Building a Personalized Music Intake Form in LTC

by Various Writers

Many people at Room 217 educational events ask: “what music should I use with residents in LTC?” Our response, always: “ask the residents first.” This MCCP Level 2 grad developed a music preferences assessment form, as a way of gathering more thorough information about each resident and their musical background. Imagine the possibilities for individualized music care if an assessment form like this was a part of each intake for every new resident!
I’ve been fortunate to be involved in helping a long term care home in my community with an initiative to bring iPods with personalized playlists to residents.   While our facility has long been incorporating music into group programming, we wanted to find a way to bring more meaningful and familiar music to individuals, particularly those with dementia.  The research and anecdotal evidence is compelling; music has the power to shift mood, stimulate positive interactions, reduce problematic behaviors and promote well-being, among other things.
We identified a small number of residents who we thought would benefit from having a personalized playlist and then began the task of finding their familiar and meaningful music.  Not surprisingly, we found that this was not a straightforward task.  Some residents were able to tell us who their favourite artists were, or their favourite songs, but most, because of their advancing dementia, were not able to.  However, many were able to gives us clues: some always sang in church, or one of their parents played piano and sang old pub songs, or they liked western movies when they were younger.   We needed to ask questions that would prompt discussion and give us some of these clues. 
To help with this we developed a form (Music History and Preferences, shown below).   We spoke to music therapists and other facilities who had similar initiatives to get ideas on the kinds of questions that we might include in addition to the obvious “what are your favourite songs?”  We heard we should include questions about childhood (parents playing an instrument or singing), music as part of family gatherings or holidays, music at places of worship, dancing, cinema, television.   We also know from research and our own experience that we often have a strong connection and identify with music we listened to in our teens and twenties, so we wanted to ask questions about music preferences at different ages.
In addition to using the form to guide us in our discussions with residents about their music preferences, we use it with families find them to be an invaluable resource.  Most often it is spouses or children we sit down with, but on the rare occasion we are able to find a sibling we have found them to be very rich sources of information. 
While this form was developed because we needed to find music for those residents with iPods, it didn’t take long to see that this information is something we should have for all residents.  Our goal is to incorporate it into our intake for new residents, to ask them to share their connections to music with us so that we will be better able to help them enjoy the music they love when they most need it.

Below is the sample form:

Music History and Preferences Assessment Form


Date of Birth

Place of birth                               

Where did you live in your teens and 20’s

Did you play a musical instrument?  If yes which instrument(s)?

Did you sing in a choir?  If yes which choir? 

Did anyone in your family play an instrument?  If yes, who and what instrument(s)?

What songs did your parents play or sing to you?

What songs remind you of your parents or siblings?

What music was played or sung at family gatherings or holidays?

Do you have favourite songs from a place of worship?

Did you attend concerts when younger?  If so, what kind of concerts (classical, country, folk, rock, other? 

Did you go out dancing? If yes, what songs or bands did you dance to?

What song did you dance to at your wedding?

Who are your 5 favourite singers or bands?

What are your 3 favourite songs?

What songs did you sing to or play for your children?

What albums/songs/singers did you listen to most or were most significant to you

During your teen years
During your 20’s
During your 30’s & 40’s
During your 50’s & 60’s

What music or songs do you like now?

Did you go to the cinema and if so what were your favourite movies?

Did you have favourite television or radio shows?

What were (and are) your favourite hobbies or sports?


Terry Horton is a social worker, currently volunteering at a Long Term Care facility in southern BC. She completed Level 2 of the Music Care Certificate Program in April 2016, in Calgary.