Music professionalism promoting gerotranscendence: An instrumental case study of healthcare musicians in an eldercare hospital

Abstract

The effect of ever-increasing life expectancy on global demographics has had a significant impact on many professional landscapes, not only in social services and healthcare but more broadly. This instrumental case study explores professional healthcare musicians’ work through their collaborative, socially engaged music-making practice in eldercare hospital wards. Two healthcare musicians were interviewed, and their work and professional practices were observed in the infection and orthopedic wards of an arts-promoting eldercare hospital. The empirical material was analyzed using thematic analysis, and finalized by instrumentalizing the case through the theoretical lens of gerotranscendence and music professionalism. The findings of the study open up a diversified understanding of aging as a transformative process of change and development, and reveal how professional music practices can support a holistic care and healthcare approach. Furthermore, it is discovered that healthcare musicians’ work as a socially engaged approach to professionalism reframes musicianship as part of an expanding professionalism, and calls for further development of higher music education as well as in-service training in the field of music.

Due to the increased life-expectancy of large segments of the world’s population, the lives of many aging people are increasingly characterized by prolonged independence and activity. On the other hand, this impactful global demographic development (World Health Organization[WHO], 2015) can be accompanied by increasing health issues and a decline in wellbeing for some individuals, which makes them more dependent and care-reliant at this point in their lives. This development leads to new service demands that consequently are changing professional landscapes around the globe, not only in social services and healthcare but also in fields such as music. The use of artistic and arts-based approaches in healthcare contexts is becoming increasingly common, as the preventive nature and holistic characteristics of social work and healthcare are emphasized (All-Party Parliamentary Group on Arts, Health and Wellbeing, 2017; Fancourt & Finn, 2019; Stickley & Clift, 2017; WHO, 2015).

In this case study, we will explore two healthcare musicians’ collaborative, socially engaged work and music-making practices in eldercare hospital wards in Finland. Methodologically, the case serves the instrumental purpose (Stake, 1995) of identifying connections between music professionals’ transformative work and elderly care needs. The study aims to exemplify how the work of healthcare musicians expands when their professional responsibility, as a significant aspect of their overall professionalism (Cribb & Gewirtz, 2015; Sugrue & Solbrekke, 2014), encompasses more than the musical skills or pedagogical needs of the participating people. By professionalism we refer to the qualities that characterize the specialized and professional attitude and competences of a person, viewed as an asset that should not be taken for granted (Cribb & Gewirtz, 2015). The qualities of music professionalism have usually been manifested through musical competence(s) and skills, but following Cribb and Gewirtz we suggest we should make an effort to understand music professionals’ work more broadly, as contextual and relational (Westerlund & Gaunt, 2021). This kind of professionalism, considering various working contexts such as eldercare or healthcare, has been conceptualized as transformative, socially engaged professional work (Sugrue & Solbrekke, 2014), and has been characterized as an expanding professionalism in music and higher music education (Westerlund & Gaunt, 2021). Through a reflexive and thematic analysis (Alvesson & Sköldberg, 2018; Braun & Clarke, 2006) we address the hitherto underutilized interprofessional possibilities in eldercare that arise when bridging music professionals’ work with holistic medical and care approaches.

In the recent attempts to reframe professionalism in the music field from the perspective of emerging workspaces in healthcare contexts, a solely medical discourse has been characterized as being insufficiently diverse (see Ansdell & DeNora, 2016; Ansdell & Stige, 2015) to frame socially engaged music practices. Hence, music scholars have started to construct a wellbeing discourse with a more holistic approach to healthcare. However, this discourse has been considered as too uncritical, individualistic, and idealistic (ArtsEqual, 2021; see Ganesh & McAllum, 2010), demanding further scrutiny and scholarly confirmation. In this study, expanding professionalism is considered significant in terms of accessibility and equal opportunities for participation in music education, throughout our changing society (ArtsEqual, 2021; Stickley & Clift, 2017).

Theoretical landscapes

Music professionalism in healthcare contexts

Research on musicians’ and music educators’ work in medical and healthcare environments, especially in somatic and general hospital services, has remained scarce so far, and musicians working in hospitals represent a rather new occupational group (see, however, De Wit, 2020; Dons, 2019; Koivisto & Tähti, 2020; Preti, 2009; Preti & Welch, 2013). Nevertheless, music has been practiced and performed for a long time in general and psychiatric hospitals by the eldercare patients themselves, hospital personnel, and volunteers, as well as professional musicians and music educators. The range of activities has varied from giving concerts and artistic residencies in hospitals (e.g., Edwards, 2008), to musicians and music educators working in veterans’ hospitals after World War II (Gilliland, 1944), to bedside music practice in children’s hospitals (Preti, 2009). While historically many hospitals have had a rich legacy of supporting collective cultural communities, contemporary healthcare environments are mostly dedicated to medical recovery from somatic diseases, relating to the diseases solely in a physical way (see Berwick, 2009). Whilst the music therapy profession was established in the early 20th century, since then music-making in hospitals has become more medically and diagnostically oriented, creating the understanding of music as a form of treatment to be offered by professionally educated therapists (Bonde & Wigram, 2002). This led later to the need for more holistic frameworks such as community music therapy (Ansdell & Stige, 2015; MacDonald et al., 2012) and music as health promotion (Bonde & Theorell, 2018), bridging the medicalized music therapeutic practices with more conventional music education and the emerging community music perspectives.

Music interventions and practices in eldercare have been explored by, for example, Batt-Rawden and Storlien (2019), Hallam et al. (2014), and Garrido et al. (2020). Only a few researchers have focused on the professional music-making practices in eldercare beyond music therapy or the everyday uses of music (e.g. De Wit, 2020; Dons, 2019). Previous studies of professionals facilitating music-making in healthcare and hospital contexts feature terms such as health musicians (Ruud, 2012; Stige, 2002) and hospital musicians (Dons, 2019; Preti & Welch, 2013). In this article, we coin the term healthcare musician to highlight the importance of the interprofessional work (Cribb & Gewirtz, 2015) in musicianship that takes place broadly in all kinds of healthcare and care contexts, and without necessarily emphasizing the expectation of implications for people’s health conditions that are prevalent in music therapy. Healthcare musicians’ professional responsibility may be considered from multiple criteria of quality (Laes et al., 2021), and can contribute to the quality of the individual’s life in care and healthcare environments, including the eldercare patients, family members, and staff, as well as the overall quality of the healthcare system as a whole (see Creech et al., 2014, 2020).

A critical perspective on aging in eldercare contexts

Studies of aging have long examined individual’s quality of life, social (dis)engagement, and general wellbeing from a rather positivist perspective (Bengtson et al., 2009; Tornstam, 2005). Researchers have criticized these past perspectives on aging populations as being too narrow, defining the aging population first and foremost as a societal and economic burden (Bengtson et al., 2009; Tornstam, 2005; Walker, 2012). The current discussion regarding later life in social, educational, and healthcare contexts highlights active aging (Bengtson et al., 2009; Hage & Lorensen, 2005), which stresses the importance of staying physically and socially active. In healthcare and eldercare contexts, this discourse has been accommodated by encouraging professionals to “activate” the elderly, often without deeper reflection on the meanings of individual experiences of aging, wellbeing, and quality of life (Bengtson et al., 2009; Hage & Lorensen, 2005; Tornstam, 1994, 2005).

Social gerontologist Lars Tornstams’ meta-theory of aging, termed gerotranscendence (1994), treats aging as a process of moving beyond physical needs and even realities into a sphere of increased satisfaction with life (Tornstam, 2005). The theory stems from the insight that the prevailing social gerontological views do not fully coincide with the lived experiences and self-reflections of older people themselves. Gerotranscendence challenges the normative understandings of aging by introducing the perspective of continuous change and development into old age (Tornstam, 2005; see Hage & Lorensen, 2005;). Drawing from the concepts of transcendence and transcendental change, without their religious or metaphysical meanings, gerotranscendence signifies a shift “from a materialistic and rational perspective to a more cosmic and transcendent one, normally followed by an increase in life satisfaction” (Tornstam, 2005, p. 41). The meaningful experiences and goals of aging are understood as being based on the individual’s own definitions, not those of others (such as care professionals).

Gerotranscendence is a little explored phenomenon in the field of music (in music therapy, see Halverson-Ramos, 2019), especially lacking any empirical studies. Playing together, listening to music, reflecting on experiences and emotions evoked through music, or singing with and for the eldercare patients, may generate a broadened understanding of the identity, self, and roles a person has had and still has in their life. Engaging in reciprocal musical reflection, for example through musical memoiring and selecting personally relevant and meaningful music either to listen to or to play and sing, may facilitate the experiencing of life satisfaction and ongoing transcendental development, despite an individual’s actual physical condition or their overall declining state of wellbeing (see Halverson-Ramos, 2019; Tornstam, 2005).

Design of the study

As an instrumental case study (Stake, 1995; see Crowe et al., 2011), this work facilitates a broader understanding of a phenomenon, by utilizing the case study to gain knowledge about the underlying principles of healthcare musicians’ work in the healthcare context, and to help understand eldercare more broadly in relation to it. Our overarching task is to initiate critical discussion in order to encourage a deeper understanding of the means and effects of expanding music professionalism within the healthcare and eldercare contexts, as well as to better respond to the ongoing changes in society and science in general.

The research task is guided by the following questions:

1. How is the nature of the work in eldercare hospital wards reflected by the efforts of healthcare musicians?

2. How may the understanding of these music professionals’ work contribute to the development of expanding professionalism in music and higher music education?

Study context and data

The context of this study is a newly established, arts-promoting eldercare hospital. Specialized in inpatient and outpatient treatment and rehabilitation, the hospital was designed to support the ability of people to live longer in their own homes. Since the establishment of the hospital in 2017, numerous artists, among them the professional musicians in this study, have been invited to support the health and recovery of the eldercare patients with music and art practices. This study is part of a multiple case study project of the first author—who is a music therapist, music educator, and health promotion expert—on healthcare musicians’ work in somatic hospital wards, including a children’s hospital and eldercare hospital. A research permit for the multiple case study was granted by the municipalities in charge of the hospital administration. In addition, an ethical statement for the research project was approved by the Research Ethics Committee of the University of the Arts Helsinki.

The generation of the empirical material took place over 2 months in Fall 2018, in the infection and orthopedic ward of the hospital. The data, generated by the first author, includes (1) observational data in the form of a researcher’s observation diary, (2) individual semi-structured interviews with two healthcare musicians, and (3) written professional narratives from both healthcare musicians. The observation phase, which took place over 5 days in the wards, included observational data on the music sessions, social and contextual interaction, and relationships that took place beyond the shared music-making. The rigid medical context and research permits did not allow any audio or video recordings during the data gathering process. To create reflexive (Alvesson & Sköldberg, 2018) and relevant understanding of the case (see Butler-Kisber, 2018; Stake, 1995) the observational diary was organized on the temporal order of the interactions under the following categories: (1) musical interaction in-between healthcare musicians and participants; (2) verbal and embodied communication; (3) selected musical instruments, tools, and approaches; and (4) interprofessional and collaborative ways of working in the ward.

The first author conducted two interviews with each healthcare musician, of approximately 1 hour each, which resulted in 4 hours of interview data altogether. The interviews were recorded, and the transcriptions were returned to the musicians for a member check. The professional narratives served as a source of professional background of the musicians. Healthcare musician A is a freelance music practitioner with approximately 5 years of work experience in healthcare settings at the time of the study, including different kinds of hospital and care environments. She has pioneering experience in developing in-service training for healthcare musicians, collaborating with various stakeholders within healthcare and music. Healthcare musician B is a symphony orchestra musician with an international career as a musician and instrument pedagogue. He started to work as a healthcare and care musician as part of downshifting his career, approximately 1 year ago during the data generation. Both musicians have a higher education degree in music and an extensive in-service training background in their occupational fields.

Analysis of the data

The analysis of the empirical material was conducted on three levels. First, the first author classified and coded the interviews, condensing the data into thematic ideas (Braun & Clarke, 2006). Second, the first author sought to interpret and understand the professional phenomenon through the interviews, observational data, and professional narratives, creating a reliable and solid knowledge basis through data triangulation (Butler-Kisber, 2018; Stake, 1995), as well as attempting to avoid sources of researcher bias such as misinterpretations of the observational data. Third, both authors finalized the analysis by instrumentalizing the study through the theoretical lens of gerotranscendence and music professionalism in changing contexts, in favor of contributing to eldercare and expanding overall professionalism in music/arts collaboratively.

In a qualitative instrumental case study there are limitations to how far a researcher can remove oneself from the data (see Stake, 1995), and the context-specific features of the case—such as the first author being a single researcher in the hospital wards and the limited amount of data—created limitations for the study. We have therefore adopted a more insight-driven rather than a solely data-driven approach to the analysis (Alvesson & Sköldberg, 2018, p. 344). In the more positivist research tradition the status of the first author—a music therapist, music educator, and researcher in the field—might be seen as a bias, but here it was considered a strength and innovational aspect, as it enabled conducting a non-medical study within and beyond the medical protocols and procedural ethics (e.g. for arts in health protocols see All-Party Parliamentary Group on Arts, Health and Wellbeing, 2017; Fancourt, 2017; Fancourt & Finn, 2019; Stickley & Clift, 2017). While the data for this study consists of material from two interviewees, observations of their work in the hospital ward, and professional narratives written by the healthcare musicians themselves, the analysis is also affected by the first author’s deeper knowledge and understanding of the wider study context as part of her research project (Alvesson & Sköldberg, 2018, p. 11).

Findings

Healthcare musicians’ work in eldercare hospital wards

The healthcare musicians, who worked individually within the ward environments, described their work in the hospital wards as free and rather improvisatory. Although their visits to the wards were pre-scheduled, they were able to change the nature of the ward space on the spur of the moment, as they were making music by playing and singing with and for the eldercare patients in the ward halls, lounges, recreation rooms, and individual rooms. Healthcare musician A used her voice and many kinds of instruments (e.g. Finnish kantele and percussions) in her work, with singing being the main element; healthcare musician B mainly used his main instrument from the orchestra, which was a brass instrument, and he had many kinds of smaller instruments with diverse soundscapes in his repertoire. Both musicians described their music work as involving a great deal of interprofessional collaboration, such as working with music therapists, giving lectures and workshops to the nurses, participating in hospital community seminars, and attending the nurse station meetings. Through these multiple tasks the musicians integrated themselves into the hospital community, without directly attending the nursing or medical work.

Five themes were defined through the thematic analysis of the musicians’ interviews and the first author’s observations.

Considering other people’s reactions

The first theme attends to the way the healthcare musicians reported their awareness of taking into account the wishes and desires of the eldercare patients and their families, nurses, and doctors regarding music-making situations. According to both musicians, the eldercare patients, their family members, and the healthcare personnel had varying reactions to the invitations to participate in shared music-making, and it was important to consider beforehand how to enter the ward space in the first place: “It is very essential, how you start the work and how you enter the ward space. It all relates to the process of entering as a healthcare musician into a community” (Healthcare musician A). The previous musical experiences of the eldercare patients and their families were vital in music-making situations; they could refuse or simply be unable to participate in the music-making, and there were many other particular challenges to their participation in the singing. The identification and recognition of these reactions were an inseparable part of shared music-making in the wards, and could be called active resistance, rooted in the nature of the recent decades’ music education. Many time the experiences that the eldercare patients described to the healthcare musicians during the music-making were intertwined with their prior experiences of making and learning music:

May I tell you a story? When I was seven years old and went to school, we had a Christmas party there. It happened that I and the other pupil did not have a good enough voice to sing. The teacher put us in the choir and told us that you cannot sing. — Wasn’t that a horrible thing that teachers could do back then? (An eldercare patient to the musician/Researcher’s observation diary)

According to the healthcare musicians, the eldercare patients and their family members sometimes hesitated to participate in singing or music-making despite their obvious desire to participate. Navigating within these different experiences of the eldercare patients required a great understanding of how to implement music practices in the ward, and how to include rather than exclude participants in the shared music-making. In contrast to the negative memories, many eldercare patients and nurses told stories of how they had been supported and appreciated in their musical efforts during their lifespan.

Appreciating silence and silent participation

The two musicians described the importance of learning to appreciate the ”non-participating eldercare patient” and silent participation during music-making situations, in other words providing space for many ways of participating:

I think I have learned to take advantage of silent moments. You don’t have to use all of the time in doing something, such as singing or playing. Many times, if you as a musician have the patience to be silent, the listener will soon say something or give you some kind of sign on how to proceed. (Healthcare musician A)

When hospitalized, some eldercare patients may find themselves in more vulnerable positions than they have ever been before in their lives. Some may apologize for being in such a sensitive mood during the music-making. Sometimes the identity of an ill, disabled person, was reflected through music or the healthcare musicians’ work: “But I cannot sing. I have turned 80 years and I am sick. Anyway, thank you for your songs” (An eldercare patient to the musician/Researcher’s observation diary). The shared music-making, being a voluntary activity for the participants, could in many cases seem impossible to start, and it required many attempts and much effort to draw the person into social interaction. Sometimes an eldercare patient would use their “right to remain silent” and not to participate in music-making with healthcare musicians. Mirroring the situation through silence was a conscious working tool for healthcare musicians, and a way-of-being and lingering in the moment for the eldercare patients, and required a great sensitivity from the healthcare musician to acknowledge.

Tolerating incomplete situations and shapeless processes

The third professional theme relates to tolerating the pending, unaccomplished issues when healthcare musicians worked in the wards, where the hectic work of the nurses and the eldercare patients’ often slow pace intertwined:

We had a rich discussion after the music-making with one person. Then, a nurse came to draw him away in his wheelchair, and that was the end of it. — It may feel like the nurses could be heartless. But, they have their schedules, and they have many eldercare patients to take care of. (Healthcare musician B)

According to the observations, and the musicians themselves, oftentimes the healthcare musicians’ visits were surprising situations for the eldercare patients and personnel, even though the visits were scheduled beforehand: “There are some wards, and it happens regularly, where they ask and wonder [with humor]: Whose son are you?” [an old Finnish saying] (Healthcare musician B). In practice, the music work was disrupted at some point. This demanded the healthcare musicians’ conscious decisions about how to settle oneself professionally in the ward environment and orientate oneself in the situational and contextual work: “I decided that I will get used to the interruptions and learn how to focus on this kind of practice — in this work, you will have to take into account that interruptions will happen sooner or later” (Healthcare musician B). Rather than considering the environment as unappreciative, the unsettledness was even seen as a rewarding context, where a healthcare musician had to be able to be open with all of their senses and understanding: “I work here-and-now, in the moment. And I see you now in this moment, and came here to be with you” (Healthcare musician A to an eldercare patient/Researcher’s observation diary).

Celebrating life and acknowledging despair

The fourth theme emphasizes how professional musicians’ work can relate to life as a celebration by simultaneously acknowledging, instead of minimizing or ignoring, the existence of personal despair:

The door is open. A woman is laying on her side in the bed, her face towards the hallway. The situation appears to be so fragile that I decided to stay outside the room. Her eyes are just half-open. The healthcare musician sings two peaceful songs for her. The moment seems very sensitive in nature. (Researcher’s observation diary)

Some of the eldercare patients may end up spending long periods in the wards and may be transferred from one hospital to another depending on the rehabilitation framework or the necessary care procedures. The routines in the hospital may enclose an aging person within what could be called a hospitalized life. Many eldercare patients reflected on this with the healthcare musicians:

I am having a difficult situation. I have lived for forty years in my own house. Life is crazy, it is a pity that everyone will have to go through this in life. Music has brought so much meaningfulness to my life. I don’t know whether it had some kind of meaning when my musicianship ended. — It was mentally a very heavy situation for me when I had to sell my house. I should also polish my trumpet, and sell it. (An eldercare patient to a healthcare musician/Researcher’s observation diary)

Celebrating and affirming the life cycle together, and managing time and space through music-making, becomes very important, although sometimes much elicitation and effort is required to convince and enable an eldercare patient to join in a music-making situation. When hospitalized and presumably spending a lot of time in bed, plunging into new activities may not be as easy as in normal living conditions outside the hospital. Healthcare musicians also serve as alternative facilitators in the hospital soundscape, with its beeping and buzzing equipment. During the observations, many eldercare patients expressed experiencing pervasive, continuous pain and suffering, and the healthcare musicians usually responded to these experiences with music, without necessarily occupying the space with their own words. Without exception, the initiative came from the eldercare patients, through their words or actions; and the healthcare musicians confirmed this in their interviews:

There was an eldercare patient in the room who seemed to be suffering and a little bit tired. — She told me that she was feeling a little bit nauseous, but asked me to come in, close the door, and open the window. So she wanted silence for the music-making. When making music, I could see how her breathing slowed down, how she relaxed, and she closed her eyes after a while. I sang a little bit more, and she somehow expressed how this singing could relieve her from being there. And she listened to the words of the songs very carefully. (Healthcare musician A)

Taking up the challenge of expanding their professional identity

The fifth professional theme relates to the challenge of integrating professional identities within changing working contexts. When organizing their work in a healthcare context, musicians might be seen as “free” and bohemian artists who may struggle with settling into the highly hierarchical healthcare system:

The hierarchy I was part of as a professional musician was not of any help, naturally, when I started to work in this hospital, because the hierarchy here was completely different. — When working in healthcare you plan your work by yourself, and you have both freedom in and responsibility for your music practice. (Healthcare musician B)

Simultaneously, professional music practitioners can be bound to the professional hierarchies and rigidities of their music field, and there may be a desire to expand on the image of the bohemian artist and its affiliated professional identity:

This musicianship was my world, and in that world, I had a narrow portion, which was my instrument. That drew me forward in life. I did not need anything else, because that road in front of me was so beautiful. Then, it was no longer such a beautiful road. I got older and did not have the strength anymore. (Healthcare musician B)

The healthcare musicians of this study worked within their own frameworks, which consisted of their individual professional experiences and expertise, including traditions within different musical genres. On the one hand, the healthcare musicians may recognize these instrument-specific professional boundaries as limitations that make it difficult to expand their practices in changing and sometimes surprising care and healthcare environments. On the other hand, the hospital environment was seen by them as a free environment within which to (re)build their professional identities in general, and their individual professional identities as healthcare musicians more specifically. The level of engagement with the community was seen as an opportunity, rather than as a challenge: “In this environment, I am able to develop my own thinking and give myself some professional freedom” (Healthcare musician B).

Emerging expanding music professionalism

In the analysis of the healthcare musicians’ work in this eldercare context, we distinguished both opportunities and challenges when utilizing contemporary music professionals’ practices in non-traditional contexts, such as hospitals. First, the musicians understood themselves not simply as experts in music or a particular music genre(s), but also as responsible practitioners socially engaged music work, without making a dichotomous division between the two. Musicians integrated their professional responsibility with the needs of elderly people, depicting themselves as practitioners who are responsible for implementing high-quality music practices in different societal sectors. Second, they challenged themselves to be versatile in terms of participation, including silent participation, and supporting the different and sometimes conflicting attitudes that the eldercare patients had toward their own aging. Third, a great opportunity to expand professionalism can be seen in the musicians’ reflections on the incomplete and unpredictable nature of their music work, which are filled with images of navigation through the “professional jungle” of the eldercare hospital wards. Being truthful and revealing the potential and the challenges of music practices can open up new professional approaches wherein interprofessional learning may take place through mutual negotiations and reflections, beyond taken-for-granted professional boundaries.

Conclusions

The findings of this case study indicate that healthcare musicians’ work can support a socially engaged approach to professionalism (De Wit, 2020; Dons, 2019; Sugrue & Solbrekke, 2014), as well as the holistic and integral wellbeing of eldercare patients in care and healthcare contexts (Creech et al., 2020; WHO, 2015). The work may unfold diversified understandings of aging as a transformative process of change and development (Bengtson et al., 2009; Tornstam, 2005). A deeper approach to such professional work includes musical encounters where the eldercare patient’s own lived experience and self-reflections are emphasized. This approach may be manifested in, for example, how the healthcare musicians show respect toward the eldercare patient’s independent choice for silent participation.

Music professionals have the potential to invigorate gerotranscendence within care relationships in eldercare contexts in and through musical encounters, by perceiving elderly people as having their own agency over how they relate to the process of aging. The ways in which healthcare musicians were able to change the nature of the whole ward space, through free improvisation and sensitive ways of utilizing music beyond the usual healthcare and artistic intentions, shows how engaging with transformative processes can facilitate holistic change, and most importantly can provide a chance to understand the processes of transformative change and developmental aging occurring in a larger community. Beyond collaborative discussions and reflections with the eldercare patients and healthcare personnel, gerotranscendence was manifested in the actual music practices, such as synthesizing speech, humming, and playing; transforming the medical realities within the wards into very beautiful and ethereal musical world; and opening up considerations and possibilities for cultural change and engagement.

Gerotranscendental music making is not restricted in time and place, but happens at the nexus of an individual’s being-in-the-world, whether the eldercare patient might be oriented within their past, present, or future at that moment. Social engagement with music practices in the eldercare context, facilitated by music professionals, can therefore contribute to a novel understanding of aging that goes beyond activity and disengagement theories and celebrates transcendental change and growth (Tornstam, 2005). Considering the increasing number of aging people in our societies, there is a need to pay attention to how “good aging” is defined. The recognized risk of current wellbeing discourses, which uncritically instrumentalize the role of music and the arts to “cure” people, requires attention from higher music education professionals to sharpen the discourses and practices that highlight the multifaceted potential of music professionalism in broader contexts than those traditionally ascribed to music education, or as previously defined by music therapists.

While interprofessional collaboration in hierarchical organizations such as healthcare might seem a challenge for music professionals, it enables expanding professionalism through practicing musical skills and imagination in diverse ways, being proactive, and seeing possibilities for music practices where other agents in the context or policy levels of organizations might not yet see them (e.g., Ansdell & Stige, 2015; Ruud, 2012; Stige, 2002). Hence, instead of being narrow professional advocates of their own field (Cribb & Gewirtz, 2015), or solely serving the medical health agenda, the healthcare musicians of this study were welcomed into somatic hospital wards to support the gerotranscendence of the eldercare patients—from the celebration of life to sharing moments of despair. Higher music education could consider how to better support students by creating opportunities to practice similar professional imagination (Laes et al., 2021), for example by understanding and navigating different structural possibilities outside of the silos of music professions (Westerlund & Gaunt, 2021). In this way, music professionals expand their own work opportunities, and increase the broader societal relevance and institutional resilience of their profession (Koivisto & Tähti, 2020; Laes et al., 2021).

Considering the expanding professional landscapes in the music field, we identified three emerging educational and professional tasks that should be emphasized in professional (pre-service) training and continuing education: (1) Supporting future music professionals’ capacities for navigating the administrative and economic environments within the varying organizations they work with; (2) encouraging musicians to reflect on how to make music practices more accessible to and visible in all sectors of society and public services; and (3) avoiding merely advocating for an art and wellbeing discourse in healthcare and, instead, actively engaging in innovative ways of supporting the holistic wellbeing of all participants, integrating the whole professional community into the ongoing creation of novel musical spaces.

This study supports the view wherein holistic approaches, including arts approaches, should be considered an active part of decision-making and social policy in the future, as an integral aspect of efforts to promote the wellbeing of all citizens. If we overlook the qualities that healthcare music-making and gerotranscendence can illuminate and strengthen—growing, living, and learning together within social relationships—we may abandon an important part of our aging population in eldercare facilities to lesser lives than they either are capable of or deserve.