Perceptions of Older Adults and Caregivers on the Life Story Questionnaire in the Transition to Long‐Term Care in Côte‐Nord Region

Transitioning into a long-term care facility (LTCF) can be challenging [1], and is associated with risks, such as behavioral symptoms of dementia, delirium, or adverse drug events [2, 3]. In response, transitional care initiatives have emerged [4]. In Quebec, LTCFs were redefined as “living environments” rather than healthcare institutions in 2003 [5], promoting person-centered, humanized care that adapts to residents' needs. A 2022 policy further supported personalized care through recognition of residents' life stories [6]. One of the tools developed to implement this policy is the Life Story questionnaire [7], that collects information on residents' habits, relationships, and life events (Supporting Information: Text S1). Despite growing use, little is known about how these tools are implemented in rural contexts. Rural regions like Côte-Nord face unique challenges, including workforce shortages and geographic isolation [8]. This study described older residents' and caregivers' perceptions regarding the Life Story questionnaire during transitions to LTCFs in Côte-Nord. A descriptive cross-sectional qualitative study based on semi-structured interviews was conducted. This study was part of a broader initiative on transitions to long-term care and received approval from the Centre intégré de santé et de services sociaux (CISSS) of Chaudière-Appalaches Ethics Board (MP-23-2024-1084). Participants were older adults who moved into a Côte-Nord LTCF and their caregivers. Eligible individuals could communicate independently or with support. Convenience sampling was used, with local healthcare staff identifying potential participants. Two qualitative researchers (M.L., F.L.), with no prior relationship with participants, conducted in-person semi-structured interviews. The interview guide, co-developed with the CISSS-CN, included questions on the transition and perceptions of the Life Story questionnaire. Interviews lasted 30–75 min, were audio-recorded, transcribed verbatim, and validated by a team member. The research team analyzed transcripts using a descriptive interpretive approach [9] with a hybrid deductive–inductive thematic analysis. Initial themes stemmed from the interview guide. Two team members independently coded early transcripts (F.L., M.L.), refined the codebook collaboratively, and applied it to the remaining data. Quotes were translated for publication (M.L.B.). Fourteen participants (11 residents, 3 caregivers) were interviewed between fall 2023 and winter 2024. Most residents were women (n = 10/11), with a mean age of 88 years (Table 1). Three main themes emerged from the interviews: (1) completing the Life Story questionnaire, (2) integrating it into care, and (3) perceived benefits and limitations (Table 2). “She can't drink anything cold. It has to be room temperature, so they make sure to warm her milk a bit or take it out earlier… They do that with yogurt, cheese, everything—because I wrote it in the little questionnaire. They knew, they were informed” (Caregiver 6) “And in the morning, if we want to, we stay in bed. Some people go for breakfast at 9, at 10. Well, they ask us: do you want to be woken up? Me, I get up at 5:15. Yeah, we're all early risers here.” (Senior 3) “It's respected. And the guys know. They turn around at the door. Well yes, it's written in my file that I don't want men in my room” (Senior 12) “Yes. There were a lot of things they had asked and that she had answered. They knew from the start. Well, every morning they come and bring her a coffee; they know she gets up early” (Caregiver 4) “Ah, yes, they bring me my coffee every morning” (Senior 3) “No, no. They always called me ‘Madame,’ but they never asked me any questions. No… they never asked if I took snacks or not.” (Senior 9) “What time do we go to bed? It's not on our schedule… For me, it's not the time I would like to go to bed” (Senior 11) Participants reported that social workers typically completed the questionnaire with older adults or caregivers, usually before admission. In urgent or unplanned admissions, it was completed shortly after arrival. Participants described how staff used the questionnaire to tailor care, adjusting meals, routines, and room setup to foster familiarity. One caregiver noted, “She can't drink anything cold. It has to be room temperature, so they make sure to warm her milk a bit or take it out earlier… They do that with yogurt, cheese, everything—because I wrote it in the little questionnaire.” (Caregiver 6). A resident shared: “And in the morning, if we want to, we stay in bed. Some people go for breakfast at 9, at 10. Well, they ask us: do you want to be woken up? Me, I get up at 5:15. Yeah, we're all early risers here.” (Resident 3). Information from questionnaires also supported emotional well-being and social activities, like birthday celebrations and music. When completed early and used consistently, questionnaires helped staff understand residents' needs and preferences. However, inconsistent use reduced potential benefits. Some residents reported never being consulted: “No, no. They always called me ‘Madame,’ but they never asked me any questions. No… They never asked if I took snacks or not.” (Resident 9). Others mentioned that routines, such as bedtime, did not reflect their preferences. Residents and caregivers generally viewed the Life Story questionnaire as beneficial in fostering person-centered care and wellbeing. However, inconsistent use limited its impact. Staffing limitations could explain these inconsistencies, as collecting life stories and applying preferences can be time-intensive and require staff availability [10]. Simplified formats, such as one-page summaries, have been suggested to improve usability [10]. Study limitations include partial coverage of the Côte-Nord region. Limited caregiver availability led to interviews primarily with residents, restricting perspectives. Recall bias among some residents, due to delays between admission and interview, may have reduced the completeness and accuracy of recollections. Given the importance of person-centered care for resident well-being, further research is needed on strategies to support consistent use of the Life Story questionnaire. Exploring healthcare providers' perspectives could reveal organizational and resource-related factors influencing implementation and inform optimization of care practices. Study concept and design: Maude Laberge, Manon Cody, and Mathieu Hotton; Acquisition of data: Maude Laberge, Fanny Leblanc; Analysis and interpretation of data: Maude Laberge, Fanny Leblanc, Manon Cody; Writing – Original Draft Preparation: Mélanie Le Berre, Fanny Leblanc, and Maude Laberge; Writing – Review and Editing: Mélanie Le Berre, Fanny Leblanc, Maude Laberge, Mathieu Hotton, Marie-Pierre Gagnon, Émilie Dionne, Marie-Soleil Hardy, Maxime Sasseville, Samira Amil, André Côté, Manon Cody; Study design, interpretation of results and the revision of the report: Louise Bertrand. The authors would like to acknowledge Alphonse Sowanou and Akouvi Gloria Nella Vossah for their support with data entry and analysis. The authors would also like to thank the CISSS-CN for their support with participant recruitment, and the participants who shared their perspectives. The authors declare no conflicts of interest. Text S1: Translated example of the Life Story questionnaire. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.