Art, music and pet therapy - Today's Ancillaries, part 2

Nursing Homes, July-August, 1996 by Laura Bruck

Today's - and tomorrow's - consumer of long-term care services is demanding a more holistic approach to care - one in which the emotional aspects of life are considered just as critical as the physical. To that end, Part 2 of "Today's Ancillaries" explores modern approaches to art, music and pet therapy.

Overall Status

The therapeutic effects of art and music are well-documented. But in the nursing home, as in other health care settings, both still tend to be viewed more as diversionary activities than as bonafide therapeutic modalities. Nevertheless, a growing number of nursing homes are discovering the benefits of both art forms in achieving a number of therapeutic ends.

Music therapists are trained in a four-year college program followed by a six-month internship, and are registered through the National Association for Music Therapy in Silver Spring, MD. Medicare and Medicaid have been reimbursing for music therapy in long-term care, on a case-by-case basis, for over eight years. As with all ancillary therapies, music therapy goals, objectives and outcomes need to be spelled out specifically and in detail, especially when dealing with managed care payers.

Art therapists are registered through the American Art Therapy Association upon completion of a masters-level program and 1,000 hours of supervised clinical experience above and beyond graduate internships.

While some private insurance reimburses for psychologist-ordered art therapy sessions, third-party payers generally don't reimburse for art therapy in the nursing home, a situation that may change as art therapists seek state licensure.

Art Therapy

Art as a means of creative expression is a natural for the nursing home. Many residents are unable to express their thoughts and feelings verbally due to the effects of conditions such as stroke or dementia. The therapeutic effects of art are inherent in both the artistic process and in the artwork itself, a tangible finished product.

Art therapist, Katherine Kahn-Denis, MA, ATR coordinates a one-year private foundation grant aimed at training staff to incorporate various expressive modalities, including art and music, into their day-to-day work with the residents of Judson Retirement Community in Cleveland, OH. Much of her work is done on Judson's unit for residents with advanced cognitive impairment due to stroke and dementias. "I try to teach staff to seize the moments when residents are responsive and to recognize a reaction to art or music and take advantage of that reaction."

Denis uses a variety of media including paints, ceramics, natural materials and fabrics, to guide residents through everything from one-on-one painting sessions to group quilting projects.

Evaluative Uses

To the skilled eye of the art therapist, a piece of artwork can sometimes reveal clues about the severity of a medical condition that might not otherwise be apparent. This is especially true of residents with dementia, whose artwork can be used to help caregivers assess disease progression.

The three paintings in Figure 1 were all done by an Alzheimer's patient over a two-year period. "Despite intact social routines throughout this time span, her paintings demonstrated the progression of her dementia and functional losses," says Denis. She explains that artwork by dementia patients tends to have certain common elements that suggest organic changes in the brain: omission of essential features, an impoverished, cramped appearance, and multiple repetitions of lines or features, to name a few. In this case, says Denis, the progression of the dementia is suggested by the changes in the paintings: the short, "picky" lines in the background of the first painting, the second painting filled with fragmented lines, and the eventual disappearance of form in the third.

These paintings illustrate another important point - the need to know when the use of art becomes a source of confusion rather than of joy. Denis, who no longer holds art sessions with the resident described above, explains that, now that she is "in the throes" of her dementia, she no longer understands the function of a paint brush, and suggesting that she use one would prove frustrating and confusing.

Reminiscense

Both the act of creating art and the artwork itself can elicit reminiscing and socialization when verbal communication is impaired or simply not occurring. Artwork that depicts aspects of a resident's life story, for example, can serve as impetus for discussion, and can help "personalize" residents to staff who learn the story of residents' lives through their art.

Nonverbal Communication

Art offers a creative, nonthreatening means of expressing emotions that may be too difficult, painful or even frightening to express verbally: loneliness, isolation, loss, fear of dying, and so on. This is especially valuable when verbal communication is limited.

The self-portrait in Figure 2 was done by a woman with multi-infarct dementia and Alzheimer's who was able to speak only a few words due to expressive aphasia. After seeing the completed work, Denis asked the resident a simple question, "Are you sad?", to which she responded with a resounding "Yes." The self-portrait proved to be this resident's sole means of communicating her feelings, and this visual expression provided Denis with a way to "see" how she was feeling and to initiate verbal communication about those feelings.