Tag Archives: dementia

Care Home Culture

I’ve been running life story sessions at a care home in Worthing since April last year. Previous blogs record some of the positive changes that we’ve noticed. This morning I spent a few minutes catching up the team- two young members of care staff- to explore their observations about our work.

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Charlotte has noticed how knowing the residents through their stories has really helped her support them through good and bad times. ‘We can have real conversations together. If someone’s upset or agitated I can begin talking about a place we both know or a story they’ve told me. Working with one man has changed how I see him. Staff used to try and get him to take his hat off and he got upset about that. I understand why it’s important for him to wear his hat. All his life he’s worn a hat- when he was a paperboy, in the boy scouts, in the Navy and in the Glider Air Corps. Now I understand why his hat is important and I can let the other staff know.’

This particular man is very frail now and has to stay in bed in his room. Charlotte says she knows his life story is of value to him. He said to her recently, ‘That’s the book we did together’.

I asked Charlotte and Lana how they share the resident’s stories with the rest of the team. ‘When we get spare time I get the books out and say; Have a read. Quite a few are surprised, especially the new staff who see people as ‘bed-bound’, not realising they used to be active people. But now they can see people because of their stories. The other staff are really interested in taking part and want to know what we’re doing.’

I asked them if they could generalise from their experiences of getting to know people through their stories. We’ve worked with about half the 29 residents. What about those whose stories we don’t really know yet? Charlotte said, that she felt differently towards the residents even if she hadn’t done a life story project with them.

I wondered if participating in the life story work had altered the way Charlotte and Lana felt about their jobs. Both agreed they felt more ‘satisfied with their work’. I asked why that was and they said that their relationships with the residents had improved, ‘You start to feel a bond with them’.

Charlotte told me that a couple of weeks ago she had found two of the female residents sitting side by side on the bed. They were reading through one of their life-story books and said they didn’t want to go to bed they wanted to have a ‘sleepover’ so they could carry on sharing stories. She said it was ‘really lovely’.

Lana also thought that one of the benefits was in getting families involved in the projects. Coming in to work on family histories gave relatives a real purpose and was a great catalyst for conversation. ‘Building relationships with families brings us all together’.

The care home has made a significant commitment to the value of life story work and this has been recognised in their most recent CQC inspection report. Two members of staff are ‘off the floor’ every fortnight to allow for clear project time. At handover everyone is reminded to keep the quiet lounge free so that we can have a dedicated workspace. There is access to a laptop computer for writing up stories and doing searches for relevant information or pictures. I am available for advice and support as needed but also, and perhaps more importantly, modelling ethical and practical approaches to life story work as part of the team.

A few minutes chatting with Charlotte and Lana reminded me of the many values of doing this work. Not only are the residents benefiting because they are known and understood in the context of their personal histories, but also through having a motivated and committed staff team. Staff retention is acknowledged as a major challenge in residential care. If life story work can increase job satisfaction, improve staff retention and develop respectful and genuine relationships between staff, residents and their families, there is a real potential for this simple approach to play a significant role in improving the culture of care for elderly frail people with dementia.

The development of a best practice methodology for embedding life story approaches at a care home for people with dementia.

I’ve been meaning to blog about my experience working with this group of wonderful people over in Worthing since I finished the project back in August, so here goes.

This is what I take from the experience:

  • To use whatever material already in existence as a starting point. This will include the info gathered when residents moved in and photo albums. There are some excellent guides to doing life story work with people in this client group on websites like Dementia UK. Having a guide and template for gathering experiences can be very helpful. See http://www.dementiauk.org/information-support/life-story-work/

 

  • To build relationships with family and invite them to help out with projects in whatever way possible. This has worked well and although it’s important to keep in mind that the resident is the focus of your attention, the value for family and friends cannot be underestimated.

 

  • For support staff to work 1:1 with a resident until their project is complete. Consistency and relationship building is key.

 

  • For support staff to have access to computers and photocopier to copy and search for  images and type up gathered stories ( Search engines are a fantastic resource when photos aren’t available to support or trigger memories. Searching for and printing images and information, for example about a school or regiment, demonstrate interest and provide illustration to otherwise wordy pages of type).

 

  • Support staff find it very difficult to find the time to write up & present the life story information gathered. I suggest they alternate sessions so that one is gathering info and the next presenting it. This should be done with the resident wherever possible.

 

  • For staff to develop and share methods to redirect people away from distressing memories in to safe territory as necessary. This is especially important as a session draws to a close. Fortunately the staff working with the group continue to be around later in the day, have excellent relationships with the residents and are sensitive to their needs.

 

  • For support staff working on the projects to find a time to share life story information with other staff in order to increase the understanding and well-being of the residents.

 

  • ‘Having a Life Story book is great, but it’s a culture of really knowing people that matters’- A carer made this comment and is absolutely right. The Life Story Projects need to be used and referred to in order to benefit the residents. Maybe this needs to be a session where residents share their stories, part of new staffs’ induction process, or becoming ‘second nature‘ when working with someone to take the time to read through and chat about their Life Story with them? 

 

  • To have a display folder of the completed project in the resident’s room for daily reference and a copy kept safely in the office in case of loss/damage.

 

  • To use the life story project in any way that works to improve the well-being of the resident.

 

  • Life story books are being used in exciting and unexpected ways to restore positive states of mind. One woman who becomes distressed at dusk is, within seconds, returned to a calm place when shown her book and engaged in conversation about  her story. Another woman who has begun to sleep a lot during the day and is very difficult to rouse, is found to brighten and her posture straightens and she begins to converse when her story is read aloud to her. A man who has become very upset by his loss of memory is comforted by using his life story book as a reference for recorded memories. And there are observable differences in some of the group. One woman who was reluctant to join the group and left after a few minutes saying: ‘I’m not welcome’, was able, through skillful 1:1 support, to recount her experience of having her first child before she was married. Her family’s treatment towards her at the time had left many emotional scars. It’s not possible to put the transformation in her mood and confidence down to the life story project alone, but having the opportunity to have her story witnessed is a likely factor. On my last visit to the care home this woman walked through the lounge with a huge smile on her face, happily chatting to her carer. She looked so different I nearly didn’t recognise her!

 

Lastly, I heard a wonderful programme on BBC Radio 4 where Kim Normanton talked about her mother’s experience of dementia.

 

‘My dream scenario is to have the idea accepted that once someone is progressing along this pathway of dementia it isn’t possible for them to come in to our world- we have to step in to their world. Their world is inevitably in their past and therefore the more you know about each individual the more you can access their world and the more comfort and support you can give them. And each time you allow them to be in that world and share it with you their confidence and pleasure is enormous’

 

from: Living in the Memory Room BBCR4 July 2nd 2013

 

(For some background to the project see previous blog https://noellemccormack.wordpress.com/2013/05/26/reflections-on-doing-life-story-work-with-people-with-dementia/ )

Reflections on doing life story work with people with dementia

Earlier this year I was invited develop a process to embed life story work at a care home for people with dementia with the aim of enhancing the day to day lives of the residents.

Life story projects have the capacity to be beneficial to vulnerable people by supporting ‘self-hood’, increasing self-esteem, providing a place to express loss and to grieve, improving the continuity and quality of care and offering opportunities for reciprocal conversation.

My proposal set out a guide for implementing group work, much along the lines that I’ve done for many years with learning disabled adults, (see previous post). The methods that I’ve developed use group discussion, reminiscence and turn taking to gather stories. After the first introductory session in the care home I realised this approach wasn’t going to work, so, together with the permanent staff, I’m adapting and developing a practical and workable model.

  • Group versus 1:1

Group work wasn’t the most appropriate approach for a number of reasons. The narrators all have hearing loss and are quietly spoken which makes round table discussion difficult, but more importantly, their memories are private. Although some of the group might get along quite well with each other, their relationships are made difficult by the extent of their memory loss. They seem to prefer talking to the person closest to them in a private and focussed way.

Life story work is fundamentally a 1:1 activity and with this client group it doesn’t appear either a practical or ethical course to make it otherwise. By the second session we had divided the group in to three groups of two, each with a member of staff. Rather than sitting around a large table, the small groups used different parts of the room. This created a more intimate and focussed atmosphere, but was not ideal. By the end of the third session, listening to feedback and from my own observations, we have decided to work 1:1 in either the quiet lounge or resident’s rooms. We came to this conclusion after noticing that the room was quite noisy, thus making talking & listening difficult, and also the distraction of some residents who find it difficult to concentrate ( the room is used as a thorough-fare). Also, as interviewers, we were either working with one or other of the residents in our small group. What should the other person do while it was not their turn? Dose off or feel ignored or become distressed?

  • Using existing material

All the residents have some information gathered by staff from family members from the time they arrived at the care home. The extent of the detail in these accounts varies from a few paragraphs of basic life events to rich and colourful stories of lives lived. Most of the residents have photo albums. These accounts are providing a useful starting point for the resident’s life story projects and in some cases can be sufficient, with the addition of selected photos & images to create excellent projects. Some of the resident’s family members are able to join the sessions and can corroborate and elaborate on the existing information the care home has. The role of the staff member then becomes one of making  sense of gathered information and presenting the life stories in an accessible and attractive way.

There are some excellent guides to doing life story work with people in this client group on websites like Dementia UK. Having a guide and template for gathering experiences can be very helpful. See http://www.dementiauk.org/information-support/life-story-work/

Search engines are a fantastic resource when photos aren’t available to support or trigger memories. Searching for and printing images and information, for example about a school or regiment, demonstrate interest and provide illustration to otherwise wordy pages of type.

  • Memory and imagination

To my horror I hear myself saying ‘Do you remember…’ during the sessions. This is distressing and unnecessary, but hard to skillfully avoid. I’ve found that it’s better to talk around a subject in an apparently casual manner and wait for the narrator to add their voice in a way that doesn’t make them uncomfortable or remind them of their memory impairment. Stating known information clearly is effective in creating a safe environment. For example, ‘You got married in November, I wonder what the weather was like?’. The narrator is then free to talk about what they wore, who and where they married, or the weather in November, without feeling they are being interrogated about something they have no recollection of. There is also a need to redirect people away from distressing memories in to safe territory as necessary. This is especially important as a session draws to a close. Fortunately the staff working with me continue to be around later in the day.

Thanks to an email exchange with Sam Robson from Groundswell Oral History for Social Change  http://www.oralhistoryforsocialchange.org  I recently found out about Anne Basting’s TimeSlips method: http://www.timeslips.org – a story telling approach that frees people with memory loss to imagine stories. Working alongside this group has made me question the emphasis we place on the real versus the imagined. From personal experience I understand that for a person with a diagnosis of dementia to function well it is necessary for them to feel at ease. Spending two hours asking them to recall their memories about various aspects of their lives, when they clearly aren’t able to, doesn’t create ease & contentment. Over the next few months I’ll continue to notice what is effective in eliciting and recording the resident’s stories and put together a practical & ethical guide for doing life story work with this client group.

singing a soundtrack

I’ve been working with this lady on her life story over the last few weeks. As she is always breaking in to song I thought it would be an idea to use snippets of her voice fading into the record on the soundtrack of her life story film. It was tough going though because she kept laughing… Very enjoyable.

You can listen to the singing and the laughing here: