Last week, we looked at the negative impact of not knowing a person well, how lack of insight into their history and habits can lead to an adverse outcome. This week I want to review the positive side of understanding the consumer of aged care services better and how using a Lifestory work (LSW) approach can help you and your organisation demonstrate the Aged Care Standards. After all, as we noted last week, the Aged Care Standards are all about understanding and putting the person at the centre of care.
We all want the best for the people we care for.
Having a way to communicate the key elements of who the person is, what events have shaped them and what’s important to them can profoundly affect the quality of care they receive now and/or in the future. This is the premise of the Lifestory Album or Profile.
Originally conceived and run as an eight-week program for people living with dementia and their carers, my approach to Lifestory work changed and adapted to meet the needs of different target groups from urban and rural residential care services to community and remote settings. The 20-page scrapbook album condensed down to an eight page A4 booklet, then to an A3 poster – with minimal words, rich in graphics which appealed to and met the needs of low-English literacy and English as a Second Language (ESL) carers.
The key to effective Lifestory work is to adapt the process and resource to the person’s abilities, needs and situation. In an aged care service setting, this means producing something that is accessible to care staff – after all, having information that is hidden or incomprehensible to staff is probably as bad as not having the information in the first place.
I’m passionate in promoting KnowMeWell™ posters – in all aged care services. They can be placed at the beginning of care plans, mounted on walls in residential care and are a great resource to be taken to hospitals and respite centres as and when needed. This is especially relevant for caring for people living with dementia.
The benefits of Lifestory Work are now well documented. For more information, check out the White Rose Online Lifestory Report here, and the Foundation of Nursing Studies Lifestory report here.
Let’s explore how Lifestory Work reflects the New Aged Care Standards through three stories.
Henry* had early stage dementia and attended an eight-week group program to create a life story album with his wife. Over the time they explored different themes each week, documenting areas such as personal achievements, important people in Henry’s life, significant places, etc.
The album proved its worth in the very first visit from the new support worker, who spent two hours reading through the album with him, helping to establish their relationship. This helped Henry get over his concern about having a stranger come to his home to care for him. It also provided ideas when his care plan was developed, such as identifying outings based on his interests, music to enjoy together and ongoing reminiscence activities.
This is an example of an ideal scenario – a lifestory done just before professional care is hired. It enabled Henry to start with his first carer feeling he was at the centre of the situation and maintaining his identity, which of course is at the heart of Standard One.
The LSW album acted as a conversational prompt for reminiscing, promoting engagement and understanding what was important for Henry. It helped the carer provide meaningful activities and connected him to previous social networks, reducing social isolation, great practical examples of how you can meet the Standards.
Support workers using LSW albums have noted that getting to know a person better makes their work easier, and more satisfying. Communication can improve between staff and consumers, and empathy is enhanced.
As the examples below will show, it doesn’t have to be a 20-page album. LSW profiles can be brief and cover a few essential points that are relevant at the time.
Ruby*, an elderly Aboriginal woman with mid-stage dementia and complex behaviours, was a long-term resident in a residential care facility. Ruby’s behaviours were well managed by care staff who had identified suitable responses and strategies over a period of time.
All went well, until Ruby needed to go to hospital. The hospital staff were only informed of her medical needs and “behaviour” was mentioned but no strategies to manage this were passed on. During her hospital stay, Ruby became very agitated and wouldn’t settle at night, roaming the ward and calling out. She was unable to make staff understand her needs.
As the creative-engagement consultant for the Dementia and Behaviour Management Advisory Service (DBMAS), I was asked to meet with Ruby and develop strategies to assist all involved. After talking with the staff at the residential facility, I was able to identify her interests, needs and wishes. A laminated poster was created with a photo of Ruby at the centre and placed next to her bed. Now the staff knew:
- “If I’m agitated, settle me with some drawing pens and sketch book”
- “I like to listen to Slim Dusty”
- “I can’t express my needs”
- “I come from a remote community and my first language is Warlpiri”
Ruby was given pens and drawing paper, and the ward’s CD player with a Slim Dusty CD. An interpreter was called. Pictures of her home country were put up around her bed and cushions with aboriginal colours added to her bed. She no longer roamed at night and was happy to take showers and be attended to by the hospital staff.
Ruby’s story is a great example of the saying “Best care is usually delivered to those who are best understood”. Understanding someone’s needs and preferences for care is fundamental to ensuring their health and wellbeing.
The process of assessing the situation and gathering personal information about Ruby was able to shed light on the reasons why Ruby reacted negatively to her new situation and its clinical approach to care and to make necessary changes to meet her needs.
LSW puts Ruby at the centre of her care. Her identity, her culture, her wishes.
Care staff undertaking training have frequently reported feeling confused or challenged by people’s behaviour until they discovered, often through LSW, that there was a perfectly rational explanation for it.
When working as an aged care support carer, I was sent to a home to provide care to a 93-year-old lady, Bessie*, who was bedridden. That’s all I knew. Her care plan noted her medical condition and brief Activity of Daily Living notes.
I was met at the door by her teenage granddaughter, Sally*, who looked at me with exasperation as she realised I was yet another new staff member that she had to explain things to.
Sally and I talked; she told me it was best to give Bessie a cup of tea with a dash of milk in her favourite teacup, before offering her a shower. Sally noted that her grandmother loves dogs – “tell her stories about your dogs as you make her bed, but be careful as she doesn’t like it if you talk too loudly”. I learnt that if you rush her, Bessie was likely to refuse her shower.
Sally was a fount of knowledge of all things Bessie, but she had to continually educate each new staff member who came to care. I showed Sally a KnowMeWell Lifestory profile booklet I had done for another client and gave her a template. When I returned the next time, Sally had made up a booklet, complete with photos of her grandmother’s favourite cup, her dogs and of when she was young. Sally told me she was now able to give the booklet to the many different carers who came to her home and that Bessie was a lot more relaxed.
Here, LSW helps improve ‘consistency of care’. Sally no longer had to tell each new personal carer her grandmother’s wishes, preferences and needs, and demonstrates that making an effective LSW profile can be easily managed with some guidance.
These are just a few examples where I have seen LSW make a difference to the quality of care a person receives and demonstrates how LSW can help an organisation meet the Aged Care Quality Standards.
Christabelle delivers programs and guides organisations in Lifestory work. If you would like to know more about how she could help you or your organisation, head over to her website: Dementia Wellness.
*Names have been changed for privacy purposes