Benefits, Challenges and Solutions for Implementing Personalised Music Playlist Programs in Residential Aged Care in Australia

Figures & data

Table 1 Focus Group Participants

Participant No.	Gender	Role
Group 1
1	Female	Diversional therapist
2	Female	Aged care educator
3	Female	Music therapist
4	Female	Dementia consultant
5	Female	Education coordinator
Group 2
1	Female	Pastoral care coordinator
2	Female	Recreational activity officer, dementia specific
3	Female	Recreational activity officer, dementia specific
4	Female	Memory support
5	Female	Team coordinator
6	Male	Lifestyle manager
Group 3
1	Female	Person with dementia
2	Male	Carer (husband)
3	Male	Carer (son)
4	Female	Carer (wife)
5	Female	Carer (wife)
6	Male	Musician in Aged Care

Table 2 Themes and Sub-Themes Relating to the Benefits of Music Programs

Theme	Sub-Theme	Quote
Behaviour management		For years we have been using music to engage residents not just when they have certain behaviours but as a normal daily engagement and we have found that very successful (P5 Group 1)
Engagement/entertainment		We do use music on a daily basis as a way of distraction or engagement, and also stimulation (P5 Group 2)
To achieve certain affective states	Enjoyment	Sometimes people will say they do not like music but then when you engage them in music their faces light up and they tap along or sing along or something. (P5 Group 1)
	Relaxation	We have found that music is very beneficial as far as, I suppose, keeping you in a more relaxed state (P1 Group 1)
	Energising	He just likes to watch it now, and listen, and the family loves it because R becomes much more vibrant when he hears it (P4 Group 3)
	Creating an atmosphere	I think sometimes it might not be as specific as to help with a challenging behavior so much as to help create a certain atmosphere in a cottage (P1 Group 1)
Carer wellbeing		I think it improves the staff wellbeing as well (P5 Group 1)
Make connections		It’s an opportunity for care staff to get to know the resident and make the person real, make the person normal. Seeing the person and not the behaviour. Also it gives that perspective to the other residents because if the other residents share the same base with residents they will see the person having fun or enjoying life. Sometimes it makes them less afraid of that certain resident or they can find opportunities to relate as a lot of times they like the same music. It creates some space to be together to connect and I think that also reduces social isolation (P4 Group 1)
Effect on memory		I find it calms a lot of our residents, and reminiscence is wonderful. I have one lady who cannot put two words together. Her hand and eye coordination is not there, but you get her singing to a record. The words come out and the music is there fresh as anything. (P3 Group 2)
Palliative care		It had kept her going in palliative care for 9 months before that last 2 weeks, and it was largely through music (P3 Group 3)
Can have negative effects		Music can be like a Pandora’s box. We do not exactly know what’s going to emerge from it (P1 Group 2)

Table 3 Themes and Sub-Themes Relating to Challenges to Implementing Music Programs

Time	In facilities	They just did not have the time to do it for him. He struggled to press the buzzer to get staff, so he was just in a room by himself. They would turn the TV on in the morning because that could be left, and it would be on all day, whereas the music, I just had CD’s, so you know they only lasted for so long before they needed to be turned over, so it was just me having to go in and turn it on for him to give him some sort of stimulation (P5 Group 3)
	In home-based care	[referring to music programs]: We do not have the time to devote to that kind of stuff (P2 Group 3).
Staff Perceptions	Mindset that they just wash & feed	I think it’s the mindset of care staff, that they are here to do the washing and drying and the feeding and that type of thing. (P2 Group 1)
	Mindset of busyness	I think it’s a time factor that everyone sometimes thinks they are too busy, which can be a problem too … (P2 Group 1)
	“Set & forget” attitude	They would put the iPod headphones on and think of it as “well I can do this while I go and care for other residents and just leave this person alone”. That was not as beneficial and there are a few occasions where it caused distress in residents (P6 Group 2)
Family perceptions		Sometimes families do not see the value because they focus more on “I want mum to go to a big social activity” or “make sure she’s had a shower and her hair done”. They tend to focus on different things as well and their expectation is “oh mum’s never liked music so I don’t see the value” (P5 Group 1)
Managerial Support	Seeing value	This is something that I have to deal with every single day, constantly being asked those questions by the leadership team “why is it worth it? What’s your pre-post assessment? Show us your validated tools to show that this is working”. (P3 Group 1)
	Culture of care	[Referring to care practices]: It can just easily veer over into the medicalised care system. It just seems to bloom as the most important thing when it’s when it’s not theoretically and really (P1 Group 2)
	Accountability	[Making sure that] staff feel responsible for the implementation of music, not just one care staff but different care staff at different times of day (P4 Group 1)
	Engage all staff	That kind of problem could happen with an individual playlist unless everybody’s owning it and there’s a facility for everybody, for it to be clear in the care plan. Otherwise it could get lost. (P1 Group 2)
Equipment	Appropriateness of equipment:	Equipment is preeminent. You need to have headphones that are comfortable, that sit on the ears and do not get sweaty and people do not feel that that is adding to the problem rather than relieving it (P2 Group 3)
	Care of equipment	I think another big challenge is getting the equipment ready and making sure that it’s available (P4 Group 1)
	Cost	You have to buy the technology and there’s not really any way of getting around it (P3 Group 1)
Music Selections	Getting the music right	Giving them the right music is so important. I think every step is really important, but we could throw the whole thing backwards if we put the wrong music on (P2 Group 1)
	Individualising	For a resident that has no input at all, and then to get movement and expression and body language [in response to music], and I believe it’s because it was an individualised program for that person (P2 Group 2)
	Finding out preferences	The individual that you are making the playlists for will actually have an emotional connection to that song as well and you will not have that direct knowledge, because we are relying on somebody else to provide that (P2 Group 2)
	Duration of listening session	People do not have long attention spans and if you can make a shorter, concentrated and involved session, rather than this kind of preconceived idea of leaving somebody with headphones on listening to music, that certainly worked better in all of the studies that we did (P2 Group 3)

Table 4 Solutions to the Challenges of Implementing Music Programs in Aged Care

Education of management	About value	Essentially, it’s a new skill and we are trying to shift a mindset. To provide that scaffolding that is necessary for behaviour change there’s a cost investment both in resources and technology. There needs to be a strong justification to decision makers, generally right at the top, that it’s worth it (P3 Group 1)
	About need for engaging all staff	Trying to persuade facilities that this is something everybody should own, and everybody can be involved in would be the ideal, that would be the blue sky thinking (P1 Group 2)
Education of floor staff	Embed within current practice	To make changes, basically you have to look at what are the staff do as a matter of course, and realise, “yes they’re going to do that”, but how can we then adapt and innovate based on that … We rely on what we know they are going to do, and we try to be very creative, so that we can then personalise. We use the impersonal things that they have to do to then build the individualised tailored platform so that each person’s life can be much better (P4 Group 3)
	Personally observe the benefits	When a carer has that experience, that’s the shifting point to overcome some of those barriers around “I don’t have time for this” or “it’s not part of my job, that’s what the therapy assistant or the lifestyle person is responsible for” (P3 Group 1)
	Caring for the person as a whole	Something that I have learned across the years of working with carers in particular is to try and change that mind set and shift their thinking where music is part of who someone is. Part of the role of a carer is to support that person’s whole identity and broader wellbeing (P3 Group 1)
	More than entertainment	If you can show how it benefits them in their normal task-oriented role that will help translate these things into practice a lot more than just saying “listen, it’s great for the residents”. If they see how it actually benefits them in their role, they will be much more likely to engage with it, use it, which then has a knock-on effect of being a benefit for the rest (P6 Group 2)
	Realistic expectations	I think we have got to talk about what are realistic and unrealistic expectations. It’s not going to be a silver bullet. Something may not work every single time. And the reality is that people have good and bad days and some bad days, nothing is going to work. (P1 Group 2)
	The need for personalisation	I think the identification of personal tastes and preferences should be pretty well number one (P4 Group 3)
	The need to monitor and review	It’s got that cycle where music is part of the care plan and then we are constantly monitoring, reassessing, adjusting the music as we need to (P3 Group 1)
Education of family	Understand the value	Sometimes you can overcome the financial barrier if the family is on board because they will actually be willing to purchase the equipment and even put the music on the equipment for the person (P5 Group 1)
	About music selection and how needs can change	Definitely monitoring, observing the reactions is a key step to maintain the programme because it’s not just selecting the music and “now we have a device”, but also “how can we implement these regularly according to the person’s needs that are also changing”? (P4 Group 1).
	On appropriate technology	I would have very early on a discussion of equipment, about the comfort of headphones whether open or closed, how tightly they clasp … Equipment is something I would concentrate a lot on (P3 Group 3)
Develop appropriate standardised tools for evaluation		It would be really beneficial if there were some standardised outcomes that are measured outcomes. That could be provided as a justification for the financial spend on music therapists, on iPads, on equipment and all of these things. Right now it can be anecdotal and or it can be difficult to gather that evidence. But if there was some evidence available, it would be easier to make the case to bring these programs into the facility (P6 Group 2)