Life Story - part 1
Courtesy of Gabriele Rohde, Adobe Stock
Life story work is not a new concept: it has been used for children and people with learning disabilities in the care sector for many years. However, it has also been recognised as a useful tool to promote person-centred care for people with dementia.
Photo courtesy of Laney Smith, Unsplash
Life story work in dementia care should involve people with dementia, as well as their families and/or carer, recording aspects of their past and present. This has both personal benefits and can be used to enhance care. There are several methods of doing life story work, which include:
Chronological: Focuses on memories and attempts to accurately record life from birth to present day.
Narrative: A personal interpretation of life which emphasises strengths/interests/feelings over facts.
Care focussed: Focuses on using life story work in care settings to potentially improve care.
Hybrid: Narrative approaches applied in care settings.
There is some disparity between the understanding of life story work between the individuals and care professionals. Life story work that is led by the person with dementia is a reinforcement of their identity and supports the pride they have led in their life. However, when it is carried out by service providers it tends to be less organic, led by a member of staff using a template. When it is carried out in this way the aim is to increase communication and staff understanding of the person. It should be a tool which can help staff to understand the person when they are unable to represent or communicate effectively as dementia progresses.
There does not appear to be an agreed method of good practice when it comes to life story; it generally depends on the perspective being taken, such as from the person with dementia or as a professional. The National Institute for Health Research (NIHR) funded a study into life story work in 2012 which identified nine good practice points: the SCIE and Alzheimer’s UK appear to have elements of this within their guidance and templates.
One of the issues raised in the research is that life story work is often seen as a one-off event, however this is not the case, and it should be seen as a living document. As you get to know and chat with the individual, you will become aware of other significant information which should be incorporated into their life story. Negative information can also be useful, especially when trying to determine the causes of behaviour at times. Sometimes, understandably, this type of information is tried to be kept private, but when families are educated as to the significance of the information then they may be more open, especially if there is a relationship there to begin with.
One example of this comes from a practicing social worker seeking some advice. There was concern over a male resident in a care home becoming aggressive and hostile towards other residents and staff, particularly in the communal areas and during personal care. The context was discussed and explored with the family and care home staff. It transpired that the gentleman had previously been in prison, and by understanding this there were several strategies put in place by the staff, modifying their approach.
The individual’s reality of being admitted to a care home brought back the feelings of the time in his life where he had been in prison, with reduced ability to do as he pleased. Having lived alone and then thrust into a group environment again, when the only other time in his life where he had experienced this was while in prison, brought back the vulnerabilities; not feeling safe and all the other negative emotions of that time.
The solution was:
Carers did not wear uniforms when prompting him for personal care.
He was provided with quieter areas and to have meals alone, if he wished.
Staff were more mindful of ‘care speak’ and engaging in a more therapeutic, friendly manner, rather than being task orientated and rushing.
On review, these strategies helped greatly, and the gentleman displayed far less distressed behaviour and was more co-operative when attending personal care, therefore improving quality of life for him and care staff.
Life story can also inform meaningful activity – what one person enjoys another may not. It is important to understand the individual to be able to provide stimulating activities that they are likely to enjoy. Knowing what they used to do means that you can support them to continue these or make adaptations to allow them to continue to enjoy them.
Life story can have far-reaching implications in practice, more than many practitioners realise, and it is not just down to one individual but for all who obtain information to add to it. There can be medical aspects, psychological and social components, all providing a personal, holistic overview of the individual, and an essential tool in providing person-centred care.
