Day In, Day Out as a Hospice Music Therapist

Last week I talked about the most important thing I’ve learned so far in my music therapy hospice internship. This week, I thought I’d share what a typical day is like. Hospice music therapy is one of those jobs where each word is familiar to everyone, but put together…the actual job description is hazy.

ff_righttodie_characteristics of hospice patients in the US

Let me disclaim that I’ve only been at this three weeks so I don’t have much experience yet. Also, hospices work differently depending on the size of the staff, service area, and whether or not patients are in an in-patient unit or in their own homes or nursing homes. This is how a day is for me:

The day starts at 8 am, and I  go to one of the three offices. There are three because the service area covers 12 counties – 6 in Ohio and 6 in Indiana – so each ‘zone’ has a home base office. Since I am mostly observing at this point, I am jumping around to the different offices throughout the week.

The first order of business is learning about changes in patients’ statuses. Obviously, there are many more changes over a weekend, so Monday mornings take a little bit longer than the other days to get up to speed. A patient may have died or is in rapid decline. A patient may have been admitted to respite care (in which the patient goes into 24-hour care with hospice to manage symptoms that are out of control, or to give the caregivers rest, or both). There may be new admissions. Priorities are set at this time and it may be common to take off ASAP to see a patient who is “impending” (close to death) or has a great need for music therapy.

So, depending on the route for the day, I may ride with my supervisor or follow her in my car. I switch days with the two music therapists, so that I can observe both of them in their work. We usually see between 2-5 patients a day. Most visits last 30-45 minutes. We arrive at either a home or a nursing home and my supervisor gets out her guitar, iPad, and maybe some other materials like small percussion instruments and binders full of music, depending on the patient. If it’s a nursing home, we walk in and go straight to the patient’s room. We don’t have to sign in or anything, usually the staff knows who we are. If the visit is an assessment (new patient), we let the nurse on duty know who we are and ask if we can see the patient. When we enter the patient’s room, we find seating near the bed. Sometimes the patient is alone, sometimes family members are visiting, sometimes other hospice staff are there, such as aides or the nurse. If the patient is at home, we call first before visiting and drive to the home, knock on the door, and come in, similarly finding seating and then doing our session. Naturally, caregivers or family members are there with the patient, although sometimes the patient lives alone.

So what do we actually do? In an assessment, we try to find out as much as we can about the patient’s background, history, and music preferences. There are some standard songs that everyone seems to like, such as “You Are My Sunshine” and “God Bless America” that are a pretty good bet. Most songs we sing are old hymns, old country and western, golden age songs, and some singer-songwriter music.

When the patient has been seen often by the music therapist, a rapport has been built, between the therapist and the patient, and also the therapist and the caregiver/family. Favorite songs are known, so the therapist will sing those and perhaps other songs like them, either the same genre or are by the same artist. If there’s a song they patient likes and we don’t know it, it’s our job to learn it. I’ll get into the specific goals and interventions for music therapy next week…this post is already long!

After the visit is over, we pack up and say goodbye. Then it’s time to do documentation. The documentation for our hospice is electronic, so we can complete everything on our iPads. A lengthy assessment is completed after each session and some of it is integrated with the other disciplines (nursing, social work, spirituality).

We also have to complete timesheets everyday to show where we were and calculate our hours. We also factor in our travel time including mileage, which we get reimbursed for. At the end of the day, around 4-4:30, everything is finished up and I leave to go home.

Sometimes we’ll stay in one city for most of the day, and sometimes we drive quite a lot, up to 2-3 hours total in the car. Sometimes we’ll be able to go back to one of the offices to do documentation or eat, sometimes we’re out all day. It just depends on who we see. I’m pretty tired by the end of the day.

So, that’s what a typical day is for me! Next week I’ll talk about what we do as music therapists to meet our patients’ needs, and the needs of their caregivers/family.

I’ll leave you with a song I learned for a patient. It’s a doosy!

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