Music Therapy in Hospice: A Natural Vehicle for Patient-Centered Care

Music Therapy in Hospice: A Natural Vehicle for Patient-Centered Care
By Laura Kanofsky, Board Certified Music Therapist and Licensed Clinical Social Worker

Photo credit: Joan Allen
Photo credit: Joan Allen

Patients on hospice service, their loved ones and the professionals who work with them often experience a need for sources of comfort and avenues of communication that go beyond the pharmacological, verbal, and even the linear. Music Therapy, a professional discipline that was formally established in the U.S. in the 1940’s, but has existed, less formally, since biblical times, is remarkably well-suited to address many of the issues that arise for hospice patients and families.

Music Therapy

“Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”[1] Generally, music therapy aims to restore, maintain or improve mental, physical, emotional or spiritual health.

Music therapists work with an array of clinical populations across the lifespan and in settings ranging from psychiatric and medical to educational, clinic-based and private practice. Whatever the context, there are two constants:

  1. Music therapy always involves three elements: the patient/client, the music therapist and music
  2. The music therapist meets the patient where he/she is. Since a particular pitch, piece or even style of music does not affect everyone the same way, music therapy is not prescriptive in nature. The design and delivery of music therapy is largely determined by each patient’s unique story and set of needs, and occurs in the context of the therapeutic relationship.

Thanks to research using brain imaging of the past 25 or so years, much has been learned about the complex ways music is processed in the brain. This work has revealed new and exciting information, and also has validated what music therapists and others have known for a long time – that music can dramatically enhance functioning in many domains, including verbal and motor abilities, mood and affect, self-awareness, pain perception and a host of psychosocial areas. Continue reading “Music Therapy in Hospice: A Natural Vehicle for Patient-Centered Care”

Designing Loneliness out of the Patient Experience

Designing Loneliness out of the Patient Experience
By Darien Kadens Ph.D., MBA – Director of Research, Healthcare and Principal Health Outcomes Scientist, Sodexo USA and Thomas Jelley M.Sc., LL.B. – Director, Sodexo Institute for Quality of Life

Introduction
For many patients and seniors, loneliness is a significant feature of a healthcare experience that is exacerbated by exposure to the unfamiliar and which contributes to a heightened sense of vulnerability. Factors include the aseptic environment and technical language of healthcare professionals, processes and routines often far removed from daily life.  The quantity and quality of social interaction are also often reduced with an impact on the quality of life of patients, older adults, families, carers and workers.

What is loneliness?
Loneliness is often defined in subjective terms and can be considered with reference to three dimensions[1]:

  • an absence of intimate connectedness (i.e., lack of intimate, romantic relationship, lack of connection with immediate family members);
  • an absence of relational connectedness (i.e., lack of authentic friendships, lack of people that one can confide to; lack of social support); and
  • an absence of collective connectedness (i.e., lack of belongingness to referent groups that one can identify with and call one’s own).

Objective considerations in the evaluation of loneliness include its impact on:

  • health-related wellbeing in relation to sleeping and eating disorders, substance abuse, increased susceptibility to disease, mental illness, depression and suicide;
  • financial wellbeing through unnecessary spending, unemployment and lower income; and
  • leisure wellbeing through excessive television watching or online gaming.

If we keep in mind the three levels of loneliness above based on proximity to the individual – a lack of intimate connectedness, the absence of relational connectedness and the absence of collective connectedness – the following framework[2] helps to explain the determinants of loneliness and its impact on quality of life.

Loneliness graphic

The determinants of loneliness in the framework above present a range of factors to consider. These vary from situational factors that may be recent or short term – which an individual can adapt to or which can themselves be adapted, to deeply embedded cultural or personality-based determinants that are more difficult to change. Nonetheless, the range of factors indicates that there are numerous perspectives from which to consider the causes of loneliness, and therefore many potential entry points to mitigate it.  Individuals’ experiences of care settings and care services are just one example.


[1] Cacioppo J. T. and Patrick W. (2008); Loneliness: Human nature and the need for social connection; WW Norton & Company

[2] Sirgy, M. Joseph (2014). Loneliness as experienced by the elderly: Construct, antecedents and consequences.  Presentation at the Sodexo Institute for Quality of Life Dialogue ‘Social interaction, loneliness and Quality of Life in healthcare and older adults’ care’, Ottawa, Canada, September 2014.

In Memoria of Joe Parimucha

In Memoria of Joe Parimucha: A Planetree Healing Environments Pioneer

Joe-ParimuchaI never had the pleasure of meeting Joe Parimucha in person. However as both a healthcare designer myself in my previous work and during my current tenure as a member of the Planetree organization and liaison to our Planetree Visionary Design Network (PVDN), I was certainly aware of his reputation as a design pioneer and of the many contributions he made to the field of Patient and Resident Centered Design.  Any time the design industry loses one of its great talents, there is a perceptible void. This is especially true when that great talent devoted his life and his work to creating designs for environments that facilitate providing patients and continuing care residents both dignity and a sense of control during a time when they often feel their circumstances provide them very little of either. Because I did not know Joe personally, I did not feel as though my attempt to eulogize him would nearly due justice to the legacy he left us.  For that I turned to other Planetree Patient Centered Design Pioneers that were willing to share their memories of Joe and thoughts on his passing.  – Lisa Platt, MS, EDAC, LEED AT BD+C, Director of Business and Product Development, Planetree

Marc Schweitzer, M.Arch, AIA; Sr. Project Architect, Patient Experience Specialist; Stafford King Wiese Architects; Planetree Visionary Design Network Founding Member and Planetree Lifetime Achievement Award Winner

M SchweitzerJoe’s life work has been to prove that design can impact human outcomes. My experience is that Joe’s simple presence at any gathering impacted everyone attending.  Joe’s charisma and obvious delight in life inspired camaraderie and collaboration among others.

I knew Joe from working together with his wife, Barbara Huelat, on the Planetree Visionary Design Network.  At every meeting Joe contributed his insights into both what made an environment healing as well as how to organize our efforts to bring out the very best from everyone involved.  Joe spoke quietly but had a great influence on the PVDN’s direction.  His carefully considered comments always added depth to the discussion on patient-centered design, but more importantly perhaps, on how we could marshal ourselves to maximize our impact on the practice of healing healthcare design everywhere.

I will miss Joe’s warm and thoughtful presence at these PVDN meetings – and his camera!  Joe served as our unofficial documentary photographer.  He brought his camera to every meeting and his images show his personal warmth and joy reflected by his subjects.  Thanks to Joe we have a visual record of the camaraderie at our gatherings.  Without Joe some of the pleasure will be missing from PVDN meetings.  But we will strive to make our work a testament to Joe’s belief in design as a tool for health and healing.

Rest in peace, Joe.  It is a great pleasure for me to have known you.

Phyllis (Kurtz) Goetz, EDAC, PVDN; Director, Strategic Programs and Services at Herman Miller Healthcare; Planetree Visionary Design Network Founding Member; Planetree International Conference Collaborator and Healing Design Continuing Education Developer

P GoetzJoe Parimucha was one of the most charming humble men you could ever meet and I know that he is now surrounded by loved ones and at peace.  The lives he has impacted both by his work and his life are innumerable and his best friend, his wife, Barbara Huelat, was the love of his lifetime.

I first met Joe when I invited Barbara to join me at a Planetree Conference.  She couldn’t make it, but offered to have Joe join me. Little did I know that those days with Joe would begin my love affair with an amazing man and his wife.  Joe and Barbara credit me with bringing them back to Planetree. You see, they were involved very early and have always put the patient first in all their design and architectural work, but truly, they have impacted me in so many ways.  Joe’s delight in seeing how Planetree had developed and his joy in the great work of serving the patient, family and staff was nothing short of contagious.  Joe could always be found with a camera in his hands and a smile on his face and his dedication to his work and to the patients we all serve was paramount in all he did.

The emptiness created by losing Joe will never be filled, although those that he impacted with his passion for a better healthcare environment and creating beautiful spaces will hold his memory dear to our hearts.  Joe, you will always be with me and I hope that the work I, and the entire PVDN complete, will honor your memory and serve as a tribute to your beliefs, you will be missed my friend!

Hope in the Garden: Design Thinking Yields a New Model for Dementia Care

Hope in the Garden: Design Thinking Yields a New Model for Dementia Care
By Beth Zeitlin, Director of Marketing and Development at Abe’s Garden

One of the many benefits of being a member of the Planetree organization, is the ability to have direct access to an ever expanding pool of Patient and Resident centered innovative practices.  Strategies for creating holistically healing environments co-designed by patients, continuing care residents, and families originate over the course of the four decades we have been in existence and from Planetree affiliates all over the world.  From Saudi Arabia to San Diego, outpatient services to continuing care, it is clear from our perspective as a pioneer in Patient & Resident Centered Care that the concept of true human centered design is a construct that is no longer a “nice to have” but rather an imperative if an organization is going to be effective in its ability to deliver personalized adaptive care.  Recently, Lisa Platt, Planetree Director of Business & Product Development, was invited to tour a new Alzheimer’s and Memory Care Center facility called “Abe’s Garden,” at her home base in Nashville, Tennessee.  She was so struck by the intentionality with which they have designed not just their living environment, but aspects of their cultural infrastructure, that she asked them if they would be willing to share the story of their journey with our Patient and Resident Centered interest community.

Nature-Discovery-Area-webAbe’s Garden, an Alzheimer’s and Memory Care Center of Excellence in Nashville, TN (USA), anticipates beginning to care for its first residents in September.

Ten years in the making, the residence incorporates an unprecedented level of evidence-based architecture, interior and landscape design and  in addition to intensive, ongoing training in person-centered care for every employee, from the CEO to the maintenance staff.

It’s personal

When beloved Nashville physician Abe Shmerling developed Alzheimer’s disease, his family tried every available support option; first, day care, which proved insufficient, then after a few traumatic moves, and subsequently six residential care settings, Dr. Shmerling’s final move was to a nursing home, where the institutional environment and lack of appropriate engagement shocked his children. In 2006, eleven years after developing Alzheimer’s, Abe died there without ever receiving the quality of care his family wanted for him.

Devastated, Abe’s son, entrepreneur Michael Shmerling, along with his sister, Judy Shmerling Given and their brothers Rob and Jim Shmerling vowed, “Never again.” Continue reading “Hope in the Garden: Design Thinking Yields a New Model for Dementia Care”

Bayhealth Kent General Hospital’s New Progressive Care Unit

Bayhealth Kent General Hospital’s New Progessive Care Unit
By Debbie Hines MSN, RN, PCCN, CNML, Nurse Manager PCU/Centralized Telemetry and Gretchen Massey BSN, RN, PCCN, Clinical Coordinator of the PCU, Bayhealth Kent General Hospital

When you step off the elevator on the 3rd floor of the Progressive Care Unit (PCU) at Bayhealth Kent General Hospital, you are immediately struck by the warmth and beauty of the environment.  It is reminiscent of a contemporary hotel, rather than a critical care unit in a hospital.  The multidisciplinary design team considered human factors, environmental sustainability, patient exposure to daylight and views, and advanced integrated technology in creating a patient-centered unit.

An Inclusive Planning Process

Planning for the 30,000 square foot PCU began with a multidisciplinary team from all areas of the organization in September 2013.  Working within a predetermined footprint, the team worked with a group of architects and engineers to draft a space that was conducive to the provision of patient- centered care.  From the renderings, the team created a mock patient room.  Patients and direct care staff were invited into the space to offer opinions and suggestions on how to make the space more patient-centered.  With the final design settled, the construction process began. PCU-1-webAs the construction process got underway, a PCU Strategic Planning Committee was formed in February 2014 under the leadership of Ann Keane, MSN, MA, RN, NEA-BC, FACHE, CCRN-Director and Debbie Hines, MSN, RN, PCCN-Nurse Manager for PCU.  The membership of the committee consisted of staff who would be working in the new space and feedback on planning received from patients and families.  The committee immediately began working on reaching out to organizational resources to examine new technologies to use in the space.  Every piece of equipment was examined from the perspective of how it would work for the patient. Continue reading “Bayhealth Kent General Hospital’s New Progressive Care Unit”

Developing Plans for a Healing Garden at VA New Jersey

Developing Plans for a Healing Garden at VA New Jersey
By Mary Therese Hankinson, Planetree Coordinator & Sandra Warren, Public Affairs Officer; VA New Jersey Healthcare System; Richard V. Piacentini, Phipps Conservatory Executive Director; Karl Steinmetz, Studio Phipps Landscape Architect; and Lisa Platt, MS, CSSBB, EDAC, LEED AP BD+C, Planetree Director of Business & Product Development

Source - Rendersing
Source – Rendersing

Since Robert S. Ulrich’s ground breaking research in 1984, which demonstrated that even visual access to nature has the potential to decrease healing time and provide comfort for patients[1], there has been a myriad of other complementary studies that support that having the ability to see and physically experience nature can have a multitude of physical and psychological benefits for both patients and staff.  Although emerging research on the impact of access to nature for mental health patients has been compelling[2],[3], there are few settings where the call for continued study into the benefits of exposure to natural elements has been more imperative.

Planetree has long been a proponent of increasing both access to and the presence of nature within healthcare environments.  This is in part due to empirical evidence in much of the aforementioned body of research, but also because of ongoing information gathered from the many focus groups and interviews Planetree has conducted over the past four decades.  Based on this qualitative data, patients, family, and staff frequently express a desire for or satisfaction with ongoing innovations that Planetree affiliate thought leaders are implementing which increase access to elements of nature within in the environment of care.  Fortunately, the Department of Veterans Affairs (VA) New Jersey Health Care System has consistently been one of these innovative patient-centered thought leaders.

Transforming a Courtyard into a Therapeutic Natural Environment

Over the years, VA New Jersey has received donations and bequests from Veterans Service Organizations and family members who make endowments for enhancing the quality and experience of Veteran care.  The concept of creating a healing garden within an existing courtyard on VA New Jersey’s Lyons Campus developed from discussions regarding using certain of these donations to create a setting where Veterans would have year round access to a therapeutic natural environment.

With this goal in mind, a team consisting of VA New Jersey’s leadership, staff and Veterans began compiling a list of elements they felt would be essential to a design for a healing garden that promoted both wellness and tranquility. Design features such as seating, lawns, paths, as well as reflective and recreational areas were decided as imperatives if this garden was to achieve the goals of being a place for physical, social, and emotional well-being.  An additional and critical intent was to have this healing environment provide a secure and supportive space for Veterans receiving care within VA New Jersey’s mental health programs to engage in outdoor activities. Continue reading “Developing Plans for a Healing Garden at VA New Jersey”

The Innovation of Using Toy Libraries as a Way to Impact Community Health and Well-Being

The Innovation of Using Toy Libraries as a Way to Impact Community Health and Well-Being
Dr. Jane Aronson, President and CEO, Worldwide Orphans Foundation as interviewed by Lisa Platt, MS, EDAC, LEED AT BD+C, Director of Business and Product Development, Planetree Jane-headshot_credit_Mani_Z

I recently had the great privilege of talking to Dr. Jane Aronson, the President and CEO of the Worldwide Orphans Foundation and a recent Keynote Speaker at the 2014 Planetree International Conference on Patient-Centered Care.  During her presentation at the Planetree Conference she had touched on the concept of Toy Libraries and their ability to meaningfully change the developmental progress and coping abilities of children in dire conditions and those that have been orphaned or abandoned. 

Being a completely new concept to me, I was struck by how this notion seemed to have particular relevance to healthcare and that often this same concept applies to patients and families finding that they are facing life altering health events without necessarily having the tools and capabilities to emotionally and mentally deal with their circumstances.  The following is Dr. Aronson’s synopsis of this truly innovative approach, and how applying the concept of Human Interactions, Access to Information, and Healing Environments through these Toy Libraries can have an absolute game changing impact on creating Healthy Communities and Enhancing Life’s Journey.

I have a long history of working as an adoption medical specialist.  I was introduced to the concept of the toy library when I started my work in Russia. When I arrived in Russia in the early 1990’s, I was at an early intervention institute in St. Petersburg and that had a toy library.  This was a concept that this institute in St. Petersburg had originally adopted from Scandinavia.  Scandinavia has, for some time, had a fairly robust network of educators and specialists that use toy libraries as a way of connecting with children with differing abilities and special needs.  The purpose of the toy library at this early intervention institute was to prevent abandonment of children.  The director of the institute would work with mothers of children who were disabled sometimes mentally and physically, and at risk for abandonment. This risk of abandonment was often due to the economic poverty of the family. These mothers did not have access to education about their child’s condition. Aronson quote The mothers-They were so afraid of their child’s differing abilities and their lack of ability and resources to cope with them that they would end up abandoning their institutionalized child.  The toy library was a great tool to be able to educate mothers and care takers who visited the institute. The toy libraries proved to be a great source of prevention for abandonment while concurrently helping to improve the development of a child that had disabilities and was institutionalized. During this time I was also approached by several adoption agencies that were really concerned about how children were languishing in orphanages all over the world and becoming increasingly more developmentally delayed, depressed and traumatized by their circumstances of abandonment.  My take on this was to look at the activity of play that would occur in these toy libraries as a way to moderate those circumstances. Continue reading “The Innovation of Using Toy Libraries as a Way to Impact Community Health and Well-Being”

It Takes a Village to Deliver Resident-Centered Care

It Takes a Village to Deliver Resident-Centered Care
By Cindy Donovan, Chief Executive Officer, Loch Lomond Villa

Our new home, “The Village” is one of the most exciting initiatives Loch Lomond Villa, a long-term community in the Canadian Province of New Brunswick, has added to its journey of excellence and resident-centered care.  What we have created in East Saint John is a home for 100 of our residents, one that celebrates life—a home that maintains connections with family, friends and community, bringing peace of mind, happiness and contentment.

Designing With Residents

Informed by current literature on healing environments, site visits and tours to other locations in Canada, and support by the team at Planetree, the Village’s design concepts focused on creating a nurturing environment of a non-institutional home that meets resident, family and staff needs while encouraging a relationship-based community.  Most important, though, was engaging all our stakeholders in sharing what was working in the existing space and what was not, and the compilation of wish lists for what it would take to create a resident-centered care environment.  As with any change within a resident-centered community, the changes to the built environment are not made for residents, but with them.  Their involvement in the process builds ownership and pride in their new community.

The design was driven not by a specific model.   Rather, the foundation for this work was the voices of those who live and work at Loch Lomond Villa.  An analysis of qualitative data collected through several focus groups and town hall meetings with residents, staff and families highlighted core themes about the resident, staff and family perspective on life at Loch Lomond Villa, as well as the challenges or barriers that have hindered their preferences from being met.  These themes framed every aspect of our improvement initiatives and our priorities for building a new environment.  Indeed, the process involved mechanisms by which all stakeholders, including residents, staff, families, neighbours, board members, volunteers and physicians were not only heard, but also actively involved in creating and sustaining our strategic vision for our new home. Continue reading “It Takes a Village to Deliver Resident-Centered Care”

Integrating Participatory Methods into Healing Design; An Interview with Robert Sharrow, Albert Kahn Family of Companies

Integrating Participatory Methods into Healing Design; An Interview with Robert Sharrow, Albert Kahn Family of Companies
By Lisa Platt, RID, LEED AP BD+C, EDAC, Planetree Director of Business & Products Development

Albert Einstein
Hospital Israelita Albert Einstein
Sao Paolo, Brazil

Albert Kahn Family of Companies is a founding member of Planetree’s Visionary Design Network.  Kahn has been an active and ongoing supporter, helping to educate Planetree affiliates and the patient-centered care interest community on the merits of Patient-Centered Healing Environments and the impact they make on the patients’ and families’ perception of care experience and quality.  I recently reached out to Robert Sharrow, AIA, ACHA, LEED AP, EDAC, Kahn’s Vice President, Director of Health Care Planning to discuss his thoughts about the utility of integrating participatory methods that include the voice of the patient, family members, and frontline staff into informing and developing the design of healthcare spaces.

Platt: In your opinion Robb, what role does “Participatory Design” play in the creation of Healing Environments?
Sharrow: It’s actually a very important role.  The designers of a healthcare environment need input.  We have experience designing healthcare environments but do not work in them on a daily basis.  Although we have also all been patients at one time or another, we don’t have the same perspective as a patient or family member of a patient receiving care.  Every facility is very unique.  Their organizational cultures are unique. Their patient populations are unique. The languages that they speak may be diverse and may influence the ways patients and their family members need to be supported. It’s important that, as designers, we listen to the input of patients, family members and caregivers, to be sure that the design of healthcare environments will be truly supportive of patient, family, and staff needs. When designing a healing healthcare environment, it’s important to get as varied a number of opinions as possible from a diverse group of individuals that are using the space.

Elmhurst
Elmhurst Memorial Hospital
Elmhurst, IL

Platt: Could you describe some of the approaches and methods used in participatory design?
Sharrow: As designers, we are responsible for the design outcomes, so we listen carefully to diverse input by patients, family members and care givers.  We advance the design process through concept development, down to the final details of the healthcare environment. We listen to input from many, many people.  One of the tools we’ve used effectively to gain this input is by developing mock-ups.  At Elmhurst Memorial Healthcare, a Planetree Designated® with Distinction hospital, we did mock-ups for all the acute care spaces, the intensive care room, and the pre-op and phase-two recovery rooms for surgery.  We used the mock-ups to gather input from hospital leadership, nurses, and physicians; and there was also a large contingent of family members and patients that also went through the mock-ups to provide insights and opinions on the design for these rooms. Continue reading “Integrating Participatory Methods into Healing Design; An Interview with Robert Sharrow, Albert Kahn Family of Companies”

Making Visible the Presence of Spirituality in Healing Ourselves and Our Communities

Making Visible the Presence of Spirituality in Healing Ourselves and Our Communities
By Annette Ridenour, President, Aesthetics, Inc.

It seems paradoxical that, as careful research over the past thirty years has consistently demonstrated a powerful relationship between spirituality and healing, hospitals and other healthcare facilities have continued to remove religion and spirituality from the patient experience.

Scripps Mercy Catholic Chapel
Scripps Mercy Catholic Chapel

Some organizations have increased the availability of religious and spiritual counseling, but they are doing so most often within an overall physical environment that makes little reference to faith. The spark of spirit is nowhere in evidence. Walking the halls of most hospitals today, you could conclude that God might be an embarrassment rather than a potential source of wellness, healing, comfort, and hope.

Continue reading “Making Visible the Presence of Spirituality in Healing Ourselves and Our Communities”