Several years ago, I met Brian*, a young adult who was living with stage 4 lung cancer. The highly aggressive disease had metastasized to multiple parts of his body, including his brain. In our lengthy conversations over many music therapy sessions at the hospital, I was struck by his focus on legacy. He told me he was constantly wondering if and how he would be remembered. At only 27 years old, he was at once youthful and existentially weighed down by the reality of the disease progression, eager to soak in as many experiences as he could while being mindful that his time was limited. As a music therapist, I often focus on “legacy work” through songwriting as a vehicle for creative self-expression but also as an offering to the patient’s family. The songs I write with patients who are receiving palliative and end of life care often represent that which holds meaning to them. We write songs for loved ones, about loved ones, about oneself, about hopes, dreams, regrets, ideas, and reflections. Sometimes the patient wants to infuse humour, other times the lyrics and chord progressions are pensive, even melancholic. However, the songs come together, they always serve as a form of legacy. Perhaps that is an intrinsic outcome of songwriting: it’s inherently representative of a point in time and can be revisited as a reflection of that moment, of that person, of that experience or relationship. In one of our music therapy sessions, I introduced the idea of songwriting to Brian, who immediately connected with the concept and told me he’d be thrilled to try it, though he wasn’t sure what he wanted to say or how the process would unfold. Together, over several weeks, he and I crafted lyrics, which he would later speak atop a chord progression we created. He told me he wanted the chords to feel “deep, painful, yet hopeful,” a contrast which he named as his own current reality, as he was balancing living while dying. I had heard of other music therapists recording patient heartbeats with a stethoscope and using the audio as a backing track of sorts, a rhythmic line that threaded through the song. Having just been generously gifted a digital stethoscope from a community organization, I knew in my own heart that Brian would be the perfect first patient for me to create a heartbeat recording with at the hospital. With a little help from my nursing colleague, we recorded Brian’s heartbeat, embedded the sounds into the track he and I had written and recorded, and a few days later, presented it to his family. Brian died several months later but his vitality remains embedded into the song he wrote, both in the music and lyrics but also in the acoustic representation of his life force: his heartbeat. Over the past several years, music therapists have been using heartbeat recordings as legacy work with patients and families in a number of settings including but not limited to oncology, pediatric intensive care units, and hospices. Last year, together with the Adolescent and Young Adult (AYA) Oncology Program at Princess Margaret Cancer Centre , the Music Therapy Program launched a “Heartbeat Recording for AYAs” research project where we will be writing songs with this patient population and researching the lived experience of the legacy work and heartbeat recording for these patients. We’re so thrilled to be able to carry on this work as a research endeavor and hopefully come to a richer understanding of the impact of this songwriting approach. When I reflect on the work Brian and I did together, I’d like to think he would be excited to see this type of legacy work expanded for adolescents and young adults. Perhaps his courage to be the first patient to trial this experience is part of his legacy, too, and I will be forever grateful. Dr. SarahRose Black PhD RP MTA is a certified music therapist and registered psychotherapist, specializing in palliative care and psychosocial oncology at the Princess Margaret Cancer Centre, and her private psychotherapy clinic (Whole Note Psychotherapy) in Toronto, Ontario. She is a pianist, vocalist, and music health educator, and has performed, taught, and presented on her clinical work and research across Canada.

With the Juno Awards taking place this past weekend, there has been a renewed focus on the role music plays in Canadian culture. It brings people together and creates shared moments. This same idea surfaced in a different context earlier last week. During the recent Ontario Long Term Care Association conference, a keynote from Mike Downie, Telling Our Story: The Power of Narrative to Inspire and Connect, reflected on the legacy of his brother, Gord Downie, and the impact of The Tragically Hip. One of the main insights of this reflection was a simple idea: music connects people. During the keynote, reflections shared from residents at Kensington Health offered a powerful reminder: Music is a common ground for community gathering It is not about what is lost, but what is still there Music that has meaning can bring us back, even if only for a moment Mike Downie also reflected on how the storyteller can become the story. This is a clear theme in the life of Gord Downie, who was known for storytelling through his lyrics and later became the story himself through his health journey. His later work, including Secret Path , also highlighted his advocacy for Indigenous communities and demonstrated how music can be used to share stories that might otherwise go unheard. In care environments, this idea shows up in different ways. Projects like The Green Bench create space for people to share their stories directly. Music can do something similar. It can bring forward identity, memory, and moments of self-expression, even when communication changes. These reflections may feel familiar to those who work in care environments. It may look like a resident quietly joining in with a familiar song, or a shared moment where a room shifts as music begins. Connection through music may appear as: A familiar song leading to singing or humming A moment of recognition seen in a glance or a smile A shift in the tone of the room when music is introduced These moments of connection are often described as spontaneous. However, they are not accidental. Music, when used intentionally, can support connection in everyday care. This might look like: Choosing music that is familiar and meaningful to the person Using music to support transitions or care routines Creating opportunities for shared listening or singing The legacy of Gord Downie reminds us that music has always brought people together. In care environments, through the intentional use of music, that same connection continues.

Professionally, I have continued to develop my skills as a hand drum facilitator, moving beyond technique into a more intentional, care-focused approach. Incorporating Music Care strategies into drumming has transformed how sessions feel and function, allowing rhythm to become a tool for connection, engagement, and emotional expression. One of the most impactful strategies I’ve used is picking songs for care contexts during drumming facilitation. Choosing familiar and meaningful music creates instant buy-in and excitement. Some of the most joyful moments have come from drumming along to ABBA and AC/DC, songs selected by both team members and residents. These shared musical choices encouraged participation, helped everyone catch the rhythm more easily, and created an atmosphere of laughter, movement, and shared energy. The familiarity of the music allowed participants to feel confident and included, regardless of their musical experience. To support inclusive and adaptable sessions, I intentionally assembled a Music Care Kit tailored specifically for drumming facilitation. My kit includes a variety of drums, some smaller, some larger, and others with handles to support different hand grips. I also include drumsticks of varying weights to ensure adaptability for different strengths and abilities. A speaker is essential for song-based drumming, along with facilitator notes that help guide session flow. Additional instruments, such as chimes, allow me to introduce moments of calm during drum washes, while a jam drum block supports call-and-response interactions. Even my portable tote has become an essential part of the kit, allowing me to easily transport everything from one community to another. This flexibility ensures music care can meet people where they are. Music Care has also become a vital part of my personal self-care. I intentionally use music while driving to work as a way to decompress from the previous day or to prepare myself emotionally for a compassionate and grounded workday. This simple practice has helped me manage stress and transition more mindfully between personal life and professional responsibilities. Beyond daily routines, music now shapes how I experience the world. As part of my personal Music Care Plan, every vacation I take includes music as a way of learning about culture, history, and identity. In Norway, I attended a midnight concert in a local church in Tromsø and sang along with an Indigenous Sámi man who shared a song about his grandmother. In Poland, I experienced a Jewish Kazimierz performance featuring violin, singer, and accordion. In Ireland, I listened to harp and flute music at the base of the Rock of Cashel and played the drums at the Ireland Rock and Roll Museum. My travels also included attending Mozart, Strauss, and Beethoven concerts in Vienna, visiting Mozart’s birthplace in Salzburg, and participating in the Silent Night Chapel service on December 24. Each experience reinforced how music transcends language and creates a sense of belonging across cultures. Looking ahead, my journey with music continues to evolve. During my hand drum facilitation course, I unexpectedly fell in love with the didgeridoo. The low tones and full-body vibration felt deeply soothing and grounding. Quietly, I’ve signed up to learn how to play. This instrument requires internal and circular breathing, something I find challenging due to ongoing lung issues, but I see this as an opportunity rather than a limitation. Learning the didgeridoo may support Motor and Respiratory Exercises (OMREX) ® , a core Neurologic Music Therapy technique that uses singing and wind instruments to build respiratory strength and control. Through diaphragmatic breathing, increased expiratory pressure, and improved breath control, this practice has the potential to benefit both my personal health and my future work in care settings. Music Care has reshaped how I drum, how I travel, how I breathe, and how I care for others and for myself. What began as skill development has become a way of moving through the world with greater intention, curiosity, and connection.

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.

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.