Art Therapy in a Nursing Home and Hospice

Joanna Tan (J), one of Singapore’s pioneering art therapists, sat down for an interview with Tan Hsiu Li (HL), the current art therapist at St Joseph’s Home, to talk about the initiation and development of the art therapy service in the nursing home. Joanna shared some of her interesting encounters with her past clients and her thoughts about the impact of art therapy on the residents.

J: Art has been around since the beginning of human civilization. There is something in each and every one of us that responds to colors, lines, shapes, textures, space and more. We all have an imagination and an innate need for expression and connection; for enjoying beauty and making meaning. Art therapy taps into these aspects of the human capacity to nurture a person’s state of wellbeing.

J: It must have been a vision of the leaders of the home to provide clinical interventions to residents where possible. I applied and I was so blessed to have been selected! When I joined in the latter half of 2015, the home was located at the temporary location in Mandai while the new permanent building was under construction in Jurong. I went in one day a week to provide art therapy sessions for the residents.

J: I worked with residents both individually and in groups. There was one woman who was loud and complaining endlessly. I approached her several times to do art therapy but to no avail. Finally, she was willing to sketch. She drew such beautiful pictures of her younger self. Noticing that she was responding to sketching, I gave her a book to keep and sketch in whenever she felt like it. In time, she added scenes of attap houses on a beach and different species of birds. With these drawings, her images were now visible and out in the open. She has also became visible and seen by those around her. Subsequently, I noticed that she became more conscientious towards the people around her. This gave the care staff a new opportunity to relate to her in a new way and to see her in a new light. So in this instance, art therapy strengthened her identity and supported her dignity.

Another story is my journey with a resident suffering from a brain tumor. When we started art therapy sessions, she was still alert and able to share with me photos of her family and the life she had had up to her diagnosis. The tumor gradually affected her speech and cognition.  It was hard for me to see her deteriorating so quickly. Her whole person was still inside but the shell that was her outside was slowly breaking away. When she lost her speech, I tried to be her voice and shared photos of places she had been to and played the music she told me she loved to all those around her. I hoped that through this way, others could also “see” and “hear” her. My hope was that even if just for a bit, if I could help her do this, she would feel consoled by my presence.

There was another man I encountered who was quite sick. Despite his physical weakness, he managed to make cards for each of his three daughters just before he passed away. There was a special message for each daughter in each card. I was privileged to witness how much it meant to them to receive it from him. Here, art therapy helped the resident leave this world in a concrete way, with precious and enduring messages to his loved ones.

In a group session that I ran at Mandai, I used the opportunity to engage residents to make artworks that would eventually go on the walls of the anticipated new building. Art in this instance, was useful to bring some of the residents together to collectively achieve that purpose and the project provided an enjoyable focus for all involved. They became very proud of the completed pieces. When finally we moved into the new building and they saw the artworks displayed on the walls, they were all proud and excited to announce that “I made this!”.

J: In the beginning, many residents and perhaps even staff wondered “who was this person going from bed to bed with an art trolley? Was she a nurse, a volunteer, an artist who provided entertainment?”. It might have been confusing for them. To help them understand better, I did several presentations and answered many questions. After a few months, they started to get used to me.

Another challenge was looking for a suitable space to conduct my sessions without interruptions.  There were moments when I needed to protect the therapeutic space and tell regular visitors and well-meaning staff not to interrupt or comment on artworks while I was with a resident.

I really could not have overcome these challenges without the support and confidence of the management at St Joseph’s Home. They ensured that there were areas that I could use for my sessions and gave me opportunities to share what I do with all the staff so that they could understand its value and role. They also appreciated that any new program, especially ones that were relatively unknown, takes times to develop and be accepted. With this in mind, there was not so much focus on traditional key performance indicators but more so on introducing art therapy and educating everyone about its value therapeutically.

Joanna Tan, 2023

There is a poem titled “I Still Matter” by Pat Fleming and this is a verse from there:

But the thing that really makes me sad
Is despite what people see,
Underneath my tattered, worn out shell,
I’m still the same old me.

“I Still Matter” by Pat Fleming

Many elderly people, especially those in nursing homes, can feel very “face-less” and “voice-less”. They may even feel sad or frustrated at having to rely on others for the most basic activities like eating and changing positions in bed. They may also feel that other people see them as useless now that they cannot do many things, not like before.

Evidence suggest that art therapy can help boost confidence and restore a sense of personal identity in elderly participants. Art engagement can also alleviate anxiety, depression and stress. How it works might always be a little elusive because it is a mental health service that is hard to quantify as a lot of the effects are internal and subtle. It is not big and obvious to those who do not engage in it. More so with a profile of clients whose verbal expressions and cognitive responses are not usually big, bold, instant or direct, for example, in people with dementia.

J: There were many meaningful encounters but the moment I treasure the most was when my Dad sat in one of my group sessions at Mandai. He was a handsome 75-year-old gentleman at the time and was keen to come to the home to volunteer to assist me if I needed help. One week, I decided to take up his offer. I remember that week, we were using the theme of “Reminiscing”. I shared images of old places in Singapore, famous celebrities and we listened to old songs. Then, the song ‘Last Waltz’ by Engelbert Humperdinck started. As it was playing in the background, one distinguished Eurasian lady reminisced aloud that she used to dance to this song with her late husband. Without prompting, my dad stood up and gallantly invited her to dance. She shot up from her wheelchair immediately and they glided along the ‘dance floor’. They danced so gracefully to the whole song while the group watched in enjoyment. It was such a beautiful moment!

J: It is important for art therapists to understand that art therapy in a nursing home is challenging in its own ways. Indeed being the only full time art therapist in a nursing home takes a special kind of strength and persistence and I genuinely admire those like Hsiu Li who are doing this work. They have to always be mindful to be an uplifting presence and that they play an important role in instilling hope in the elderly residents. However, in order to sustain their practice and cope with this responsibility, the importance of self-care becomes a big factor. It is particularly critical to regularly set time aside for self-care in order to prevent professional burn out.

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This article is published as part of #RootedtoRise, a celebration of St Joseph’s Home’s 45th anniversary. We trace the hard work of pioneering Art Therapist and the senior leadership at St Joseph’s Home to the current work that has been done to provide better psychosocial care of our residents.

Art as therapy is where residents relax and reminiscence together. It also includes art projects held in collaboration with community partners and visiting artists.

A form of art psychotherapy that can facilitate death preparation and reconciliation. Caregivers may be involved in the process.

This could be one-to-one or group-based, where the trained art psychotherapist provide supportive interventions that help with anxiety, depression, grief, trauma and loss.

Trace the full journey in pictures here.