Music of Life: how music therapy helps in hospice

music therapist jenna justice

Music therapist Jenna Justice. Photo by David Reese

Jenna Justice of Frontier Hospice is a certified music therapist

By DAVE REESE, Montana Health Journal

 There’s a crumpled piece of yellow paper in Jenna Justice’s guitar case. On this small piece of paper are the names of some 20 songs, from Happy Birthday to Auld Lang Syne and The Yellow Rose of Texas.

These titles are not mere words; they are some of the last music that a client of Justice’s will ever hear before he dies.

The names of the songs were given to Justice by a client of hers in hospice care. It’s Justice’s job to help people in the last six months of their lives find peace, and she does this by surrounding them with her music.

Justice is a music therapist for Frontier Hospice in Kalispell. Music therapy is part of the entire hospice approach to creating end-of-life peace. Hospice is not a place where people go to die or spend the final days of their lives. “Hospice is a way of care,” Justice said. It’s a way of creating dignity, comfort and peace in a person’s dying days, weeks and months.

Music has a way of touching our souls like nothing else. In fact, the part of the brain associated with emotion is the same part of the brain that processes music. The part of the brain that holds musical memory is also least affected by brain disease, so as a person is dying, they will cling to their music, Justice said.

Justice, who has a bachelor’s degree in music and a master’s degree in music therapy, says music has a way of healing our souls, of bringing us to the cores of our beings in a rather immediate way.

She has watched over the bridge of her guitar as clients with ailments such as severe pain and respiratory problems were able to become calmer, and even sleep better, after participating in music therapy. A singer, pianist and guitar player, Justice sings or plays for clients. She lets the clients dictate how much of that should take place. Sometimes, the guitar never makes it out of the case and they just talk. Other times, a client might say “’Come on in here, honey, and play me a song,’” Justice says.

Music therapy is not about the notes or the music played. Justice described it as being about the relationship between the musician and the dying person. “The whole reason I’m there is to build a relationship,” she said.

Music therapy got its start in Veterans Administration hospitals after World War II, when officials began to notice that the patients in VA hospitals who were sung to by the nurses recovered from their physical and emotional traumas faster, Justice said.

She might use her music to spur someone’s conversation of life, to help them refocus their perception of pain. Or, she might use song writing with the client “so they can send a message to someone who is important to them,” she said. Justice also might engage the client in actually making music, which would help increase their sense of accomplishment. Another way to use music therapy would be lyric analysis, “so we can find songs that help mirror what they’re feeling,” she said.

Music therapy can elicit a few different reactions when families choose it for a loved one. Some people, for whom music did not play a large role in their life, might react to it with casual interest. Others want to take what they learned during a music therapy session — such as breath control or relaxation — and practice it on their own.

Hospice care is provided by organizations such as Frontier Hospice and is paid for by Medicare, Medicaid and private insurance. In order to quality for hospice care, a patient must have been certified by two physicians to have a life-limiting illness with six months or less to live. Hospice also provides support such as bereavement counseling after the person passes.

Music therapy is part of a team approach to hospice care, and that team includes a physician, nurse, chaplain, hospice aide and social worker. She assesses the patient for many issues, such as pain management, comfort, a life-review or respiratory illness, and then uses music therapy as a modality to help the entire team with their goals. “The goal is to look at the person’s whole end-of-life therapy,” Justice said. It’s important, Justice said, for physicians and families to contact hospice when a patient’s prognosis for living is six months or less. That way, she said, “We can better address all of their needs, from symptoms to family dynamics. It’s a whole continuum of care.”

Music therapy is one of the fastest-growing aspects of hospice care, Justice said. Music therapy is also used in settings where you might find other therapists, such as schools, clinics, and even prisons. Since music therapy is often not one of the core benefits of hospice care, local hospices usually decide whether they want to offer it. Frontier Hospice, which also has offices in Butte, Bozeman and Helena, is the only hospice organization in the Flathead Valley that offers music therapy, Justice said.

Justice began her career in music therapy after teaching music in the Washington, D.C., area. When she was working on her masters degree in music therapy she did a practicum in hospice care. “It was then that I discovered this was exactly where I needed to be,” she said. “I’m really fed by it.”

Her work helps her form close relationships with the families of hospice patients. “I feel so honored that people invite me into this most personal time of their lives. It’s extraordinary to be able to be a part of a family’s journey at the end of life.” That relationship often continues after the patient passes, and music, she said, “gives families a greater connection to their loved ones and their loved ones’ stories.”

The music is most always live, so that she can control tempo, key, rhythm, volume, and lyric content. “By doing it live I can control all of these things moment to moment.”

With all of the various kinds of music that a family might request, Justice said “My repertoire has to be pretty enormous.” One client might want reggae; another might want country. “I have to be ready for all of those,” she said. One day she might be gently strumming her guitar in a person’s final hours. Other days she might at the bedside of a person singing John Denver songs to alleviate his pain, “So he can die peacefully,” she said.

Music therapy was chosen by one family whose mother has terminal dementia. Justice arrives near sundown, when the patient feels particularly anxious, and plays music to help the mother relax. It also helps the family. “The family gets to take a deep breath and know their mom is being taken care of,” she said. Another of her clients has dementia and is unable to perform daily tasks such as personal care. But when Justice begins singing “You are my Sunshine,” her client is able to remember the song and sings right along. “We have such an emotional tie to music,” Justice said.

Hospice is meant to create what is called a “peaceful holding environment” for a person’s last moments, according to Justice, who also teaches music therapy across the country. Music helps create this safe space.

Justice remembers when she was first starting as a professional music therapist in Tallahassee, Fla. One of her hospice clients, an elderly woman, wanted to be taken to the ocean to see her beach house one last time. Justice sat in the back of the ambulance with the client and played music on the 90-minute trip to the ocean. They drove the ambulance out onto the beach and opened the doors to the ocean so the woman could hear the waves, while Justice played what’s called an ocean drum.

They drove the woman back to her house in Tallahassee, and within an hour she passed away. People ask Justice if her job is difficult, forming relationships with people she knows will soon be gone. “I don’t diminish the fact it’s hard work and it’s emotional work,” she said, “but the joy and peace I can provide with music therapy and the relationship I get to establish with the family far outweigh the hard parts.

“I know how important music is to me. I’m reminded what a powerful intervention it is.” •

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