Care for Music - an ethnography of music in late life and end of life settings

The project focuses on music-making in situations of modern dying and in relation to both (i) end-of-life (time-limited illnesses or conditions) and (ii) late life (more lengthy 'dwindling' and/or long-term disability). The research begins with a basic question which in our view has not yet been answered adequately: how does music work in situations of care? Behind this question is an assumption that musical care is more complex than models in music therapy and community music might imply. These models have tended to prioritise the activities and agencies of specialist music providers through a notion of music 'for' 'care recipients' and in individualistic and pathologised ways. But looking at music 'for care' (as opposed to 'care for' music) sidesteps the complex collaborative practices, and forms of agency, on the part of all the people involved (musicians, music therapists, carers, health professionals, family and so-called 'care-receivers'), that make music helpful (and meaningful) within scenes of care. A focus on this practice brings to the surface three otherwise implicit problems in the music and care literatures. These are perceptual, ontological and methodological. Processes of musical engagement are often tacit, fleeting and socially-spatially distributed and therefore difficult to perceive. They are also tied to a language of 'music' as an object and therefore to an ontology of stimulus-response rather than music as a joint activity. They are difficult to document unless they are observed in temporal and spatial contexts and in terms of their evolving histories - and for this specialist methods are required.

The methodological perspective to be employed is ethnographic, to trace connections and relationships between people as they are crafted from moment to moment in real time through music and in ways that may be consequential for action opportunities within settings of care. The project will produce four interlinked ethnographic case studies:
(1) A longitudinal study of community music therapy in a care facility (with specialty in neuro-disability), tracking the micro-detail and developing connections within and between individual and collective musical-communicative work (2) and (3) Studies of music/music therapy across the milieu of two flagship hospices, one in the UK, one in Norway. (4) A study of a novel approach to working relationally with people with memory loss by cueing pre-chosen sounds and memories using simple digital resources.

In each case, the project will examine the subtle, adaptive, and often unnoticed practices of managing to make and attend to music under constrained circumstances - how mutual orientation takes shape, how allowances are made, how musical gestures and acts are supported, by whom, with what and how. This focus will in turn support a second key task which will be to map the diversity of musical practices to be found and to follow these practices as they are connected (by participants) to other practices, activities, situations, and events that develop concurrently within the setting and in ways that inform future events. Ultimately, the project will address the question of how making music together may open new opportunities for caring understood in its widest sense, for example, fostering musicalised situations within which clients and carers may discover new forms of relation, empathy, activity, and mutual understanding.

Four interlinked groups will benefit:

(1) Music Therapists, Community Musicians, Music & Health Practitioners
Increasingly Music therapists, community musicians and music & health practitioners are working in late and end-of-life settings, as individual specialists or as part of large-scale initiatives. Practitioners and service organizations speak of the need to develop effective techniques for 'reaching' the various groups with whom they work. But the current framework for thinking about their role and musical relationship with those groups (care recipients, families of care recipients, care staff) often portrays musical activity as specialist 'intervention' in ways that emphasize the 'delivery' aspect of music to people - through performances or more interactive work. The project will raise awareness of musicking in scenes of care as mutual, reciprocal and 'ecological' in ways currently under-appreciated. It will work with musicians and music therapists in bespoke workshops and symposia to highlight the often-subtle activities, practices and contributions to on-going musicking made by care recipients.

Our aim will be to enrich curricular resources for both expanded theoretical perspectives and fine-grained practical coaching in music therapy training. We will run workshops with music therapy and community music trainers, presenting a novel perspective on what counts as 'music', and how care and music interleave in practice. (We have experience of running a highly successful Masterclass on Ethnography for early career music therapists in 2017 at Exeter.) In these events, Ansdell, Schmid and Simpson will provide participant workshops specifically to present perspectives and techniques and to mentor practitioners. DeNora will contribute a wider perspective linking alternative music aesthetics and ontologies within a sociology of health and illness perspective. Rolvjord will offer specialist commentary on eliciting client perspectives and our partners from Earl Mountbatten will share their flagship practices for community-hospice interchange (as part of a wider education project musically-led about cultures of death and dying).

(2) Care givers, Care recipients, Family members and friends of care recipients
The introduction of a new form of client-centered approach that explicitly highlights how music can encompass and enhance the whole 'scene of care' will help shift the balance in care settings where music is happening in ways that should empower clients, carers and others involved, drawing to the fore their interests, talents and musical needs and thereby improve quality of care. But all this need sensitizing musicians and music therapists to really attend to how care-receivers themselves 'care for music' and how this can be worked with and extended.

(3) The General Public
We aim to increase public empathy with groups of people who are typically sequestered and conceptualized as 'disabled' and lacking social and cultural resources by highlighting 'alternate forms of musical ability and sociability' and the ways in which musicalizing activities associated with 'care' may help to eclipse some of the barriers to shared meaning making in music. Calling attention to the sounds of musical care and to music in scenes of care will help to make those scenes less 'strange' to families and visitors who have loved ones in care facilities. At the same time we aim to raise public awareness of how to use music for wellbeing in daily contexts.

(4) Policy makers
We will aim to influence policy by contributing new perspectives for thinking about evidence and music's role in scenes of care through briefing documents, website entries and alignment with the All Party Parliamentary Group on Arts/Health as well as with Clinical Commissioning Groups. The aim will be to improve quality of care in care facilities.