Portrait of a Life
– a multi-media toolkit for life story work
The toolkit and what are we
trying to achieve..
A multi-media toolkit for training and supporting the
development of life story work
Primarily indicated for use in care homes but developed for
wider use with MHF support
Supporting the knowledge and evidence base of staff utilising
the toolkit
Promoting positive engagement with individuals and family
carers
Something practical containing two DVD‟s, a CD Rom, a
written guide and photocopiable resources
Menu of options for life story work
An accessible resource meeting a range of learning styles
and settings
Toolkit contents
Acknowledgements
Foreword
Introduction
The Importance of and the rationale for Life Story work
The Evidence base
The Benefits and the Risks
Consent and Ethics
A Practical approach to developing life stories
„Going Home‟ – learning and reflection
Personal Stories
Leo‟s story
Mary‟s story
Embracing and sustaining life story work in practice
Final thoughts
What is a life story?
Personal details
Place of birth/upbringing
Family history – parents, siblings, partner,
children
Family life – family network, close relationships
Early years – school, special friendships, learning
Working history – occupation, importance of work,
retirement
Religion/spirituality – practicing religion, spiritual
needs/choices/values in life
Marital status/relationship
Wartime experience
Understanding Person Centred Care
V = Values the person with dementia
I = Treating people as Individuals
P = Perspective of the person with dementia
S = Supportive Social psychology
(Brooker 2004)
Personhood
The outcome of person centred care
“A standing or status that is bestowed upon
one human being, by others, in the context of
relationship or social being. It implies
RECOGNITION, RESPECT and TRUST”.
(Kitwood 1997)
Signs of well-being indicate this is being
achieved
Maintaining Personhood
Positive Person Work
Supportive Social Psychology
Inclusion- Being a part of the social world
Attachment-To others, particularly in times
of change
Comfort- Provision of warmth and
closeness
Occupation- Being involved in the process
of life
Love- The central need
Identity- Having a sense of who you are
“Dancing with dementia:
My story of living positively with dementia”
“As we become more emotional and less cognitive, it‟s the way you talk to
us, not what you say, that we will remember. We know the feeling, but
don‟t know the plot. Your smile, your laugh and your touch are what we
will connect with. Empathy heals. Just love us as we are. We‟re still
here, in emotion and spirit, if only you could find us.”
(Christine Bryden, Dancing with Dementia, 2005 p138)
Why do life story work?
To maintain personhood
To improve understanding of behaviour and
presentation
To improve relationships with family carers
To provide quality of life for individuals
Transforming care planning
Increasing engagement and job satisfaction
Meets the Dignity in Care challenge-
Respect
DVD AND GROUP EXERCISES
What do you think are the main
issues/concerns for Stan?
What could staff in the home have done to
improve Stan‟s experience?
What are the benefits of undertaking life
story work?
What information do staff need to gather
to complete a life story for Stan?
STAN:- STAFF:-
Lack of meaningful Engage with Stan to find out
occupation as much about him as
No personal touches in terms possible
of his environment Collaborate with family and
The corridors all look the friends to learn even more
same-no landmarks/signposts Make time to build in
to aid orientation opportunities for engaging in
Little/poor staff interaction hobbies and interests
Poor engagement in daily Plan his daily routines to take
routines of the home into account the things he
Groundhog day-all the days likes and still can do for
are the same himself
Ensure the environment
Hobbies/interests not known
or acted upon by staff around him reflects him as an
individual to maintain his
Lack of opportunities to sense of identity
maintain his sense of identity Create a space for him to
engage in work like tasks
Benefits
Achieves a holistic and comprehensive
understanding of the individual as a person
rather than through the biological processes of
dementia.
Reduction in challenging behaviour through
individualised care planning
Promoting positive therapeutic interventions
Positive engagement 1 – 1 and with services
Reduced re-referrals / reduced complaints
What individuals say…
You have given me back my life….
No-one has done Are you really interested in me?
anything like that I want to cry. Can I cry?
for me before
The carers are always asking me about my life now
The poem reminds Memories are lovely things
me of school.. as long as you don’t get the
Thank you! bad ones
Can’t tell you what your input has
meant to her and us…
Risks
Proceed with caution!
Communicating the worth of the
person as being in the domain of past
competencies and achievements
rather than in the present (Killick and
Allan 2001)
The impact of negative life histories –
a recommended area for further
research
Evidence Base
No official research
Life story work helps staff form a better
understanding of a person
Recent policies DO support life history work
The Evidence Base…
Carers as experts model (Nolan & Keady 2001)
Support carers through sharing knowledge
(Charlesworth 2001)
Family health nursing (WHO 1999)
National Service Framework for older people (DoH
2001)
The Essence of Care (DoH 2001)
The Dignity campaign (DoH 2006)
Kitwood T (1997) Dementia Reconsidered; The person
comes first. University Press. Buckingham
Brooker D (2007) Person-Centred dementia care;
making services better. Jessica Kingleys Publishers.
London
Home From Home (2007) The Alzheimer's Society
CSCI (2007) See me not the dementia
Things to consider…
Consent from the outset
Ongoing Informed consent
Confidentiality
Defamation Act 1952 & 1996
Supervision and support for staff
Practical Models and Approaches
CARER model
Life Books
Memory Boxes
Life Story Boards
Special Interest/Hobbies Books
Significant Events Music CD
Practical Approaches Life books!
Memory boxes!
Life Story boards
The CARER model
C : Collaboration
A : Assessment with
R : Relatives of
E : Elderly
R : Residents
A model for working in partnership with
individuals and family carers to promote
person-centred care
The CARER Life story
Model Life Books, Life Story boards and journals
Memory Boxes
Ruth Endicott
Creating Life Story
Boards
Lynda Holroyd and Memory Boxes
Exercise 1
Think about an object you currently have in your
possession, that is meaningful to you
If you are happy to, place it on the table in front of
you
What significance does this have for you as a person
How does this represent you as a person?
How would you feel if these were taken away?
Exercise 2 – “No ideas?”
Choose an object from the table
Why have you chosen this object?
Consider using objects to stimulate
discussion.
Getting started
Introductions
Discuss life story work & consent form
Developing a rapport
Build trust and confidence
Familiar face/voice
Giving people time
Showing empathy
Showing a genuine interest
Give some of yourself
The Process
Using CARER model to gather information from individual/
families/partners in care.
Spend time with the individual & consider the environment. Is a quiet
area more appropriate for discussion?
Use information gathered as a baseline for stimulating discussion with
the individual. E.g. Tell me about your school days? Where did you go
to school? Did you wear a uniform? Can you remember any special
friends? - See CARER model info leaflet.
Make notes without detracting from flow of conversation.
Or, tape recorder with permission!
Be aware of individual‟s body language during discussion – happy?
sad? excited? Open/closed posture? eye-contact?
The Process cont...
Share their enthusiasm.
Be sensitive to emotional memories and offer
support.
Is the information factual/confabulation? – Is this
important?
Be willing to share your own memories.
Be aware of the time you are spending – too much?
too little?
Ensure you have support networks yourself. Life
story work can evoke memories for you too
Potential Barriers
Dysphasia
Repetitiveness
Reduced concentration
Sensory impairments
Others perceptions “they won‟t remember!”
Task orientated environment “I don‟t have
time? It‟s not my job!”
Overcoming barriers
Communication aids
Body language/facial expressions
Short sessions/don‟t overload with info.
Using sensory objects to touch/smell/hear
They may not remember the content but may
remember the enjoyment/feeling
Person Centred Care is everybody‟s
business! A 5 minute conversation can make
a difference!
Role modelling
What do I do with the information?
Decide on a theme or significant memory
Research information relating to the theme or
significant memory.
Work with families/friends/partners in care for
information
Gather relevant media
Consider confidentiality
Researching information
Internet – clip art/Wikipedia – free to use.
Be aware of copyright laws when using
internet.
Library
Books
Charity/second hand shops
Using individual‟s photographs/personal
memorabilia – colour copy/scan. Originals
are precious!
Themes for storyboards/boxes
Holidays Hobbies
Pets Fashion
Schooldays Favourite colours
Washdays Through the years
Working life Childhood days
Down the pit Dancing
Make do and mend Gardening
Motorbikes/cars Landmarks
Music memories Sweetshop past
Suggested materials
Newspaper cuttings Glue sticks
Copied photographs Scissors
Wrapping paper Imagination/fun
Scraps of material Picture frame( can be
Familiar pictures recycled)
Coloured card Shoebox or similar
vessel
Glitter
Anything pertaining to
the theme of the box
Plastic wallets
Display booklet
Practical session
Using your photographs and the provided
materials, begin to assemble your memory
box or board.
Related activities
Craft work
Poetry books
Concentrate on facilitating hobbies
Colouring/drawing
Painting
Using music tapes
Talking books
Reminiscence sessions
Picture books
Confidentiality and keeping data secure
•Written permission via
„consent form‟
•On going „informed‟ consent
•Use of photographs
•Data storage
•Encryption
Dear Sir, He has his own keys for the house and was left to go for a walk once when mum had a hospital
I am writing this on behalf of my mother in law to try and outline some of her problems with my
and was When to go for walk once said had
He has his for my keys infor the house appointment. left we got back dada “hit the roof” andwhenwemumlocked him in the house.
father in law, Leo. For the past 12 months it has been very difficult
own mother law.
Another time dad shouted and carried on and he said mum had been out playing games and dancing
had at hospital appointment. until 4am when dad not the at all. hope this we had
Because of Dad’s changing behaviour he now has no interests a all and just wants to be with herWhen we got backshe had “hitbeen out roof” Iand saidgives you a little insight of what is going
all the time. He is confused regarding clothing, like not remembering to put shirts on etc or not on, and as you can imagine there is a lot more. On the whole dad is a lovely man and means no
the because
locked him indifficult house.he
taking them off and also wearing them under his night clothes. It is also harm, but it is causing mum to be ill and upset because dad does not know he is doing it. We feel
wears two hearing aids but has very selective hearing. He will totally ignore you and then it is mum that needs the breaks.
repeat things to mum when we have gone. He is also moving and losing things. Dad worked until he was 82 in a little cleaning job or washing up for three or four hours a day
He cannot relax and he is up and down all the time and in and out looking for glasses, hearing and he loved it because it was his independence and got out of the house. Now I feel not only is
aids, teeth, etc, but are usually either wearing them or have put them away and forgot where. it his age, but boredom too. But as much as we try to give him his independence he relies on
We realise a lot of this is age related but it is making mum ill. When they are on their own, dad mum for everything from dressing to food. He will not make a decision about anything and then
Another time dad saying that she always on on and (mostly when we had
can be verbally aggressive to mumshouted and iscarried the phone he said mum ring been out playing games and dancing
says he was not asked.
to see if she is alright), and that she does not do things for him, etc. He snaps at her and then He is very jealous of anyone going to the house, including us, grandchildren and great
until 4am forgotten it.
five minutes later has when she had not been out at all. grandchildren, as we are taking up mum’s time. he does not think we are family and calls us sir
Mum used to have two shopping days a week which gave her a break, but now dad insists on going or madam, or friends. I do hope this helps you and that you can help us. I am sorry but my
with her. Sometimes he will be fine, but other times he can be very moody and takes it out on mother in law is not up to coming to this appointment with dad as she finds it all too much and
her when they get home. He is very confused as to days and times, etc. Recently mum had been very upsetting. There is not many days go by where she is not in tears and it is taking its toll
quite ill with the stress and had to go into hospital, but he told people that she had gone to the
hairdressers or shopping.
When they are on their own, Dad can be verbally aggressive to
on her health.
Yours Sincerely,
Mum.
Recently mum had been quite ill with the stress and had to go into
hospital, but he told people that she had gone to the hairdressers or
shopping.
Developing the story.
The flowchart
Basic interviewing
Hopefully, by undertaking a Life Story Project, you can help the person build
self confidence and feel valued and respected.
It is also important when engaging with the person to ask relevant questions
Basic Interviewing techniques
Ask open-ended questions
which can be developed at length by the client. It is essential that the
interviewer be as unobtrusive and inconspicuous as possible.
Start the session with easy and enjoyable kinds of questions…
Tom Kitwood.
As we go through life we build up a personal
history with its unique mix of joys and pleasures,
sorrows and pains. Our sense of who we are is
linked to that history and if we lose that we lose
something of ourselves
Thank you !