A Cost-Benefit Analysis of Music Therapy in a Home Hospice

Rafael Romo, MSN, RN; Lisa Gifford, MSN, RN

Disclosures

Nurs Econ. 2007;25(6):353-358. 

In This Article

Discussion

For this sample population, the cost-benefit analysis indicates that the expense of the music therapy program is greatly offset by the cost savings seen in other areas of care. The ratio was higher when examining the cost PPD, indicating that the savings may be even greater in the wider patient population. The findings of this study are similar to that of Walworth (2005), who examined the use of MT for procedural support with pediatric patients. These findings should be of interest to hospices, which frequently are faced with patients who have symptoms that are difficult to manage. The unintentional consequence of cost savings could help hospices as they struggle to maintain costs in a time of increasing fiscal restraint while maintaining a high quality of patient care. It is important to note that while there were 35 additional days of patient care, there were fewer hours of RN care but increased hours of LVN and HHA care. This may indicate that patients in MT and their families are more open to the breadth of services provided by hospice. The findings of this study should also be of interest to those who care for the elderly, especially skilled nursing and long-term care facilities. Caring for patients in skilled nursing facilities presents many of the same problems as caring for the dying, especially since many elderly have early phases of terminal diseases. Future research needs to examine the use of MT in long-term care.

As a small, focused study, generalizing these findings to a wider population is not possible. Though attempts were made to control for gender, age, and length of stay, the sample size prohibited control for diagnosis or prognosis. Patients with non-cancer diagnoses present challenges for hospice as prognostication is difficult (Ferrera-Reid, 2004; Schonwetter et al., 2003), and some research suggests that caring for non-cancer patients is more costly (Campbell, Lynn, Louis, & Shugarman, 2004; Pyenson et al., 2004). Future studies need to control for the effect of these variables and allow for a larger sample size. Patients residing in skilled nursing, residential care, and assisted living facilities were not included in the sample. How the residential setting affects patient outcomes and cost was not ascertained. While all patients were considered for MT, not every patient was deemed appropriate nor elected to participate; this may have had the effect of biasing the MT program to patients who are more open to its benefits.

Finally, because the MT-BC tailors each care plan to the unique needs of each individual patient, there is no control for the MT intervention. The hospice administrator viewed using an MT-BC as a strong point and critical to the program's success, a view supported in the literature (Chawin, 2002; Gallagher et al., 2001; Kemper & Danhauer, 2005). MT-BCs are graduates of accredited university programs, vetted by a national certification exam, operate under a standard of practice set forth by the AMTA, and follow a standard methodology for assessing patients, planning interventions, and evaluating outcomes (AMTA, 2004). Many of the studies examining music therapy do not use MT-BCs and frequently use only recorded music interventions, which may limit the effectiveness of the interventions.

In addition to the tangible benefits measured in this study, other benefits are evident. Evidence exists that MT may improve risk management for the hospice. Agitation and restlessness are leading causes of patient falls and staff injuries (Sung & Chang, 2005; van Doorn et al., 2003); consequently, one can argue that MT may reduce the number of falls and injuries. In skilled nursing facilities, such incidents are estimated to cost as much as $16,000 for hospital costs alone (Occupational Safety & Health Administration [OSHA], n.d.; Titler et al., 2005). A decrease in patient and staff injuries would then have a direct effect on insurance premiums (Iyer, 2004; OSHA, n.d.). Future studies should examine how MT affects falls and staff injuries and the cost benefit of this affect. Intangible benefits not included in this analysis can also be seen. The research cited indicates that MT may help improve hospice quality indicators, a direct benefit to quality control and accreditation processes. Improved patient behavior should lead to improved staff interactions with patients, which in turn should lead to improved working conditions, job satisfaction, and staff retention.

The impact on staff satisfaction may be significant. At the conclusion of the study, a short survey was given to all the hospice staff with 20 of the 40 staff members responding. All respondents strongly agreed that MT is beneficial to patients and that it improved their interactions with patients and their families. Though there was greater variation when asked if MT improved their working conditions, 70% agreed or strongly agreed. Only one disagreed, and the others had a neutral opinion. Most importantly, 70% of respondents agreed or strongly agreed that the MT program increased their job satisfaction, and 80% of the respondents felt that knowing the hospice paid for the MT program increased their commitment to the agency. The impact of alternative therapy programs on staff morale and commitment needs to be studied.

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