The Lifesongs Project

Evaluation report by Laurie Browne, MA

April 2015

1.0 WHAT IS THE LIFESONGS PROJECT?

The Lifesongs project aims to bring to life memories, reflections and feelings of older people through a combination of theatre, humour, spontaneous music-making and songwriting. Since January 2014, Klawitter Theatre Group’s Hedda Kaphengst and Rod Paton, founder and director of Lifemusic, have been running regular workshops and performances in selected care homes. The project confronts issues involved in the ageing process touching on meaning, significance, memory and loss.

The project is ongoing. Stages 1-3 have been completed and will be reflected on in this report.

1.1 Aims To involve and empower older people in participatory music

workshops To gather informally narratives of their lives To test an innovative and sustainable approach to music making

with older people (the Lifemusic method) To write songs and incidental music based upon the improvisations

and stories of participants To create a music theatre piece out of the songs and improvisations To develop a production model for performances of the musical in

care homes and in theatre To devise and implement a training programme based around the

Lifemusic method and specifically designed for work with older people.

To provide a viable practice as research framework for sustainable projects with older people

1.2 The Lifesongs project employed the Lifemusic method developed by Dr. Rod Paton of the University of Chichester and explored the outcomes of spontaneous music making within residential Care home settings for older people. This provided a space to explore feelings, evoke memories and express emotions. Working together with Hedda Kaphengst of Klawitter Theatre Group, an interactive musical program

was created which would test the effect these workshops had on a group of residents from a selected group of care homes in Ireland. The intention was that any life stories which would naturally emerge from this process would inspire song writing. The ultimate goal was to create the conditions for the inclusion of people in nursing homes as lively members of society whose life experiences are significant.

1.3 PARTICIPANTS

Dr. Rod Paton of Chichester University in West Sussex, England and Hedda Kaphengst of the Klawitter Theatre Group in Dublin, Ireland organised the project.

An independent evaluator was invited to gather data through observation and interviews and questionnaires.

Nursing home residents as well as friends and family were invited to join the workshops.

Care staff, activity coordinators and managers were asked to assist in observing the residents and provide their own perspective by filling out questionnaires.

Actors, musicians and singers from Klawitter, who were part of the creative process leading to a workshop performance.

2.0 CONTEXT

2.1 The complex care of people in nursing homes should go beyond bed, board and nursing care. The Health, Information and Quality Authority ( HIQA) published new standards for Nursing homes on the 1st July 2009. Since the introduction of these regulations, Nursing Homes in Ireland must operate under these standards– the National Quality Standards for Residential Care Settings for Older People inIreland. Health care in nursing homes now must include regular provision of “quality of life” activities for their residents.

2.2 These activities are scheduled into the daily routine of the residents and around the care provision and are likely to include musical entertainment by independent service providers, movie afternoons, bingo games, pet therapy, exercise classes, tea parties, Mass, aroma therapy or hobby related activities such as arts and crafts, gardening or baking. The frequency and quality of these activities depend on the budget that is made available by the respective care home and whether an activity

coordinator is in charge of the organisation of such activities. Smaller homes with up to 36 residents often do not have a dedicated budget or cannot afford a large range of activities and therefore have a greater reliance on volunteers to carry out such activities.

2.3 It has become standard in more progressive homes to provide reminiscence therapy, a therapy designed to stimulate memories of the past. There may also be planned outings such as theatre visits or trips to local sights or gardens. These activities are usually organised, arranged and executed by an activity coordinator who also encourages residents’ participation.

2.4 In a busy nursing home environment where physical care is the priority and a person’s leisure time may not be taken so seriously, the role of the activity coordinator can be challenging.

2.5 Trying to structure activities around routine and residents’ privacy within the nursing home setting, the scheduling, planning and executing of activities plus including families, managers and care staff can be problematic. Problems can occur from strictly structured and controlled activity. Residents can be forced into routines causing feelings of loss of control over the right to choose as well as causing frustration in residents who may be bored or feel patronised.

2.6 Within this context, the development of innovative programs like the Lifesongs Project, made possible by a grant from the Community Foundation for Ireland is a welcome addition, offering an alternative means of exploring a sense of self and an aid to self- esteem without being obtrusive.

2.7 When observing the Lifemusic method my own understanding of the needs of those in residential care became clearer. Rod Paton brought the wonder back into activity by putting residents in charge of their own creativity. He gave residents the space to freely explore their own abilities of self-expression and communication through music making. The making of music, their own music, became the vehicle to unlock the creativity.

2.8 The Lifemusic Method states that everyone is musical and that there are no wrong notes. This can remove the fear of not being good enough to participate as well as removing the belief that music must be structured and a learned skill.

2.9 Personally I can think of nowhere else where this idea could be of more use than in a nursing home environment where approx. 60% of the residents on average are effected by various degrees of Dementia. If pure emotion can drive the ability to be musical then there are no barriers to being creative and communicative even when mental abilities are compromised.

3.0 METHODOLOGY

In 2014, Hedda Kaphengst and Rod Paton ran a series of Lifemusic workshops in three care homes in Bray and Wicklow. Each home was visited by the workshop team including the evaluator.

3.1 The Lifemusic method has been developed by Dr. Paton to unlock musical potential in participants. It follows these principles

Everyone is musical.There are no wrong notes in music.Every sound has a meaning.Making music is an act of trust

3.2 The workshops are designed to stimulate music making using a diverse collection of percussion instruments provided by Dr.Paton. These ‘instant access’ instruments allow individuals to explore rhythms, change rhythms, join in with existing rhythms or end them. There were no instructions but ‘holding forms’ are used to structure the activity. No other boundaries or rules are imposed and singing was also employed and integrated into the process. Using this wide variety of percussion instruments plus voice, participants create entirely original pieces of music based upon ideas, images, stories and feelings.

3.3 The number of participants in the workshops was between 12 and 20. Stories that emerged during the music-making were noted down and formed the basis for the lyrics of the songs written for residents.

3.4 On November 20th 2014, a workshop performance in the theatre of the Mermaid Arts Centre, Bray was presented to participating residents, care staff and relatives.

3.5 The Lifesongs project is ongoing and develops in different stages. Stage 3 has been completed.

Stage 1 – visiting, performing, listening, recordingStage 2 – reflection/scenography/songwritingStage 3 – return visits with interactive workshopsStage 4 – creating the music/theatre pieceStage 5 – performance

3.6 Criteria Participation is in agreement with the management of the homes. Contact with residents is non-intrusive, voluntary and monitored. Conversations are informal and grow spontaneously out of the

music sessions: there are no questions.

None of the information will be used directly or explicitly in any way and will serve only as a general background and inspiration in devising a longer piece about the experiences of ageing.

3.7 Execution The sessions were divided into two parts. Each part lasted approximately one hour. Rod and Hedda lead the workshops. The evaluator along with care staff and/or managers and/or activity coordinators observed the residents participating in the session but also joined in. The latter proved to be very helpful and clearly enhanced the experience for the residents. In the second half the evaluator presented a series of questions to those residents who were able and willing to answer. In addition, any member of care staff, manager or activities person who had the opportunity to observe residents during the session were asked to complete a questionnaire relating to their opinion of the participants reaction to the session.

4.0 ANALYSIS OF QUESTIONNAIRES

Across the three selected care homes 47 questionnaires were completed by residents. The evaluator sat with the residents and read the four questions out aloud. This was necessary because some residents were affected by physical issues such as impaired vision or hearing and memory problems. Most residents were pleased or surprised that their opinion was asked for.

4.1 What did you enjoy most?

Seventeen participants responded saying, “The music” or a particular instrument is what they enjoyed most.

Twenty- three participants gave a positive and emotional response and were more descriptive about their feelings, for example one woman from Ashford House explained how she had never played instruments or sang in front of anyone before and was taken by surprise by her own ability at this stage in her life.

Another woman simply said, “It made me feel”. Six individuals appeared to be non- committal and held their cards

close to their chests by saying they thought it was “Rather lovely” or that they “Did not know” without elaborating further.

One man declared he didn’t enjoy “it at all” and was annoyed that we were in his space. He added that he was expecting someone to come and sing what he called “real music” and that what we were doing was a waste of his time.

“I feel this is giving me something, I feel it in my heart but can’t put it into words.”- Wilma, a resident at Kinvara House after a Lifemusic session

“At first I thought it was weird, but I really got into it. The music that came out was really good”- A male resident at Kinvara House

4.2 Summary and reflections

The results indicated that most residents were emotionally involved in a positive way. Ohers simply did not know where they stood with the exception of one person who was clearly negative in response to the workshop.

There are many possibilities as to why he reacted the way he did, however the purpose of this project was not to force anything on anyone but to allow emotions to come to the surface without judgement of them. Participation was voluntarily and if someone didn’t like there was the choice of leaving or not participating.

Leaving is more difficult if a resident needs assistance for doing so. This needs a carer’s time which can be a challenge.

4.3 Was there anything that you found difficult?

Out of our group of 47 participants, 34 people said that they had no difficulty and some elaborated on the point, “No, not at all, I was happy and it was pleasant!” Eleven participants answered with yes. Reasons given were health issues, the technicality of the process and on two occasions external circumstances were mentioned. There were 2 people who gave no response to the question.

4.4 Summary and reflections

Overall most of the residents had no problem joining in the experience though a percentage needed some assistance. Knowing when to intervene as an activity unfolds without being obtrusive or patronising can be a challenge. Good communication with care staff is important here since it is necessary to know if someone is having a bad day or if they generally are impaired for health reasons. If a person is hard of hearing then it is of course a more difficult activity. Arthritis can be affecting their ability to hold the instrument or beater. Environment comes into play as well. Is there enough space or are the right people sitting next to one another? Are there unnecessary interruptions occurring? People naturally vary in the nature and level of their needs. It is by inquiring that we find out what can be altered or added to make the activity a better experience for the resident.

No = 72% Yes = 23% No answer = 5%

Residents Having Difficulty in Workshop

no yes no answer

(Fig. 4.2)

4.5 Could you describe in one word how you felt after the workshop?

A significant number of participants responded positively: 36 out of the 47 gave an upbeat answer. Among the responses were words such as, “happy”, “joy”, “magic”, and “evocative”. Only 4 had a less positive outlook, using the terms such as “tired” or “bored”. 7 individuals were unable to find a word to describe the experience.

4.6 Summary and reflections

It is possible that some individuals may respond positively because they like the facilitator or have always been positive people. As the workshop developed over the months a woman from Kinvara House always said, “Magic” to describe in one word how the workshop made her feel. Interestingly, even though some participants gave a more negative word to describe how they felt after the workshop early in the project, the same residents answered the questions more positively as the work developed. For example one participant said after the third workshop that she had no difficulty and what they enjoyed most about the workshop was, “Getting together with everyone”.

Positive = 76% Negative = 10% No answer = 14%

Positive vs Negative Word Description of How Res-idents Felt After the Workshop

Positive Negative No answer

(Fig 4.3 )

4.7 Would you like to have workshops like this one on a regular basis?

33 participants answered YES, they would like to have workshops regularly. 7 said NO with one man making the comment that he felt, “It’s not really music” and another saying, “I would rather not have to be physical”. 5 were unsure or didn’t care. 2 who did not answer.

4.8 Summary and reflections

There was more hesitation in answering this question. Perhaps residents were still considering what they had just experienced and making their mind up .

Note that residents may be answering ‘yes’ because they wanted to please the evaluator or were nervous about answering wrongly.

Yes = 70% No = 14% Not sure = 10% No answer = 1%

Those Wanting More Workshops

Yes No Not Sure No Answer

(Fig. 4.4 )

5.0 FEEDBACK FROM MANAGERS AND CARE STAFF

Over the months of evaluation through to December 2014 a total of only nine questionnaires were completed by care staff/managers across the three selected care homes. The evaluator introduced the questionnaires to a group of managers and care staff in the hope that they would comply with the request or simply have time to observe the process of the workshop and take time to fill out the questionnaire. This was a more

challenging task because care staff was busy doing their routine work. Whenever staff got involved the atmosphere changed positively.

5.1 How many residents were present in the workshop?

According to the managers and care staff there was an average of 12 residents for each workshop they had attended but as many as 15 in some workshops were present.

5.2 How would you rate the value of this activity to your residents on a scale of 1 to 5 where

Where 1 is low and 5 is high

1 2 3 4 5

(Please circle one)

Our 1-5 scale was answered by the nine staff members as the workshops unfolded. With 3 on the scale being the middle ground, one person circled 3. Seven from our group selected the number 4 on the scale seven out of nine times.

5.3 Analysis

This result indicates that this activity was generally perceived to be of value to the residents. One person rated the activity low and circled 1 on the scale. Taking the word “value” into consideration on this particular question one must examine the context in which the word is placed and how much importance is placed on activity by that staff member.

5.4 How do you feel the residents responded to the workshop?

Positively, negatively, neutral (Please circle)

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

How Residents Responded to the Workshop According to Managers and Care Staff

Positively = 0.6 Negatively = 0 Neutral = 0.3

(Fig. 5.3)

5.5 Did you notice any of the residents experiencing difficulties during the workshop?

If yes-please comment briefly:

Out of the nine questionnaires answered by staff 50% answered yes and gave a brief description of what they perceived to be difficulties for participants during the workshop.

One staff member commented that a female resident had trouble holding her instrument due to arthritis so she joined to assist her which was very positive for the resident.

One carer reported a resident was upset as she did not appear to know what was going on and had trouble using her instrument. The carer tried to help but the resident just wanted to be there and watch rather than participate.

Another carer reported that a male resident found the music was too loud and became quite agitated. He was brought to his room but came back next time.

According to the staff members half of the residents found the task at hand challenging, half appeared to have no trouble at all.

5.6 What do you consider to be the principle benefits of this kind of activity?

Staff were generally satisfied with the Lifemusic sessions: “Trying out a different skill can be encouraging and engaging”. One staff member who didn’t wrote : “I can’t see any benefits from this activity and the residents seem to be in two minds about it”.

5.7 In your experience have your residents previously engaged in a similar kind of workshop? y/n

Three staff members answered ‘no’ and six said ‘yes’.

5.8 Would you like to have workshops of this sort on a regular basis?

y/n

Of the nine questionnaires 2 individuals did not answer, 6 said ‘yes’ and one answered ‘no’.

5.9 Do you have any further comments?

Only two carers added further comments. One mentioned the need to explain more about the instruments and felt that in her opinion, the music went on for a long time and that the residents became bored. In contrast another carer commented how she observed the residents smiling and how easily everyone got into the playing of the instruments.

5.9 Challenges in connection with the staff questionnaires.

It was difficult to get the staff involved observing residents during the workshop hour as some of them tended to go in and out of the room or disappeared altogether needing to look after other residents’ physical needs. Some questionnaires did not come back at all and some of those that did come back were incomplete or filled out incorrectly. There was an apparent language barrier for some of the care staff. For these reasons, the feedback from the staff was relatively sparse.

6.0 MERMAID THEATRE WORKSHOP PERFORMANCE

Lifesong objectives as per evaluation plan:

1. To write songs and incidental music based upon the improvisations and stories of participants

2. To create a music theatre piece out of the songs and improvisations 3. To develop a production model for performances of the musical in

care homes and in theatre

6.1 Summary:

The Mermaid workshop performance was staged on the 20th of November 2014 in the afternoon as part of “Yarn”- the Bray Festival of Story and Song. This was the third time that Klawitter Theatre Group was given the opportunity to stage a performance especially targeted to an audience consisting of nursing home residents, carers and relatives to provide a day out together. The performance was also open to members of the public. The performance was free of charge and advertised in the Mermaid brochure and the Yarn brochure and also on the Mermaid website as: “Lifesong Project: The story so far…….”

At that stage eight songs had been written based on stories told by residents. Five of those were included in the workshop performance. The project is ongoing.

The rehearsal process and the performance were filmed and over 800 photographs were taken. The material has yet to be edited and will be turned into a presentation.

6.2 Aims:

To give those residents who had participated and volunteered their story to the project an opportunity to see it performed in a theatre.

To invite relatives, carers and managers along to see an outcome of the work done

To test an approach on how those stories/songs can be summarized and transferred into a script

To test how and if the Lifemusic method could be used in a theatre setting and with a larger audience participating

6.3 Breakdown of audience participation:

Twelve homes received invitations to the performance via email and in person through Hedda of Klawitter. Posters and flyers were distributed.

Seven homes attended. Two homes with just one resident and relative/s.

(Brookfield, Ashford, Ailesbury, Ashbury, Tara, Northbrook, Belmont)

The performance was attended by 105 people altogether. Four of them were relatives of the actors.

The three participating homes (Ashford, Kinvara, Earlsbrook ) were informed through posters and flyers and by Hedda in person that songs and stories collected from some of their residents would be used during the performance. The cooperation with the management and activity coordinators was crucial in this.

Earlsbrook home had to cancel their attendance due to a HIQA inspection on the day.

Solution: Hedda Kaphengst and Rod Paton went back to the home to perform the songs for the residents in question as part of the final Lifemusic session in December and gave them a chance to hear them. The activity co-ordinator in Earlsbrook (part of the First-care group of 6 Nursing homes) subsequently introduced the project at an activity co-ordinators meeting in January 2015.

Kinvara house doesn’t organise outings for their residents but the residents and relatives were informed of the performance through posters and flyer. One lady and her daughter attended

Ashford house attended with 12 residents, 12 relatives , 2 management, 5 carers

One lady from Belmont house (Maura Kelly) and her two daughters attended the performance

Belmont didn’t participate in the project but a song was written for a resident (Maura Kelly). The song was based on her disappearance when

a child in Enniscrone in Co. Sligo. The family gave permission to use her photos and story to be used as a case study for this report to demonstrate the value of the Lifesong project and how it affected them and their mother.

6.4 Audience reaction:

The feedback was collected in cooperation with the activities people of each home and Performers of Klawitter Theatre Group through

Observations and informal questionnaire with Northbrook House co-ordinator in particular

through Klawitter performers and informal chats with audience after the performance and noted down at an evaluation meeting afterwards

6.5 Observations from Northbrook:

The activity was executed with a great deal of planning and consideration for the workshop participants, however residents from other homes were invited and gave us a larger group to observe while immersed in the Lifesongs performance. The performance was unique in that the audience was drawn in by the performers both by dialogue and musical interaction. Along with live brass and string instruments audience members were encouraged to play their own instruments handed out by performers to accompany the drama. Viewers were given percussion instruments to play with songs that were written especially for specific individuals from our workshops making the whole experience more personal. Some family members were particularly impressed by the musical content and care taken to involve their loved ones in the process.

Despite the efforts of the performers to include the entire audience in the instrument interaction, we found that it was difficult to reach people beyond the third row. Also, there was a problem with content of the written music from life stories of others being unfamiliar. It was not possible to include all of the residents who had songs written for them for organisational reasons.

Residents brought from Northbrook House nursing home in Dublin were interviewed directly after the performance to get opinions on the level of enjoyment experienced during the evenings events. There were two negative responses out of the seven ladies interviewed, as one said she didn’t understand the story and the other didn’t know the music so it didn’t interest her.

Though responses seemed to be in keeping with that of individual’s normal disposition, it was clear that sharing the event with a loved one enhanced the experience. One woman confided, “I felt so glad because my daughter came, I thought it was brilliant”. Expressing in a way that only this person can, another resident said, “It felt stylish and seemed

marvellous.” The resident song bird proclaimed, “I felt like singing, it was just great and oh yes I really liked the people.” Two women in the front row found themselves literally involved in the interaction of the drama unfolding and did not realise that the people on stage were acting. When asked how they felt about playing instruments along with the performance one woman said, “I felt like I was needed”, while another said, ”I didn’t expect that, what a treat to be involved!”. Another woman’s daughter said, “Mom was so sociable before Alzheimer. It was great to get her here to see the show”.

6.6 Observations from a member of Klawitter:

87% of the audience liked the performance in general.

10% were surprised or sceptical

3% didn’t enjoy it (these were 2 relatives of an actor)

Opinions of the Audience on the Lifestories Theatre Performance

Liked the Performance Were Surprised or ScepticalDidn't Enjoy it

87% = Liked the Performance 10% = Were Surprised or Sceptical 3% = Didn’t Enjoy it

6.7 Examples of responses:

Couldn’t get any better. (Resident Ailesbury House)

You are getting better every year. (Management Ashford House)

It was lively and unusual. (Resident Ashbury House)

It was very energetic and all the lovely colours. (Resident Brookfield)

Nice to see and hear something different. I enjoyed it (Carer Ailesbury)

I missed some familiar songs. (Resident Ashbury)

Didn’t know what to make of it in the beginning (same resident Ashbury)

It took so long to start (resident and carer Brookfield House)

We missed Hedda (Residents Tara House)

The outing gives people something to look forward to (Management Ashford)

Feedback from Maura Kelly, a resident in Belmont House and her two daughters on the day:

“Mummy was so sick for a while with shingles and had to stay in her room for weeks. This lifted her spirits and we are all very touched that you wrote a song for her. It is so special for Mummy. All our relatives in the US are so excited about it and I filmed it and will send it over to them.”

In a letter from her daughters:

Dear Hedda and Rod:

“Thank you for composing the beautiful song ‘The lost child’ in memory of Maura being lost in March 1924 when she was two and a half years old. You have brought a lot of joy to Maura and her family. With every good wish and gratitude. Maura (the lost child),Renee, Eugenie and Annette.”

6.6 Feedback from Actors:

"I found the life music workshop with Rod an amazing experience for me as a person as well as a performer."

"For me it was an honour to hear the stories of Maureen, Maura, Helena, Ralph and Glady’s and it was very special to sing their stories/songs in front of them".

“I enjoyed the experience, it was great to do something outside the normal programme we do. “

“Having not done improvisation or singing in a production I found that really fun and a great opportunity to try new things. It pushed me out of my comfort zone and made me think outside the box.I thought it was so rewarding seeing and hearing the feedback from all the women and how they felt about the show. I know that certain people

in the third and fourth row were missing out and didn't get instruments so maybe if each person before the performance  is given something before the show, so nobody is left out.  All and all I found it great working with everyone and would love the opportunity to get involved with working with you all again. It's an amazing thing you are doing in Klawitter and there were lots of lovely people going very happy.”

6.7 Feedback from the Director:

When I learnt on the first day how Rod works ( Lifemusic) I was so excited because my own thoughts on approaching the  project that were based around building the action from a rhythmical base which quite coincidentally  paralleled the  life musical approach and particularly the pulse  and musical event that Rod showed us would have created a bridge allowing us to dovetail the two strands when the performance day came….. My own feeling was that it is okay, and maybe desirable, for actors to feel lost at that stage; ( improvisation ) having to jump ahead of the process due to time pressure wasn’t helpful ……I felt it muddled the quality of what we could have gained all the way through and took any sense of having a direction.

6.8 Conclusions for stage 4 to 6

Important insights were gained for the further development of a final script which is part of the project objectives.

The initial idea of involving the Lifemusic method in the final musical theatre piece was dropped. The distribution and collection of instruments before and after the performance proved to be very time consuming and impractical.

It was decided that the intended outcome of developing the musical theatre piece(a script and score) should be aimed at the general public to place emphasis on themes that are relevant to residents in care homes and of interest to a wider audience.

The concept that was used for the workshop performance: improvisation, a story framework including new songs written for residents can work successfully within the nursing home settings but familiar songs should also be included.

The work, discussions and improvisations contributed by the actors/director gave vital clues for the overall theme and for a more defined script story.

7.0 Recommendations for stages 7-8

Clearer communication and collaboration with care staff is key for this type of activity.

Staff need to be made aware of their importance regarding their participation in the project throughout its entirety.

More discussion and information on the project itself with care staff.

One dedicated information session with staff and manager per home. All staff should understand what the project wants to achieve.

But involve less staff in the data collection. Two or three should be seriously committed to observing the

residents and completing the questionnaire directly after the workshop.

Training for staff in the Lifemusic method would be of great support to firmly establish this activity on a regular basis.

Klawitter continues to support homes with budgets constraints by applying for training funds support.

Training should be tested and evaluated in one selected home

Laurie Brown is a community musician and an activity coordinator in a care home in Dublin