Gerontology & Geriatrics Education, 36:109–123, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0270-1960 print/1545-3847 online DOI: 10.1080/02701960.2014.925888

Using Life History Narratives to Educate Staff Members About Personhood in Assisted Living DENISE GAMMONLEY School of Social Work, University of Central Florida, Orlando, Florida, USA

CONNIE L. LESTER Department of History, University of Central Florida, Orlando, Florida, USA

DANIEL FLEISHMAN School of Social Work, University of Central Florida, Orlando, Florida, USA

LLOYD DURAN Public Affairs Doctoral Program, University of Central Florida, Orlando, Florida, USA

GEOFFREY CRAVERO Department of History, University of Central Florida, Orlando, Florida, USA

Oral life history narratives are a promising method to promote person-centered values of personhood and belonging. This project used resident oral history interviews to educate staff members in an assisted-living setting about personhood. A single group pre-post test design evaluated impacts on 37 staff members to assess their use of resident videotaped oral history interviews and impacts on their perceived knowledge of residents. Perceived knowledge of residents declined ( p = .003) between pretest and posttest. Older staff members were less likely to view a video. Staff members are interested in resident oral history biographies and identify them as helpful for delivering care. Oral history methods might provide an opportunity for staff members to promote personhood by allowing them to expand their understanding of resident preferences, values, and experiences. KEYWORDS assisted living, biographical, person-centered care, personhood, reminiscence

Address correspondence to Denise Gammonley, School of Social Work, University of Central Florida, P.O. Box 163358, Orlando, FL 32816, USA. E-mail: denise.gammonley@ucf. edu 109

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Care of the whole person in delivering geriatric services has emerged as an important theme for advocates, policy makers, practitioners, and researchers. The humanistic psychology of Carl Rogers (1961) is acknowledged by many as a foundation for person-centered care (Love & Pinkowitz, 2013; McCormack, 2003; Morgan & Yoder, 2012). Early efforts by Kitwood (1997), focusing on persons affected by dementia, emphasized the need for health providers to move away from dehumanizing older adults by reducing their individuality to descriptions of behaviors or diagnoses. Person-centered care has also come to be recognized as individualized and responsive care within the unique organizational contexts of elder care settings (Koren, 2010, Love & Pinkowitz, 2013; McCormack, 2003). Honoring personal preferences and resident self-determination, along with social and community engagement, are foundational principles that have been described in the context of delivering long-term care (Koren, 2010). Person-centered care prioritizes care for the whole person recognizing personhood as a key value. Delivering person-centered care requires staff members to attend to residents’ unique values, belief systems, current and past relationships, along with their desire for a purposeful life. Positive and meaningful social relationships between staff members and residents are central to person-centered care. McCormack (2003) and colleagues (McCance, McCormack, & Dewing, 2011) emphasized the quality of relationships between the care provider and care recipient in their conceptual framework for person-centered practice with older people. This model of care highlights how elder values and beliefs can be identified and supported in the delivery of care only by recognizing the unique identity of the individual, the elder and care provider. Use of biographies, in the form of stories told by the elder and narratives describing their care experiences, are recommended as a routine part of assessment to promote respect for values in care planning and delivery. This framework has been applied to studying the care experience received by elders in a rehabilitation facility. Findings revealed that care experiences and preferences revealed in stories heard by care providers reflected connections to past lived experiences and were useful for more individualized multidisciplinary care planning (Hsu & McCormack, 2011). This kind of individualized approach using life history stories may also be a promising strategy for educating staff about the importance of individualizing care within assisted living. Prominent themes from the few empirical studies using biographical methods to influence care delivery note the benefits of biographical interventions to improve staff understanding of the unique identity of the older adult, communication between residents and staff, and relationships between staff, residents, and family members (McKeown, Clarke, Ingleton, Ryan, & Repper, 2010; McKeown, Clarke, & Repper, 2006;). Hansebo and Kihlgren (2000) found that training staff followed by one year of supervision in using a formal psychosocial assessment

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strategy to gather biographical information resulted in staff members communicating more detailed narratives of the life stories of residents. Clarke, Hanson, and Ross (2003) found staff engagement with resident life stories generated more dynamic and fuller understandings of residents and closer relationships between staff and residents and staff and family members. Gathering individual life histories presents an opportunity to individualize social engagement while heightening staff awareness of core values of personhood, respect, dignity, and belonging. Exposing staff to resident biographies through life story narratives also creates a focus for meaningful dialogue and mutual activity between staff and residents. Educating staff members using these methods may pose challenges in the assisted-living environment due to the large number of staff members (e.g., transportation providers, dining room staff, activities staff, hands on care providers) interacting with residents, along with variability in their frequency, intensity, and duration of interactions with residents. It is not clear, for example, if all categories of staff are able to take the time to view life histories or if they will find benefit in doing so. To examine these factors the focus of this exploratory project was to determine if life history narratives could be successfully disseminated to staff members. We also sought to determine if staff members identified any impact of viewing resident life history narratives on their perceived knowledge of the resident. Understanding lived experiences, as told by residents themselves, was conceived of as a strategy to engage staff members with the core person-centered care value of personhood.

CONCEPTUAL FRAMEWORKS GUIDING THE USE OF ORAL LIFE HISTORIES TO PROMOTE PERSONHOOD Our approach to gathering the oral life histories was guided by the principles and best practices established by the Oral History Association (2009) and by training materials developed by the university’s (University of Central Florida, 2011) interdisciplinary public history project. From the perspective of historians, oral histories form a critical component for understanding the past. Oral histories differ from interviews by content and extent. Hearing the inflection of the voice and the pauses in conversation are often as informative as the words spoken. Oral histories connect the listener to the past through an experience with the individual participant. Oral histories are conducted according to standardized methodologies that place the interviewee in control to limit the parameters of the history provided and reflect broadly on themes. This approach honors the personal preference and choices of the respondent in keeping with the principles of person-centered care. Oral histories of World War II Veterans have been successfully gathered by student and faculty nurses from elders residing in community settings and nursing homes (Taft et al., 2004). In a review of the literature using oral

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history methods with older adults Dorfman, Murty, Evans, Ingram, and Power (2004) identified generational themes, key events in history, environment influences over the life span, and cultural values associated with attachment to place as prominent themes that emerge in oral histories conducted with elders. Evolving conceptual models of delivering person-centered elder care include those emphasizing individuality and personhood (Kitwood, 1997), humanistic philosophy (Edvardsson, Winblad, & Sandman, 2008), and context- and task-specific models of personalizing care delivery (Hoeffer et al., 2006). In this project we emphasized the unique context of the assistedliving setting and core domains of person-centered practice developed by the Center for Excellence in Assisted Living (2012). Sharing oral life histories with staff was a strategy to promote the core values of personhood and belonging by providing personalized information about residents through their narrative expressions of the important events, relationships, and accomplishments over a lifetime. The participatory approach we used to engage the assisted-living unit acknowledged independence and choice. The methods we implemented to share the stories with staff members were designed to support intentional relationships and community building between residents and staff members. Guided by concepts associated with this framework, and in recognition of the facilities’ adoption of a person-centered care philosophy, we anticipated staff (a) would be interested in using the oral histories, regardless of their particular employment role; (b) perceive benefits of using oral histories as a tool to identify resident preferences; and (c) demonstrate change in their perceived knowledge of residents after being exposed to the oral histories.

THE LIFE HISTORY PROJECT A 40-bed assisted-living unit within a large not-for-profit continuing care retirement facility served as the setting. The project was reviewed and approved by the Institutional Review Board of the University of Central Florida. Undergraduate students interviewed residents and documented the life histories using videos. Students prepared for the project by completing classroom experiential exercises to practice interpersonal communication with older adults and an introduction to the person-centered care model developed by the facility. Students also received instruction and written guidelines in conducting in-depth interviews with older adults (Kaufman, 1994), observed and discussed video examples of oral history interviews during a classroom session, and practiced oral history interviewing techniques and use of the video cameras. The written guidelines for students included strategies to encourage open-ended responses through descriptive questioning, focusing on broad

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themes, and using probing questions to focus on emerging themes. Topics to explore during the oral history were developed by the resident collaborating with the student during an initial face-to-face discussion. A final outline of the topics and interview questions was prepared by the student, reviewed and approved by their instructor, and then presented to the resident for his or her final approval. Student learning outcomes were evaluated separately (Gammonley et al., in press). Videos were made available for staff to informally access on the assisted-living unit during the course of their regular workday and through scheduled “premier” events. These featured a resident video followed by an informal discussion facilitated by a graduate research assistant in the television lounge or dining area of the unit. The staff outcomes project reported here assessed the practicality of using oral life histories gathered by student-resident teams to help staff gain more intimate knowledge of resident personal biographies. We were interested in learning if busy staff members from across a range of roles would be able to participate and engage with resident biographical stories, if staff members would demonstrate increased knowledge of residents, and if staff members found value in being exposed to life stories of individual residents.

Engagement and Life History Documentation Capacity building, resident, and staff engagement. An advisory committee comprising residents, managers, staff, and the project team outlined a plan for recruiting residents, matching them with student teams, and engaging staff members in viewing the completed oral life histories. To elicit staff interest and recommendations a group meeting was conducted 2 weeks prior to student involvement. From the group we learned that staff members identified overcoming lack of time for detailed conversation with residents as a potential way the oral histories could help them succeed in their job. Residents were recruited by a graduate research assistant who made personal visits to each resident on the unit to explain the project and invite them to an initial group meeting with the service-learning students. Gathering narrative life histories. To prepare for the project students attended three orientation and preparation classroom sessions. The first session was devoted to experiential exercises to practice appropriate communication techniques and learn strategies to respond to sensory and cognitive limitations of older adults in assisted-living settings. The second session, an orientation to the facility and its person-centered care model, was cofacilitated by the first author and the director of volunteers at the assisted-living facility. The third classroom session introduced concepts of community mapping that was planned as an activity for the first visit. One half of each of the 3-hour classroom preparation sessions was devoted to learning about oral history methods and planning for the visits.

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Students engaged with residents in the facility during one-hour visits beginning with the group icebreaker introduction community mapping activity. Teams of two to three students were paired with a resident. Student teams identified one or two residents they met during the group activity who indicated they were interested in participating in the video interview. Following the initial group activity the graduate research assistant again met individually with these residents to obtain informed consent for participating in a videotaped interview. Student-resident engagement prior to completing the formal video interview was a critical component as it allowed time for the resident-student teams to develop rapport before gathering the formal interview. Once the resident agreed to conduct the formal interview students and residents met up to three times (30-minute to 1-hour meetings) to build rapport and to collaborate on developing a topical interview guide. Most often students proposed the topic to explore in the interview and the residents decided whether to comment on those themes in their formal interview. Themes explored included family relationships, school experiences, work roles and experiences in the military, proudest and most memorable moments, and reflections on significant historical and world events. A total of 23 residents participated in at least one interview session with a student team. Fourteen residents met with students more than one time and 11 residents provided informed consent for having their oral history interview documented using videotape. Declining physical health status required four of these 11 residents to discontinue participation before the oral history video could be completed. In addition, two residents chose to discontinue their participation after having initially agreed to have their interview documented. Five residents ultimately completed a video interview. Dissemination to staff. Dissemination of the videos was guided by resident choice. The research assistant first consulted individually with each resident to determine their preferences for sharing their oral history with family, other residents, and staff members. One resident requested to view their DVD privately with the research assistant before deciding to let others view it. Four of five residents shared their videos. Three residents agreed to a premier of their full-length interview and one resident agreed to share only an excerpt produced as part of the edited compilation version. A final project celebration featuring an edited compilation video was attended by a wide range of staff members and residents. A series of full-length premiers featuring the three profiled residents with a complete video interview (ranging in length from 30 minutes to 1 hour) were offered to staff and residents in the TV room on the assisted-living unit for 6 weeks following the departure of the student group. Providing staff access to the completed video interviews entailed some challenges due to participation by staff members from across the large and spread out facility. Screening sessions had to be adapted to the schedule and working location

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of staff. Many staff working within the assisted-living unit had difficulty sitting through an entire full-length oral history uninterrupted as they were frequently called away to respond to resident requests for assistance or other duties on the unit. After the first few full-length premiers an alternative viewing format needed to be offered to attempt to engage staff members from throughout the facility who had provided a baseline assessment. Attempts were made to schedule a group viewing session for dining services staff, but this was difficult due to scheduling issues. A better alternative proved to be scheduling individual visits with staff members to show them an edited compilation video on a laptop computer.

METHOD Design Staff impact evaluation. A single group pre–posttest design was used to understand staff member initial knowledge of residents while providing all staff members who participated in the pretest the opportunity to view a resident video. A primary outcome of interest was determining the ability of the project to engage staff members with the videos. A convenience sample of 50 staff members was recruited by distributing a flyer announcing the study. All eligible staff members provided care to the residents who had their life story profiled in a video. A pretest survey assessed staff perceived knowledge of residents using a standardized instrument. Staff members received $10 to thank them for completing the survey. After viewing a video they completed a posttest survey consisting of the same standardized person-centered care knowledge scale and additional closed and open-ended questions about perceived benefits of the oral histories for helping them provide care to residents. Impacts were evaluated using the 13 item Individualized Care-Know the Person (IC-KNOW) scale (Chappell, Reid, & Gish, 2007). It assesses perceptions of how well staff in long-term care settings have general knowledge of the residents in their care. Seven items are scored on a scale from 1 (strongly disagree) to 4 (strongly agree) where higher scores indicate more individualized care. Six items are reverse coded representing scale values of 1 (strongly agree) to 4 (strongly disagree) where higher scores indicate more individualized care. We anticipated potential change in staff knowledge of residents using this measure because items address the individuality and preferences of residents (e.g., “I do not feel like I know each resident as a unique individual” and “I know what the residents I care for like”). Possible scores on the IC-KNOW range from 13 to 52. Reported internal

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consistency of the IC-KNOW is α = .77 with test–retest reliability of .56 (Chappell et al., 2007). In this sample we achieved a lower Cronbach’s alpha of .65 on the IC-KNOW scale. Additional investigator developed items gathered demographic data and anticipated interest in viewing an oral history. At posttest additional free response items inquired if and how the staff member accessed the resident oral history information and their perceptions of the impact of the project on residents, family members, and staff members. Statistical analyses evaluated factors associated with the likelihood of staff participation and change in staff perceived knowledge of residents as assessed by a paired-sample t test of pretest to posttest changes on the ICKNOW instrument. We established an alpha level of .05 to test significance in these exploratory analyses and analyzed data for staff members who had complete pretest and posttest responses (N = 37). To examine equivalence at pretest between the group of staff members who chose to view one of the oral history videos (n = 27) and those who completed the posttest but did not view a video (n = 10) we conducted a Wilcoxon Mann–Whitney U test to determine group equivalence. There were no differences at pretest between the group of staff who ultimately viewed the video versus the group that did not view the video on measures of knowledge of the resident as measured by the IC-KNOW (p = .158) or length of employment in aging services (p = .559). In addition to statistical analyses we used thematic content analyses to evaluate responses to open-ended questions about staff experiences engaging with the oral history video interviews. This helped address a limitation of the IC-KNOW scale, which examines general knowledge of all residents in a facility, by providing some details about impacts on specific residents. Responses to the open-ended questions assessing staff perceptions of the impact of the project were content analyzed using Atlas ti 5.0 software (Muhr, 2004). First-level data reduction of the free-response items consisted of open coding of text segments based upon staff references to the perceived impact of viewing the videos. First-level coding was conducted independently by two members of the project team who then met to discuss discrepancies and to refine coding rules. Initial coding categories were refined and then codes were revised to be consistent. Subsequent analytic coding and analysis involved identifying common themes that cut across the initially identified potential dimensions of impact including the context of varying staff roles. Researcher interpretations of themes were further subjected to review and confirmation by sharing interpretations of staff members’ open- ended responses with members of staff at the facility who served on the advisory committee.

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RESULTS Staff Participation As shown in Table 1 staff members from across the spectrum of service providers within the facility participated in the pretest, and 76% of these expressed initial interest in viewing a video at the pretest. Overall staff members averaged more than 8 years being employed in the facility and more than 11 years of experience being employed in aging services. Among staff completing the pretest and the posttest (N = 37) 27 of these ultimately (73%) viewed a video. Each of the 27 identified it as potentially helpful for providing person-centered care and enhancing their knowledge of residents. To further understand staff motivation for viewing the oral history videos we examined job category (direct service or management vs. dining or environmental services), staff age, and length of employment in aging services as predictors of viewing a life history video using a binomial logistic regression model. Results presented in Table 2 indicate that the model fits the data well since the Hosmer-Lemeshow Goodness-of-Fit test (p = .359) exceeds p = .05. The model correctly classified 81% of cases. Only age significantly predicts the likelihood of a staff member viewing a video. A negative relationship exists indicating for every increase of one year in age, the odds of a staff member viewing the oral history video interview declines by 10.2%. The association is significant (p = .019) but small.

Perceived Knowledge of Residents Staff members who viewed a life history video reported a decline in their perceived knowledge of the resident between completing the pretest and TABLE 1 Profile of Staff Participants (N = 37) Demographic Age Men Women Job category Direct care and management Dining or environmental services Years employed in facility Years employed in aging services Expressed initial interest in viewing oral history video Viewed oral history video and completed posttest survey Viewed video by job category (n = 27) Direct care and management Dining or environmental services Rated videos as helpful (n = 27) Very helpful Somewhat helpful

M

SD

47.03

13.03

8.41 11.85

n

%

16 21

43 57

12 25

32 68

28 27

76 73

9 18

33 67

20 7

74 26

9.91 10.58

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TABLE 2 Results of The Binomial Logistic Regression of the Likelihood af a Staff Member Viewing a Life History Video (N = 37) Variables Direct service or management (vs. dining or environmental) Age of staff member Length of staff employment in aging services Chi-squared (df )

OR

95% CI

.656 .898 1.004 8.180

[.126, 3.680] [.820, .982] [.997, 1.013] (3)

Note: OR = odds ratio; CI = confidence interval. p = .359. OR is statistically significant at .019 level.

posttest. As shown in Table 3 results from a paired-samples t test of the mean scores on the IC-KNOW scale indicate staff member knowledge of residents declined from a mean of 43.35 to 40.85 (p = .003, two-tailed). Calculation of a Cohen’s d revealed a moderate effect size of .55. To identify more specific impacts on individual items from the IC-KNOW scale a series of Wilcoxon signed ranks tests were conducted. Results indicated that staff members who viewed a life history video reported a decline between the pretest and posttest assessment on two of 13 scale items: “I do not have the time I need to read the social histories of residents” and “I know what the residents I care for like.” The median change for “I do not have the time I need to read the social histories of residents” was 1.0: Mean (SD) at pretest = 3.36 (.87), Mean (SD) at posttest=2.62 (.92), Z = –3.181, p = .001. The item “I know what the residents I care for like” had a median change of 1.0: Mean (SD) at pretest= 3.77 (.51), Mean (SD) at posttest= 3.19 (SD = .84), Z = –2.578, p = .01.For the item pertaining to social histories the ratings represent a change from a median rating of strongly disagree at pretest to somewhat disagree at posttest. As this item pertaining to social histories is reverse coded this change represents a small increase in individualized care as measured by the IC-KNOW. For the item “I know what the residents I care for like” scores indicate a change from a median rating of strongly agree at pretest declining to a median of somewhat agree at posttest. Staff perceived benefits of viewing the oral histories. The overall impact of viewing the videos was characterized by some as “eye opening,” “surprising,” and “meaningful” and engendering pride in the accomplishments of residents. As outlined in Table 4, staff free responses were clustered along TABLE 3 Pre- To Posttest Changes in Perceived Knowledge of Residents Among Staff Who Viewed an Oral History Video (N = 27) Pretest

Knowledge of residents

Posttest

M

SD

M

SD

t

p-value

Effect size

43.35

4.25

40.85

4.85

3.24

.003

.55

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TABLE 4 Prominent Themes of Staff Free Responses Concerning Potential Benefits of Viewing Video Biographies of Residents • • • • • • • • • •

Enhanced job performance Additional topics to explore in conversations with residents Appreciation of how to approach specific topics in discussions with residents Building personal connections with residents Encourage more listening and talking with residents Increased knowledge of residents Preferences for food Past life experiences that may influence desired care routines Resident point of view Uniqueness of residents

two dimensions: staff reflection on new insights and knowledge gained about residents and staff reflection on how knowledge gained from viewing a video might be used to promote their job performance. Enhancement of communication with residents as a result of viewing the videos was the overriding theme for impacts on job performance. Staff members identified several ways enhanced communication would improve their job performance. A certified nursing assistant noted, for example, that viewing a resident biographical video helped her “to be more appreciative of residents; to help me better connect to them; to help me find numerous places to build personal connections and better relate to them.” A member of the facility management team noted that viewing a video would enhance knowledge of a residents’ past which would enhance the ability to address individual needs. A member of the dining staff noted that viewing the video reminded him that “I should talk more with the people that live here.”

DISCUSSION Inviting residents to contribute to an oral life history project was best accomplished by offering different avenues for participating. Options for participation included conducting a videotaped interview or engaging in the interview without producing a permanent record of it. This approach respects choice and privacy, core aspects of person-centered care, while promoting options for meaningful social engagement. Slightly more than one half of 40 residents participated in at least one session of an interview with a student team whereas only 11 consented to be videotaped. One important limitation of the project was that ultimately only five video interviews were produced. Resident frailty and declining physical health status prevented continued participation or lack of interest in continued participation. This suggests that the time devoted initially to building rapport between students and residents (up to three 30-minute to one-hour visits) may have exceeded

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the capacity of residents to stay engaged. Future efforts might limit these sessions and focus more immediately on developing the topical guide for the videotaped interview. Although staff responses to the qualitative questions indicated that viewing the video life history was a positive experience that enhanced their understandings of residents this was not supported by results measuring impacts as measured by the IC-KNOW scale. Staff members who viewed the videos reported a decline in their overall perceived knowledge of residents between pretest and posttest. Analyses of individual IC-KNOW scale items indicated that perceived time available to read social histories (“I do not have the time I need to read the social histories of the residents”) and knowledge of resident preferences (“I know what he residents I care for like”) demonstrated a decline pre- to posttest. Open-ended reflections by staff members who viewed videos highlighted how they were surprised at what they learned about the prior lives of residents. Given the study design limitations, we cannot be sure that other factors, such as receipt of a $10 incentive for participation in the surveys, did not exert influence on staff perceptions about the impact of the videos. Social desirability bias in responses made to the open-ended questions is a possibility as all the comments submitted by staff members noted potential benefits of viewing the videos and none offered potential negatives of viewing a resident video. The study design lacks a comparison group and relies upon a small sample and self-report information from an instrument developed initially for a nursing home setting. The low Cronbach’s alpha we achieved with this sample is a major limitation of the study suggesting that the IC-KNOW measure has inadequate validity to assess outcomes for an oral history project within assisted living. Assisted living is not identical to the nursing home setting (where the IC-KNOW was developed) in terms of resident characteristics, staff caregiving roles or responsibilities, and this may have contributed to the weak measurement validity for the IC-KNOW in this study. The development of standardized tools to assess staff knowledge of residents specific to assisted-living settings is an area for future efforts. In addition other facility factors such as staffing levels, facility size, or, resident characteristics, beyond the viewing of an oral history video, may exert a stronger influence on knowledge of residents. Randomized trials are needed to evaluate potential benefits of this approach across a broader scope of assisted-living facilities. As staff members had on average a lengthy tenure working at the facility we might also expect that they would have had extensive opportunities to learn about resident lives. The majority of staff participants in this study came from dining or environmental services. These roles might be expected to have more limited direct interaction with residents and less opportunities to read resident social histories. Dining services is nevertheless an important element of delivering person-centered care in long-term-care

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settings. Efforts to enhance the built environment of dining rooms are one approach to strengthening person-centered care receiving increased attention (Chaudhury, Hung, & Badger, 2013). Enhancing the quality of the meal time experience of residents has been noted as an area for additional attention to provide person-centered care and to enhance the well-being and nutritional status (Mahadevan, Hartwell, Feldman, Ruzsilla & Raines, 2013). Dining staff perceived enhanced opportunities for communication with residents as a benefit of viewing resident video biographies suggesting that they might provide helpful information on resident preferences to guide enhancements of meal times. There is a long tradition of utilizing reminiscence activities in assisted living. The oral life history approach used here differed from the common practice of structured and guided reminiscence reflections, often in group settings. Instead, these oral histories sought an in-depth account of personal experiences and reflections as chosen by the resident. Oral histories connect the listener to the past through an experience with the individual participant. Oral histories are conducted according to standardized methodologies that place the interviewee in control to limit the parameters of the history provided and reflect broadly on themes (Oral History Association, 2009). Further evaluation of the benefits and limitations of using this individualized and open-ended approach for residents in assisted living is an important next step in determining its utility for enhancing personhood. Supported by management, staff members took time to view resident oral histories and identified them as a useful educational tool for increasing their knowledge of residents. Whether this time is available and supported among a wider range of facilities is a practical issue that could limit using videotaped oral histories as we have done in this project. Technological advances may ease the incorporation of resident video biographies into regular care delivery and the electronic medical record. Expansion of multimedia may help to make life history biographies more accessible. The Digital Life History and Digital Life Story applications, for example, create digital archives of resident life histories that can incorporate text, photographs, audio, and video. In addition these applications include options for family members to contribute information about resident biography. They are designed to be used across a variety of platforms including tablets and smartphones so that staff members can refer to them easily as they are carrying out their duties (Maiden et al., 2013). Regardless of the technology used to be in service of person-centered care oral life histories must be useful for staff members to enhance their relationships with residents and contribute to building a sense of community within assisted-living facilities. Sharing resident stories using multimedia applications, web sites, or a public video premier honors resident accomplishments and could convey an important message about how facilities value personhood and belonging.

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FUNDING This work was supported by a grant from the Winter Park Health Foundation, Winter Park, FL.

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