help to make: improved sleep, improved appetite, greater engagement, safer transitions for example. There really is nothing more person-centred than music care. It is completely customizable.

 

Most of all, the care experience changes – for everyone in the circle of care. Better care. Improved quality of life. Moments of joy. Empowerment. Human connection; those are the changes we need and are looking for.

A guitar , cowboy hat , cowboy boots and hay are on a wooden table.

When Music Care Becomes Personal (Yet again)

By Shelley Neal • April 2, 2025
I undertook the MUSIC CARE Certification program when I had journeyed through caring for my mother with Alzheimer’s. It was during my training, I learned how music works in terms of timbre, melody and rhythm and beat, music care domains and music care strategies. It helped me to support mom as the disease progressed. I continued to certify through Music Care and then I had the joy of teaching others the level 1 program Fundamentals of Music Care Theory and Context . I have loved coming alongside others in Long Term Care and using music to support giving voice of what is within one’s life, preventing isolation and loneliness, creating community. I enjoyed all it all. Then, I found myself once again in the Emergency Room with Tim, (my family member) as we were helping him home in his palliative journey. My “outside life” took a back seat and my inside hospital life began. Tim’s was failing and he was no longer able to open his mouth and swallow to obtain nutrient’s due to Parkinson’s . We tried various types of foods, textures and flavours, however, opening his mouth and swallowing remained inaccessible. Tim loved Glen Campbell and Rhinestone Cowboy . When he was a young man, he would repeated play this song until the LP was worn through. He was given a new Glen Campbell CD at Christmas and the song was welcomed back into our lives. There I was ,in my new environment on the tenth floor of the hospital, playing Rhinestone Cowboy. Tim sang along. He actually sang along! He moved his mouth, swallowed and sang along. We were able to get pureed food into his body. Later, the disease continued to ravage his body and Rhinestone Cowboy helped us connected with other such as the speech language pathologist, doctors, cleaning staff and nurses. We sang and danced together with the music and Tim smiled. He knew he was part of a community who loved him. As we knew the end was coming, I played music with a simple melody, 60 beats per minute and soft timbre on my harp to support Tim as he fell into sleep. Near the end, I used tonal music in simple phrases to support calmness matching his breath. Tim passed peacefully and gentle. Today, at his funeral our last song “Rhinestone Cowboy”. After hearing the importance of this song, all the people present joined in singing to honour the village of Tim that so lovingly cared for him. Music Care training has become a natural rhythm in my life to use with aging and sick family members, supporting young children’s learning and providing self-care when I was tired after intense caregiving.

Grow

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

Using Music to Connect with Older Relatives

By Julia Cara • March 29, 2022
This article was written by Julia Cara, and is part of a series provided by upper year Health Sciences students at McMaster University.

Remembering the First Room 217

By Bev Foster • January 10, 2022
I will never forget the call that came on that cold, crisp January afternoon twenty years ago. I knew it was imminent. I was expecting it and I thought I was ready. But would I ever be ready to say the final farewell to my father?

Like all the babies rock and roll was born in post WWII America

By Deb Bartlett • September 11, 2020
Poodles skirts, saddle shoes, ducktails and fins on your cars. If these words don’t evoke memories and images from the ‘50s maybe this will:

Folk is music of the people, shares news of struggle and home communities

By Deb Bartlett • August 28, 2020
Ask people what folk music is, and you'll get a variety of answers. Is it about the music? The lyrics? The song's history? According to Wikipedia's entry on folk music , it's all of those things: music that's performed by custom over a long period of time; that has no known composers; and that has been transmitted orally. It can describe the traditions of the "uncultured classes" and definitely means it's music of the people. And because it's been shared orally, it is music that has a place, or is indicative of a community. In some circles, because folk music tells stories about events and history, it's known as world music. In a dissertation, Rachel Clare Donaldson simply stated "Folk music is what the people sing."

Secular hymn Hallelujah among world’s most popular and recorded songs

By Deb Bartlett • August 24, 2020
As explained in this blog post Not Afraid album, the intent behind the Not Afraid album was not to tell people in hospice palliative care that they needn't be afraid; it was to let them know there are people who love them and are sharing the journey.

Not Afraid CD highlights value of relationships at end-of-life journey

By Deb Bartlett • August 17, 2020
Room 217 ’s music was designed for use in palliative care. The music is produced at 60 beats per minute (resting heart rate) which has several benefits for the person receiving palliative care. It also aids others in the circle of care. This link will take you to a report that discusses the benefits of music in hospice palliative care .

The Beatles led the Invasion that changed North America

By Deb Bartlett • August 11, 2020
Do you remember where you were the first time you heard them? The Beatles? Had you heard them on the radio? Or was your first experience with The Beatles watching the Jack Paar show, or Ed Sullivan?

House of the Rising Sun memorialized by The Animals’ guitar chord and organ music

By Deb Bartlett • July 29, 2020
Room 217’s British Invasion album features 16 tracks of soloists and bands from the U.K. that changed the North American music scene.
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