Dementia Centred

By Wendy Perry

February 14th, 2018

To Tell the Truth

As a kid I remember watching re-runs of To Tell the Truth, which for those of you who have never seen it, is a game show in which three contestants all claim to be the same individual. Each contestant is asked questions by panellists who are attempting to gather enough information to identify the real individual in question.  The show often began with a unique story from the real individual’s past.  One of the appeals of the show was whether you, as the audience, could discern who was lying and who was telling the truth.  But I think the appeal of the show went beyond that and said something about our fascination with other people’s stories. 

Our experiences retold act as little snapshots which gives greater insight into who we are and removes us from the easily identifiable boxes which might define us to others. In health and social care we do life story work in order to learn people’s stories and better understand them as an individual.  It is our way of seeing past a diagnosis of dementia, and in to the real person.  Life story work is not a new concept within health and social care services, I think I did my first social life history with a client in 1994, and it wasn’t a new concept then.  However, I still spend couple of hours on life story work in our making Activities Meaningful for People Living with dementia course, because it is the foundation of tailoring an activity programme to meet the interests and strengths of the individual. 

I guess I thought that the use of life story work is more widespread than it actually is.  According to a recent study by the University of York in which they surveyed dementia care service providers in England, they were able to estimate the rate of use across similar services in England.  Surprisingly, life story work was only estimated to be used in 48% of dementia specialist care homes and 23 % of general care homes.  I was particularly concerned by this, as an individuals history is what makes them unique, and give us, as providers, insight into how best to support the individual who is using our services.

One of the points of learning that came out of the York study is the opportunity that such work provides in building relationships between services and their service users and families.   This can often be an overlooked opportunity.  For many services that use a life story template such as This is Me or Getting to Know Me, those forms are frequently given to a family member to fill in and return.  However, this provides a very narrow slice of the individuals’ life story (just as yours would be, if told by one family member).  Life story work, though often an afterthought of the admission process, is vital to the creation of person-centred support plans, so the robustness of the background information often makes the difference between a person-centred support plan and a boiler plate support plan.

Because service users are not on To Tell the Truth, life story work should not be done immediately upon arrival in a care setting, rather a period of building relationships and trust needs to occur before people may feel comfortable honestly sharing their experiences.  Since this cannot be achieved immediately, there should be a recognition that this is a living document that grows over time, and continues to inform support throughout a person’s stay.  It should not be signed off after 72 hours and put into the back of the individuals file, unread by any of the carers who would benefit from it.  And yet, this is a common scenario that I hear as an educator when I ask about life story work organisational practices.  So, how can we begin to strengthen relationships, and utilise life story work more effectively?

Something that can help is the thoughtful creation of a procedure around who, what, when, where and why life story work is done.  These questions matter because, as a provider the goal should not merely be to get answers to life story prompts, but to get the answers that tell you who this individual is.  Without this information we cannot effectively reinforce personhood, nor can we hope to identify the best ways of supporting wellbeing.  This is the information that transforms our services into places where person-centred approaches can flourish.

Wendy includes Life Story work the Making Activity Meaningful course, find out more here

Read the University of York’s report on the use of life history work

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