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  Industry Profile




Industry Profile: Dan Cohen

— By Larry LeBlanc (CelebrityAccess)



This week In the Hot Seat with Larry LeBlanc: Dan Cohen, founder, and executive director, Music & Memory.

There are an estimated 46 million people with dementia across the globe, and the number is expected to double by 2030.

About 5.2 million people in the United States have Alzheimer's disease--the most common type of dementia. Every state is expected to see at least a 14% increase in cases by 2025, according to a recent report by the Alzheimer's Association.

Dan Cohen is the founder and executive dir. of Music & Memory, a nonprofit New York-based organization which encourages caregivers to have residents take part in a digital music program that improves the lives of the elderly.

While nursing and memory care facilities help treat those who suffer from dementia and Alzheimer’s, Music & Memory offers a further treatment option with such benefits as improvement in alertness, engagement, mood, sense of community, feelings of acceptance, and improvement in the patients’ interaction with their caregivers and loved ones.

Music & Memory trains nursing home staff and other elder care professionals, as well as family caregivers, how to create and provide personalized playlists using iPods and other related digital audio systems that enable those struggling with Alzheimer’s, dementia and other cognitive and physical challenges to reconnect with the world through music-triggered memories.

Another benefit is music’s ability to allow people to reconnect with themselves. When people go into a nursing home, they leave much of their former life behind. So reconnecting with one’s self is personal and important, and music allows people to do this, and paired with everyday activities, can enable patients to develop a rhythm that helps recall the memory of that activity, and improve cognitive ability.

Since its inception in 2010, Music & Memory has brought iPods, iPads and iPhones loaded with personalized playlists program to over 3,000 certified long-term care facilities in the U.S., Canada, Europe and Australia. The organization has been touted by such artists as Sir Paul McCartney, Dave Roth, Kenny Chesney, and Carole King.

By providing access and education globally, by creating a network of certified organizations, Music & Memory is striving to make this form of personalized therapeutic music a standard of care throughout the health care industry.

You now have 3,000 facilities using the Music & Memory program.

Correct. We train people in each nursing home, living facility, homecare organization, hospital or hospice. We set up their iTunes library. We train them on how to run the program themselves and set them up with all of the individuals who work with them.

You have established Music & Memory programs outside the U.S.

Yes. In Canada, we have more than 230 homes running Music & Memory. In Australia, we have 70 homes with Music & Memory. In the UK we are now rolling out our 12th home. In Holland, we have a dozen homes. We just started the first programs in Switzerland and Germany. We have a home in South Africa, and we are about to roll-out in Israel.

Music therapy has been used in residential and adult healthcare facilities since the ‘80s. Mostly the techniques have been more connected with exercise, facial massage or aiding patients to sleep. The use of individually customized music, and headphones is quite a departure.

If I can backtrack a little bit. So there’s ton of music therapy out there. There are professional music therapists trained in how to use music for people who have had a stroke, a brain injury or PTSD (post-traumatic stress disorder). What we are doing is really a step down from that. What we are doing is making available music in the way that we--who are pretty functional, and have access to technology, and the fact is that we only listen to music when we want and how often we want to--and making it available to all those who are not all that familiar with or able to use the music. They have lost touch. They don’t have the fine finger dexterity anymore. They don’t have the cognitive wherewithal to stay connected. So we are bringing this to them. It just turns out that music does bring a variety of benefits for people with a range of cognitive and physical challenges.

[Hearing music may evoke emotions in even the most advanced of Alzheimer’s patients. According to neurologist Oliver Sacks, “Music evokes emotion, and emotion can bring with it memory… it brings back the feeling of life when nothing else can.”]

Still, music was previously being used differently by caregivers in contrast to creating a personalized music list that residents can relate to hearing on their headphones.

Absolutely. We are moving from an era where this was a nursing home thing where there is sort of a loop of 50 songs from the ‘40s and, maybe, half of the people are sleeping as they are all listening to that music. This is really their music. Everybody has their own personal jukebox. That is the big difference. “Technology, cheap technology, let’s do that.”

The relationship people will have with a personalized music list is different than programming say ‘50s music because they might like ‘50s music. You are curating music specific to a person’s social background.

That’s exactly right.

As medical costs rapidly rise, there’s pressure to bring down the use of expensive drugs, especially geriatric meds. As well, the U.S. government is currently tracking nursing homes nationally with the goal of ending the unnecessary drugging of residents. In many cases can music not be used in place of certain drugs?

Exactly. There are certain types of drugs where that does apply. There are antipsychotic drugs that are massively overused. They are really drugs meant for people with a psychiatric diagnosis, but what a lot of people don’t realize is that they (nursing homes) use them in situations like, “Mom has dementia and they are giving her an antipsychotic drug just to calm her down.”

She’s agitated.

She’s agitated and they give her these drugs but the fact is that these drugs when used this way double and triple the mortality rate and scramble the brain. So the federal government has been telling doctors and nursing homes, “We want to see you drastically reduce these drugs.” So yes we can replace this category of drugs with music about half the time. Not only less of these antipsychotic drugs but also fewer anti-anxiety medications, anti-depressants, and sleeping pills. We can help people be calm and not be agitated. All of these things are affected when people have their music when they need it.

A lot of these old age or nursing homes have been more focused on trying to ensure a restful path to death for their residents as opposed to providing a quality of life for them.

Yes.

Contemporary society has yet to come to terms with aging. Many people dump a parent or a family member into a home and never return to visit.

That does happen. What you are saying is true but I have to say that there are a lot of people advocating for cultural changes in eldercare models from long-term nursing home care. There’s an annual conference with a group called The Pioneer Network. Every year a thousand people, who are in nursing home care and in all sorts of professional disciplines, are working to re-boot care so that it is the way that we would want it.

Music also provides an added benefit in that it raises morale with staff members as well. It’s a lonely job caring for elderly people. Also once a staff member learns what kind of music a resident likes, that humanizes the resident a great deal for that employee.

It is a great opportunity. This is a win-win situation. So yes, if someone a caregiver is caring for is agitated, and upset, and then they are in a better mood because of hearing music, the day is better for them. There are things that they need to do with residents. They need to bathe them. They need to dress them. They need to take care of their wounds and whatever. With the change in mood everything becomes much easier. There’s less resistance to care. So, therefore, staff morale goes up. All of these things are connected.

One comment you made was, “The feelings related to the music have to be personal.”

Yes. When I started this, people said for someone with advanced dementia that if you give them five songs, and they connect with five memories, that’s great; but if you give them 100 songs, and every one of them is associated with a memory, that is really going to help them keep a sense of who they are. To be alive and feel good and be more interested in being social, and connecting with other people. All of that is true.

Music positively affects everything from cognitive function to mood to relationships for patients with dementia. Different studies suggest that music can even provide a reversal in decline. That differs from an environment in which old age or nursing homes basically prepared people for their final days.

There are some interesting statistics. Time and motion studies for a couple of New York City nursing homes revealed that 90% of a person’s time (in a nursing home) is spent idle. Another statistic that is generally accepted, and it might even be low, is that half of the people in nursery homes never get a visitor. So if you are in a nursing home, and none of your friends or family come to visit, and you are sitting around doing nothing all day, your physical state might be stable but, boy, you might feel that life is over. Why live anymore? So that’s the challenge. There are many places that have really taken up that challenge. They are working very hard to provide what they call person-centered care or person-directed care and give people a life. But there are many others that are not. So that’s the challenge.

You began to meet that challenge in 2006 when you came to the realization that you wouldn’t want to go into a care facility without your music. You also heard people talking about the accessibility of iPods. What crossed your mind exactly?

I am a social worker by training (with a Masters in Social Work) but I had a career working with technology companies. I heard a journalist on the radio talking about how iPods were ubiquitous. They were everywhere. And I thought, “Well that may be true for young people, and many older adults, but certainly it’s not true for everybody in nursing homes or elders in general. When I googled iPods and nursing homes I couldn’t find any of the 16,000 homes using iPods.

That’s an amazing number.

That is an amazing number.

So you volunteered at a local nursing home and asked if you could put together a sort of trial run with three iPods. You then began creating personalized playlists for residents filled with music they remembered from their youth.

I live on Long Island, and I called up a local facility and said, “Look, I know that music is already your number one recreational activity, but can we see if there is any value if we totally personalize the music?” I came in with a few iPods and a laptop, and I did that. I wouldn’t just (add music) if someone told me they liked Frank Sinatra, or if they liked this or that because I may pick all the wrong songs. I came back every couple weeks as a volunteer, and I would hone the list. I would get rid of the songs that were so-so and keep the ones that were really loved.

[Rather than simply picking music from an era, Cohen sat with residents and addressed their individual tastes, customizing their playlists to their memory and specific preferences. This went on for 18 months before an organization stepped in and funded his experiment, expanding it to 200 people across New York City nursing homes.]

What is your background in technology?

I got caught up in the PC boom in the ‘80s. I was involved in sales and training and consulting.

For what companies?

Well, there was Computer Factory, do you remember that? Then they got bought bought out by Compucom Systems and I worked for Compucom for a long time in corporate sales and other things.

This early program in nursing homes became the prototype for a bigger effort.

Well, the only small value added was that nursing homes were the last institutions to automate. To bring in personal computers. They only did so when they were forced by the federal government to bring in Lotus 1-2-3 to do their accounting in the ‘80s. Adopting to technology it has only been when it has been required. When people saw Henry (the 94-year-old who responded to the music featured in a 2012 video) and then young people said, “I could do this” and they started setting up one to five people and it would work, but they then hit a wall of institutional resistance. “Oh, this is very nice but don’t bother anybody else.....We don’t want any of these things stolen...The staff has no time.” They were limited. My approach is that I have always done corporate roll-outs of equipment and services. I knew that there was a path here to allow it to scale.

Unquestionably the 2014 documentary “Alive Inside: A Story of Music and Memory,” directed and produced by Michael Rossato-Bennett, has had a tremendous impact in boosting the profile of Music & Memory.

It’s about 44 million views now. Recently, UNILAD put it up on its Facebook page, and it had 33 million views within a week. It was pretty wild.

When you first began approaching facilities about using iPods with personalized playlists for residents was there a general resistance to technology?

Yep. Like with my parents. My father is 93, and he’s never wanted to touch any of this stuff.

You were trying to coax caregivers into a world that many knew nothing about. And even if operating an iPods is easy, in a large institution, training would be needed, otherwise, the music therapy treatment may not work at all.

Yeah. All organizations are resistant to change. Even if some (technology) is low cost or no cost, there is a cost to change. It’s just a matter really communicating the benefits to them. For staff, your day is going to be better if you do this.

Your playlists average about 150 songs, and residents listen to the music for 30 minutes daily while staff supervises to see whether the resident is enjoying the music or needs help to change songs. What methods did you use to figure out how to streamline lists so a resident would respond?

Well, I would just ask them. I would give them a print out of all of the songs on their playlist, and by listening to them would cross off the ones the ones that they wanted me to take off, and they’d indicate which ones they love and may want others that are similar.

With someone unable to communicate how do you develop a meaningful playlist?

For people who are unable to communicate, we will ask families and friends and even staff, if somebody has been there a long time, about their history. Did they sing in a choir? Did they play a musical instrument? Do they like Broadway musicals? Did they go to any live concerts? Do they have any long-playing recordings in storage somewhere which would give us a tip? Then we’d watch their reaction to each song. If they can’t quite articulate “I like this artist or that one” you can still watch this sense of pleasure from them while they are playing each song.

You must have must noticed early on some patients reacting very strongly to what they heard or heard from staff at the homes how the music made residents more social.

Oh, it (the program) was successful right way. That’s what really clicked me into this. There was one guy who was bedbound. He had diabetes and he was blind, but he was sharp as a tack. I made up a 200 song list for him, and he said, “Watch out I have a really eclectic set of preferences.” But we made it up. Then in six months or so, he had a stroke, and he was unconscious. We said to the nurses, “What should we do?” The nurses said, “Well, this is his music. Let’s keep trying.” So we divided the list in half, and every certain number of hours it changed what was playing. I came back in a couple of weeks, and asked, “How is it going?” They said, “We don’t know but when the music is playing his eyes are moving.” So we didn’t know if it was a “Johnny Got his Gun” scenario where he’s sort of is locked inside but his emotions are either responding to music or it is an automatic reflex and his eyes are just going for some reason. They kept playing him the music because they felt that this was one way to reach him.

Then somebody else, not at all in a bad physical situation, but her best friend had just died and she was very depressed. The program helped bring her out of depression. She loved listening to the music with us. She said she didn’t feel her arthritis in her wrists when she listened to music.

After the Long Island experience, you branched out to 56 homes with the program?

Correct.

Shortly after the Henry video went viral in 2012, you got a call from the Department of Health in Wisconsin to set up 1,500 of their nursing home residents who had Alzheimer’s with their own iPods across 100 homes, and the University of Wisconsin would track the results over 18 months. But Wisconsin quickly expanded the program.

The research was for 18 months by the University of Wisconsin and, yes, six months in the Secretary of Health (Kitty Rhoades) said, “We’re not waiting for feedback of this 18-month study. We are just going to do it with 1,500 people with dementia in 150 additional homes, and we are going to make this state policy.”

What lessons did you learn during the early period that led to a broadening of the program to include homecare organizations, hospitals, and hospices?

I started off in a nursing home because I was someone not in the system. I didn’t have any connection. It just seemed to be the best place to volunteer. Where I could get feedback from the staff that worked there. I couldn’t say “I want to do this in homecare.” They were not going to send me into peoples’ homes. They were not going to put me in a hospital doing this. It just seemed to work out well (with the nursing home) but I knew that it would apply to any setting because it’s music. But when I started it was just easier for me to start as a volunteer.

So you learned.

I really didn’t know at first if this program was going to be good for somebody with Alzheimer’s or with dementia. I had to ask that question of people. They said I should talk to (music therapist) Dr. Connie (Concetta) Tomaino who co-founded The Institute For Music and Neurologic Function with Oliver Sacks. So I called Dr. Tomaino, and she said, “You are on the right course. This is exactly right. Music will have this impact on people with dementia.”

So today, we are working in many health care systems and with people in home care and even in hospitals. Nine hospitals with The New York City Health and Hospital Corp., the largest public safety system in the country, are using this program. Not just with their elderly patients, but with behavior health. They are using it in rehabilitation to help people be more motivated to get better. It’s exciting to see. In Australia, it’s being used in the largest health care system there as well. They are using it in mental health situations and with people who have had car accidents and who are in facilities for long lengths of time. They are just sitting there sort of in this one position. So what are they going to do all day? “Let’s give them music.”

Do you monitor and follow-up with the practitioners?

So this is what we do. Music & Memory is also an education organization. This week, in fact, three days in a row, each day for three days for 90 minutes I do webinars. This week it was with 98 nursing homes and other organizations on how to do this and how to roll it out. then we provide them with access to a forum where they can communicate with each other. We have monthly conference calls with our staff and peer supporters. So we have all of the support, yes, over time long term support, and provide group support materials so that their program is sustained.

Did you receive criticism for placing headphones on residents? It might be argued that this could lead to further isolation. And why use headphones?

Good questions. When I started this my friends told me I was really crazy and that what I was going to do was going to be harmful to people. That people in the nursing homes would put the headphones on residents and then put them in a corner. These people are already isolated enough, and my doing this was going to make them even more isolated. I got my first funding from The Shelley and Donald Rubin Foundation in New York. Don Rubin’s mother was at home with dementia with around the clock care. The only thing that changed her mood was the music. He and his wife enabled me to roll this out to more nursing homes, and that (headphone concern) was my question.

That funding enabled you to roll the program out to 200 people across four New York City nursing homes to see if it really worked. Does it scale? How well did this program integrate into nursing homes which are very structured?

So we did roll it out to 200 residents of these nursing homes, the 33 professional staff said, “We are not seeing anybody more isolated, but boy, they are they more social.” Responses from residents were “You have gotta hear this music....This remind me when I met my husband... Oh, you are about my age do you remember the Andrew Sisters?” It just took people to a new level of interaction. They (the staff) found that people were less agitated, more co-operative, more engaged, in less pain, and more articulate in their speech because music and speech are closely tied and music and movement are closely tied. So you benefit both and people are articulate longer and also in terms of people moving when they need to move when they haven’t been moving.

To answer your question about why headphones. It turns out that when people have Alzheimer’s one of the characteristics of the disease is that people will lose the ability to filter out multiple audio streams. So if you are in a nursing home and you are sharing a room with someone and the person in the next bed has a TV on and has visitors laughing and there’s noises coming from the hallway, and you have your music on in a speaker in your room, you aren’t going to be able to focus on it. So the Alzheimer’s association folks want to have those headphones over their ears. They want to block out that ambient noise and they want to people to have that direct input into their emotional system because when you have Alzheimer’s or another form of dementia even if it’s very advanced the emotional system is still intact. Why do we love our music? It’s our emotions that are responding. Not our cognition of “I love this song.”

Other than being personalized for the patient does music in the program have to be tailored to each setting?

Logistically, there are differences. In hospices, at first, they said, “Oh we can’t do this. We only get people for a day or so or three days. A short period of time.” Then the hospices figured it out. They weren’t just going to wait until next Tuesday when a certain volunteer came in. Now there is a certain group of people who are ready. “They (the resident) is coming through the door. Let’s set them up.” Before the resident comes, hospices are called. “So and so is going to be coming in a day or two.” They will now say, “Okay. Can you put together a playlist so that when they come through the door we will have the music that they want?”

Researchers have found that playing music from someone’s young adult years is likely to provoke the strongest response. As patients enter late-stage dementia, music from that time may hold the most personal feelings. Why is that?

That’s a great question but I think for all us when we are younger and we are coming of age, there are experiences. We are going to the beach with other kids, and hanging out with friends. The music that was playing is somehow more deeply tied with our emotions. And when we hear those songs, it somehow brings back those memories more quickly than a song that we heard today or last week or last year. I think that is really it. There is just some embedding that is deeper. I don’t really have a neurological explanation for that.

Perhaps music from our youth is deeply embedded in our neural-network, because while a teenager life is simpler, and music is a huge part of your life. Music gets displaced in the lives of people over time. As a teenager, you tend to know all the music out there. When you get older, you lose touch with music.

That’s for sure.

Are all types of music covered in the program? Heavy metal, show tunes, classical? The program doesn’t appear to be musically restrictive.

That is absolutely true. It is also in different languages. One of the hospitals in New York City said, “We have 7 patients speaking 17 languages here. Can you help come up with music they will react to?” So what we did was we created a guide Top Album Music in 26 languages.

Where do you source your music?

iTunes or Amazon, and then load it into iTunes.

Do you license the music?

We follow iTunes’ terms and conditions. We are fine on how we do the music and the music industry is familiar with what we do, and endorses what we do. All of the big music industry oversight entities are helpful in different ways. They might donate money or screen the movie (“Alive Inside: A Story of Music and Memory”) and different things. So what we are doing is fine but still every time we have 1,000 more nursing homes well it’s a 1,000 iTunes libraries that you have to talk to.

Where does the funding for Music & Memory programs come from?

It varies. For starting up programs in nursing homes there is a category of federal money that is available that states use. That source doesn’t add more than the first 15 iPods to a nursing home, and does not apply to hospice, homecare or assisted living. So we depend on people to put it in their budget or they get donations. We are always doing iPod donation drives. Every month I get a couple of hundred donated iPods. We have on our website a postage page label that people send in if they have old used but working iPods we’ll put out there in a non-profit within 30 days.

Have you moved away from iPods to utilizing other devices for playback?

iPhones, iPads, and iPods. We use all of those. But the question that comes up now is about streaming, which is big with Pandora, Spotify, and Apple Music.

It’s more difficult to completely personalize music lists with several of the streaming services.

With Pandora certainly, you just can’t get a solid list. But with Spotify you can. But a lot of nursing homes don’t have Wi-Fi or don’t have a decent Wi-Fi so you can’t use these services. You also have to use a more expensive device so it can connect to the internet. That means it’s more like to get stolen in a poor area.

Are the iPhones, iPads, and iPods donated?

Yes. We certainly rely on the generosity of others to make this happen.

Have any of the audio companies stepped forward to support the program?

The headphone companies have all done something here and there. They have been our main source of support from corporate America.

Apple would seem to be a natural potential supporter of the Music & Memory program.

They know about it. I did get to show “Alive Inside” at their headquarters in Cupertino, California, and they loved it. They said that it really represents what (the late Apple co-founder and CEO) Steve Jobs would have loved, where people are changing the world. They encourage us to be with the community. But there are so many different things being done with Apple equipment. Special ed teachers, there are a million of them using Apple equipment and doing great things. So you give to one (program), you have to give it to them all.

How were you able to attract country music superstar Kenny Chesney in 2013, and recently Carole King to record PSAs asking fans to support Music & Memory?

Amazing luck. Amazing luck and through our publicist (Shore Fire Media). They made these things happen. I didn’t have the connection. We just really released the Carole King PSA. It was on the CBS series “The Doctors.”

[Here's a link to the Carole King PSA.]

Many entertainers have encountered dementia and Alzheimer’s with family members or friends.

Absolutely. Everybody either knows someone or knows someone or close to someone who has been challenged with this disease, yes. Or will know someone in the not too distant future

Have you had people in the entertainment world seek you out?

It happens, but I would like it to have much wider. It’s just such a natural fit.

What is your wish list for the entertainment sector?

There are a number of things. Just to have spokespersons or fundraisers. To have them donate music. Donate oldies so we don’t have to pay for them (recordings) all of the time. That would be wonderful. I just think that the elders paid for all of their music in the ‘50s and ‘60s, and they bought those long-playing records, and here they are in the last days of their lives. What a gift it would be to keep them connected with their music.

Larry LeBlanc is widely recognized as one of the leading music industry journalists in the world. Before joining CelebrityAccess in 2008 as senior editor, he was the Canadian bureau chief of Billboard from 1991-2007 and Canadian editor of Record World from 1970-89. He was also a co-founder of the late Canadian music trade, The Record. He has been quoted on music industry issues in hundreds of publications including Time, Forbes, and the London Times. He is co-author of the book “Music From Far And Wide.”

Larry is the recipient of the 2013 Walt Grealis Special Achievement Award, recognizing individuals who have made an impact on the Canadian music industry. He is a board member of the Mariposa Folk Festival in Orillia, Ontario.

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