Hospice Administrators' Knowledge of Music Therapy: A Comparative Analysis of Surveys

ABSTRACT: This study compares results of surveys sent six years apart to 382 hospice administrators seeking their level of knowledge regarding music therapy for the terminally ill, whether or not they currently employ or would like to employ a music therapist, and what obstacles exist in utilizing music therapy in their agencies. The results indicate a need for music therapists to be able to address the financial needs of hospices and to include business aspects of the benefits of music therapy in their marketing endeavors to hospice administrators. Furthermore, colleges and universities training future music therapists need to incorporate end-of-life training in the coursework, practica, and internships to provide a pool of qualified music therapists for hospices to employ. Introduction and Literature Review Hospice and palliative care music therapy has been emerging in the past decade as a growing field, and many professionals have been presenting their clinical work at professional conferences as well as publishing their work in scholarly journals. Hospice is a philosophy of care where palliative treatment is chosen over curative treatment, and goals are to alleviate pain and discomfort rather than to strive for a cure. To access hospice services in the United States, a patient must be diagnosed with a terminal illness with a prognosis of six months or less to live. Hospices provide a myriad of services, and Medicare regulations mandate that the interdisciplinary team consist of physicians, nurses, counselors or social workers, chaplains, adjunct therapists, home health aides, and volunteers. Hospice professionals serve terminally ill patients and their families in private homes, nursing homes, assisted living facilities, hospitals, and in-patient hospice settings. Reimbursement for hospice care is provided by Medicare, Medicaid, private insurance companies, and Health Management Organizations, and non-profit hospices often fund raise in order to serve those who are not covered by insurance and have an inability to privately pay. Medicare requires that hospices provide professional services (i.e., counseling, nursing, etc.), durable medical equipment, medications related to the terminal illness, and bereavement services to patients' families for 13 months following the death. Music therapists have been serving patients with a terminal illness and their families and have documented their work in the literature. Much of the literature is rich in qualitative studies illustrating the uses of music therapy for people with a terminal illness. Several studies have shown how music therapy was used to increase relaxation, provide emotional support, bring families closer together, cope with anticipatory grief, and provide spiritual support (O'Callaghan, 2001; Salmon, 2001; Weber, 1996; West, 1994). While music therapists utilize a variety of techniques, several studies explain the use of Guided Imagery and Music (GIM), songwriting, the creation of musical profiles, and the planned gifts of songs to loved ones or for memorial services (Erdonmez, 1995; O'Callaghan, 1989, 1990, 1995, 1997;Skaggs, 1997; Whittal, 1991;Wylie & Bloom, 1986). Cognitive-behavioral music therapy techniques have been utilized to ease pain, anxiety, and depression and provide a frame work for grief support among patients receiving hospice care and their families (Hilliard, 2001 a). While much of the qualitative literature in end-of-life care music therapy consists of program descriptions, theories, and case studies, grounded theory and phenomenological research techniques have also been utilized to document music therapy for people with a terminal illness. O'Callaghan (1996) utilized grounded theory and thematic analysis to document the use of songwriting to provide emotional expression and support patients as they live out important themes in their lives. In another study, phenomenological research was used to identify emerging essences in music therapy sessions. …