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N E T W O R K

n 2009 Queens Court Care Home worked with the social enterprise Many Happy Returns to deliver a life story project which we called ‘Collected Short Stories’. By ‘Collected Short Story’ we mean an autobiographical album that tracks the pictorial story of the person’s life using photographs and printed materials, starting from their early years including place of birth, upbringing and their immediate and extended family. The album includes details of work, marriage and children (if relevant) as well as information about life in middle age and after retirement.

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Getting started We did a number of things to get the wheels in motion for the project. We introduced staff and residents to reminiscence materials, specifically Chatterbox 1940s cards produced by Many Happy Returns. These picture cards include background information to prompt conversation between people of different ages, and focus on people’s everyday experiences at the time, with subjects like evacuation, housework, making do and mending, washday, rationing and romance and more. Sarah (co-author, and from Many Happy Returns) also ran three REAL Communication workshops. These workshops helped to improve staff reminiscence, empathic engagement, active listening and conversational skills. Staff who had completed the workshops were responsible for cascading their knowledge to other team members. We also asked family members for their help in making the Collected Short Story for their relative. We introduced the idea at a meeting for relatives and residents and they showed considerable interest. Shaaron Caratella is the General Manager of Queens Court Care Home. Sarah Reed founded Many Happy Returns, a social enterprise that produces reminiscence products, games and activities, in 2008. She also works as a trainer and facilitator with My Home Life.

London

Collected short stories

Shaaron Caratella and Sarah Reed describe how life story work helped build relationships in a care home

Above left: Sarah (left ) and Shaaron. Above right: chatting with residents and staff at Queenʼs Court.

Practical lessons

Wider learning

Resident: I wonder what Paul is doing now on holiday with his family. I never knew that he had three sons. He’s in South Africa. I used to visit South Africa years ago, my daughter used to live there. As each short story is an ongoing record of the resident’s major interests and achievements, residents have been able to enjoy social participation and stimulation in a way that has reflected their personal preferences. As a result of the project, families have spent time together discussing the photographs, the places they visited in the past, life events and the people they have in common. Some family members were initially reluctant to discuss the past with their relative for fear of distressing them, but in fact, they found that the discussions were meaningful for all concerned as well as generally being pleasant trips down memory lane.

The Collected Short Stories approach has offered the residents the opportunity to preserve their identity, share their stories, their knowledge, and also to gain a closer relationship with the staff. There is a positive counter-effect as well: residents enjoy listening to the staff talking about their own lives and have asked questions about their countries of origin, their families and their culture.

Son: We even went to see where our mother was born… that was a family day out for us. It was in East Ham. It had changed so much. But we were able to come back and describe it all to her. Despite her dementia, she remembered a number of incidents and stories and we had quite a long chat about things we had known little about.

We learned that we needed to offer a long time frame to complete the work. We found that making a few books at a time generates more interest and allows more people to join in and assist. Staff share interesting facts and this strengthens their relationships both with the residents and with each other. We also learned that albums need to be inexpensive, easy for the resident to hold, in colours that are appealing to them and immediately recognisable as their own. Pictures and type need to be large enough to be seen by residents whose eyesight is impaired. The staff have had to learn new skills such as enlarging photographs, and how to use maps, the library and the internet to glean information about places and events that have shaped the lives of residents.

Having more knowledge about the resident’s past has improved the quality of conversations and activity between residents and their families. Daughter: The rewarding conversations we had about Mum’s dog-breeding days as a result of the album led us to bring in some of her rosettes and press cuttings and we have produced a photo montage for her room about her dogs and her prizes which she can enjoy when she is alone and we can enjoy together.

Learning for staff We always wanted this project to demonstrate the value of a ‘whole home approach’: a collaborative approach to care home management involving the residents, relatives and staff to promote relationship-centred care. It encourages all staff to share resources with each other, which breaks down barriers and encourages communication. In fact, the project has involved clinical, catering, administration, maintenance and housekeeping staff, and each staff member has brought their own skills and experience to the task. When this project started, while enthusiastic in principle, staff seemed to need regular reminders that they should actually start working on the project with the residents. Many felt more comfortable with

(Vol 19 No 6) November/December 2011 Journal of Dementia Care 9

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N E T W O R K routine tasks such as bathing or personal care. This was surprising, as we assumed that they would be happy to be involved in spending time with the resident, to talk, discover stories and go through photographs. Staff needed different levels of assistance to develop their communication skills – from understanding what was being said and learning how to respond, to gaining confidence in asking questions. Levels of fluency in English language vary and this can have a significant influence on how staff express their opinions or participate in conversations. Teamwork in care homes is not always well understood by staff. This is generally because they have been used to working within a hierarchical, taskorientated culture, as opposed to collaborative structures that try to build relationship-centred care. Many staff have been trained abroad and this can also influence their expectations of teamwork and hierarchy. In this project, staff have been encouraged to work alongside peers to secure consent, research personal stories, places and events, obtain photographs and liaise with relatives. Each member of staff has expressed pride in developing the Collected Short Story album with their assigned resident. All the staff have reported feeling more comfortable and having greater empathy with the residents than when they originally met. Staff: She said that there was a dreadful coal slag heap slide that day in Aberfan… she did not go to school and so survived something awful when she was very young, but a number of her school friends died. Can you imagine that? Staff: I discovered that Mrs S used to live in Africa – I know where she lived. It was not far from where I went to school! With a project such as this, leadership is clearly important: there has to be a balance

between the needs of the service and allowing enough time for meaningful engagement. Shaaron (manager and counderstood this. author) Originally, staff wanted ‘to take the book home to complete it’. They needed a supportive leader to persuade them that it is the residents’ own shared experience and not time that is the issue and that ‘work in progress’ with residents is not only more important, but vital. A little while into the project we wrote guidelines giving staff overt permission to work and spend time on the project, and we also held a number of meetings to address this point too. Maintenance: We knew we needed to be very sensitive to the way Mr. George felt about his room, but he thanked me for painting it. This might not have happened before the Collected Short Stories project. Housekeeper: We enjoyed talking about our families when I cleaned Millie’s room today. One resident has moved to another home where she was able to use her book to introduce herself to her new carers. Two residents have died. Both their books were used at the bereavement teas and the families have described how they treasure the books with nostalgic pleasure to recall their relatives’ comments. Six life story albums were completed during the first six months, and a further three were in progress. Now, over two years later, roughly two-thirds of our residents have a completed album. Life story work has not been only an opportunity to get to know and understand residents better, it has also helped staff in their relationships with relatives and their peers as well. Acknowledgements We are grateful to the staff, residents and relatives of Queens Court Care Home who participated in and interacted with and supported this project with such enthusiasm.

10 Journal of Dementia Care November/December 2011 (Vol 19 No 6)