Steven Nelson is one of 10 residents at the Villa Coronado Skilled Nursing facility participating in a study exploring the connection between music and memory. (Megan Wood/inewsource)
Steven Nelson had decided he wanted to be a nurse. He had spent his teens in trouble and his early 20s in prison. Finally, in his mid-30s, with a steady job as a receptionist in an urgent care and five kids to support, he believed he had found his calling.
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Steven Nelson, left, singing to his grandmother on her birthday. Source: Hawkins family home video.
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“He tried to get his life together,” said Gloria Hawkins, Steven’s mother.
The regret in her voice wells, as Hawkins recalls what had been the happiest moments of her son’s life, cut short by five bullets and a beating to the head at a San Diego nightclub in 2011.
Nelson, now 44, suffered a traumatic brain injury that was so severe he has been kept alive in a nursing home with breathing and feeding tubes for nearly seven years. He is unable to move his body, except for his left hand. He doesn’t speak.
But music may now be offering hope where there once was none, both in Nelson’s quality of life and in his ability to respond to the world around him.
Science has shown music has a way of invoking memory. It’s been used to help people suffering from dementia reconnect to themselves and to their environment. Now, researchers are trying to figure out whether music can be used as therapy for people once considered unreachable.
“There is neuroscientific evidence that music is very embedded deep in the brain … and linked to experiences,” said Debra Bakerjian, an associate adjunct professor at the Betty Irene Moore School of Nursing at the University of California Davis.
Debra Bakerjian, an associate adjunct professor at the Betty Irene Moore School of Nursing at UC Davis. She says the choice of music is key. Click here to listen. (Megan Wood/inewsource)
Researchers at UC Davis have partnered with the California Association of Health Facilities to determine whether music can replace antipsychotic drugs in nursing home patients who are prone to agitation and help improve their quality of life.
“We’re going to try to show an association between the use of the music program and whether or not it reduces their aggressive behavior. Whether they can come off from their antipsychotic medication, whether they’re at least using it less frequently,” Bakerjian said.
More than 4,500 men and women living in 300 California nursing homes are taking part in the study, aimed at residents with dementia. Those with traumatic brain injury can also display aggressive behavior, requiring medication and even restraints.
Nelson’s bed is kept low to the floor with a mat below because he has become so agitated he has fallen out of the bed three times. That made him a good candidate for the study, said Christopher Walker, Villa Coronado’s chief operating officer.
“We wanted to see, does it help? Can we use a non-pharmacological intervention to actually reduce some of these things (and) improve their quality of life?” Walker said.
***
On a Wednesday morning, Vanessa Radilla, an activities worker at the Coronado nursing home, placed headphones on Nelson and clipped an iPod the size of a matchbook onto his hospital gown. It was preloaded with some of his favorite songs and artists:“Stand by Me” and “Amazing Grace,” and 50 Cent and Eminem.
“You wanna listen to your iPod today?” Radilla asked. “Are you gonna dance?”
Nelson, with his mother at his bedside, nodded. He smiled. He lifted his head so the headphones could be adjusted. All of these seem like routine responses but not for Nelson. For him, they were like tiny miracles.
He was first diagnosed as being in a vegetative state as a result of his brain injury. While people in a vegetative state may appear awake and alert, medical experts say they are unaware of themselves or their environment.
inewsource first reported on this population in 2014 in a special series called An Impossible Choice. The stories exposed a largely hidden world of special nursing home units in California, in which more than 4,000 people are kept alive with breathing and feeding tubes.
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Recent research suggests music therapy could help with recovery for people in a coma or in a vegetative state. It may even help diagnose consciousness, which continues to mystify scientists. Studies have consistently shown high rates of misdiagnosis in vegetative patients, indicating there is more likely a spectrum of consciousness where they drift in and out.
“Half the time you might think that your patient is unconscious, although he is conscious or showing signs of consciousness. This is mind-boggling,” said Caroline Schnakers, an associate clinical professor in the Psychiatry Department at UCLA and an assistant director of the Casa Colina Research Institute.
Schnakers’ work has demonstrated a 40 percent to 50 percent error rate in determining consciousness. A misdiagnosis can affect medical treatment and end-of-life decisions, Schnakers said. Getting the diagnosis right is especially important when predicting a patient’s chances of recovery, she said.
“The patient in a minimally conscious state has more chance to emerge or get better than a patient in a vegetative state,” she said.
Ken Warm, Nelson’s doctor at Villa Coronado. (Megan Wood/inewsource)
For Nelson, his condition appears to be improving, but he hasn’t been re-evaluated by a neurologist in four years. His doctor, Ken Warm, has noted Nelson’s improvement in his medical chart. But Warm acknowledged the nursing home, run by the nonprofit Sharp HealthCare, does not have the resources to evaluate residents for consciousness.
Most of Villa Coronado’s long-term nursing home patients are covered by Medi-Cal, the state health care program for the poor and disabled.
“It’s very clear that he doesn’t fit that (diagnosis), that he is responding to events in his environment which would not be consistent with persistent vegetative state,” Warm said. “There’s so much unknown about their cognitive function and their ability to process language or what recovery they might have in the future.”
***
The idea of using music in nursing homes took off after the debut in 2014 of the documentary, “Alive Inside: A Story of Music and Memory.” The documentary showcased the work of Dan Cohen, who had been providing iPods to nursing homes since 2006 and is now the executive director of the nonprofit organization, Music and Memory.
The film follows the stories of nursing home residents with dementia who were “reawakened” after listening to songs of their youth. Music and Memory now provides iPods to thousands of nursing homes across the country.
UC Davis researchers plan soon to have initial results from their study. But regardless of whether music is able to replace medication, Bakerjian said she is certain it can improve quality of life.
“I was almost in tears doing this interview with an activities director in a nursing home who was sharing how excited they were at their nursing home about the response of the residents. He told me how they just come alive,” she said.
Walker, the nursing home director at Villa Coronado, has also witnessed a similar change in some of the residents with iPods.
“When you see someone go from non-participating in anything, to all of sudden smiling and nodding their head, and it really seems as though they are reacting to the music that they’re listening to, it’s really amazing,” Walker said.
Gloria Hawkins sitting next to her son at the Villa Coronado Skilled Nursing Facility. (Megan Wood/inewsource)
Gloria Hawkins knows her son, Steven, will never fully recover from his brain injury. But she would like to know whether he is capable of more — especially now as she watches him respond to the music he once loved.
“Sometimes he’s very emotional with it and stuff, like he’ll remember and tears will start coming,” she said. “Or he’s very happy, he‘s laughing. It just seems like his memory, just kinda like soothes it.”
Related:
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[two_third_last] An Impossible Choice
More than 4,000 people are on life support in California nursing homes. They live on special wards called subacute units, but among some doctors these places are known as “vent farms.”[/two_third_last]
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[two_third_last] Team effort unlocks mystery of man on life support in Coronado
It took 16 years and a binational team of government officials and citizens to identify him, but finally the family of a man on life support in Coronado has some answers.[/two_third_last]
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[two_third_last] San Diego Hospice: The end of a journey
It’s been a long goodbye for San Diego Hospice, an institution that helped people die with dignity and without pain.[/two_third_last]
inewsource is a nonprofit, nonpartisan newsroom dedicated to improving lives in the San Diego region and beyond through impactful, data-based investigative and accountability journalism.
Our Vision
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Diverse Staffing Report
Below is a breakdown of staffing data at inewsource. We determine the composition of our staff by asking them to self-identify. It is based on a newsroom of 11 and a total staff of 15 as of August 2020. Percentages are based on 15 total survey responses. The numbers include full-time and part-time staff, full-time fellows and full-time and part-time interns.
All Staff Percentages are based on 15 total survey responses. The numbers include full-time and part-time staff, full-time fellows and full-time and part-time interns.
Newsroom Percentages are based on 15 completed survey responses to this question.
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Gender Identity
Gender Identity
Gender Identity
Women
80%
Women
82%
Women
75%
Men
20%
Men
18%
Men
25%
Sexual Orientation
Sexual Orientation
Sexual Orientation
Straight
87%
Straight
82%
Straight
100%
LGBTQ-identifying
7%
LGBTQ-identifying
7%
Not specified
7%
Not specified
7%
Speak a language beyond English at home
33%
Speak a language beyond English at home
18%
Speak a language beyond English at home
75%
Race/Ethnicity
Race/Ethnicity
Race/Ethnicity
White
67%
White
73%
White
50%
Hispanic or Latinx
20%
Two or more races
18%
Hispanic or Latinx
50%
Two or more races
13%
Hispanic or Latinx
9%
Age
Age
Age
20-29
40%
20-29
45%
20-29
25%
30-39
47%
30-39
45%
30-39
50%
60 or older
13%
60 or older
9%
60 or older
25%
* The percentages in the charts have been rounded and may not add up to 100.
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inewsource is a nonprofit organization, whose legal name is Investigative Newsource. It does business as inewsource. The business was incorporated on Aug. 4, 2009 in the state of California. Tax-exempt status as a 501c3 was granted by the IRS on Sept. 15, 2010. inewsource is funded primarily by individual contributions and foundation grants. We are guided by a board of directors.
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inewsource reporters have primary responsibility for reporting, writing, and fact-checking their stories. But before a story is published, the reporter reviews all facts and sources with an editor or another reporter. Facts must be traced to a primary source.
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Lorie Hearn is the chief executive officer, editor and founder of inewsource. She founded inewsource in the summer of 2009, following a successful reporting and editing career in newspapers. She retired from The San Diego Union-Tribune, where she had been a reporter, Metro Editor and finally the senior editor for Metro and Watchdog Journalism. In addition to department oversight, Hearn personally managed a four-person watchdog team, composed of two data specialists and two investigative reporters. Hearn was a Nieman Foundation fellow at Harvard University in 1994-95. She focused on juvenile justice and drug control policy, a natural course to follow her years as a courts and legal affairs reporter at the San Diego Union and then the Union-Tribune.
Hearn became Metro Editor in 1999 and oversaw regional and city news coverage, which included the city of San Diego’s financial debacle and near bankruptcy. Reporters and editors on Metro during her tenure were part of the Pulitzer Prize-winning stories that exposed Congressman Randy “Duke” Cunningham and led to his imprisonment.
Hearn began her journalism career as a reporter for the Bucks County Courier Times, a small daily outside of Philadelphia, shortly after graduating from the University of Delaware. During the decades following, she moved through countless beats at five newspapers on both coasts.
High-profile coverage included the historic state Supreme Court election in 1986, when three sitting justices were ousted from the bench, and the 1992 execution of Robert Alton Harris. That gas chamber execution was the first time the death penalty was carried out in California in 25 years.
In her nine years as Metro Editor at the Union-Tribune, Hearn made watchdog reporting a priority. Her reporters produced award-winning investigations covering large and small local governments. The depth and breadth of their public service work was most evident in coverage of the wildfires of 2003 and then 2007, when more than half a million people were evacuated from their homes.
Laura Wingard is the managing editor at inewsource. She has been an editor in San Diego since 2002, working at The San Diego Union-Tribune, KPBS and now inewsource. At the Union-Tribune, she served in a variety of roles including as enterprise editor, government editor, public safety and legal affairs editor, and metro editor. She directed the newspaper’s award-winning coverage of the October 2007 wildfires and the 2010 disappearance of Poway teenager Chelsea King. She also oversaw reporting on San Diego’s pension crisis.
For two years, Wingard was news and digital editor at KPBS, overseeing a team of four multimedia reporters and two web producers. She also was the KPBS liaison with inewsource and collaborated with inewsource chief executive officer and editor Lorie Hearn on investigative work by both news organizations.
Wingard also worked at the Las Vegas Review-Journal as the city editor and as an award-winning reporter covering the environment and politics. She also was the assistant managing editor for metro at The Press-Enterprise in Riverside. She earned her bachelor’s degree at California State University, Fullerton, with a double major in communications/journalism and political science.
Brad Racino is the assistant editor and a senior reporter at inewsource. He has produced investigations for print, radio and TV on topics including political corruption, transportation, health, maritime, education and nonprofits.
His cross-platform reporting for inewsource has earned more than 50 awards since 2012, including back-to-back national medals from Investigative Reporters and Editors, two national Edward R. Murrow awards, a Meyer “Mike” Berger award from New York City’s Columbia Journalism School, the Sol Price Award for Responsible Journalism, San Diego SPJ’s First Amendment Award, and a national Emmy nomination.
In 2017, Racino was selected by the Institute for Nonprofit News as one of 10 “Emerging Leaders” in U.S. nonprofit journalism.
Racino has worked as a reporter and database analyst for News21; as a photographer, videographer and reporter for the Columbia Missourian; as a project coordinator for the National Freedom of Information Coalition and as a videographer and editor for Verizon Fios1 TV in New York. He received his master’s degree in journalism from the University of Missouri in 2012.
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