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Who Can Deliver Music Therapy? Understanding the Roles of Professionals, Nursing Staff, and Family Caregivers

You may wonder whether you need a professional music therapist or if nursing staff or family can simply play music for your loved one with dementia. The answer is nuanced: both approaches have value, but they serve different purposes. A board-certified music therapist (MT-BC) provides a structured, goal-oriented therapy that can be billed through some insurance, while family and nursing staff can use music in everyday ways to soothe, engage, and connect. This article explains the differences, when to use each, and how to combine them for the best care.

Key points

  • Music therapy is a clinical service delivered by a board-certified professional (MT-BC) with at least four years of training; it is not the same as playing music casually.
  • Nursing staff and family can still use music effectively, especially if they receive training from a music therapist. Research shows CNAs can lead music activities that improve depression and well-being.
  • For everyday calming or engagement, family can use personalized playlists from the person's young adult years, sing along, and offer simple instruments.
  • Professional music therapy is recommended for complex needs (severe depression, agitation, end-of-life care) and may be covered by insurance in hospice or developmental disabilities settings.
  • Always observe your loved one's response to music—if it causes agitation, stop and try a different approach. Music should be a tool for connection, not a one-size-fits-all solution.
  • Advocate for music therapy in nursing homes and memory care facilities; it can reduce reliance on medications and improve quality of life.

The Difference Between Music Therapy and Music Activities

Music therapy is a clinical, evidence-based practice delivered by a trained professional who has completed at least four years of university training in music theory, anatomy, and counseling. A music therapist assesses your loved one's needs, designs active or receptive interventions (like singing, playing instruments, or listening), and tracks progress toward specific goals, such as reducing depression or improving mood. This is different from simply playing a song on a phone or speaker, which is a passive experience. A music therapist actively engages the person, adjusting in real time to their responses, and can bill through Medicare or private insurance in some settings, especially hospice or developmental disabilities care.

Why Nursing Staff and Family Can Still Use Music Effectively

Research shows that music activities led by certified nursing assistants (CNAs) who are trained by music therapists can significantly reduce depression symptoms and improve well-being in nursing home residents with moderate to severe dementia. For example, a study found that a singing intervention designed by a music therapist but facilitated by CNAs helped sustain mood improvements. Similarly, family caregivers can use music to calm agitation, ease transitions (like bathing or dressing), and spark moments of connection. Teepa Snow’s Positive Approach to Care emphasizes that music can 'awake and arouse the brain' or 'calm and quiet the brain,' making it a powerful tool for care partners. The key is that untrained caregivers may not recognize when music might trigger distressing memories or overstimulation, so some guidance from a professional is helpful.

When to Seek a Professional Music Therapist

You should consider hiring a board-certified music therapist if your loved one has complex needs, such as severe depression, agitation that doesn't respond to simple music, or if you want to use music therapy as part of a formal care plan. Music therapists can also help train nursing staff and family on how to use music effectively. Administrators of senior living communities are encouraged to hire a music therapist because it makes a significant difference in quality of life. If you're in a nursing home or memory care facility, ask if they have a music therapist on staff or if they can contract with one. For hospice care, music therapy is more commonly covered, and the therapist can help with end-of-life comfort and caregiver education.

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

Step-by-step

  1. Step 1: Identify your goal. Ask yourself: Do you want to reduce agitation during a specific task (like bathing), improve mood over time, or simply create a pleasant moment? For targeted, clinical goals, consider a music therapist. For everyday calming or engagement, you can start with music yourself.

  2. Step 2: If you choose to use music yourself, start with songs from your loved one's young adult years (ages 15-25). This music is often deeply connected to positive memories and can boost confidence and recognition. Play one or two songs at a time, at a moderate volume, and watch their reaction.

  3. Step 3: Use music actively, not passively. Instead of just playing a song, sing along, tap your foot, or offer a simple instrument like a shaker or drum. This active engagement is more effective than passive listening. For example, if you're helping them dress, sing a familiar song together to make the task easier.

  4. Step 4: If you are a nursing staff member in a facility, ask a music therapist to train you on a specific music intervention, such as a weekly singing group. Research shows that CNAs can successfully facilitate these groups after training, leading to sustained improvements in depression and well-being.

  5. Step 5: For family caregivers, use music as a 'pleasant distraction' during challenging care tasks. For instance, play their favorite song before or during bathing to set a positive mood. Pamela D. Wilson recommends this approach to make caregiving easier and reduce resistance.

  6. Step 6: If your loved one is in hospice, ask the hospice team if music therapy is available. Hospice is supposed to provide therapy if the person needs it, and music therapy can help with comfort and caregiver education. Discuss this with the hospice nurse or doctor.

  7. Step 7: Evaluate the response. If music seems to cause agitation or distress, stop and try a different genre or a quieter volume. If they become more relaxed or engaged, note which songs worked and use them again. Keep a simple log of songs and reactions.

  8. Step 8: If you want to pursue professional music therapy, search for a board-certified music therapist (MT-BC) through the Certification Board for Music Therapists. Ask about insurance coverage, especially if your loved one has Medicare or private insurance that may cover therapy in certain settings like hospice or developmental disabilities care.

What not to do

  • Do not assume that playing any music is automatically therapeutic. Music that is too loud, unfamiliar, or associated with negative memories can cause agitation. Instead, choose familiar, preferred songs from their youth and observe their reaction.

  • Do not use music as a 'babysitter' or mere background noise. Research shows that aged care staff sometimes view music this way, missing its potential as a treatment tool. Instead, use music intentionally—during transitions, for mood regulation, or to spark conversation.

  • Do not force participation. If your loved one doesn't want to sing or play an instrument, that's okay. Passive listening can still be beneficial, but let them lead. A music therapist can help you find ways to engage them without pressure.

  • Do not rely solely on recorded music if your loved one has severe dementia. A live, interactive experience with a music therapist or a trained caregiver can be more effective because it adapts to their responses in real time.

  • Do not skip training if you are a nursing staff member. Without proper guidance, you may not use music effectively. Seek training from a music therapist to learn how to design and facilitate music activities that meet clinical goals.

Practical tools

  • Personalized Music Playlist

    Create a playlist of 10-15 songs from your loved one's young adult years (ages 15-25). Use a simple MP3 player or a smartphone with a dedicated playlist. Label it with their name and a photo. Play it during calm times or before stressful care tasks. This is a low-cost, high-impact tool that family and staff can use.

  • Simple Rhythm Instruments

    Keep a small basket of easy-to-hold instruments like maracas, a small drum, or a tambourine. Offer these during music time to encourage active participation. Even if they can't play in rhythm, the act of holding and shaking can be engaging and calming.

  • Music and Care Routine Checklist

    Create a short checklist for staff or family: 1) Choose a familiar song. 2) Play at a moderate volume. 3) Sing or hum along. 4) Offer an instrument. 5) Observe mood and engagement. 6) Stop if agitated. This helps ensure music is used purposefully, not as background noise.

  • Exact Phrases to Say

    When starting music, say: 'I remember you loved this song. Let's listen together.' or 'Can you help me sing this one? I always forget the words.' This invites connection without pressure. If they seem upset, say: 'That's okay, we can try a different one later.'

  • Music Therapy Referral Form

    If you're in a facility, create a simple form for staff to request a music therapy assessment. Include fields for: resident name, current mood/behavior, preferred music (if known), and specific goals (e.g., reduce agitation during bathing). This helps the music therapist tailor interventions.

Discuss with your clinician

Ask your loved one's doctor or hospice team: 'Can we get a referral for a board-certified music therapist? Is this covered by our insurance or Medicare?'

If your loved one has severe depression or agitation that doesn't respond to simple music, ask: 'Would music therapy be appropriate as part of their care plan?'

For nursing home residents, ask the facility administrator: 'Do you have a music therapist on staff or can you contract with one? If not, can our CNAs receive training from a music therapist?'

If your loved one is on medications for mood or behavior, ask: 'Could music therapy help reduce the need for these medications?' (Research supports this, but always consult the doctor.)

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