Mrs Smith was known to staff as “the lady in the room”. She rarely came out of her quarters and never received visitors. She was quiet, did not make a fuss and seemed to have very little to say for herself. She was timid. Staff members did not say much to her, but ensured she was clean, safe and had meals. The other residents were not particularly interested in her. She sat at the dining room with the others but did not initiate conversation. The other residents had stopped trying to converse with her, given her sullen, empty gaze.
Thousands of older Australians live in aged care facilities (Australian Institute of Health and Welfare, 2015). At last count, approximately two hundred thousand Australians were living permanently in long-term residential facilities, or more recently termed, aged care homes, and of these, nearly half have a diagnosis of dementia (Australian Institute of Health and Welfare, 2012), and up to 80% have symptoms of depression or anxiety, with nearly 30% diagnosed with major depressive disorder (McSweeney & O'Connor, 2008; Seitz, Purandare, & Conn, 2010). For most residents, this living arrangement was unexpected, not by choice and forced upon due to illness, safety concerns or practical difficulties of having adequate care. This shift is associated with considerable adjustments, and losses that most of us can only try to imagine – the loss of control, health, independence, one’s home, familiar sounds and smells, routine, and perhaps most poignantly, one’s identity. Without the objects and cues that reflect a person’s selfhood, how could one be reminded of who one was, what made one unique?
Professional carers in such settings, caring as they may be, are busy. Staff at such settings are primarily charged with ensuring that the safety and instrumental needs of residents are catered for. Driven by polices such as “person-centred care” (Brownie & Nancarrow, 2013), professional carers aspire to provide sensitive and tailored care to the individual. However how can staff provide individualised care to residents when they do not know the individual well, especially when they are confronted by a facade of vacant expressions like Mrs Smith. Who is the person behind such expressions?
In 2015, at Swinburne University of Technology, we launched a pilot project aimed at assisting care staff at an aged care facility to gain a better sense of the resident as an individual through developing and sharing three-minute digital life stories about the residents. The project was based on a simple premise – if you know someone’s story, the resident can come alive in your mind and you are potentially more likely to understand and appreciate the person for who they are beyond their immediate presentation.
It is widely accepted amongst narrative therapists and writers that the telling of one’s story is a means to communicate one’s identity to others, and to oneself (McAdams & McLean, 2013). Can such stories assist residents like Mrs Smith to express their uniqueness and their identity to their carers, those who are charged with providing care on a day-to-day basis? Would these life stories improve carers’ knowledge, appreciation, and understanding of the resident?
Surprisingly, there is a marked lack of research on the outcome of such stories and limited literature on how to construct such stories for residential care settings. Typically, such stories are elicited through social conversations with others, or through group based activities such as music groups, craft classes and scrap booking sessions and the creation of storyboards showcasing the resident’s important and meaningful life experiences. Self-directed website and apps have also become available to guide the development of life stories (e.g., storycorp.org). Yet, the research literature on the outcomes of such efforts on the attitudes of carers towards residents remains surprisingly absent.
The pilot project
In collaboration with a lifestyle manager of a residential aged care facility in Melbourne, a film producer, and a number of student volunteers from Swinburne undergraduate psychology courses, the creation of digital life stories of residents for presentation to aged care staff members commenced. Over a period of 7 months, the undergraduate psychology students met with the aged care residents (in most cases more than 70 years apart between the student and the resident), weekly or fortnightly, to learn about the resident, to interview them, and most importantly to understand how the resident viewed herself or himself. The students were provided with ongoing supervision, training, and support to turn the many hours of conversation into a three-minute digital story.
With few precedents to follow, there was a degree of uncertainty about whether residents would be willing to share their life story with such a young ‘stranger’, and consent to have it made into a digital story. Further, little was known about the operations of such projects – and even less about the effects on staff attitudes.
- Not all residents were prepared to share their story.
Whether it was too personal or precious, inaccessible, of limited interest, low perceived value, or for other reasons, it was an unanticipated finding worthy of further exploration.
- The approach of the student was crucial.
Genuineness, care and respect along with a preparedness to resonate with the person’s preferred pace for telling their story were essential factors. The residents’ stories needed to be constructed from many hours of conversation involving different story elements. Not one of the students reported the experience of simply being given a story to record. Ultimately, many of the stories to date have had to be based on the listener’s view of the resident. The students have been challenged to ask themselves questions such as ‘What are my impressions of Mrs Smith?’; ‘What stands out about her for me?’; ‘If I were in her shoes, how would I like to be known?’.
- Students as story makers have needed to be flexible in what comprises a resident’s story.
For some residents, the stories have focused on their professional lives, while for others, the focus has been on family involvement, or on their contribution to the community or church. Some of the stories have taken an historical approach whilst others have emphasised a theme such as hobbies, art, involvement in the theatre, sport, marriage, or even a tribute to a lost partner.
- To achieve a compelling and engaging digital story, the fundamentals of story telling needed to be observed.
In eliciting and compiling the digital stories, it became clear that in order for the story to be engaging, it needed a beginning, middle and end; to have an introduction that captured attention, a build up towards a climax, and a resolution. As well as including accomplishments or experiences of the residents, the students were encouraged to focus on those that could be united under a theme, so that the footage came across as serving to illustrate a point, rather than simply as a collage of unconnected material. It needed to be emotionally engaging and express values that a resident may have stood for.
Results of the pilot project are currently being prepared for publication, but preliminary results are encouraging. Staff members were asked to rate their level of knowledge of the resident prior to watching the digital stories, and again after watching the stories. Preliminary findings indicate that carers knowledge of residents at the aged care facility significantly improves and their attitudes appeared to become more positive following watching the digital life stories. Anecdotally, the stories appear to have had a positive impact not only on the residents but also on the students. There was a noticeable increase in the residents’ positive feelings about themselves, and in turn the experience has had a positive impact on the students.
Stories are powerful. They are powerful not only because they can influence how we regard the world and ourselves, but also because of their impact on listeners. We flock to the movies, read books, and watch online TED talks in order to be captivated, transported, educated and enlivened. Stories become the vehicle for the transmission of cultural messages, common experiences and also highly personal insights. As listeners, we are far more likely to be impacted emotionally by stories than by a multitude of facts. Our minds crave structure, and stories satisfy such a need by organising information in structured narrative form. In aged care, residents have not only lived lives that are rich, complex and long, but few have opportunities to express, articulate and record their values. There is also a huge need to strengthen their identity through emphasising and reflecting on who they have been. Perhaps providing an empathic listener who can develop a relationship and assist in structuring a digital story could begin to fulfill such a need. Could it be that simple? Would a three-minute digital story convey whom you would like to be known to others? We think it’s a start.
Acknowledgements: The authors would like to acknowledge Rebecca Collins (the lifestyle manager at a residential aged care facility in Melbourne), Jahar Bhowmik (statistician at Swinburne University), and Fiona Dalziel (film producer), for their contributions to the Life Story project.
- Australian Institute of Health and Welfare. (2012). Residential aged care in Australia 2010-11: A statistical overview Aged care statistics series no.36. Cat. no. AGE 68. Canberra: AIHW.
- Australian Institute of Health and Welfare. (2015). Use of aged care services before death. Data linkage series no. 19. Cat. no. CSI 21. Canberra: AIHW.
- Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: A systematic review. Clinical Interventions in Aging, 8, 1-10. doi: 10.2147/CIA.S38589
- McAdams, D. P., & McLean, K. C. (2013). Narrative Identity. Current Directions in Psychological Science, 22(3), 233-238. doi: 10.1177/0963721413475622
- McSweeney, K., & O'Connor, D. W. (2008). Depression among newly admitted Australian nursing home residents. International Psychogeriatrics, 20(04), 724-737. doi: doi:10.1017/S104161020800700X
- Seitz, D., Purandare, N., & Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: A systematic review. International Psychogeriatrics, 22(7), 1025-1039. doi: 10.1017/S1041610210000608