1. Portrait of a Life – a multi-media toolkit for life story work

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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

8. “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)

9. 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

10. 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?

11. STAN:-
Lack of meaningful 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 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

12. 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

13. Are you really interested in me? I want to cry. Can I cry?
What individuals say…
You have given me back my life….
Are you really interested in me? I want to cry. Can I cry?
No-one has done anything like that for me before
The carers are always asking me about my life now
The poem reminds me of school.. Thank you!
Memories are lovely things as long as you don’t get the bad ones
Can’t tell you what your input has meant to her and us…

14. 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

15. Evidence Base No official research
Life story work helps staff form a better understanding of a person
Recent policies DO support life history work

16. 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

17. Things to consider… Consent from the outset Ongoing Informed consent
Confidentiality
Defamation Act 1952 & 1996
Supervision and support for staff

18. Practical Models and Approaches
CARER model
Life Books
Memory Boxes
Life Story Boards
Special Interest/Hobbies Books
Significant Events Music CD

19. Practical Approaches Life books!

20. Memory boxes!

21. Life Story boards

22. 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

23. Life Books, Life Story boards and Memory Boxes
The CARER Model
Life story journals
Life Books, Life Story boards and Memory Boxes
Ruth Endicott
Suzanne
Lynda Holroyd
Creating Life Story Boards
and Memory Boxes 23

24. 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?

25. Exercise 2 – “No ideas?” Choose an object from the table
Why have you chosen this object?
Consider using objects to stimulate discussion.

26. 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

27. 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?

28. 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

29. 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!”

30. 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

31. 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

32. 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!

33. Themes for storyboards/boxes
Holidays
Pets
Schooldays
Washdays
Working life
Down the pit
Make do and mend
Motorbikes/cars
Music memories
Hobbies
Fashion
Favourite colours
Through the years
Childhood days
Dancing
Gardening
Landmarks
Sweetshop past

34. Suggested materials Glue sticks Newspaper cuttings Scissors
Copied photographs
Wrapping paper
Scraps of material
Familiar pictures
Coloured card
Glitter
Anything pertaining to the theme of the box
Plastic wallets
Display booklet
Glue sticks
Scissors
Imagination/fun
Picture frame( can be recycled)
Shoebox or similar vessel

35. Practical session
Using your photographs and the provided materials, begin to assemble your memory box or board.

36. Related activities Craft work Poetry books
Concentrate on facilitating hobbies
Colouring/drawing
Painting
Using music tapes
Talking books
Reminiscence sessions
Picture books

37. Confidentiality and keeping data secure
Written permission via ‘consent form’
On going ‘informed’ consent
Use of photographs
Data storage
Encryption

38. When they are on their own, Dad can be verbally aggressive to Mum.
Dear Sir,
I am writing this on behalf of my mother in law to try and outline some of her problems with my father in law, Leo. For the past 12 months it has been very difficult for my mother in law.
Because of Dad’s changing behaviour he now has no interests at all and just wants to be with her all the time. He is confused regarding clothing, like not remembering to put shirts on etc or not taking them off and also wearing them under his night clothes. It is also difficult because he wears two hearing aids but has very selective hearing. He will totally ignore you and then repeat things to mum when we have gone. He is also moving and losing things.
He cannot relax and he is up and down all the time and in and out looking for glasses, hearing aids, teeth, etc, but are usually either wearing them or have put them away and forgot where. We realise a lot of this is age related but it is making mum ill. When they are on their own, dad can be verbally aggressive to mum saying that she is always on the phone (mostly when we ring to see if she is alright), and that she does not do things for him, etc. He snaps at her and then five minutes later has forgotten it.
Mum used to have two shopping days a week which gave her a break, but now dad insists on going with her. Sometimes he will be fine, but other times he can be very moody and takes it out on her when they get home. He is very confused as to days and times, etc. 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.
He has his own keys for the house and was left to go for a walk once when mum had a hospital appointment. When we got back dad “hit the roof” and said we had locked him in the house.
Another time dad shouted and carried on and he said mum had been out playing games and dancing until 4am when she had not been out at all. I hope this gives you a little insight of what is going on, and as you can imagine there is a lot more. On the whole dad is a lovely man and means no harm, but it is causing mum to be ill and upset because dad does not know he is doing it. We feel it is mum that needs the breaks.
Dad worked until he was 82 in a little cleaning job or washing up for three or four hours a day and he loved it because it was his independence and got out of the house. Now I feel not only is it his age, but boredom too. But as much as we try to give him his independence he relies on mum for everything from dressing to food. He will not make a decision about anything and then says he was not asked.
He is very jealous of anyone going to the house, including us, grandchildren and great grandchildren, as we are taking up mum’s time. he does not think we are family and calls us sir or madam, or friends. I do hope this helps you and that you can help us. I am sorry but my mother in law is not up to coming to this appointment with dad as she finds it all too much and very upsetting. There is not many days go by where she is not in tears and it is taking its toll on her health.
Yours Sincerely,
He has his own keys for the house and was left to go for a walk once when mum had a hospital appointment. When we got back dad “hit the roof” and said we had locked him in the house.
Another time dad shouted and carried on and he said mum had been out playing games and dancing until 4am when she had not been out at all.
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.

39. This is a copy of a letter sent by Dr
This is a copy of a letter sent by Dr. Orange to Leo’s GP indicating improved MMSE score.

40. CODGER!...Mood lifting visibly and relationship with myself developing.

41. 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…

42. 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 !