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Note to friends and family members filling out the biography on behalf of a resident, please read the "you" in all questions as meaning the resident, as if they were filling out the form for themselves.
Name of Resident: Room No:
Name by which (you/they) prefer to be called:
a. What time do(es) (you /the resident) like to get up in the morning?
b. Do (you) prefer to stay in bed for awhile or get up immediately upon waking?
2. Briefly outline what (your) waking routine is like (wash, brush hair, brush
3. Do (you) eat breakfast in the morning? If so what are (your) preferred
4. What kind of clothes do (you) prefer to wear during the day?
5. Do (you) like to take naps during the day? If so when, where and for how
long do (you) usually rest?
6. What kind of night time attire do (you/they) prefer?
7. What time do (you) like to go to bed for the night? Do (you) enjoy a snack
or a drink before bed?
8. What kind of assistance do (you) require? (Support when walking, help
with dressing, toileting, bathing, foot care etc.).
Please list a few of (you/the residents) favourite things and least favourite things under the following categories and perhaps note if they hold any special meaning for (you/them) and why.
1. Food and Beverages
2. Television Shows and Movies
4. Favourite things brought from home
5. Favourite time of year (ie. Fall or the Christmas Season)
6. Special Holidays or Anniversaries
Please tell us a bit about (yourself) and (your) family.
a. What is (your) marital status? (Married, Widowed, Divorced, Never Married
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"Proposal for Resident Biography for Nursing Home." 123HelpMe.com. 18 Aug 2018
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(Their name, number of years together etc.).
a. Do (you) have children? If so tell us a bit about them (how many do you have, names occupations, where they live, anything (you) feel comfortable sharing).
b. Do (you) have grandchildren or great-grandchildren? What would (you) like
to tell us about them?
c. At this point in (your) life do (you) enjoy interacting with children and
would (you) enjoy having children around.
3. Where did (you) live: As a child? What was (your) favourite place?
4. Have (you) travelled? If so to where? What was (your) favourite place?
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5. What was (your) occupation? What did (you) enjoy most about (your) work?
What did (you) enjoy the least?
6. What are some of the volunteer organizations or service clubs (you) may have worked with or continue to work with?
7. Is religion and spirituality important to (you/them)?
8. Are (you) a more social or a more stay at home type of person?
9. What are some of the significant events in (your) life, for good and bad?
10. Are there any certain times of year (you) are feeling low, under the weather?
If so why?
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11. What are some of (your) accomplishments?
12. Is there anything else (you) would like to share about (your) background?
HOBBIES, INTERESTS AND TALENTS
1. What are (your/theresidentss) artistic talents? Have (you/they) drawn,
painted, danced etc. or continue to do so?
2. What are (your) musical talents? Do (you) sing, play an instrument, write
3. What arts and crafts have (you) enjoyed doing either now or in the past?
(Knitting, needle work, model building, woodworking etc.).
a. Do (you) enjoy gardening? If so what kind of plants did (you) grow? (Roses, orchids, vegetables, indoor plants etc.).
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b. Would (you) enjoy having plants around (you) now?
a. Did (you) have pet animals at home? If so what kind did (you) have?
b. Would (you) enjoy having pet animals around (you) know?
c. Is there any kind of pet animals that (you) don't like, are allergic to, or are
6. Have (you) enjoyed sports, either watching or participating? If so what sports?
7. What are the other activities (you) find meaningful? (Playing cards, birding,
stamp collecting, cooking, baking etc.).
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Please include any other useful information about you or your family member that might be
helpful to us.
The Life Story Book
The Life Story book is another opportunity for staff and volunteers to gain further insights into the social history of the residents who have made Northwood their home. As you know, the person with dementia often lives in the past. These years often represent a period of time filled with pride and meaningful experiences, many are retained as memories. This book can be a wonderful tool for reminiscing and conversation.
Making a Life Story Book
A Life Story Book can be made from phot albums, notebooks or any durable booklet. A three ring binder is also a good idea so pages can be added at any time. Using thick, stiff paper or cutting up file folders for paper can provide a sturdy page that will survive constant handling. Drawings, writing, pictures, maps, etc. can be used. This way special items will not get destroyed. Please write information about the item in short sentences or phrases. Placing names under photos is especially important. Use a dark pen, printing the words clearly and in large print so they will be readable for years to come.
If you would prefer, we would be happy to put this story book together for you. To do so, we would need photos or copies of photos. Please attach any information relevant to the photos that you would like to include, ie. Names of people in photos, relationship of people in photos to the resident, year, any other memorable detail, if applicable. We would appreciate if you would print this information.
If you are interested in this option, please let the biographer know and arrangements will be made.