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TimeSlips: Group Storytelling Helps Nursing Home Residents with Alzheimer's

TimeSlips is a simple and inexpensive group storytelling technique that allows nursing home residents with Alzheimer's disease and related dementia to express themselves without relying on failing memories and deteriorating language skills. It has been shown to successfully engage residents, improve their ability to communicate, and gives them an opportunity to have fun and laugh. The technique also appears to improve relationships between nursing home residents and their caregivers.

The Issue: Alzheimer's disease and related dementia (ADRD) directly affects more than 4 million Americans, and as many as 70 percent of residents of long-term care facilities are thought to have some form of this disease. For these individuals, quality of life becomes paramount as therapeutic interventions become less and less effective. Nursing home residents consistently name their relationships with caregiving staff as the factor that most affects their quality of life. The impairment of memory and language skills caused by ADRD, however, makes it difficult for people with dementia to forge relationships with others. Consequently, many residents with ADRD become socially isolated, withdrawn, and clinically depressed. Therapies that emphasize orientation and reminiscence, such as discussions of current events or previous personal experiences, are the tools most commonly used for interacting with ADRD residents. But given these residents' language and memory deficits, traditional communication tends to be limited, which frustrates and discourages residents.

Organization: TimeSlips National Program, Center on Age and Community at the University of Wisconsin—Milwaukee

Target Populations: Nursing home residents with Alzheimer's disease and related dementia; nursing home caregivers and administrators

The Intervention: TimeSlips uses creative storytelling to engage residents and help them communicate with their caregivers. The method is grounded in research showing that people with ADRD are still able to express themselves even after their capacity for traditional, literal expression is gone. A storytelling group usually meets once a week for an hour with 10 to 12 residents, and there may be multiple groups in a single facility. To encourage participation in group storytelling, facilitators hand out a picture to serve as the basis for the story. Pictures may come from anywhere: calendars, postcards, design or photography books, or old National Geographic or Life magazines.

Sample images on the TimeSlips Web site, ( include a smiling baby sitting inside a woman's handbag, a man riding an ostrich, and a mountaineer leaping across a chasm. The facilitators—most often nurses' aides, social workers, or activities' aides—ask open-ended questions about the picture and record the residents' responses, making it clear that there are no wrong answers. Facilitators then weave the responses into a story, periodically reading it back to the participants as it progresses in order to maintain the group's focus and enthusiasm. The story is next transcribed and, together with the picture, displayed in the residents' unit. Stories are often included in a facility's newsletter or collated into books for families. Results: The technique, which is easy to teach, has been enthusiastically received by care providers. A national "train-the-trainer" program, with eight regional training bases, helps to diffuse TimeSlips among nursing homes.

The TimeSlips Web site includes a training manual and video ($30 for the manual, $60 for the video, and $75 for both), though the video and manual are designed to give an overview of the method rather than take the place of training. Also available on the site are a Flash presentation of the TimeSlips process, a list of resources, and a discussion room. A study of the TimeSlips method applied in one nursing home found that, over a period of weeks, residents' verbal communication skills improved, their depression lessened, and caregiving staff gained a better understanding of ADRD residents. A larger, ongoing evaluation of five test facilities and five control facilities is seeking to determine how TimeSlips affects the quantity and quality of interactions between nursing home staff and residents with ADRD. Preliminary results indicate that higher levels of social and non-social engagement and general alertness were observed in residents in the test facilities, compared with more disengagement among those in the control facilities.

For Further Information: Contact Anne Basting, Ph.D., director of the TimeSlips National Program and director of Center on Age and Community at the University of Wisconsin—Milwaukee, at [email protected].

November 2005

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