Use-Case for Using Biographical Information in Elderly Care Facilities
Overview of Germany’s health care
Germany has an aging population. According to recent data in 2015, 2.86 million people in Germany required care as defined by the German Care Insurance Act, with 27% of all people needing nursing care receiving care in long-term residential care facilities.¹ It is estimated that the number of people needing nursing care will continue to increase, reaching 4.5 million in Germany by 2050.1 To date, Germany has more than 10,000 residential care homes for the elderly, with 700,000 residents and 350,000 healthcare professionals working in these institutions.²
Problems with current health care models
The traditional healthcare model often focuses more on patients' diseases and the medical reasons behind their suffering, rather than their overall health and well-being.³ As a result, older patients may be viewed based on their medical history and age-related stereotypes, rather than as individuals with rich life experiences. The focus on the understanding the diagnosis over the person has been a contributing factor to the reduced psychological well-being among elderly people observed in residential care facilities. In fact, more than 50% of these people suffer from emotional and social loneliness, which can be caused by the loss of loved ones and changes in their social situation as a result of moving into long-term care. ⁴ Moreover, institutionalized persons often complain about the lack of meaningful relationships, the loss of meaning or identity, and sadness, all of which are known contributors to declining cognitive function and dementia.⁵
Person-centred care
To address the psychological issues prevalent in aged care facilities, a person-centred care approach and related concepts, such as patient participation and patient participation, are gaining more attention. Person-centred care specifically aims to ensure that healthcare providers consider the whole person, and ensure that they feel a shared responsibility toward their health and treatment by sharing information and decisions, providing compassionate care, and being sensitive to patient needs.6 This approach requires practitioners to learn more about the older person as an individual and to have a better understanding of the patient's personal meanings, experiences, and attitudes to better tailor their individualized care. There is growing evidence that person-centred care has a positive impact on a variety of patient outcomes such as patient empowerment, patient satisfaction, health and length of hospital stay.⁶ Person-centred care is especially important for older people to optimise functional health, ensure independence and provide high- quality care.
Benefits of collecting biographical information
To learn more about patients as individuals, staff can use a biographical approach.⁷ This approach gives older people the opportunity, if they wish, to talk about their life experiences – including their family, friends, work history, and hobbies – often using photographs and personal belongings as prompts for discussion with staff members. Through listening to older people’s life stories, and the memories that have shaped who they are, it is possible to gain a fuller appreciation of their wishes and aspirations moving forward with their lives. A study in a long-term care setting found that an approach that encouraged storytelling and listening resulted in care that was aligned with residents' personal meanings and values and improved the staff-patient relationship.⁸ Many studies often express that older people in long-term care enjoyed talking about their lives and being listened to, and wanted to have their personal biographies recognized and valued as a basis for individualized care.⁹
Incorporating biographical information is a low-cost intervention that can be integrated into everyday care activities. Weekly group sessions can be conducted by trained staff who are taught how to keep the conversations on track and ask the right questions to bring up memories from the patients’ past. Interactions that involve storytelling can also help to form therapeutic relationships between patients, their family members, and practitioners, which can form the foundation for a caring context on the unit and lead to increased awareness among practitioners of the positive aspects of working with older people.⁷
Limitations to collecting biographical information
Although using life-story work to improve the quality of life for elderly patients in care settings has been widely recognized as effective in promoting the well-being of the patient, the caregiver, and the bond between them, this approach has not been successfully implemented in nursing homes. Staff often report that they have a high workload and are frequently interrupted during their shifts, making it difficult to prioritize the use of biographical information in their care.¹⁰ They feel that they need more time to work with life stories, including more time with residents and more time to read and keep written records of the stories. As time is a scarce resource for staff, they may be more focused on solving immediate problems rather than incorporating the resident's life story into their care. Additionally, staff believe that it is too late to start writing down the resident's life story once they move to the nursing home, even though this is often how it is done. Instead, the life story should be recorded earlier, especially if the older person has cognitive decline or dementia.¹⁰
In Germany, healthcare authorities require that facilities gather and use information about the life experiences of their residents in their care planning.¹¹ However, studies have shown that this requirement is frequently not properly implemented in German nursing homes.¹² The lack of emphasis surrounding person-centred care is also demonstrated in research, as Germany ranks 6th in Europe for research on person-centred care with a sizable gap to western European countries such as England.¹³ Perhaps, the autonomous nature of care providers and the large number of insurance companies in the country may make it difficult for private healthcare systems to adopt person-centred care practices.¹⁴ For example, Germany has more than 200 insurance companies covering healthcare, making a national implementation of a specific innovation or care model challenging.¹³,¹⁴
Conclusion
Using a biographical approach in age-care facilities encourage practitioners to see the person behind the patient; to see the patient for who they are as a human rather than in terms of their medical needs. The use of biographical approaches may have a positive effect on the attitudes of staff towards the older people for whom they care, while also enhancing relationships between staff and the patient’s family. However, the implementation of person-centred care practices, particularly in Germany, may be hindered by the large number of public and private insurance-based health care systems that do not operate under a common organizational umbrella. Therefore, it is important for facility management to encourage the use of biographical information and support the development of person-centred care to improve patient outcomes and healthcare worker satisfaction which is especially relevant given the rapidly ageing population worldwide.
