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
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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
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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?
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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
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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
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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 challengeRespect
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: Lack of meaningful
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occupation
No personal touches in terms
of his environment
The corridors all look the
same-no landmarks/signposts
to aid orientation
Little/poor staff interaction
Poor engagement in daily
routines of the home
Groundhog day-all the days
are the same
Hobbies/interests not known
or acted upon by staff
Lack of opportunities to
maintain his sense of identity
 STAFF: Engage with Stan to find out
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as much about him as
possible
Collaborate with family and
friends to learn even more
Make time to build in
opportunities for engaging in
hobbies and interests
Plan his daily routines to take
into account the things he
likes and still can do for
himself
Ensure the environment
around him reflects him as an
individual to maintain his
sense of identity
Create a space for him to
engage in work like tasks
Benefits
 Achieves a holistic and comprehensive
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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….
Are you really interested in me?
No-one has done
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…
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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
Model
Life Books, Life Story boards and
Memory Boxes
Life story
journals
Ruth Endicott
Lynda Holroyd
Creating Life Story
Boards
and Memory Boxes
Exercise 1
 Think about an object you currently have in your
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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
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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
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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
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Newspaper cuttings
Copied photographs
Wrapping paper
Scraps of material
Familiar pictures
Coloured card
Glitter
Anything pertaining to
the theme of the box
 Plastic wallets
 Display booklet
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Glue sticks
Scissors
Imagination/fun
Picture frame( can be
recycled)
 Shoebox or similar
vessel
Practical session
 Using your photographs and the provided
materials, begin to assemble your memory
box or board.
Related activities
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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
appointment.
When we
got
back
dada “hit
the roof”
andwhen
said we mum
had locked him in the house.
He
has
his
own
keys
for
the
house
and
was
left
to
go
for
walk
once
father in law, Leo. For the past 12 months it has been very difficult for my mother in law.
Another time dad shouted and carried on and he said mum had been out playing games and dancing
had aat allhospital
appointment.
theout roof”
we youhada little insight of what is going
Because of Dad’s changing behaviour he now has no interests
and just wants
to be with herWhen weuntilgot
4amback
when shedadhad “hit
not been
at all. Iand
hope said
this gives
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
locked
him
in
the
house.
taking them off and also wearing them under his night clothes. It is also difficult because he
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
can be verbally
aggressive
to
mum
saying
that
she
is
always
on
the
phone
(mostly
when
we
ring
he was notgames
asked. and dancing
Another time dad shouted and carried on and he said mum had been outsaysplaying
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
untillater4amhas when
five minutes
forgottenshe
it. 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
on her health.
hairdressers or shopping.
Yours Sincerely,
When they are on their own, Dad can be verbally aggressive to
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 !