important to me u201d there was initially no requirement about the number of cards in any of the piles family members and staff were instructed to carry out the same exercise with regard to their perceptions of individual resident 39 s priorities the second step in the exercise was to instruct the participants to choose the top ten in the u201c very important u201d pile after they had successfully struggled with that step they were asked to rank the top ten choices and then record their choices on a grid sheet in initial trials it was found that the task of recording their choices on the form was confusing and burdensome to many residents another drawback of the recording task was that it became the focus of the exercise detracting from opportunities for discussions some of the cognitively impaired patients were so stressed out by the task of finding each of the top ten items on the list that they refused to play card games at the assisted living facility for weeks afterward subsequently the recording grid was used only if a facilitator or family member was present to assist or if the person doing the sort requested to keep a record of all their choices the residents and their family members seemed to get much more out of the exercise by talking about why the most important things were important and why the unimportant things had been chosen for the discard pile for.