Social isolation is a profound issue at skilled nursing facilities for low-income residents; a problem that has become worse during the recent COVID pandemic. Family visitation has been limited and maintaining adequate staff is a challenge. There might be only two aides covering a 60-bed floor. Residents are kept relatively safe and clean. They are fed. The staff often shows immense care and love. But the resources to spend quality time with residents aren’t available

Here is one story: Nora was blind. Aides got her up in the morning and dressed her but she sat alone in her chair until the evening when they undressed her and put her to bed. Her human contact was limited to meals and toileting. But then, one day, there was music. Then there were smiles and then foot tapping. Nora would see the harpist and say, “Oh! My friend is here!”

Add the issue of Alzheimer’s and dementia and we have a double deep isolation. It takes so much time to really reach someone with these conditions. It’s especially hard for overworked staff. Naomi Feil, founder of the Validation Training Institute has worked for decades with people with Alzheimer’s and dementia. She names the problem very well. “We have living dead people and this doesn’t need to be.” People are, too often, left alone to retreat deeper and deeper into themselves.

Music is a shortcut, a way in, a special kind of stimulant to help awaken. We all know this. We have witnessed it. There are films, studies, and research about it. We know it’s true—music can reach people. That’s why CompassionHarp exists.

This essay started with the challenging issue of elder care in our country, but we want to focus on something intimate and personal. Jayne regularly visited a resident at a skilled nursing facility; let's call her Barbara. When Barbara came to the facility about three years ago, she had dementia but was happy.

Over three years, her mental state eroded into a kind of paranoia. She was frequently upset, saying, “I’m afraid. Where are my children?” But when Barbara sings, she starts to focus and calm down. Jayne remembers, “She might take my hand and I can sit with her. The last time I saw Barbara she was very upset and confused. She would say things like ‘All the fathers are gathered in the corner.’ I said, ‘You’re upset.’ She answered, ‘Of course, I’m upset!’ When I asked, ‘Can I play my harp by you?’ she said something with the tone of ‘whatever.’ As I started singing My Bonnie Lies Over the Ocean, Barbara began singing with me despite her distress. Then I began to play Edelweiss. Startled, she turned to me and said, ‘It’s so beautiful!’”

“It’s so beautiful,” followed by tears. This reaction is a not uncommon experience when visiting with residents in long term care. Pamela remembers visiting with another woman, we’ll call her Linda. At the start of the visit Linda was tired but cheerful, happy to have the unusual experience of harp being played just for her in her room. Partway through a verse and chorus of I’ll Fly Away, Linda started weeping. Pamela quieted the music, asking, “Are you OK?” “Yes—it’s just so beautiful. I didn’t expect to have this reaction. I’m usually not so emotional. Please, please play some more.” Over the next 15 minutes, Linda released a lot of emotion—gratitude, wonder, sadness, and delight. “I didn’t know I needed this,” she said.

In hospice work, there’s something called, “breakthrough pain.” It’s what it sounds like: pain that arises even though there’s pain management in place. There are “breakthrough pain meds” to address it.

What happens with Barbara, Linda, and others can be thought of as, “breakthrough beauty.” Someone in the midst of emotional and mental anguish—or simple isolation and loneliness—can say, “It’s so beautiful” and “I didn’t know I needed this.” How is it that an experience of beauty can “break through” crisis and confusion? This is the wonder and magic of therapeutic music.

This is what CompassionHarp offers, moment by moment, person to person. We are interrupting loneliness, confusion, and suffering of elders who otherwise don’t have the means or access, by bringing beauty, the beauty of human companionship which we offer through our presence, through harp and voice.

The neurologist Oliver Sacks wrote in his book Musicophilia, “I have seen deeply demented patients weep…as they listen to music…I think that they can experience the entire range of feelings the rest of us can and that dementia at least at these times is no bar to emotional depth. Once one has seen such responses, one knows that there is still a self to be called upon, even if music, and only music can do the calling.”

“Music is part of being human.”

The Therapeutic Harpist and SInger creates an environment of peace and calm by which healing can unfold. For those who are impaired or ill, sensitively played and attentive live music can support breathing, reduce the experience of suffering around pain, aid in sleep and lessen anxiety.

It brings beauty and love to the heart and soul for the patients and family and friends. Often care givers will sit down and get a much needed rest while listening and often family and friends gather without the need to talk, just listening and ‘being with’ their loved one. Music can be wordless prayer and emotional support. Live music played intentionally with presence and care, creates ease allowing those at the end of life to ‘let go’ when the time comes.

“Music evokes emotion and emotion can bring its memory.”

In working with Elders, we find enjoyment, life and relationship through the experience of familiar music. Especially for those with Alzheimer’s and Dementia, music can restore memories as evoked through particular songs. We have seen raised spirits, comfort in musical companionship, words of lyrics sung, whispered, with sometimes just lips moving with lyrics as people tap into the stream of music they loved. Feet and hands are often moving to the rhythm. Unfamiliar music is also played for Elders and we see a wide emotional range: Joy in rhythmic music; reflection and sometimes tears in more subdued music.

“I have seen deeply demented patients weep or shiver as they listen to music they have never heard before and I think that they can experience the entire range of feelings the rest of us can … Once one has seen such response, one knows that there is still a self to be called upon, even if music and only music can do the calling”.

All quotes sourced from Oliver Sacks, neurologist, best selling author

For several years, under the direction and with the support of Chaplain Tim Dean, Pamela has been making weekly visits to the Behavioral Services Unit (the locked, inpatient psychiatric area) at Cayuga Medical Center. After a lengthy pause in services due to COVID concerns and precautions, Therapeutic Harp made a very welcome return. It's a regularly scheduled part of mental health intervention activity.

The hospital staff in this unit is grateful for her services. They greet her with smiles when they see her walk in. They warmly welcome her presence because they hunger for what she brings: an open-hearted invitation for all to join in a calmer, quieter space where breathing is easier.

Some patients with mental health or behavioral problems are not easily reached. Their emotional overload can feel exhausting, compelling, internally directed, and achingly lonely.

While playing, Pamela calms her own breath, centers her own body, and focuses her own energy on the healing properties of sound. She becomes part of this community as she plucks the harp strings. Those in the unit respond in kind. The soothing music draws them out. Bodies quiet as they listen. Patients isolated in their own rooms open their doors to hear better. Staff take advantage of the shift in atmosphere by scheduling a creative arts session during this time.

Pamela reports that the work has been deeply gratifying and affecting for her. I’ve been given some extraordinary gifts in doing this work. People have shared deep conversations about music. Sometimes patients share their art work with me. I’ve had some really beautiful interactions.

We so grateful that this partnership between Cayuga Medical Center and CompassionHarp is valued and continues. With ongoing support from CompassionHarp, staff and patients are able to rely on professional services that so clearly offer healing benefits that augment medical care.