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Who Can Deliver Music Therapy in Dementia Care?

You may wonder if you need a credentialed music therapist to use music with your loved one, or if you and nursing staff can lead music activities yourself. The good news is that both approaches have a place, but they serve different purposes. Professional music therapists design targeted, therapeutic interventions, while family caregivers and nursing staff can lead meaningful, enjoyable music activities that support well-being. This article explains the roles, when each is appropriate, and how to use music safely and effectively at every stage of dementia.

Key points

  • A board-certified music therapist designs clinical interventions for specific goals; family and staff can lead meaningful music activities that support well-being.
  • Music activities led by trained CNAs can sustain reductions in depression symptoms when the intervention is designed by a music therapist.
  • Always choose familiar, preferred music at a moderate volume; avoid overstimulation.
  • Do not sing or encourage singing during meals in late-stage dementia due to choking risk.
  • Use music as a tool for connection, not just entertainment; observe and adjust based on the person's response.
  • Music benefits caregivers too—use it for your own stress relief and self-care.

The Roles: Music Therapist vs. Caregiver-Led Activities

A board-certified music therapist (MT-BC) is a trained professional who uses music as a clinical tool to address specific goals, such as reducing depression, managing agitation, or improving communication. They assess the person's history, preferences, and current abilities, then design individualized interventions. Research shows that music therapy can significantly decrease depression symptoms in nursing home residents with dementia, especially when the intervention is designed by a therapist and then facilitated by certified nursing assistants (CNAs) who have been trained by the therapist. The therapist brings expertise in how music interacts with the brain and mental health, which untrained caregivers may not have.

Why Caregiver-Led Music Activities Are Valuable

Family caregivers and nursing staff can absolutely lead music activities that bring joy, connection, and engagement. The key is to understand that these activities are not the same as music therapy, but they are still highly beneficial. For example, playing a familiar song from the person's youth can spark memories, reduce anxiety, and improve mood. Singing along, clapping, or using simple instruments like bells or rhythm sticks can provide gentle physical activity and emotional connection. The Alzheimer's Association notes that music and art can enrich the lives of people with dementia, allowing for self-expression and engagement even after the disease has progressed. Caregivers can also benefit: music reduces stress and anxiety for the caregiver, creating a sense of calm and escape.

When to Seek a Music Therapist

If your loved one has significant depression, severe agitation, or complex behavioral symptoms that do not respond to simple music activities, a music therapist should be involved. The therapist can create a structured plan that addresses these issues and train you or nursing staff to carry out the interventions. In aged care facilities, staff may view music as mere entertainment rather than a therapeutic tool, so a music therapist can help shift that perspective and integrate music into care plans. Administrators of senior living communities often hear: 'Hire a music therapist, you will never regret it.' The therapist's assessment ensures that music is used safely and effectively, especially when the person has advanced dementia or other medical conditions.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Start by observing your loved one's response to music. Play a song from their youth or a genre they loved. Watch for changes in mood, alertness, or agitation. This helps you gauge what works.

  2. If you are a family caregiver, begin with simple, familiar music. Sing along, hum, or sway to the rhythm. Encourage them to clap or tap their feet. Use a bell or tambourine if they can hold it. Keep the volume moderate and avoid overstimulation.

  3. For nursing staff in a facility, incorporate music into daily routines. Play calming music during meals or before bed. Use upbeat music for morning activities or group exercises. Always ask residents for their preferences if they can communicate.

  4. If you notice signs of depression, anxiety, or agitation that persist, consult a music therapist. They can design a personalized intervention and train you to implement it. Many facilities have a music therapist on staff or can refer you to one.

  5. When leading a music activity, keep it short—10 to 15 minutes—especially in later stages. Watch for signs of fatigue or overstimulation, such as turning away, fidgeting, or increased agitation. Stop and try again later.

  6. Use music to connect with your loved one. Ask them about the song: 'Do you remember dancing to this?' or 'What does this song make you feel?' Even if they cannot answer verbally, they may smile or nod.

  7. For people in late-stage dementia who have difficulty swallowing, avoid singing during meals or when they are eating. Teepa Snow warns that singing can increase the risk of choking because it requires coordinating breath and swallow. Instead, play soft instrumental music in the background.

  8. If you are a nursing assistant trained by a music therapist, follow the therapist's plan exactly. Use the same songs, at the same times, and note any changes in behavior or mood. Report back to the therapist so they can adjust the plan.

  9. Consider using a personalized playlist. Programs like Music & Memory provide headphones and curated playlists. These can be used by family or staff and have strong research backing. The music should be familiar and meaningful to the person.

  10. For yourself as a caregiver, use music to reduce your own stress. Play your favorite songs while you care for your loved one, or take a few minutes to listen to calming music alone. This is a form of self-care that can prevent burnout.

What not to do

  • Do not assume that any music is good music. Playing music that is too loud, fast, or unfamiliar can cause agitation or confusion. Instead, choose music that is familiar, at a moderate volume, and matches the person's current mood.

  • Do not force participation. If your loved one does not want to sing or move, do not push. Simply let the music play in the background. Forcing can lead to frustration or withdrawal.

  • Do not use music as a 'babysitter' or mere entertainment without purpose. In aged care facilities, staff may view music this way, but it is more effective when integrated into care plans with specific goals, such as reducing agitation or improving mood.

  • Do not sing or encourage singing during meals or when the person is eating, especially in late-stage dementia. This can interfere with swallowing and increase choking risk. Instead, play soft instrumental music before or after meals.

  • Do not ignore signs of overstimulation. If the person becomes restless, covers their ears, or tries to leave the room, stop the music immediately. Try a different song or a quieter activity.

  • Do not assume that a music therapist is only for facilities. Family caregivers can also consult a music therapist for guidance, even if only for a single session. Many therapists offer virtual consultations.

Practical tools

  • Simple Instrument Kit

    Keep a small basket with a tambourine, bells, rhythm sticks, or a shaker egg. Use these during music time to encourage gentle physical activity and engagement. Let the person hold and shake them along with the beat. This works well in early to middle stages.

  • Personalized Playlist

    Create a playlist of songs from the person's youth (ages 15-25 are often most meaningful). Use a music streaming service or a simple MP3 player. Programs like Music & Memory can help. Play this during calm times or when the person seems anxious. For late-stage, use headphones to reduce background noise.

  • Phrases to Use During Music

    Say: 'Let's listen to this song together.' 'Do you remember this one?' 'I love this part.' 'You can tap your foot if you like.' 'Let's hum along.' Keep your tone warm and encouraging. Avoid asking too many questions if the person cannot answer.

  • Seated Dance or Movement Program

    Programs like 'Active for Life' offer seated dance and fitness routines designed for people with dementia. These can be done at home or in a facility. They exercise both brain and body while spreading positivity. Look for videos or classes online.

  • Music and Memory Headphones

    These are specialized headphones that deliver a personalized playlist. They are designed for people with dementia and can be used by family or staff. The headphones block out distracting noise and allow the person to focus on the music. This is especially helpful in late-stage dementia.

  • Observation Log

    Keep a simple notebook or digital note to track what songs you played, the person's mood before and after, and any changes in behavior. This helps you and any music therapist adjust the approach. Note: 'Played 'Blueberry Hill' - she smiled and tapped her foot for 5 minutes.'

Discuss with your clinician

If your loved one has a history of seizures triggered by music (musicogenic epilepsy), discuss safe music use with their neurologist.

If the person has a pacemaker or other implanted device, ask their doctor if any musical instruments or headphones could cause interference.

If your loved one has severe hearing loss, ask an audiologist about using headphones or bone conduction devices for music.

If the person is on medications that affect mood or behavior, discuss with their doctor how music activities might interact with those medications.

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