Lesson 7: Communicating Effectively This lesson explains how to communicate effectively with residents who have difficulty communicating due to physical or mental impairments, disease, or are non-English speakers.

Overview: This lesson explains how to communicate effectively with residents with illness such as dementia and Alzheimer’s.

Learning Objectives: At the conclusion of this lesson participants will be able to:

  • Interpret non-verbal communication
  • Incorporate the guidelines for effective communication behavior into their ombudsman practice.
  • Communicate with residents who have Alzheimer’s disease.

Duration: 1 hour

Communication

Communication is the act of exchanging ideas, knowledge, information, and sharing personal experiences. Regular and timely access to long-term care facilities and residents is essential for Ombudsman program communication with residents, resident representatives, family members, visitors, and facility staff. The way you speak to and listen to an individual builds trust and meaningful connection, which is an important part of complaint intake and investigation.

Effective communication is a two-way process of how information is provided and received. Both verbal and non-verbal communication contributes to how one interprets information. Word choice, tone of voice, and body language all contribute to successful communication. From a total of 100%, the following is true of how information is communicated.

  • 10% is communication through words or speech.
  • 40% is communication through our tone of voice
  • 50% is communication through body language.
Words or Speech

The words you choose and how you say them set the stage for building relationships. It is common for family members to contact you because someone has told them, “The Ombudsman program can help.” Most have no idea about LTCOP responsibilities and what representatives can and cannot do, so it is critical to provide them with a clear understanding of your role right from the very beginning. Family members may expect you to share all information gathered and may request your follow-up on their concerns. Take particular care to explain that the resident is your client, not them. Here are some possible responses you can use:

  • “The resident - your mother- is our client and we’re going to do the best we can for her.”
  • “I am a resident advocate. I am here for your mother and what she needs, and hopefully we can all work together on this.”

As opposed to saying:

  • I work for the resident, not the family.”
  • “I can’t tell you anything about my visit with the resident.”

Another common situation you may encounter is when the complainant tells you the resident has dementia so there is no point in speaking with them. Here are some responses you can use:

  • “Please understand that I am required to meet with the resident face to face."
  • “I will go and see the resident and talk with them about this. Then, we can see where we’ll go from there.”
  • “I understand what you are saying, but my obligation is to go and speak with the resident first. It’s important that I see for myself.”

As opposed to saying:

  • “Regardless of what you say, I have to talk to the resident.”
  • “Thanks for the information, but I need to find out for myself.”
Tone of Voice

Your tone of voice impacts how a message is heard. Emphasizing a specific word in a sentence can result in different interpretations of the intent of your message.

Body Language

Body language speaks volumes. Be aware of the impact your non-verbal cues have on those with whom you are speaking. There are many ways to effectively communicate without using words, such as:

  • Positioning yourself at the resident’s eye level
  • Leaning forward when listening
  • Facing the person
  • Nodding your head
  • Relaxing and acting natural
  • Using positive facial expressions (e.g., smiling as opposed to frowning)
  • Waiting through pauses
  • Listening without interrupting

Try not to:

  • Cross your arms in front of your body
  • Check your phone or divide your attention
  • Tap your foot or drum your fingers
  • Use negative facial expressions

Words Matter: Conveying Your Message

Effective communication is more than just relaying your ideas, knowledge, and experience. There are other factors involved that influence how information is received and understood. In addition, you may use different communication approaches depending on the individual receiving the message. (e.g., a resident, family member, staff person, etc.). Whether you are communicating verbally in writing, or using another means, there are several elements to consider when communicating your message.

To avoid confusion and misunderstandings, don't:

  • Use technical terms, acronyms, vague words, and slang
  • Relay conflicting messages
  • Use a language that is not understood by the recipient
  • Include too much information

To maximize the chance for successful communication, consider the following:

  • Is your message clear? Use simple and easy to understand language.
  • Is your message factually correct? Ensure information is not vague, subject to interpretation, or false.
  • Is your message complete? Include all relevant information, particularly if it is the basis for decision making.
  • Is your message precise? Provide straightforward and concise information to avoid incorrect interpretations of the message.
  • Are you professional and respectful in your message? Deliver the message in a manner that is considerate of the person and sensitive to the topic at hand.
  • How do you ensure your message is received? Consider with whom you are communicating. What is their role, knowledge of the subject, ability to understand, what mode of communication works best, and what language does the receiver understand?

Listening Skills

There are techniques to use when verbally communicating with someone to indicate you are listening. Those methods include demonstrating interest, active listening, affirmation and validation.

Demonstrate Interest

  • Use minimal responses such as, “oh,” “so,” and “I see.”
  • Encourage additional information such as, “Is there more you would like to share…” and, “I’m happy to listen…”

Active Listening

  • Paraphrase what is heard. For example, the resident says that he keeps telling the Certified Nursing Assistant (CNA) not to put his clothes on the floor; she just doesn’t listen. You paraphrase by saying, “Sounds like you are not feeling heard by the CNA regarding your clothing.”
  • Ask open-ended questions for more details instead of closed-ended questions. Open-ended questions are questions that cannot be answered with just a “yes” or “no” response. To allow for more detailed responses, open-ended questions often start with “how,” “tell me about…,” and “why.” Closed-ended questions lead to answers of just, “Yes,” “No,” or a brief piece of specific information.

Affirmation

  • Restate what is heard in sentence form, such as:
  • “I hear you saying…”
  • It sounds like…”
  • “It appears as though…”

Validation

  • Acknowledge the resident’s feelings, such as:
  • “It’s okay to feel sad…”
  • “There is nothing wrong with being angry right now about…”

Observation

  • Look for non-verbal forms of communication, such as:
  • Facial expressions
  • Eye contact, or lack thereof
  • Posture
  • Gestures
Based on your observation, what is going on in the picture? Does the medical person look as though she is listening to the individual? What would you do in this situation if you were this individual’s advocate?

Communication Tips

Many of the communication tips below apply to communicating with anyone, particularly residents. However, certain tips are even more helpful when communicating with residents who have a disability or a diagnosis that may affect their ability to provide and receive information. To effectively communicate, consider the best way to communicate with each individual resident.

Individuals Living with Memory Loss

Memory loss does not always affect one’s ability to communicate. Therefore, it is important not to make assumptions based on a diagnosis related to dementia or memory loss.

  • Approach the resident from the front and identify yourself
  • Speak to the resident and not about the resident when others are in the room
  • Talk to the resident face to face in a quiet space with minimal distractions
  • Look at the resident and speak slowly and clearly
  • Ask one question at a time
  • Ask yes or no questions
  • Give the resident ample time to respond to your questions
  • Consider the feelings behind words or sounds
  • Be respectful

There are also specific communication actions to avoid when talking to individuals who have memory loss.

Don’t:

  • Ask the resident if they remember you
  • Argue or try to convince
  • Explain reality or try to reason
  • Get too physically close to the resident, invading their personal space
  • Raise your voice, frown, or scold
  • Use confusing language, language that could be misinterpreted as romantic (e.g., sweetie, honey), or idioms (e.g., “it’s raining cats and dogs”, or “are you pulling my leg?”) as residents may take the words in literal form
  • Take it personally if the resident doesn’t remember you, doesn’t want to talk, or uses offensive language

Individuals Who are Blind or Visually Impaired

  • Speak to the resident when you approach them
  • Face and address the resident directly
  • Identify who you are and introduce anyone else with you
  • Be descriptive about what you are doing
  • Speak in a normal volume and natural tone
  • It is okay to use words such as “blind”, “visually impaired”, “seeing”, “looking” and “watching” when speaking with someone who is visually impaired
  • Don’t touch or distract their service animal (if applicable)
  • If documents must be read or signed, ask the resident what would be most helpful for them to see better (e.g., increased lighting, magnification, etc.)
  • Ask in what format they would like to receive information (e.g., Braille, large print, audio, etc.)
  • Let the resident know when you enter and leave the area and/or room

Individuals with Speech Impairments

  • Concentrate on what the resident is saying
  • Be patient – take as much time as necessary
  • Don’t speak for the resident or attempt to finish their sentence
  • Use your regular voice tone and volume
  • Ask questions which require only short answers or a nod. Consider using yes or no questions. Avoid insulting the person's intelligence with oversimplification
  • If you don’t understand what the resident has said, ask them to repeat themselves, or repeat back what you heard to confirm it is correct
  • Don’t pretend to understand when you don’t
  • If you have difficulty understanding the resident, consider writing or another means of communicating, but first ask the resident if this is acceptable

Individuals Who are Deaf, Hearing Impaired, or Hard of Hearing

  • Gain the resident’s attention before starting a conversation
  • Look directly at the individual, face the light, speak clearly in a normal tone of voice, and keep your hands away from your face
  • Use short, simple sentences
  • Avoid eating or chewing gum
  • If the resident uses a sign language interpreter, speak directly to the resident, not the interpreter
  • If you are talking to a resident by phone, speak clearly and be prepared to repeat your questions and comments
  • If you do not have access to a Text Telephone (TTY), dial 711 to reach the national telecommunications relay service, which facilitates the call between you and an individual who uses a TTY
  • If you are having difficulty communicating with the resident – whether in their presence or not - ask the resident if it is acceptable to communicate via written word
  • Ask the resident for their preferred form of communication (texting, email, etc.)

Individuals Who Speak Another Language

  • Have program information available in other languages to provide to residents
  • When using gestures and nonverbal cues to help the person understand, be sensitive to their reaction. Some American mannerisms such as pointing directly at a person may be interpreted differently in other cultures
  • Use a communication board or a free application on your phone
  • Ask the resident if there is someone they trust to interpret
  • Following your program policies and procedures, ask the facility how they communicate with the resident
  • Ask if the facility has a handheld translation device, and request to use it
  • Know your local resources for in person and telephone language services
  • If the options above are not sufficient, use an interpreter. When using an interpreter:
  • Explain LTCOP rules of confidentiality
  • Explain the need to translate word for word (ask them not to put statements into their own words)
  • Ask them to be neutral
  • Direct questions to the resident
  • Look at the resident not at the interpreter, when talking

Every resident is unique and may have different ways in which they communicate with others. As a ombudsman, the key to successful communication with residents, family members, facility staff, and others is the ability to actively listen, identify the best way to connect with the individual, and clearly convey your message in a way the individual understands.

Communication

Residents who live in long-term care facilities are just as varied as individuals living in the community. Residents of long-term care facilities such as nursing homes, assisted living facilities and adult-family care homes, are of varying ages and backgrounds. Through your work as an ombudsman, you will probably find that is easier to communicate with some residents than others; however, an ombudsman’s most important role is to visit with all residents and provide information and services to them which necessitates communicating with them. Depending on a resident’s age and/or disability, this may require you to communicate in a different way and notice certain non-verbal communication the resident is using.

In this reading, you will review communication methods and ways to communicate effectively with residents who may have physical or mental impairments. You will find tips throughout this module.

  • Verbal Communication - Verbal communication simply refers to the words we use.
  • Non-verbal Communication - Non-verbal communication accounts for most of the information we communicate, and tends to convey our true emotions.

The following information will explain the basics of non-verbal communication to give or provide a better understanding of certain non-verbal communication skills and techniques. As an ombudsman, it will be important for you to notice the non-verbal communication of residents you are visiting. It will also be important for you to have an awareness of what you are communicating non-verbally because so much can be learned from non-verbal cues.

Non-Verbal Communication

Eye Gaze

Looking, staring and blinking is a type of non-verbal communication. When individuals encounter things they like, their rate of blinking increases and their pupils dilate. Making eye contact with another person can express many emotions, including hostility or interest.

Facial Expressions

Facial expressions are another type of non-verbal communication. Consider how much information is conveyed with a smile or a frown. While non-verbal communication and behavior can vary between cultures, the facial expressions for happiness, sadness, anger, pain and fear are similar throughout the world.

Paralanguage

Paralanguage refers to vocal communication that is different from actual language This includes factors such as tone of voice, loudness, inflection, and pitch. Consider the powerful effect that tone of voice can have on the meaning of a sentence. When said in a strong tone voice, listeners might interpret approval and enthusiasm. The same words said in a hesitant tone of voice might convey disapproval and a lack of interest.

Haptics

Communicating through touch is another important non-verbal behavior. There has been a substantial amount of research on the importance of touch in infancy and early childhood. Harry Harlow’s classic monkey study demonstrated how the deprivation of touch and contact impedes development. Baby monkeys raised by wire mothers experienced permanent deficits in behavior and social interaction.

Gestures

Deliberate movements and signals are an important way to communicate meaning without words. Common gestures include waving, pointing, and using fingers to indicate number amounts. Other gestures are arbitrary and related to culture.

Body Language and Posture

Posture and movement can also convey a great deal of information. While these non-verbal behaviors can indicate feelings and attitudes, research suggest that body language is far more subtle and less definitive than previously believed. However, intense positive and negative emotions can be portrayed through body language.

Proxemics

People often refer to their need for “personal space.” That is also and important type of non-verbal communication. The amount of distance we need and the amount of space we perceive as belonging to us is influenced by a number of factors including social norms, situational factors, personality characteristics and level of familiarity.

Words Matter: Conveying Your Message

Effective communication is more than just relaying your ideas, knowledge, and experience. There are other factors involved that influence how information is received and understood. In addition, you may use different communication approaches depending on the individual receiving the message (e.g., a resident, family member, staff person, etc.).

Whether you are communicating verbally, in writing, or using another means, there are several elements to consider when communicating your message. To avoid confusion and misunderstandings, don’t:

  • Use technical terms, acronyms, vague words, and slang
  • Relay conflicting messages
  • Use a language that is not understood by the resident/recipient
  • Include too much information

Create a Positive Atmosphere

As an ombudsman, you will be entering facilities to conduct resident visitations, administrative assessments, investigate complaints, and other tasks. Much of your information will come from communicating with the residents who live in the facility. It is important to create an atmosphere where residents feel comfortable discussing their life and concerns with you. Below are some ideas on creating that atmosphere.

  • Do not stereotype! Residents are individuals.
  • Do not talk down to older adults, adults with disabilities, or adults with mental health issues. Do not treat adults as children.
  • Show genuine warmth, responsiveness, caring, and a supportive attitude.
  • Demonstrate acceptance and respect for the individual person. Remember, to accept a person is not the same thing as accepting or approving of that person’s actions.
  • Be aware of feelings, both the other person’s and your own. Indicate openness to any feeling or viewpoint by what you say and how you respond. Remember that everyone has a right to his or her own feelings, and they make sense to that person in the context of his/her personal experience and frame of reference. Pretending not to feel, will not make the feeling go away.
  • Express empathy. Empathy is a deep awareness and sharing of another person’s thoughts and feelings. Empathy involves “walking in another person’s shoes,” while remembering that each person is a separate, unique individual.
  • Begin interaction by introducing yourself.
  • Give your name and state that you are a certified ombudsman there to advocate for his/her rights.
  • Give the person time to process the information and respond.
  • Invite the other person to communicate but do not try to force them.
  • Do not take over the conversation by dominating the topics or doing most of the talking.
  • Do not ask the resident, “Do you remember my name? or a similar question. That type of question puts the resident on the spot, elevates the resident’s stress level, and calls upon the resident to utilize short term memory, which can be a issue due to a resident’s mental health issues, medication, or as a person ages.
  • Always knock on the door to a resident’s room before entering, even if the resident can’t verbally respond or if the resident is watching you approach. Knocking acknowledges that the room is the resident’s “space” and home. It also conveys a sense of respect for the resident’s privacy and dignity and models the appropriate interaction to facility staff members who may see you.
  • Ask the person for permission to talk or discuss a situation.
  • Begin by asking questions about the resident’s day. Be sure to allow them time to discuss what is important to them. Chat with the resident – you may be the only person the resident talks to all day.
  • Chose an appropriate place for the type of conversation or visit you plan to have with the resident. If you are just greeting people, a day room or porch setting is appropriate if that is where the residents are sitting. If you need to discuss personal information, find a setting with privacy and quiet. The setting in which communication occurs directly impacts the nature of the interaction.
  • Be dependable. Visit or check back when you said you would. Promise only what you can deliver/control.
  • Be honest. Avoid giving false hope or expectations. It’s OK to admit, “I don’t know.”
  • Cultivating friendly, trusting relationships takes time. Be patient while visiting. Allow residents to get to know you while you are learning about them. Rarely does a person divulge their innermost thoughts or problems until a trusting relationship has been established. If this is your assigned facility, the residents should be more comfortable with you the more they see you. Be sure to visit with some of the same residents each time you visit the facility to develop a rapport with them.

Effective Listening

Listening and being genuinely interested in residents’ lives is an important factor in creating a positive atmosphere and in encouraging the residents to speak with you as the ombudsman. Below are some guidelines for effective listening. Many of these you may already be familiar with. but it is important to consider whether there is anything more you can do to improve your listening skills.

Guidelines for Effective Listening

  • Listening is a process of helpful communication. Be prepared to listen to the resident’s real thoughts and feelings.
  • Your attitude should express that you value and accept the resident as an individual person.
  • The resident may present a problem that seems to them that it cannot be resolved. Realize how upset they may be. Help the resident describe the problem, how and when it started, who is involved, etc. This will aid the resident in advocating for themselves or you in resolving the problem for them.
  • Keep in mind that the resident has the right and ability to make and take responsibility for their decision. Remember that they may not want assistance at this time. Let the resident know that you are available when the resident wants assistance.
  • Be helpful and concerned, consistently treating the resident with dignity and respect.
  • Let the resident know that they are important and their concerns deserve attention, no matter how small it seems to you or to them.
  • Assist the resident in clarifying the problem or problems. The resident may be feeling confused and overwhelmed.
  • Listen carefully for the resident’s tone of voice and mood which will help you identify the severity of the problem.
  • Respond in a way that lets the resident know that you hear and care about their problems. Let the resident know you will advocate for them.
  • Find out how the resident has handled problems in the past. This will give you clues on what might or might not work.
  • No solution is right for everyone. Discuss different options for handling the problem.
  • Never raise false hopes or make false promises. Do not say, “Everything will be better soon.”
  • Be honest with the resident. Let the resident know if you do not have the answer. Inform the resident that you will attempt to obtain the information or refer them to the agency that can address their issue.
  • End the conversation by summarizing the outcomes of the discussion. If necessary, help the resident develop a plan of action.

Listening for Clues

As you listen to residents and observe their care, be very attentive and sensitive to what you see and hear. As an ombudsman, you are in a unique position to educate and empower residents regarding their rights and the services to which they are entitled. You also have a responsibility to observe the overall care that the facility provides. To do this requires having a good rapport with residents, using effective communication skills and remaining alert to clues you see and hear.

  • In the course of a conversation, a resident says, “I used to complain about always having cold coffee, but I don’t anymore. That’s something I’ll have to learn to live with. I guess I really shouldn’t expect the service here to be like a restaurant.”
  • As an ombudsman, inform the resident you will speak to staff about ensuring the coffee is hot. Ask the resident if his complaints are ignored and if so, would he like to give consent for you to speak to the administrator.
  • As an ombudsman, make a conscious effort to continually LISTEN and OBSERVE while you are inside the facility. Even when a resident cannot express themselves effectively, their behavior, circumstances and environment can help you assess the situation. Careful use of your observation skills can make the difference between problems being ignored and resolved. These skills take time, energy and practice, but they are vital to your effectiveness as an ombudsman.

Overall Guidelines for Effective Communication

When we listen and communicate with others, we often think ahead to the next statement we want to make and make judgments about the person who we are communicating with. As an ombudsman, you should strive to listen to the resident and not judge what the resident says or does. Objectively evaluating a resident’s statements ensures that you are providing appropriate serve to the resident. The chart below identifies effective ways to remain objective when communicating with residents.

It is more effective to:

As you become more familiar with ombudsman work, residents and the facilities you regularly visit, you may develop slightly different questions that seem to work for you. That is perfectly fine. Remember that the questions listed are a guide to having a conversation with residents. You are not expected to ask every single question during an assessment or visit.

Suggested questions include:

Resident Rights

  • How do you like living here? Does this facility feel “homelike?” Why or why not?
  • Are you encouraged to personalize your living space?
  • When you believe your rights have not been respected, what do you do?
  • Do staff members knock on your door and ask permission to enter your room?
  • Are your treated with respect? Why or why not?
  • Are you able to visit freely and privately with family and friends?
  • Where do you go when you want to call someone on the telephone?
  • Are your phone conversations private?

Learn more about Residents' Rights and find Residents' Rights fact sheets in other languages on the National Consumer Voice for Quality Long-Term Care website

As already mentioned, you may encounter different types of residents during your visit. Some of these residents may have special needs which make communication more difficult. Below are some considerations for you when speaking with residents who have special needs.

Hearing Impairments, Deafness & Visual Impairments

Communicating with residents who are deaf or have hearing and/or visual impairments can be challenging. Some things for you to be aware of include:

  • All five senses tend to decline gradually.
  • It is more difficult for residents to cope with multiple impairments than a single impairment.
  • People consciously and unconsciously develop ways to compensate or sensory losses.
  • Don’t be over protective. A person with impairments should do as much as possible for themselves. Make sure you are allowing the resident to do as much as they can for themselves.
  • Communicate directly with a resident who has hearing or visual impairments. If the resident has an interpreter, communication can be accomplished in this way if the resident so desires.

Indicators of Hearing Impairment

Persons who have hearing loss are likely to exhibit some or all of the following behaviors; however, the behavior may not always indicate such a loss:

  • Leaning closer to the speaker.
  • Cupping an ear.
  • Speaking a loud voice.
  • Not speaking clearly.
  • Turning their “good” ear toward you.
  • Asking for things to be repeated.
  • Answering questions inappropriately.
  • Blank looks.
  • Inattentiveness or signs of losing interest.
  • Isolation or refusing to engage in conversation.
  • Lack of reaction.
  • Emotional upset – perhaps anger.

Visual Impairments

Visual impairments vary even more between people than hearing impairments. Residents who have vision problems may exhibit some of the same behaviors as those with hearing loss.

They may also:
  • Squint, frown or grimace during conversation.
  • Rely more on touching.
  • Give inaccurate descriptions or colors.
  • Lack eye contact.
  • Appear to be distrusting or withdrawn.
  • Seem to be worried about awkwardness.
  • Exhibit a reluctance to communicate.
  • Appear to be fearful of normal activity.

Communicating Effectively

To communicate more effectively with residents who have hearing and/or visual impairments, you should use the following techniques:

  • Be sure that the resident is aware of your approach and that you have the resident’s attention before speaking. Be careful not to startle the resident.
  • Position yourself directly in front of the resident when you converse. Adjust your distance from the resident depending on the resident’s visual, hearing and personal needs.
  • If possible, position yourself so that there is a plain background behind you.
  • Allow extra time. Speak at a natural pace. Give plenty of time for the resident to respond. Rushing will compound the resident’s stress and create barriers to having a meaningful conversation.
  • Inform the resident when leaving the room.
  • Pronounce your words clearly.
  • Use simple, short sentences to make your conversation easier to understand.
  • Lower the pitch of your voice. If you have to raise the volume of your voice, do not shout.
  • Touch can aid in concentration, thus improving comprehension.
  • Limit background noise and distractions.
  • Be certain that lights and windows are behind the resident, rather than behind you so that your face is not in shadow.
  • Have a pen and paper available. If necessary, write your message. Be sure the resident understands the language in which you write.
  • Residents with hearing and vision impairments often have more difficulty understanding when they are tired or ill.
  • If a resident has difficulty understanding something, find a different way of saying it, rather than repeating the original words.
  • If you believe that a resident needs a hearing aid, you may want to ask the resident if they have ever worn one. If the resident has worn one and the hearing aid is not visible, try to locate the hearing aid. With the resident’s permission, discuss with staff why the resident is not wearing the hearing aid. Hearing aids are often lost or misplaced, Facility staff should assist in locating or replacing a hearing aid.
  • If the resident wears a hearing aid and still has difficulty hearing, with the resident’s permission, ask the staff to check to see if the hearing aid is turned on, adjusted and has a working battery. If these are all in place, ask when the resident last had had a hearing evaluation and suggest that another may need to be scheduled.

Communicating with residents who are deaf

Communicating with residents who are deaf is similar to communicating with residents who are hearing impaired. You may want to consider the following techniques and use what seems to be appropriate when speaking with a resident who is deaf.

  • Ask staff how they communicate with the resident who is deaf and communicate the same way.
  • Use a picture or other device with illustrations to facilitate communication.
  • Be concise with your statements and questions.
  • Utilize as may other methods of communication as possible to convey your message.
  • Allow sufficient time to visit with the resident without having to be rushed or under pressure.

Visual Impairment

You should consider using the following techniques when you are speaking with residents who have a visual impairment:

  • Use whatever vision remains.
  • Check to see if the resident’s glasses are clean. If not, ask the resident for permission to notify staff to attend to this.
  • Allow the resident to touch you.
  • If you are entering a room with someone who is visually impaired, ask if they want you to describe the room layout, other people who are in the room, and what is happening.
  • Tell the resident if you are leaving the room. Let them know if others will remain in the room or if they will be alone.
  • Say the resident’s name before touching. Remember that touching lets a resident know you are listening.
  • When you speak, make clear whom you are addressing.
  • When you are in a resident’s room, leave things where they placed them so they can be easily found later.
  • Legally blind is not necessarily total blindness. Use large movements, wide gestures and contrasting colors.
  • Use large, clear lettering in any written material.
  • Encourage independence as much as possible.
  • Treat the resident like a resident who has full visual capability.

Aphasia

Aphasia is a total or partial loss of the power to use or understand words. It is often the result of a stroke or other brain damage. You may encounter residents who have expressive aphasia where they can understand what you say, but may also encounter residents who have receptive aphasia and cannot understand. For residents with expressive aphasia, tying to speak is like having a word “on the tip of your tongue”. Some residents may have a bit of both kinds of aphasia. Some suggestions for communicating with individuals who have aphasia are:

  • Ask the resident and the staff how best to communicate.
  • Be patient and allow plenty of time to communicate.
  • Allow the resident to try to complete their thoughts. Avoid being too quick to guess what the person is trying to express.
  • Be honest with the individual. Let them know if you can’t quite understand what they are telling you.
  • Encourage the person to write the word they are trying to express and read it aloud.
  • Use gestures or point to objects if helpful in supplying words or in adding meaning.
  • A picture is sometimes used. The resident merely points to the appropriate picture.
  • Use touch to aid in concentration, to establish another avenue of communication, and to offer reassurance and encouragement.

Residents Who Have Alzheimer's Disease or Other Dementias

As you might imagine, you will encounter residents who have Alzheimer’s disease or other dementias. They may live in secured or unsecured units. It is important not to make assumptions about the resident’s cognitive abilities before attempting to talk with the resident. Remember Alzheimer’s disease is a progressive disorder and someone who has it may be able to communicate quite well.

A lot of factors will determine the resident’s ability to communicate with you including stage of the disease, time of day or other conditions that may impact their communication abilities. You should always attempt to talk with a resident, even if you know the resident has a memory disorder. By asking questions like, “What do you mean?’ What were you thinking about before I came?” or “What did you hear?” you as the ombudsman will have a better sense of the resident’s abilities and you may be better able to understand the resident’s statements.

A few tips for communicating with residents who have dementia are:

  • Approach the resident from the front, or within their line of vision.
  • Speak in a normal tone of voice when greeting the resident.
  • Minimize you hand movements.
  • Avoid a setting with a lot of sensory stimulation.
  • Be respectful of the resident’s personal space and be observant of their reaction as you move closer.
  • If the resident is walking, walk with them while you talk.
  • Redirect the resident if a situation looks like it might get out of hand. Provide ample time for the resident to respond.
  • Ask a question when something is unclear.
  • When a resident has impairment in mental functioning, it is appropriate to respond to that person’s feeling even if their statements do not make sense to you in the context of your conversation.
  • Keep your tone of voice and conversation on an adult level.
  • Don’t speak with staff members or family as if the resident was not there.
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