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Comfort. Memories. Contentment. Joy. To the staff at one nursing home, giving these gifts to elderly residents is as intuitive as using an iPod. 

By Gabbi Chee

Illustration by Leigh Wells

It’s the second week of January, but The Oaks, a skilled nursing unit in Mechanicsburg, Pennsylvania, still has Christmas trees up, and photos of the facility’s 69 elderly residents with Santa still cover the walls. Taking down the decorations is on Susan Crossley’s checklist. But at the moment, Crossley, The Oaks’ director of recreation, is occupied with a more pressing problem.

“There were some songs on Ralph’s iPod that were just really, really scratchy,” she says. “I’m substituting them so it doesn’t give the guy electroshock therapy through his ears.” Crossley is sitting in Oak Terrace, a bright, airy activity room that she’ll later set up for an afternoon art class. On the desk in front of her, an iPod Shuffle is hooked up to the PC that she and her staff use to manage their residents’ personalized playlists. 

“It just constantly amazes me,” the petite 53-year-old says, shaking her head in disbelief and sending her blond waves flying. “You can upload five hours of music in 3.6 minutes.” 

The time it takes to reload the miniature iPod pales in comparison to the hours Crossley and her recreation team have spent amassing an audio library of 5,381 tracks and developing playlists. Before a resident gets an iPod, the staff devotes an average of two and a half hours talking to the individual and his or her family. The goal? Precisely defining what music the resident likes. In Crossley’s opinion, this output of time and energy is the key to the program’s success.

Even though recreation is part of her job title, Crossley doesn’t gauge that success merely in terms of the music’s entertainment value. That’s because The Oaks is one of a growing number of nursing homes that puts the evocative power of personalized music to therapeutic use for its elders, many of whom have been diagnosed with dementia or other forms of memory loss. 

The Oaks—part of Bethany Village, a retirement community of more than 700 residents—has had an iPod program since December 2011. It is one of more than 60 facilities across North America that have implemented such programs with the help of Music & Memory, a New York nonprofit. 

Dan Cohen, Music & Memory’s founder, hopes to make personalized music a standard offering in long-term care facilities, particularly those housing dementia and Alzheimer’s patients. Music is an old standby of nursing-home recre-ation, typically presented in a group setting. But after hearing a journalist on the radio comment on the ubiquity of iPods, Cohen realized that the portable music players could reunite the elderly with songs that carry personal significance—and personal significance is essential. 

Even as cognitive function and short-term memory diminish with age and disease, “the emotional system doesn’t really deteriorate,” Cohen says. That could explain why his program has been remarkably successful at reaching those who might otherwise be unreachable. 

“Even when people with advanced dementia no longer recognize their own family, or no longer have the ability to speak, if they hear a song from their youth that’s familiar to them, they’ll come ‘awake,’ come ‘alive,’” he says. Cohen, whose work is the subject of an upcoming documentary titled Alive Inside, has seen people go from noncommunicative and unresponsive to singing in perfect rhythm and recognizing their loved ones after listening to the right songs—ones that are emotionally meaningful to the individual. 

The notion that music awakens long-term memories isn’t new. Anyone who’s ever been blasted to the past by a song from their high school years can attest to that. For decades, music therapists have observed this same phenomenon in their work with dementia patients. But their anecdotal findings weren’t taken seriously by the medical community until relatively recently. 

In the 1990s, the development of functional MRI (brain-imaging technology that provides real-time measurements of mental activity) gave us the means to observe the mind at work. In the past five years, researchers have established a link between music and the storing of autobiographical memory—the scientific confirmation that music therapists had been waiting for.

Concurrently, the federal government has tightened regulations on the levels of medication—antidepressants, antipsychotics, and anti-anxiety drugs—that have traditionally been used to calm agitated residents in long-term care facilities. In other words, the climate couldn’t be more supportive and the need couldn’t be greater for
a creative alternative.

At The Oaks, nurses have already been able to cut back on anti-anxiety medications for some residents, and the soothing effect of familiar music has helped once-combative seniors become more receptive to care. Plus, the music has given staff and family members a way of connecting with the residents that is emotionally resonant and deeply personal. 

Cohen cautions that the therapy may not work for everyone; deteriorating neurological function prevents some seniors from distinguishing music from meaningless noise. But ever since Cohen founded the nonprofit in 2008, no facility that has implemented the program with Music & Memory’s  help has discontinued it. To Cohen, its staying power is a testament to its effectiveness.

Crossley has had incidences of overstimulation with some residents. These issues are easily fixed by deleting a track or two. But one problem pesters her more than any other. “Dead batteries!” she says, laughing. 

Having banished the scratchy tracks from his iPod, Crossley goes looking for Ralph. (For the sake of privacy, the names of Oaks residents and their family members have been changed.) After  finding him asleep in his room, she heads to a workroom where iPods are stored when not in use. On a countertop, attached to charging cords, a few sprout from a power strip like multicolored seedlings. Crossley opens a cabinet and pulls out a plastic box marked with Ralph’s name. She stashes the device and headphones, then ventures back out to see if there are other takers for iPods this morning. 

She checks in on James, an 84-year-old with a penchant for plaid shirts. He sports a red one today, and a lime-green iPod peeks out of his chest pocket. As he talks with Crossley, he leaves the headphones on. The volume is turned up high, and you can make out the brassy blaring of trumpets three feet away from his wheelchair. He often listens to his tunes during group meals, and his appetite for the music long outlasts the unit’s battery life. 

Doctors think James may have suffered a series of mini-strokes before he moved to the retirement community in 2010. He talks in a low, slow rasp and sometimes has trouble finding his words. But when asked, he says that the music reminds him of his sons when they were growing up. 

Later in the week, James’ 50-year-old son, Russell, a tall, good-natured man with a bushy beard, comes to visit. Russell lives two hours away (when traffic is merciful) in Washington, D.C., and makes the trip to The Oaks at least twice a month. The father and son have a long-standing agreement to disagree about music. “He was very clear,” Russell says with a laugh, “anything from the Beatles forward, the whole rock ’n’ roll spectrum, was not music. It was just noise.” 

But Russell knows how important music is to his father. James loved attending performances by the Harrisburg Symphony Orchestra, and he put his children in music lessons (violin for Russell, clarinet for his younger brother, Curt). So when Crossley sent an email to family members, announcing the start of the iPod program and asking for their help, Russell was happy to look through his father’s massive CD collection.  He picked out the 20 hours of classical music, ragtime, and jazz that would end up on James’ iPod.

Over cookies, the two men reminisce about when James took ballroom dance lessons in his late 70s. It was after his wife died and before issues with a hip replacement made it difficult for him to get around. 

“We didn’t know if the motivation was to learn dancing or to dance with pretty girls,” Russell kids his father. James’ laughter is barely audible, but you can see the joy that the memory brings—it’s plainly visible in his widening grin and shaking shoulders. 

“They … better not … stop music,” James says.

Over a chicken wrap at Cafe Magnolia, a lunch spot about a mile down the road from The Oaks, Crossley recounts a story about Dolores, an avid fan of opera who passed away last April. One afternoon, a member of the 24/7 nursing staff found her in bed, listening to her iPod, with tears streaming down her face. The alarmed nurse took the music player away, brought it to Crossley, and asked her to find out what was upsetting Dolores.

“Those were tears of joy!” Dolores told Crossley. She shared how the song had stirred fond memories of trips with her husband. “It’s good to have a cry sometimes, isn’t it?” 

In telling the story, Crossley’s sunny demeanor retreats, and her blue eyes cloud with tears of her own. “I just miss her,” she says, looking away. 

Music and recreation truly bring joy to her residents. But the programs are not cures, and death is an undeniable reality at The Oaks—as it is at any nursing home. Which is why it’s crucial, Crossley says, that every interaction between resident and staff end on a positive note. “They need to be associating you with that good time so that the next time they encounter you, you can be that refuge.”

At the core of their efforts, Crossley and her team want to create “successful” moments. “If there’s joy there, it’s successful,” she says. The iPod program dovetails beautifully with that mission, but it’s not the only way that music and personal attention have achieved that goal. 

Jenny Bistline, a tiny woman who packs an infectious giggle, is one of Crossley’s recreation assistants. The four-foot-ten (“Probably less than that because I’m shrinking!”) 58-year-old brings a lifelong passion for dance to The Oaks, where she leads a weekly program that combines simple songs with physical gestures, helping residents maintain the range of motion in their limbs.

Bistline is on her way to find Millie, a resident who missed today’s session. “Millie is usually my helper,” she says. During the activity, residents “march” in their chairs to “Yankee Doodle” or turn their hands—palm-up, palm-down, palm-up, palm-down—in time to the ABC’s. With a grand sweep of her arm, Bistline will cue Millie,
who signals each song’s end by hitting and holding a high note. 

Millie is sitting in her wheelchair in one of the common areas. Bistline takes her hands and asks if they can sing together. The older woman nods, and the two go through a tender routine. As Bistline sways to the melodies, Millie’s eyes follow her side-to-side movements. 

After each song, Bistline thanks Millie and tells her she is doing a great job. Although Millie remains silent, the look of adoration that she gives the aide is more than enough to express her enjoyment and gratitude. 

By the time they get to the ABC’s, Millie’s energy is flagging. Bistline knows Millie needs to rest, so she asks if they can sing just one more song. 

“Mmm-hmm,” Millie says, nodding slowly. Bistline starts a familiar refrain, leaving room for Millie to fill in the last word of each line. 

“You are my—”

“Sunshine.”

“My only—” 

“Sunshine.”

Millie then joins in to finish the tune, her voice wavering at first, then getting louder and clearer with each word. There’s no doubt that she knows this song by heart. 

“You make me happy when skies are gray.

You’ll never know, dear, 

How much I love you. 

Please don’t take my sunshine away!”

Gabbi Chee is an assistant editor at Spirit. She will always think of The Oaks when she hears the ABBA song “Thank You For The Music.”