Therapeutic Benefits of Choirs in Long Term Care Homes
Shannon Westlake, BMT, MTA, BA
A group of residents gathers together in the activity room at the care home. Residents chat with their neighbours, joking and exchanging smiles and laughs as more people slowly filter in. At the front of the room is a music stand, CD player, and piano. Today is choir practice!
As a music therapist I always knew that I wanted to lead choirs as a part of my therapeutic practice. I grew up singing in choirs all my life and have a firm belief in the therapeutic value of choirs. At first, I wasn’t entirely sure how I would manage to conduct a choir as well as somehow accompany it, but I was determined to find a way. I discovered that using CD accompaniment (either karaoke soundtracks purchased, or soundtracks created myself using a program called Band-In-a-Box) allowed me to conduct the choir and lead it in a way similar to other choirs. Through the years I have been leading these choirs in three different care homes with clients with dementia as well as other conditions seen in long term care facilities and I believe these choir groups to be very beneficial.
For many residents singing in a choir is a normative activity- something that they may have done in the past and for those who haven’t been in a choir before, it is a concept with which they are familiar. Residents typically understand the structure of a choir rehearsal. This usually involves physical warm ups, breathing exercises, vocal warm ups, and practicing songs in preparation for a concert. This level of structure and predictability makes it accessible for those with dementia as they are able to follow along with the activities. Broken down, each of these aspects can bring different therapeutic benefits.
I believe it is important to involve the choir members in the decision making process of what songs we are singing. There are so many aspects of their lives they no longer have control over in residential care – when they eat, the activities they do, what they wear etc. This is a chance for them to voice their opinions and be heard. Together as a group we pick a theme for the upcoming concert (I use a show of hands for voting if the choice isn’t obvious) and then brainstorm song ideas and choose which songs we want to do. After I come up with accompaniment tracks for each of the songs I ask the choir for feedback on the key/tempo and other aspects of the track and adjust it to suit their tastes. In some groups, members are hesitant to voice negative opinions, but I have seen over time, as trust develops and I show openness to any opinion that they will more willingly voice their true feelings. This alone is a benefit to them I believe – what a great thing to have power and control over something in their lives and to have someone care about their opinions and listen to what they say!
I begin the rehearsals with physical warm us (rolling shoulders, and stretching the neck gently) and breathing exercises, as I find that this both focuses and relaxes the residents. Reminding the choir members to breathe deeply and sit in proper posture for singing can aid in other medical conditions that they may be facing. I have seen some residents who are often slouched over to one side in their chair, but when singing in the choir they make a great effort to sit up straight. As we take several deep breaths and sighs together and I can see the tension and nervousness dissipate in the room. Next, the vocal warm ups get the voices primed and ready to sing. Some residents may be hesitant to sing, but through the warm ups and lots of encouragement they gradually become more comfortable.
Although on the surface it may seem like singing songs just requires one skill- singing- it actually is a very complex process. First of all, residents need to remember the melodies of the song and produce them vocally. I always remind my choir members that this is a “no talent required” choir as many people are often shy of singing and don’t think their voices are good enough. I reassure them that any sound is good and that together all our voices will combine to sing the songs beautifully. Next, residents need to read the words to the songs on the page and follow along with the CD music and conducting. That’s a lot of multitasking and brain functions! Depending on the level of dementia, simply turning the pages at the right time and remaining on the correct page following the lyrics may be challenging. However, this challenge can lead to some beautiful therapeutic moments. I have often witnessed residents leaning over to assist their neighbors in finding the correct page. In addition, residents seem to improve in their skill to turn pages at the proper time as rehearsals progress and they become more familiar with the activity. As we sing through the songs we will sometimes stop to practice a tricky part and repeat a song – this is what makes it a choir rehearsal and not just a sing-a-long. Over the weeks I see the tricky parts visibly fade away, and I am able to draw the choir member’s attention to how much they have improved. I have even taught choirs songs that they had never heard before and within a few months they are able to sing it correctly! The sense of pride and accomplishment this brings them is beautiful.
I also find that the choir groups bring a real sense of belonging to the members. They are a part of a group where their presence is noticed and matters. There are some weeks where a few choir members are absent and everyone in the group can tell the difference. On the next week when those members return we are all able to say with honesty how much we missed them. I see friendships form between choir members who choose to always sit beside each other throughout the weeks and notice these same people interacting in the lounge or during other activities. I always love the beginning of rehearsals before we actually begin. A genuine interaction happens amongst members as they laugh and chat and find their seats in the group. We always keep our arms open to new group members and I make a point of introducing new people to the group and welcoming them. It is a great way for people who have just moved into the care home to immediately feel like they have a purpose, belong with a group of people and begin to make friends.
The choirs I lead have concerts every few months. This gives our rehearsals a purpose which holds together the whole structure- why practice these songs again and again if we’re not going to have a concert? But more than anything, this is an important part of building the residents self esteem. The concerts are a chance for family, friends, and other residents in the facility to come and support the choir members and recognize their accomplishments. The choir receives positive reinforcements and gains a sense of pride through this as the room is filled with their loved ones applauding. I have a person in one of my choirs who always gets very excited for the concerts. He will invite his family and friends and talks about it non-stop for days leading up to it. On the day of the concert he dresses up in his best suit and tie and greets me with the biggest smile. It’s so wonderful to see him taking pride in his accomplishments. For those choir members who may have been more hesitant and need more encouragement to sing each week, this concert is an affirmation that builds self confidence which can carry over to other areas of their life.
It is truly amazing how many benefits can come from one simple music therapy program. Through the choir ,residents gain a sense of control through choice, are physically and cognitively stimulated, form friendships and gain a sense of purpose and belonging, as well as improve self esteem and self confidence… all while having a lot of fun!