Life story programs hold promise for improving person-centered care and relationships between nursing home residents and staff. A pilot life story intervention study in 16 nursing homes provided residents with complimentary biographical life story books and summaries, and staff with action plans to enhance care planning. Trained volunteers and program staff collected life stories, and researchers interviewed 170 residents at three points in time. Overall, residents had positive experiences with the program, but were less willing to share their books with others afterwards. They also experienced a decrease in depression (Patient Health Questionnaire-8 [PHQ-8]) over time. Surveys of 92 staff demonstrated increases over time in perceived importance of knowing residents’ life stories. Administrator/admissions staff found it conditionally feasible to incorporate the program into admission processes. Practice implications of life story work include opportunities to help staff learn more about residents they care for, improve person-centered care, and honor resident preferences in care planning.
Recruiting nursing home (NH) residents to participate in program evaluations is a consistent challenge. This was evident in a federally supported project to improve person-centered care of long-stay NH residents enrolled in Medicaid. Evaluators sought to examine the impact of a life story work intervention using a pre-post study design involving interviews of NH residents and surveys of their family members and staff. Other resident eligibility criteria included willingness to participate in both research and life story interviews, age 60+, a Brief Inventory Mental Status (BIMS) score of 8 or higher, English-speaking, and consent from a legal guardian, if applicable. A total of 16 NHs agreed to participate in the implementation and evaluation of the program, which developed complimentary, individualized life story booklets for residents and a companion summary for staff. Of the homes’ combined population of 1,817 residents, 569 met eligibility criteria for the research study. Non-response from legal guardians excluded 37 residents, and 174 residents approached for recruitment declined to have their names released to the researchers. During baseline interviews, 20 residents failed the BIMS, 21 were unavailable, and 79 refused when approached by a research interviewer. Ultimately, 238 resident interviews were completed at baseline. Common themes for refusals included disinterest in participating in life story work, statements that theirs was not a good life worth talking about, and doubts that quality of care would improve. Strategies for addressing such challenges included displaying sample life story materials during recruitment and providing residents additional time to consider participation.
A life story program was implemented in 16 nursing homes (NHs) in Ohio with partners including a company specializing in life story work and a gerontological institute. The aim was to evaluate the impact of the life story program on residents and staff. NH sites were selected from an urban/suburban and a rural county using sampling procedures ensuring variation in auspice, quality star ratings and bed size. A longitudinal design was used to conduct in-person interviews with residents at baseline (prior to the life story interview), immediately after the interview, and approximately a month after most life story books were delivered to a NH. Resident eligibility criteria included being age 60 or older, Medicaid-eligible, long-stay and having no to moderate cognitive impairment. Residents’ (n=238) average age was 77 years, 66% were female, and 52% had resided in the NH for 1-5 years. Cognitive scores declined over time, but depressive symptomatology improved significantly. Residents had very high levels of satisfaction with care, enjoyed telling their life stories and would recommend the program; these findings did not change. A pre-post study design was used with staff (n=198), who included nurse aides, nurses, administrators, social workers and activity staff. Their average age was 44 years. Although staff job satisfaction did not change significantly, the vast majority enjoyed learning about residents’ life stories and used them in care planning. The findings demonstrate that life story work may be useful in promoting person-centered care, although further testing is needed with a more generalizable sample.
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