Ep. 032 | Music Therapy & Hospice Care
Today, we chat with guest, Matt Valois, a board-certified music therapist, as he shares stories from his experiences working in hospice.
RESOURCES
A Life of Music Therapy by M. Valois
The Center for Music Therapy in End of Life Care
TRANSCRIPT
Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. My name is Erica Lee, and today, we are talking about music therapy in hospice care, with board-certified music therapist, Matt Valois.
Matt is a board-certified music therapist with Ecumen Hospice, serving patients in the Twin Cities metro and rural communities of southern Minnesota. He studied at Drury University, in Springfield, Missouri. Then, Matt completed his clinical internship at John Knox Village Hospice, in Lee Summit, MO, and received his music therapy board certification in 2018.
[Podcast intro music plays]
Erica: Welcome to the podcast, Matt. Thank you so much for being here.
Matt: Thank you. I’m happy to be here.
Erica: Awesome. So, um for a little context about who you are and what you do, can you tell me about how did you originally decide to become a music therapist?
Matt: Okay.
Erica: And how would you describe your therapeutic approach or philosophy?
Matt: Yeah. So, um, I actually uh started my college studies with a bachelor of musical arts. At the time I just knew that I really loved music, but I did not know what I wanted to do with it at the time. I spent some time kind of meandering through different odd jobs, and I ended up being a caregiver for adults with developmental disabilities in their homes. And I really started to uh enjoy that type of work - I really loved it. And um, when I realized what I really enjoyed, I started doing research. And that’s when I realized, oh my gosh, there’s actually something called music therapy - you can go to college - get a degree in it, become certified, and then be a music therapist.
Um, particularly in hospice care, it’s definitely patient-centered first.
Erica: Mmm.
Matt: Um, you may have heard of, you know, other different populations that music therapists work with. What I’ve discovered in the realm of uh hospice work is it’s less developing a treatment plan and knowing exactly what you wanna do when you go in, but it’s more you receive the patient first, and uh you begin to look at what exactly the needs are. You may have an idea going in because you’ve seen them a couple time, but, you know, there’s a 70-80% chance that something is happening right then and there that you might not have expected. So —
Erica: Mmm —
Matt: You just kinda improv [chuckles] - do the best that you can, and um you key in what -what the needs are, and uh you use music to develop something right there in the moment for them.
Erica: How did you get into hospice care? Was there a particular draw to hospice within music therapy prior to finishing your uh certification?
Matt: When I was studying at Drury University, we have what’s uh called practicums for a semester. So each semester we’re working with a board-certified music therapist in - in a different area - in my case, one of my semesters was co-directing the intergenerational rock band at the university, which was a lot of fun. One of the semesters that I had, I was given the opportunity to basically uh be mentored by a board-certified music therapist in hospice, and that semester opened my eyes to how - how prescious that type of work is, and how sacred that work is. And I just fell in love with it. So after that experience, that’s when I started looking for internships in hospice, and I ended up being accepted at a internship at John Knox Village Hospice in uh Lee Summit, Missouri outside of Kansas City.
Erica: So, can you tell me more about the specific type of work that you’re doing now? Who are you working with - uh, what does that look like?
Matt: Yeah. Um, right now, I work for Ecumen Hospice in uh Minnesota. I actually work for 2 different branches. My - my patients are basically all over the place. All of them are about an hour radius from where I am, so I get to - well, usually - before COVID-19 restrictions happened, my job was to have my guitar and my voice with me and drive all over Minnesota all day [laughs] and have a good time. So the population that I work for is basically all of our hospice patients. There isn’t a certain age group - it’s basically anyone who has been qualified for hospice, and has been referred to hospice services, and those who have decided - themselves or their families - to enroll in our hospice program.
So some of our patients uh do live in skilled nursing facilities. Some of them live in assisted living facilities. Some of them live in their private homes. But, uh, with hospice patients, they can be anywhere that they deem their home —
Erica: Mmm —
Matt: So we go to wherever they are.
Erica: Awesome. For anyone that doesn’t know - for any listeners that are unfamiliar with hospice —
Matt: Sure —
Erica: How do you define what hospice is?
Matt: You know, just generally - just basically - it’s end of life care —
Erica: Mmm —
Matt: And you’re doing with hospice patients is: either them or their families have gotten to the point where they have decided that they no longer want aggressive treatment for whatever they’re experiencing. So they don’t wanna go any more surgeries, they don’t want any more medications, they don’t want any more chemotherapy, they don’t want, you know, just a list of different things that, in their mind, detract from quality of life.
Erica: Mmm.
Matt: For a lot of people, there gets to a point where they’re wanting to transition to trying to cure everything to, I want to, you know, I want to live the best life that I can with the time that I have have, and transition into passing peacefully.
Erica: Absolutely.
Matt: So that’s what that is.
Erica: So, COVID-19 is still happening. When we’re recording this, the pandemic is still happening. How has moving to telehealth changed or adjusted how you practice?
Matt: It’s been a very large impact. One of the struggles with hospice care is that it is very personable, and a lot of it has to do with your presence. Of course, due to COVID-19 restrictions, a lot of that personal touch and that quality of life that we normally give when are with somebody, has been inhibitated a lot. So, the majority of my visits are telehealth at the moment. And how that works is: the nurses or the aids - the ones who are giving direct cares - and have to give direct cares - they’re the only ones who are aloud in facilities, like uh skilled nursing facilities, at this time.
Erica: Mmm.
Matt: So what we have to do is we have to kinda schedule with them, and figure out when they’re gonna be present - when they have time - and they’re gonna act as the telehealth facilitator for us visiting someone.
Erica: And so, when we’re in non-pandemic circumstances, what does a session look like?
Matt: Mmhmm.
Erica: Are there certain things that a family can expect in a session? Or - could you tell me more about that?
Matt: Yeah. That’s all determined on whatever the goals are. You know, pre-pandemic, my first visit with someone is getting to know who the patient is - asking questions about their musical background. If they’ve played a musical instrument or uh sang in a choir - what their relationship to music is. You know, from there I kinda just - kinda determine what their needs are as well. Particularly during the pandemic, uh a lot of the needs right now is how to deal with social isolation.
Erica: Mmm.
Matt: Uh, so kind of in a basic session like that, I’ll be playing their favorite songs, usually when they were 15 or 20 or 25. Or different types of music that have different themes with uh what they’re feeling or experiencing at the time, to give them validation through music.
Erica: Mmm.
Matt: Um, sometimes, over time, that will go into helping them to write music - or write songs - either using uh an existing song and changing lyrics - lyric substitution, or uh even writing original music in the form of creating a legacy of their life that they can pass on to their loved ones.
For example, I uh had the honor and the opportunity to work with a uh Presbyterian minister, who was a minister for 40 years. And he had a hobby of writing his own hymns. He had traveled to India - and traveled all over the world to study different religions - and it changed his outlook so much that he thought that he needed to create music, and create hymns, that reflected what he truly thought about religion - since it had changed.
His family actually found a book that had a collection f all of his music. And they told me that he did not have the opportunity to actually record any of them. So, with their permission, I started recording them. And before I recorded them, during my times with him, I would ask him questions about why he wrote what he wrote. And so, over a period of, you know, a couple months, I had recorded about 5 or 6 of his songs. And um, [getting choked up] it made him feel alive again - it made him feel important again. And all of his music - his family decided when he passed away, uh to send all of his music allover the world - because he was a world traveler —
Erica: Mmm —
Matt: So he had family and friends all over the world. SO, that was his legacy - was the music he wrote.
Erica: That is such a cool story, Matt. So very cool. In your work - I’m sure you give the elevator speech about what is music therapy, what do you do, etc, etc, etc. What are some misconceptions you hear about music therapy in hospice settings?
Matt: When people see a guy with a guitar in an assisted living facility, the - they auto-magically think, oh! We’re gonna get entertained. The things with uh being entertainers is they’re the ones who are performing. It’s a rarity to have entertainers that slow their music down so that someone can sing along with them.
Erica: Mmm —
Matt: Or, in the middle of a song go, hey, you know, we’re gonna morph into the different song because I’m seeing the questioned eyes that you have that shows that you have no clue what this song is [laughs] —
Erica: Yeah —
Matt: So I’m just gonna morph into something else here. You know, that - that’s what a music therapist is. We respond to whatever the needs are in the moment. And, that - that’s the fun thing about music is it’s very flexible - it’s very versatile - so you can change it on a dime at any given time. You can make it go fast, you can make it go slow - you can sing louder, you can sing softer - you can have just acapella, you can add instruments. I mean, there’s so many different things you can do with music right in the moment, and anything can be a source of validation.
And also, I think that, you know, whenever there’s physical symptoms, then the answer’s always medication - or, you know, I have to ask the nurse. There are situations where the nurses call on me and say, we have a patient who’s been experiencing terminal restlessness and hasn’t slept in 3 days, is there anything that you can do, utilizing music, to calm him down? So, there are a lot of times where my job is less companionship, and it’s more trying to help them relax. So I wil tune with their breathing patterns, with their body language, uh anything that I can see - anything that I can hear. And I will mirror the type of music to their breathing patterns and their body language and I’ll start to change that over time to where they gradually start relaxing, and getting quieter, and sometimes fall asleep.
Erica: Mmm.
Matt: All that’s done without the use of medication, which can be helpful.
Erica: That’s very cool, yeah. Um, how do you practice trauma-informed care in your work?
Matt: One of the benefits I have as a hospice clinician is that I’m part of an interdisciplinary team. On a hospice team, there is the physician, there is the registered nurse, there is the aid, a chaplain, the social worker, and me, and also volunteers. So there’s a whole set of people that are working on the team, with what we’re trained with, to focus on the patient to see how we can match those needs. With that, we gain a lot of knowledge on the patients - so, we get a lot of information upon admission. Usually the social worker and - and the nurse, and sometimes the doctor will visit with the family and the patient, and they’ll go through their medical history, they go through their emotional history, their mental history, their spiritual history. When you bring together all that information, then you can start to understand who that patient is - what their needs are - and you can steer away from the things that might be a conflict, and you can go towards things that are naturally going to support that patient and that family.
So yeah, [jingles a bell] for example - for those of you who are listening, I have a - I have a jingle bell in my hand I’m gonna tell a story about. A few years ago, towards the end of my internship, I was working with a woman who, you know, I was letting her know that um this was the last time that I was going to see her, since I was uh completing my internship and getting prepared to move to Minnesota. And uh, she said, oh, I wanna give you something. She goes to the Christmas tree and she gets a Christmas ornament. And she gets a pair of scissors and cuts the bell, that I have in my hand, from the Christmas ornament, and she handed it to me. And she goes, now you have a bell, and I have this ornament, so we’ll al - we’ll always be connected, even though you’re no longer gonna be able to see me. I wanted to give you something, because, out of everyone in the hospice team, you’re visits were something I looked forward to every week, more than anyone else. You know, it was always depressing to uh continue to hear questions about what’s my appetite like? Do you have pain anywhere? You know, all these different things that make me think that I’m dying. But every time that you came, all you did was you were just here with me. We had fun. I got to sing, I got to dance in my uh chair, I got to play with musical instruments - play my favorite songs. And every time that you came, I totally forgot that I was dying, and I wanted to thank you for that.
Erica: Mmm.
Matt: I don’t know what heaven’s going to be like. But once I get up there and figure out what’s going - going to happen, I will help you as much as I can from the other side.
Erica: Ohhh —
Matt: Again, I’ll have to figure that out when I get there —
[Erica chuckles] —
Matt: But if you don’t have your bell on you, then I’m gonna be extremely mad. You better have your bell on you [chuckles].
Erica: Okay!
Matt: SO, for 2 years [jingles the bell], I’ve always had this in my pocket whenever I’ve uh done hospice work —
Erica: Ohhh —
Matt: To remind me why I do the work that I do.
Erica: That is so cool - and what a gift. That’s very cool.
Matt: Hospice work has taught me how important just songs in themselves are. Are had an experience of getting a call at the office, and uh one of our nurses at one of our - you know, one of our patient’s homes, said, hey, Matt, is there any way that you could stop by? I know you haven’t seen him before, but you know, our patient, he really wants a male music therapist - which we have - and he wants to hear these 3 specific songs. He’s been terminally restless for 3 days - he hasn’t slept for 3 days, but he was talking to his brother, and they selected 3 songs that he wants to hear, you know, for his funeral. And I was like, okay, well what are the songs? So she told me.
Uh, so by the time I got there, I already had my guitar out. I introduced myself - here I am - and I started playing right away. And the thing is, he - he really loved it. He was struggling with terminal restlessness, which means his consciousness was going in and out - he was having hallucinations - but he was also singing along, you know, maybe 60% of the time.
Erica: Mmm.
Matt: I sang the 3 songs that he wanted, and then I made a joke. I was like, hey, you’re not gonna hurt my feelings if you wanna just close your eyes and relax a little bit - you don’t have to be awake for this if you want. HE’s like, no, actually it’s been my dream for a long time to have a personal concert just for me.
Erica: Awww!
Matt: So I was like, okay! I’m gonna give you a personal concert - I’m here, you’re right here, and I’ve got hundreds of songs here. So I stayed for him for, you know, an hour and a half or so —
Erica: Mmm —
Matt: Um, just playing different songs, and being with him - being with his wife. There came a point where his wife asked him, you know, are you done with music? And he said, yeah, I think I’m done with music. So I pick up my guitar, I go to the kitchen to start my documentation, and he passes away.
Erica: Mmm.
Matt: So what that tells me is, again, the importance of songs themselves. He really wanted to hear those songs before he had passed away -it’s what gave him peace. He also wanted, you know, that experience - his desire of having one personal concert, you know, one last hurrah before he left.
So, you know, in hospice work, you have the opportunity to do something very sacred and very special. And, since everyone is different, that something special is different for everyone. And, as a hospice clinician, you just do your best to try to figure out what that is.
Erica: Yeah. That’s a really special thing that you do, Matt. It’s very, very cool.
Matt: You know, I have a lot of friends who are music therapists in different populations, where they spend, you know, hours writing out treatment plans - writing out what their specific goals are - how they’re going to approach those goals. Lot of thing with hospice is it’s the exact opposite. You go in without a plan. You go in hoping that you can respond, to the best of your capabilities, to whatever is in front of you.
Erica: Mmm. Yeah. We’re coming to the end of our time for today. Do you have any resources that you can share with listeners —
Matt: Uh, yeah —
Erica: If they want to learn more about hospice care in music therapy?
Matt: One of the main sites for uh specific music therapy is HospiceMusicTherapy.org. That is a really great source - uh resource that uh was founded by uh Russel Hilliard - he’s a music therapist who’s - he’s now the vice president of operations at Seasons Hospice, I believe - that’s a national hospice program —
Erica: Mmm —
Matt: Uh, but he’s the one who formed the Center for Music Therapy in and End of Life Care. He does a lot of different workshops to get music therapists uh certified to do specifically hospice work.
Erica: Mmm.
Matt: Uh, there’s resources there that have books that go into a lot of detail about what music therapy in a hospice setting is really like. So those are really good resources.
Erica: Absolutely, yeah. SO, I will link, listeners, the resources that Matt has sent me in the episode notes and also on our website. Our website is S as in Sam, C as in Cat, music Project dot org (SCMusicProject.org). You can also follow us on all social media @SCMusicProject. We encourage you to subscribe, follow, leave a review.
Thank you so much, Matt, for chatting with me today —
Matt: Yeah —!
Erica: And being willing to share your stories. Thank you listeners for listening. We’ll talk to you next time.
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