____<<Insert Name Here>>____ My Life Story Book This life story book has been created to provide you, the health care-giver, with information about… ____<<Insert Name Here>>____

Purpose of the Life Story Book While I may sometimes have difficulty remembering things or communicating clearly, I am a unique person with my own memories, experiences, and preferences.  I have helped to create this book because it is my hope that this information will help you to provide compassionate and personalized care for me.  Thank you for taking the time to read this, and for providing care.

Purpose of the Life Story Book Information in this book is: condensed and simplified; provides a quick “snap-shot” of this person’s story and special care needs; Contains the most important personal information for care: My Life Reflections My Family and Home Life Helping Me in Everyday Life I Look Forward to…/ Hopes and Dreams

This book can help you to… Examples: …tailor direct care to better meet my personal preferences …guide and add meaning to conversations with me …support my sense of self-worth & self-esteem; engage me in activities that are meaningful and continue my life experiences

My Life Reflection I am…/ I was…/ I did… (List Major Life Achievements and Accomplishments) “This is a long ago photo of me’ “Back then I…”

My Life Reflection I always… (Identify Life-long Habits that would help provide care) “This is a long ago photo of me’ “Back then I…”

My Life Reflection I remember…When I… (Identify significant positive memories, familiar family stories, etc.) “This is a long ago photo of me’ “Back then I…”

My Life Reflection When I was… (identify significant life &/or historical landmarks, e.g., marriage, children, war years, immigrating) “This is a long ago photo of me’ “Back then I…”

My Family and Home Life Family, friends and pets who are important to me are: (List names & relationships) Current Past This is Here I am with…. We went to…

My Family and Home Life My favourite memory(ies) of time with… (family, friends, pets) is/are… This is Here I am with…. We went to…

My Family and Home Life My special memories of home are (specify)… This is Here I am with…. We went to…

Helping me in everyday life My personal preferences when helping me with my care include: Examples:, Sleeping position; Food/Beverage favourites This is a picture of me when I was… …Independent… …enjoying… …doing…

Helping me in everyday life I like talking about… This is a picture of me when I was… …Independent… …enjoying… …doing…

Helping me in everyday life I like it when others ask me… This is a picture of me when I was… …Independent… …enjoying… …doing…

Helping me in everyday life I am most comfortable when… This is a picture of me when I was… …Independent… …enjoying… …doing…

Helping me in everyday life What gives me pleasure is… (especially sensory information) This is a picture of me when I was… …Independent… …enjoying… …doing…

I am looking forward to… My favourite traditions, holidays, seasons are Here is a picture of me celebrating…

I am looking forward to… I always celebrate…(describe) Here is a picture of me celebrating…

My Hopes and Dreams (List Known Aspirations and Hopes) I want to see… I hope to… Here is a picture of me celebrating…

Hopes and Dreams List Known Aspirations and Hopes (continued): I always wished… I would like to participate in… Here is a picture of me celebrating…