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AH: Hello, it’s Anita here, and welcome to the latest episode of this podcast. This time I’m talking with Bev Foster, who is founding director of Room 217. Room 217 is a social enterprise based in Canada that uses music to change the culture of care. And although that focuses on care for elderly people, it also goes beyond that, and we’ll talk a little bit more about that in a moment. Why I thought you’d be interested is that it’s an organisation that takes a particularly holistic approach to music in care settings. Rather than providing musicians it provides music training for care staff as well as research-informed products like conversation cards, music books and CDs. So that music can become an integral part of the day-to-day life of the home. So welcome Bev, and thank you so much for joining me, it’s really great to have you here.

BF: Thank you for having me Anita, it’s just such a pleasure.

AH: Oh, thank you. And it’s particularly good to be talking about something so positive at such a strange time for everyone around the world. I’m sure things are just as challenging over there in Canada at the moment?

BF: Absolutely.

AH: I was thinking that obviously it’s an incredible period of turbulence and change, I wanted to say early on that we won’t be focusing on the pandemic because I’m hoping that we can take people’s minds of this, at least for a little while. And I hope that’s OK with you Bev?

BF: That’s fine with me.

AH: So tell me about what Room 217 is, and how it came about?

BF: So Room 217 is a social enterprise – it’s really an arts organisation here in Canada – and we want to change the culture of care, as you’ve mentioned, but very specifically we want to improve the care experience. And by positioning ourselves there, with that vision, it means really, we’re addressing the needs of the one who’s receiving care, but very much we’re trying to help the one who’s giving care. And we actually use both of those lenses in our work – all parts of that care experience equation. So that’s really what we do. We do it through developing and producing music-care designed resources, through education and training in music care, as well as research and collaboration. So that’s the scope of our work. We really are clinical. We don’t go in ‘bedside’ or any kind of way where we take music in live. We have so many colleagues that do that and we like to support them as well through our education and training and some of the research. But we leave that to them. We’re addressing this great need in care in this unique way. And I’ll tell you why we’re doing it in this unique way. It comes from a very personal experience. Some years ago in a little rural hospital, just north of Toronto, my five siblings and I – my brothers and sisters and my mom – we’re around my dad’s bedside and he had an 18-month terminal illness. And music had played a big part of my coming around him, and coming alongside him in that. But at that moment in the hospital, all of us around his bedside, as he was dying, music became the thing which connected us – with each other, with him – it was a way we could bring him comfort. I guess I would say it was an experience of connectivity, of comfort and of communication. But you know the communication wasn’t so much in the form of words. It was through the songs, it was through the tears that came with the songs – sometimes even the laughter – the communication came, maybe not even through the words, because frankly we didn’t remember them all, but that wasn’t the point. The point was that we were joining together around dad at that time of transition singing the songs that were important and meaningful to him. And watched just how that visibly strengthened him for the journey that he was about to go on. And then how it actually connected us in this incredible way and it was a whole lot of years of experience with some of these songs. But it was very much in the moment. And that’s what music can do. It kind of brings times right to the forefront, and can trigger and call out memories, and just be there to help support in a time when life is being threatened or in some sort of complex care situation. So I had a very personal experience. And when I left the hospital that night, it was so moving to me as a professional musician, watching what it did for us and what it did for dad. I just wasn’t the same. I just went OK, this is just what happened for us. What happens with other families? So I had two questions when I left, Anita, the first was, is there anything more powerful than music to bring people together through the passages of living and dying? From what I observed, I just hadn’t seen anything in its trajectory in his care of the 18 months that was as powerful as that. But probably what’s motivated me even more is the second question. Do care givers, family, professional care-givers like the nurses at the nursing station who really had nothing to offer us in music, volunteers, do care-givers have access to tools, understanding and evidence about music in care? And so these questions that I asked myself that night when I left dad, they continue to be the mission drivers at Room 217 even today.

AH: Oh wow, what an incredibly moving founding story. That must really propel you to carry on with your organisation, no matter how hard it gets. It sounds as though it’s something really, really important to you personally, and that always makes for a more powerful organisation I guess. What were you doing at the time? Were you a professional musician or did you work in the care setting?

BF: My background is as a music educator. I worked as a music teacher in an elementary and high school, and I had my own private studio for years. So that’s my professional background. I guess my connection to care – a couple of connections – I guess I’ve always seen in my craft as what I do in music. It actually is an inherently caring kind of thing. It’s got an element of care in it. Whether you’re teaching music, whether you’re performing music you’re connecting with other people and because music is so powerful, and reaches every part, I’m intimately aware of that power. So you do music full of care I guess you could say. And that’s how my approach has always been. But specifically with care settings, it’s always, always, I just can’t remember when I haven’t done it even as a teenager at my own school, but when I was a teacher with my studio, we’d always go into care settings and do concerts and some one-on-ones. My grandma lived in a long-term care facility for 15 years and that was just part of my weekly routine, was to be with her and most often it was in music. And I remember when I was a teenager, making at that time what would have been cassette tapes in the 70s. I actually made care tapes for people – friends, neighbours and family that may have been sick. I guess, looking over my shoulder, back through my life, it completely makes sense why I’m here right now. I was also playing professionally at the time when you say that this started, so I had a number of contracts professionally as well as a professional musician. So all of that to say has accounted for this work.

AH: Amazing, and particularly the mix-tape things, for personal care. That fits so well with what you’re doing now. So what happened first? What happened after that moment when you left with those questions in your head? What was the next step?

BF: The next step was just crystalising at least an idea I could pitch. So I mean my real interest was, and continues to be, in palliative and end-of-life care. And so I really just worked out some questions and pulled together an advisory group. A palliative doctor, a palliative nurse, and some other more allied professional people in palliative care and met with them and just asked some questions. I met with palliative music therapists.

AH: How did you get those people together Bev? Because often it’s hard getting your foot in the door. I know from the music organisations that I work with that sometimes it’s just hard getting even a conversation with people.

BF: Well we simply asked, and I think it was an idea. You know at that point you just say, ‘I have an idea’, I’d really like your advice on. That’s always a great way to go in is, ‘I need your advice’. That was no word of a lie. I needed their advice as this was not my world. So that was our first step and I guess tangibly speaking we then made a demo recording of what it might sound like to have some music that was made and designed especially for palliative care. And so identifying some of both the production and therapeutic values. And these were the kinds of things I was trying to understand from the professionals. So things like, we decided to use familiar music, and because there are some schools of thought that you don’t use familiar music. You use music that people don’t know so that they can actually be released into the unknown. But our interest was more in the psychosocial and spiritual care so it made more sense for us after chatting with this advisory group to use familiar music which really helps make associations, helps with life review, and in a sense can blanket people in the comfort of what they’ve known. And so that’s the choices we made. We decided to perform the music at 60 beats per minute which entrains with resting heart rate or synch’s up with resting heart rate. So in other words, our music’s going to be really on the slow side so more sedative, not a stimulative. We decided we were only going to use a few, in terms of the texture, a few instruments. It wasn’t going to be some phonic-thing, it was going to be gentle. So yeah, some of those kinds of decisions that you make early on inform then how the performers perform, and inform how we actually then message what we’re doing to the care world.

AH: And so it started off with this idea of providing a product for care homes?

BF: Well yeah. Think of it more like a tool. Because there we were in the hospital, sorry, I go back to my own experience. But there we were in the hospital, and with all due respect, dad had been in the large, terminal hospital for, you know, for a hundred nights of that 18 months, and not once had he been offered music. And it’s not a diss, it’s just an observation, and the more I asked, no one knew what to give, right? It was more about trying to define something.

AH: Interesting. So how did you start the part of your business that is now quite prominent, which is that whole thing about training care staff?

BF: It’s such a fascinating story, and I’m sure one day I will write it down. I’m an educator, so for me, important moments are when people go, ‘Oh’, we call them our ‘How moments’ right? Really, people don’t know what they don’t know, myself included. So what we did is we created these first three albums – this was in the mid-2000s, 2005-2006, and I basically went from province to province in Canada to hospice palliative care conferences and our national conference. And I just really found my tribe. What an incredible group of people, just phenomenal really. And I guess it was just timing. That the timing was absolutely right, and they were hungry for … so I would go and do workshops with the albums, but broaden the topic more to music and care and music and hospice care. Not so much about our albums. I mean our albums were part of the conversation, just a small part of it. It was more about how to use music in care, and how to begin to integrate it. And if the truth be told, I’m learning as I’m going at some levels. Although, yes and no, I mean it’s fairly intuitive for me, a lot of it, as I say from the background. But continuing to learn. In fact, as an aside, I actually did a Masters in music education and health at the Toronto University of Music and Health, you know they have a health research laboratory. That was really formative too and a bit of a part of the story of the education. But as we started, that’s how we went. Because I really, firmly believe, because we actually started a social enterprise from this, you have to be building relationships in this care world. It’s really about that. People understanding who you really are, and what you’re trying to do, and building the relationships, and us understanding who they are. And actually leveraging a relationship so that they can begin to use some of the next products we create. And that’s sort of how it’s gone. So those first couple of years, I bet you I did 125 events of some sort. It was intense, for sure. But you know, one of my new colleagues in this world, from Edmonton, he sat me down and he said, ‘Bev, you know you really do have the wrong model.’ Now I’m talking about the business model. I’m coming to the story of music care training, because it’s all part of the story. So at that time I had an incorporated music business, from my recording, and we had just made Room 217 a division of that. It was our easiest way to get it going and have some integrity as a business. But it was a for-profit business, and I mean it didn’t exactly match my goals for this. Anyway, he sat me down, because we’d had several conversations, and said, ‘You know, you’ve got the wrong business model, you’re actually a social entrepreneur.’ So in 2007 in Canada, that was a very new term. Maybe not so much in the UK, but here, social enterprise was relatively new. So I had to look it up and went, ‘Oh yeah, that is exactly, that describes it.’ So my husband and I went to a charitable lawyer and we sort of talked through the vision, and he gave us a particular kind of model, and it’s exactly the right model. So in 2009 we began this. And I’ve got to say, the day that we decided. Because I mean for me to make the decision I made to do this, it’s impacted some of what else I did as a musician. I didn’t have time to do it all, I mean there was just so much opportunity in what we were doing with Room 217. But the day we decided to do it, you know in 15 minutes I sat down and wrote the vision. And education was a huge part of it. It was, you know, really part of one of the prongs of the three-pronged approach we take – resources, education and training, and research and collaboration. So that was easy. We’d already been doing workshops and that sort of thing. So now we just went, ‘OK, so now let’s really build into this.’ That’s how that sort of started. It was really out of the need we’d discerned from doing all of those 125 workshops and speaking across the country in those first couple of years. We sensed there was a hunger, we sensed there was a need, and so we just began to work at that. And the training actually came out of, because it’s a story that has a continuum. Because we did have our first conference in 2010 and it was a huge success. It was a one-day conference, and just overwhelmingly what the call was from the people at the conference was that actually, music is more than entertainment. Music actually has this healing, therapeutic capacity.

AH: So what stage was this in your business Bev? So you’d released some recordings and you’d already started working with some care homes?

BF: Yeah, so, yeah. That was we did that, just that, for about two-and-a-half to three years. We launched the foundation in 2009 as its own entity, as a social enterprise. You know, we had to get charitable status, all those due diligence pieces for compliance. So you can’t skip those steps, those are really important. But we did our first conference in 2010. What happened after that conference is that people said, ‘Let’s, we’d really like to do this again, but could you make it a three- or four-day conference?’. And you know what, I’m just not interested in that. I think for us, when you’re doing something with music you want people to have an experience, and that’s how we’ve really designed it. You’ve been to ‘The Power of Music’ conference in the UK, and they’ve taken our model and shaped it for your culture. But generally speaking it’s the same kind of experience, it’s a musical experience and a learning experience. So we really didn’t want to change that formula, but what we decided to do instead was to develop a whole education programme. So the first part we did was webinars, which we continue to do once a month, free webinars in music and care. And the second step was to develop a music care training programme. And then the third step was to develop an online training. And we wanted to do it in that order because there is something about our music care training that’s face-to-face, it’s incomparable really, you can do a lot online, but this face-to-face, there’s something about that that’s very strong. And so in 2014 we launched the music care training, which is a 52-hour learning programme.

AH: And this is for care staff, right?

BF: Yeah, well it attracts, who we’ve really created it for would be allied care professionals, volunteer care-givers, I think you call them carers, we call them care-givers here – partners. So anyone in the practice of giving care. But also it’s created for musicians who may want to, you know they may find themselves in a care space and they’re not quite sure how to approach it. It could be a community musician, it could be a faith-based group, that all of sudden finds themselves doing some kind of work in care. And we’ve really made it so that it levels the carers and the musicians to come together into learning a bit of a new vocabulary in music and care. And so it strengthens the outcomes we’ve found, because we’ve done extensive research on the programme, intervention research, but what we found for the care-giving side is that the training helps them with just becoming more confident to use music. On the musicians side they become just more understanding of the issues that people in care spaces are actually dealing with. That was a long-winded answer.

AH: No, that’s great, and brings me on perfectly to my next question, which is that from my own experience, personal and professional of care home staff and managers, there’s an interest often in music, but a real lack of confidence, and certainly in my mum’s care home, we were very lucky that there was an amazing woman – she was the entertainments co-ordinator – and she just integrated care into every part of the day. From the morning, kind of brushing the teeth to just singing in odd moments of the day, to actually having music activities based around music which might be a quiz or something. But all sorts of ways, but it was all on her. And the other staff would say, ‘I’m not musical’. And we hear it all the time in the music education sector don’t we, from other people, ‘I’m not musical’, so I’m just interested to hear a little bit more about how you give care home staff and managers, in the first place who hold the purse strings, the confidence to believe that they and their teams can do this music work with the people that they care for?

BF: Yeah, thank you for that question. Well, first of all we’re all musical beings, so it’s tapping into that, I think. And secondly, generally speaking, even people who may self-profess they’re not musical, they tend to appreciate music and love music. And I’ve found they’re the ones with some amazing playlists, so while those two things are true, how do we do it? I guess I’m a firm believer that we can all use music in care. And I want to be careful, just to say, while that is true, there are people that are real specialists at this. And to say that we can all use music in care does not negate anything about their specialisation or expertise. In fact in my view, it makes it even sweeter and more necessary. So we’ve developed, I guess you could say, an approach and this is all done through the help of just a brilliant music therapist who we hired to help us write the curriculum, you know we did quite a bit of research around it, this whole music-care approach. So it’s not a scope of practice. We’re not talking here about somebody getting a degree in music care. It’s not what it is, it’s an approach. Much more like a palliative care approach. Everybody in the palliative care experience – family members, neighbours, volunteers, doctors – everybody can use the approach to care. And that’s much more what music care is, it’s an approach. The basic philosophy is that we can all use music, with intention, to help improve the health and wellbeing of ourselves and others. And I think it’s the ‘with intention’ part that’s the basis of our integrated model of music care. And the ‘with intention’ implies that you’re going to have some training. Because what we really have to say, right off the top Anita, is that music can also have an adverse effect. And we have to understand that it can set some things in motion that aren’t so pleasant. And so, knowing that and we want to be, you know, as intentional about learning how to do it, so it won’t go sideways or adversely, right? So that’s the basis of the philosophy. In terms of our training, and of course everything we do is piloted and tested and all that kind of stuff, so we piloted this with some caregivers. And the general flow I guess you could say, of the three courses. So level one, which is like a baseline course is the theory and the context and the application I guess you could say of music care. So again we just learn a language, we learn about our 10 domains of music care, how it gets delivered, which I’ll talk about in a moment. But the key takeaways are 10 simple strategies that people can use to integrate care. Every single day into their care practice, with confidence. We’ve had people that would come in through the door [and say], ‘Don’t make me sing. I’m not a singer.’ So we don’t make them sing, but we actually encourage them with some other strategies. By the end of the two days, they actually are singing. And they just actually realise that, you know, they’re not being adjudicated – it’s a whole-time situation. So that’s the first level. The second level – and I should just say to you, in level one we try not to make it intimidating. We really want it to be an inclusive, comfortable situation. In level two though, we really ramp up the evidence in the sense that, not that level one isn’t based on evidence, we don’t talk about it too much. In level two it’s really all about the evidence. So, not everybody goes on to level two. But people that are writing programmes, or who need more rationale perhaps for what they’re doing, will take level two. And it’s about music and whole-person care, and by that I mean that fact that music actually can penetrate and reach deeply into all human experience, and all of our dimensions. And we define that as biological, emotional, cognitive, social and spiritual. So what we do in that is look at 10 effects from the research literature that music has on those five domain areas – two in each domain. And then for the 40-or-so, we’ve had about 1,600 people in Canada and the UK take level one, and we’ve had about 450 take level two, and about 40 at level three – so far, since 2014. And this is all delivered live. And so level three what we do, by this point, people are pretty keen. The course is called, ‘Becoming a music care advocate’. So what that implies is that you’re going to become a ‘change agent’, you’re going to change the culture of care in your space with music. And what we do then – it’s a bit of a different model – this one isn’t so much face-to-face, it’s done more through mentorship like ‘phone calls, you know and Zoom and that kind of thing. And we work with the students to really help them get their, what we call ‘music-care initiative’. It’s a project they’ve been doing all through the first and second course, and actually get them to implement it fully by level three. So we give them 10 tools for music-care advocacy. So really, you can take the whole course in 52 hours, and you come out with 10 very practical strategies, 10 rationales and reasons from the research literature about why music works, and then 10 practical tools for advocacy in your care setting. So it’s a pretty comprehensive programme.

AH: It sounds absolutely amazing, and that’s why I was so interested to talk to you when I heard you talking at the Nottingham conference, ‘The Power of Music’. It’s just such a really interesting model, and clearly because you have those ‘agents of change’, will have a massive impact. Can people in the UK access that training – and I know you’re working with the amazing Opus Music who are based in Derby?

BF: First of all, the ‘Power of Music’ conference is going to happen again in 2021, in fact I just had a call on it this morning. No date’s been set yet, except that we know it’s going to be in the fall of 2021.

AH: And this is the conference organised by Nottingham University?

BF: Yeah, and I want to bring up the University of Nottingham because it was really their vision in the first place. Dr Schneider and I met at the International Alzheimer’s conference and she said we have to get this training to the UK because to her knowledge there was nothing quite like it. And so the University of Nottingham actually invested in bringing us over, I would say through them we’ve probably trained 60, maybe 75 people in the UK in level one, and about 30 in level two. And we haven’t done a level three yet with anybody from the UK. But, it certainly got it started. And it was a great opportunity because you know for us, we would absolutely have to find a UK trainer. Like there was no way this would be sustainable for us going back and forth. And we’ve toyed with the idea of putting it online, although it’s a very, very powerful in-person training, so seriously Covid-19 has made us look at that. But we haven’t come to any conclusion yet, we still would really, really like to deliver this in person. And particularly in the context, in people’s care homes, care spaces or hospitals. So in that time-frame while we were at Nottingham, my mission was to find who could we find in the UK that we could train and they would be our trainers for the UK. And we came upon, you know we looked at various groups, but we came across Opus Music. Just a brilliant group of humans, first of all, but phenomenal musicians. But they also, their whole approach, first of all they practice something called ‘health-care musicianship’ – they’ve been trained, it’s an apprenticeship training – so we really admired their model. Part of what they do is reflective practice as well as education. They are very interested in workshops. Then I guess, more of our values and visions lined-up and so we’ve just enjoyed getting to know Nick and his team at Opus Music, and they have just done such a fantastic job. And thanks to Nottingham University for facilitating the handing of the baton in that sense. We’ve been able to train them in the various levels and they’ve now done their own trainings over there with our music-care training. So if any of your listeners are interested in the training they could reach out to Nick at opusmusic.org. They’re willing to work with you, and as I say we’ve been toying with how to maybe do this remotely. We’re not sure, but I think it’s worth a conversation. In terms of our webinars, the time difference would be a bit wonky, because I think you’d be taking our webinars at night. But those are free once a month, they go 10 months of the year from September to June, so anybody in the world could take those. And we’ve just this year launched our online studio which is called the ‘Virtual Music-Care Learning Studio’, and we have a couple of courses, and we’re actually going to launch another one in June and two next fall. So these are courses that people can take to dig deeper. That’s the whole point of those. It’s a dig deep kind of time around a very specific topic.

AH: Ah, so basically there’s the free webinars which give people a flavour and the online courses take it a bit further and give a bit more information in depth. But then the full set of courses for people to eventually become advocates are those three-pronged face-to-face learning.

BF: That’s right, well put!

AH: Good. That sounds fantastic. So I hope people who are listening will kind of investigate that, have a look at your website, and also contact Opus Music. Can you tell me a little bit more about the shape and scope of the training model in detail? How it works, how much time it involves, how many people it involves?

BF: Sure, so I’ll maybe just refer to level one at the moment. It’s a 14-hour training over two days and it happens in four modules. We look first, as I say, at the theory and context, and then we look at two really important topics. One is music and entrainment and the sound environment which is a pretty hot topic I think in care spaces, just the general ambient sounds and environmental sounds and that sort of thing and how do they impact on people’s wellbeing. There’s a lot of research on that and we offer a lot of good background to that. And then the third module we focus on breath and voice, because we believe fundamentally that our voices are instruments of care and as we learn to use those with even more effect, we can certainly connect and come alongside people in ways that we never potentially imagined. I’ll give you an example of that. We were doing a training a couple of years ago, with a large, long-term care operator in Ontario, and I think they’re in another province, but we were doing the Ontario training. So we did the training, and the very next day, one of the attendees emailed us back and said, ‘I just can’t believe it works that quickly’, but she was taking one of the residents in this long-term care home, I guess it was bathing, and the resident always resisted, was always agitated. So she actually took her to the bath and back and hummed all the way one of this resident’s favourite tunes and she said there was zero resistance. She said it was like a miracle pill. So can you imagine the training? Just teaching somebody how to hum? There’s an improvement in the care experience, right there. That’s what we’re about, is teaching these, from a musicians standpoint they’re not even difficult, but they’re not things people think about. So it’s about giving them the training, but also the confidence to use it and contextualising it for them and then these changes can occur. So, and then the fourth part is, as I say, the 10 strategies and we spend the whole day at that. But the key strategy is creating a music-care initiative. So that can really be anything that matters to your care context and matters to you, but that you’ve got to do something. It’s an applied sort of thing, you can’t just come and talk about it you’ve actually got to do some things. One I can tell you about that’s just happened in the last six months, it’s extraordinary. It doesn’t sound like much, but it’s an incredible impact. So their music-care initiative, in this particular context the training was in its own care home, like one care home did the training. So 24 from the same place. So the buy-in from the care staff was amazing because the programme or the initiative they wanted to do was called ‘Music at mealtime’. And this particular long-term care home, I think it was 232 residents of something – it’s a very unique one – it’s virtually all adult, mental health residents, younger adults, so it’s a very unique group anyway. In that situation mealtime was often difficult so they thought, ‘Let’s see if we can create playlists, and get everybody’s preferences on the playlist and play them very strategically’. So they did that, very scientifically as a staff, and they began the programme. And their stats were just incredible. I mean things like people had gained five pounds, I’m talking about residents because they’re now eating, there’s less falls, there’s less food fights. You know there’s some real quantifiable differences and all from a very intentional programme using music that the staff has developed together with the residents. So that’s our happy place. And we can work with a staff or a care worker and actually come up with some ways to use music that’s appropriate for their context of care. Where you’re really meeting a need.

AH: That sounds amazing to me that in the space of two days you can take people from that totally uninformed and probably not very confident to having a kind of action plan. And I’m really interested to hear about this evidence that you’re getting back from your programme, because I was going to go on to ask how you evaluate the impact of your work, and I’m sure you’ve got so many amazing stories of change and improved wellbeing. And sometimes it’s those other sort of harder, small pieces of evidence, like putting on weight, or less behaviour incidents, or other things like that that tip the balance with somebody deciding to take on a programme or not. So how do you evaluate the impact of your work?

BF: It’s a great question, and it’s one you know, like when we started this, it’s the one thing if I could turn the clock back, I wish I’d put the measures in right from the beginning. But you learn how to do that as you go. And certainly we’ve had phenomenal qualitative and anecdotal evidence – we’ve always had that right from day one. But it’s how do you get the more quantifiable stuff over time, like weight-gain and that sort of thing. So I don’t want to mislead you that we do have a pre-test and post-test for the training. A lot trickier for us to follow up with everybody on the results, but the programme I was referring to is a very specific programme called ‘Music Care Partners’ and that’s been funded by the Ontario Trillium Foundation and it’s been actually a four-year programme, but at the moment we’re in 24 – this two-year section of the programme – we’re in 24 long-term care homes. It’s been very much evaluated from top to bottom. The challenge for us moving forward, for that as a programme that’s not a funded programme, is we just know that in long-term care people don’t have a lot of time. And you really want the people focusing their time on residents not so much on numbers. How we’ve done this particular evaluation, and I’m very excited about it, we’ve used some validated tools in the process. We’ve partnered with McMaster University in Hamilton on this so some of their science students we’ve invited them to help us do the collecting of data. The long-term care homes have loved that, they don’t mind that, because it’s not on them. But then we’ve also used YMDS data, I’m not sure, but there must be an equivalent in the UK, I’m not sure what it is, but it’s the standard way that long-term residents are assessed on a month-to-month basis. So we’ve been able to integrate that information as well in our evaluation, which is fantastic, because that they do collect. So that’s pretty exciting. The other exciting piece, but we haven’t got the results yet, they’ve just been done. But it’s our first time, it’s our first programme that we’ve ever done a cost-benefit analysis. We’re really trying to show that using music can actually lessen the cost. Like you take the one I just told you about, the Music at Mealtime, they didn’t have to use as much food, they didn’t waste as much food. So some of those numbers, when you think about cost savings, we or all of us in this line of music and health, we need to be showing these numbers so that people can actually have more evidence than simply anecdotal evidence. It’s all valuable, but to tell the whole story I think we need all of it.

AH: Definitely need both and definitely commissioners and people who hold the purse strings are influenced by different things aren’t they. There are some commissioners I’ve worked with who have surprised me because they just want to know the stories and don’t care about the statistical evidence and then there are others who will only be influenced by cost savings. So that’s really interesting that you’re beginning to gather that kind of evidence. And in terms of advocacy to people, I was also going to ask you if you had any lessons that others can learn from about how you market your own work and advocate the importance of music to care homes?

BF: Yeah, so a lot of that is done, we have a very comprehensive website that gives a lot of information. We do a lot of going to conferences. It’s very important for us again to be shoulder-to-shoulder with care-givers, with care providers. So we go to hospice kinds of gatherings, we go to long-term care gatherings. We might go to a gerontology gathering, we might go to an ageing conference and try to present at it, sometimes we’ve keynoted at it, but at least do a workshop or have an exhibit, that kind of thing. We hired this year, we wanted to test this, and it got quickly stopped in the spring by Covid-19. We did hire a music-care consultant this year and the purpose of that role on our team was somebody would go and actually get out of the office and go and visit right into the care homes. And I think he got up to 300 before Covid-19 hit. Mostly here in Ontario but he did another province as well and we were hoping to test that out. For us it’s not just about selling, it’s not about selling so much as it’s about resourcing. We wanna resource people, we wanna provide the tools. Like I’m going back to the first question. Remember those two questions I told you, do care-givers have access to tools? And the answer is, you know there’s not a lot out there that’s really targeted and I would also have to say that’s of good artistic quality. So those are of course our interests. I guess the other thing is we’ve done a bit of digital marketing and it’s definitely going to be the next frontier for us. We just need to really gain more mastery over that, and we recognise that. But certainly, the first 10 years of Room 217 it’s all been about developing relationships and developing content. You have to do it over time, building relationships and really paying attention. You can get a lot of opportunities come your way, but which ones do you take? And I have to admit that day that I met Dr Schneider, it changed a lot of things for us because it began a whole new set of relationships with the University of Nottingham, and subsequently with Opus and some other groups like Dementia 2020, and Live Music Now, and some other groups in your country, and now I’ve met you, you know, and these are important. You can’t skip these things. But you also can’t do everything, so you have to measure which opportunities, you’ve really got to stay true to your vision. And we don’t apologise that we’re not clinical. We just aren’t. I would also say that it’s really important that all of us in music and health, and the important role that you’re doing here through education, that we work together on this. There’s such a big need. We all need it.

AH: Definitely, and that’s where that conference was so brilliant because we all got to have really proper, rich conversations about it, and we need to wrap up soon so I wondered if I could go on to a couple of questions from Twitter? Liv McLennan, who’s a community musician here in the UK, she specialises in working with people living with dementia and people living in care homes and asks, ‘I’d love to know how Bev finds the challenge of integrating music and musical behaviours into the care system?’. She says it’s very challenging in the UK as the care system can be quite hard to work with as a freelancer, ‘How does she approach it?’.

BF: That’s a very good question Liz and it’s exactly why, in my view, music-care training is so essential. Because the only real way we’re going to get music integrated is to have the care staff buy-in. So whether you’re a community musician like yourself Liz, or whether you are a music therapist, you’re not going to be there 24/7. Maybe you’ll be there a day, maybe you’ll be there an afternoon, maybe you’re there two or three hours, but the people that are there all the time – they’re the ones, if we’re really going to make it sustainable – they’ve got to learn some skills. And really I would say, you may not be able to give them standardised music-care training but begin to see them as your allies. Begin to see them as the people you’re … there’s a word called ‘discipling’ right, like you’re making mini-disciples of yourself in that sense, you’re showing them how to do it. So yeah you go in and do what you do, but you wanna bring them alongside, and through modelling even, show them how to actually integrate it. It’s wonderful that you’ve got that opportunity but there’s no question that it’s a challenge. We do have one of our courses on the Virtual Learning Studio is recruiting musicians for health and social care and with that course comes a really helpful handbook – both sides, if you’re a musician going in, but if you’re an administrator of a care home wanting to hire a musician – that’s probably the tool that we could help you with.

AH: That’s a really great answer to that question, thank you for that. And then Fiona Thompson, she’s actually a harpist and also a copywriter and asks, ‘I’d like to know whether Bev thinks it’s important to use music that people with dementia can relate to – the music they know and love – or whether all kinds of music can be relevant?’.

BF: Fiona, that’s such a great question, and it’s almost a topic for another whole meeting. But I’ll try to keep it short. We all have musical stock, right? The stuff that’s accompanied us through our lifetime. And so when you play the familiar for people with dementia, typically it can wake them up. It can, from a neural perspective, actually align neural pathways because the music may have accompanied some life event. And by playing that music it can realign the pathways that may not have died because in intervention we know that musical pathways can be retained. And it actually then takes them right back to that event. So in some ways using familiar music is exactly what you want, you know it can help trigger memory, it can help trigger conversation. I’ve watched it wake people up. I’ve also watched it trigger painful memories. You just have to be really careful. You know, what I would say if how to respond to that is beyond your scope, beyond your ability to deal with, then you really need to have sort of a B-plan and somebody like a music therapist or social worker or chaplain or somebody that you can refer that situation to. But there is a case to be made for unknown music because we also know that people can continue learning and can continue making new neural connections even when they have dementia. So that’s a very short answer to a really great question, and it’s a big one.

AH: That’s really interesting, thank you for that. And finally, can you give us three practical pieces of advice for others working in music and health or social care who are listening?

BF: I’d like to do that, especially for care folks that are listening, and the musicians that are listening too. But the first thing that I would say, this is one of our demystifiers for people that are really anxious about doing music. The priority of music in care is about presence, it’s not about perfect performance. So I think that’s a really, really important piece. It’s about showing up, and being human, and being present for somebody else. I’m a musician and I’m a musician who cares about good quality and good artistic execution and all that sort of stuff. But what I’ve found is putting the priority on human presence does a whole lot of things for everybody. That’s another one I could blow out of the water in all directions, but I’ll just leave it at that. The second thing I would say is don’t feel that you’ve got to do it all at once. Start with one song. That’s one of the strategies we teach, it’s called the ‘One Song Method’ and we just encourage people to find a song, or a part of a song that you’re really confident with, like something you’d sing in the shower, something you’d sing in the car with your kids, and they wouldn’t ask you to stop singing, you know what I mean. It’s the kind of thing that you wouldn’t be afraid to, so it would be something like, [sings] ‘Lean on me, When you’re not strong, I’ll be your friend, I’ll help you carry on’. It might not even be that much of a song, but you take that much that you’re confident with and begin to integrate it, adapt it, whistle it, hum it, sing it, see what happens. Play with it. Sing it fast, sing it slow, sing it loud, sing it soft, and see what actually happens. Begin to play with the whole notion of music and care but using that one piece of song that you feel comfortable with. And then the third thing, which is probably a no brainer – is make some investment, some personal investment in tooling up. Whatever that is, you know, whether it’s coming to ‘The Power of Music’ conference, taking an online course. I gotta tell you, the Music Dementia 2020 coming out of your country…

AH: Campaign, yes.

BF: Is very impressive. And if you go on that website, there’s a truckload of fantastic educational materials there that can get you started. To me it’s not even about investing money yet, it’s about investing time. Just go and search some things out. So get started with investing time and knowing some of those things.
AH: That’s brilliant, practical advice, thank you. And thank you so much for coming on the podcast, it’s been really inspiring. That lovely story you told about the start of this organisation is just beautiful. And then to finish off with those three practical actions is so helpful. And I hope we get the chance to talk again.

BF: That would be great Anita, and thank you so much for having me and I really appreciate the relationship we have with all of you in the UK. Sending our love and greetings to all of you through this pandemic.

AH: Thank you so much, and if you want to read more about Room 217 I will share the link to their website, some resources and case studies in the show notes. So thank you all for listening.

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