6. Module 5 · Person-centred care & life history

6.3. Case, consolidation & transfer

Case, consolidation and transfer

Two cases and what to take away

Case study

Using the life history

Mrs L. (dementia) is often restless and listless; the standard activities do not reach her. Through her life history (obtained from her daughter), the team learns that Mrs L. was a passionate homemaker who loved folding laundry and laying tables. She is offered these familiar, meaningful tasks (laundry to fold, helping to lay the table). Mrs L. blossoms – she is occupied, content, feels needed and competent; her restlessness subsides. The case shows how life-history work makes meaningful, person-centred support possible – the person is seen and strengthened in their identity.

Second case

Mr Haddad and the careless talk

Mr Haddad (fictitious), 80, a retired engineer, is washed and dressed in the morning by two carers who talk with each other about their weekend while they work. They call him “Opa”, decide which clothes he wears, and when he resists a sleeve, one says, “He is being difficult again.” Over several weeks he becomes quieter, eats less and hits out during dressing. A new colleague, Lena (fictitious), notices the pattern and asks the team to reflect with Figure 5.2 at the next team meeting. They agree to greet him by name, to explain each step, to offer two jumpers, to let him hold the sleeve himself and to speak with him, not over him. His daughter tells them that he loved building models and was always careful about his appearance, so the team places a small model on his table. Over the following weeks the dressing becomes calmer, and Mr Haddad begins to explain the model to staff.

Analysis. (1) The carers did not mean any harm. Several undermining behaviours arose from routine: infantilising (“Opa”), ignoring (talking over him), disempowerment (choosing for him) and labelling (“difficult”). (2) His reaction was a message and not a character trait (Module 4). (3) The strengthening alternatives cost no extra time, once they became habit. (4) The life history, shared by the daughter with his agreement, opened a new offer: the model. (5) The change started with one colleague’s observation and a team conversation. Culture changes when someone says what they see, kindly and with an example. (6) The team still needs to check pain, hearing and other causes of resistance, because a better attitude does not replace a careful search for a cause.

🗂️ Flashcards – think first, then open
What is personhood?
The recognition of a human being as a valuable, unique individual who lives in relationship with others (Kitwood).
Which need sits at the centre of Kitwood’s model?
Love. Around it are comfort, attachment, inclusion, occupation and identity.
Name three behaviours that undermine personhood.
For example infantilising, ignoring, outpacing, labelling or objectifying. They are usually not meant badly.
Why gather a life history?
To understand the person, interpret behaviour, recognise needs and offer familiar, meaningful things.
What must you keep in mind when you write down a life story?
Collect only what helps, ask with consent and keep it protected. Health and belief data are specially protected under GDPR Article 9.

Key messages

  • Person-centred care sees the person first and the illness second.
  • Kitwood’s needs, with love at the centre, are connected. If one is neglected, the others suffer.
  • Undermining behaviour is usually unintended, and strengthening behaviour usually costs no extra time.
  • A life history is a starting point for conversation. It is not a script and not a full record.
  • Collect only what helps the person, with consent, and protect it as personal data.
  • Check every offer against what you see today.
Reflection (for yourself, nothing is submitted).
  1. Which of Kitwood’s undermining behaviours do you notice most in your workplace, and which strengthening one could you try tomorrow?
  2. What would you want a carer to know about you if you could no longer tell them?
  3. How could you ask relatives for a life story so that they feel respected and not questioned?
For your everyday work – checklist
  • ☐ I address the person by name and explain what I am doing.
  • ☐ I speak with the person, not about them.
  • ☐ I offer simple choices and let them do what they can.
  • ☐ I know at least three things this person loves, and one thing that upsets them.
  • ☐ I treat life-history information as personal data and share it only with those who need it.
Transfer to practice

Exercise: Do you know the life history (occupation, preferences, habits, important relationships) of the residents with dementia in your care? Where there are gaps: how could you fill them (relatives)? Reflect using Kitwood: do you strengthen personhood, or are there (unintentional) ways in which it is undermined?

Voluntary self-declaration – saved in your course account. Once all modules are marked as done, your confirmation of participation will be available.