Keys to Person-Centered Communication

“Communication is the essence of human life and all people have the right to communicate to the fullest extent possible.”¹

Effective communication among staff and residents builds feelings of trust and connection, supports the ability to relay and exchange information efficiently, and enhances resident wellbeing, confidence, mental health and quality of life. Similarly, staff who feel more engaged with residents report greater job satisfaction. Use the communication techniques in this tip sheet to help residents thrive with a greater sense of connection, routine and purposeful activity. In this webinar recording, Creative, Evidence-Based Methods for Conversing with Residents, Kelly Knollman-Porter, PhD, CCC-SLP and Vanessa Burshnic, PhD, CCC-SLP provide additional strategies, best practice demonstrations and examples drawn from their clinical experience with older adults. 

General Tips 

Good communication involves three basic ingredients:

• Mutuality with listening and sharing by both the staff person and the resident
• Varied topics relevant to both people;
• A creative blend of verbal and non-verbal methods such as speaking, gesturing, and use of written support or cues. 

Take your time. People with communication challenges require extended time during conversation to understand and process your message. Pause and give them time to reply. This can feel challenging in a busy community with high productivity demands, yet it’s important. A habit of listening conveys your respect, which builds trust and closeness.

Enrich your conversation with a variety of topics. Conversations can include greetings, small talk and daily care. Yet it’s also important to get to know each resident better so you can communicate about topics that are most meaningful to them. Avoid one-sided conversations. Instead, seek out a conversational back-and-forth about a resident’s hobbies or interests as these are far more meaningful and promote the greatest engagement. 

Create an environment for successful communication. 

• Find a quiet and well-lit location so the older adult can focus on the information you’re presenting. 
• Eliminate distractions. Ask permission to turn off devices that create added background noise. 
• Position yourself in front of the person to gently gain their attention before speaking. Place yourself at the resident’s eye level so you are face-to-face and they can see your expressions. If the person is in bed, pull up a chair next to them. 
• Proximity helps older adults glean important information from your non-verbal cues and it conveys your interest – that they are your top priority.

Change your speech patterns. Slow down and over-articulate your words. These changes make it easier for the person to see how your mouth is moving. Research has shown that the more people can see how we speak, the more effectively they’ll understand what we’re saying. (Also, see our webinar on Communicating Effectively While Wearing a Mask.)

Use gestures such as:

• Pantomime and hand gestures – use your hand to demonstrate an object or action. For example, pretend to hold a cup and bring it to your mouth while saying, “Would you like a drink?” Also, common signals, such as a thumbs up and thumbs down or pointing to convey direction, can improve communication. 
• Gestures can be effective during daily care: they help the resident understand what you’re doing and that you want to know how they’re feeling. 
• Create gestures relevant to the person that relay concrete, easily interpreted information. For example, if someone likes basketball, agree on a gesture (mock dribbling) to prompt conversations about the game. 

Use written communication. Written supports are easy to create and they’re durable, which is important for individuals with short-term memory problems. Easy options include:

• White paper and a black marker.
• Dry erase board (keep in the person’s room or carry one with you during your shift) for notes about the daily schedule: “Lunch at 12” or the time for a TV show the person would like to watch. Create reminders for the individual and staff. 
• Keep messages simple — use one or a few key words.
• Print — don’t use script or cursive writing.
• Use lower and upper case letters (not all caps).
• Make sure words are large and visible.

Use picture support.

• Communication boards with pictures can be purchased to relay basic wants and needs. However, they are sometimes overwhelming and difficult to read for people with vision or cognitive challenges.
• A good alternative is to create a personalized communication board with clear, legible pictures. Use a plain background, laminate the board, and consider including key words along with images. 

Tips for People Living with Dementia 

Memory books. Small books or albums with labeled pictures and photos are among the most effective interventions for people with dementia. These individualized books may illustrate meaningful facts, key life events, family and friends, vacations or hobbies. For residents with limited speech who are unable to provide their life history, begin by learning one thing about them. Then design a short book about the person’s early life or favorite activities as an adult. Invite loved ones to join in the project. 

Memory books support meaningful engagement and can also help to address challenging behaviors. For example, a person who searches for his deceased wife might take comfort in a simple page that says, “My wife Jane and I had a happy life together and she rests peacefully here” – with a photo of her gravestone. 

Reminder cards. Repetitive questions and statements are common among older adults living with dementia. A reminder card can answer a question, provide reassurance, or help to solve a problem. They are easy to create:

1. State the answer to the older adult’s question or concern. 
2. Write the answer on an index card or notepad. Use large print and keep the message brief.
3. Read the card with the person to make sure the message is clear and easily understood. For example, if a person is concerned about taking medication, the card could say: “I take my pills to feel better.” If a resident wonders when his wife will call, the card could say: “My wife Frances knows I am here she will call me at noon.”
4. The next time the person repeats the question, do not say the answer. Instead say: “Hmm, I think the answer to that question is on your card.”
5. Repeat step 4 each time the question arises. Over time, repetition and consistency will help the person learn to rely on the card instead of you for the answer. 

Wayfinding in the environment. Simple signage helps residents navigate within their community as well as understand the purpose of each space. 

• When creating informal signs, use large text with recognizable pictures or symbols – such as a hot bowl of soup to represent the dining room. If you make a sign yourself, use a white background and dark font. 
• For formal signs, consider white font on a colored background. Colorful themes (green for the dining room and red for the community center) can guide and orient residents to each setting. 

Orientation cues.

• A clock with a large face and a simple calendar help residents stay in tune with time. 
• Name tags with big print and photos help staff and residents easily identify each other and avoid the discomfort or anxiety that comes with not knowing the names of people around you. 
• Reducing clutter and labeling items such as drawers, bathroom items and other belongings promote comprehension and independence. Notes are another valuable strategy to reinforce orientation and activities. For example: “Good morning, Mom. It’s Tuesday and I’m at work. I’ll be home at lunch time. Watch TV and fold the laundry. Love, Jane” 

Supporting communication for activities. Use visual sequencing and signage to help residents carry out daily activities.

• Learn about a person’s usual routine, perhaps for getting dressed. Then create a checklist with words and pictures for each step: underwear, socks, pants, shirt, emergency alert device and hearing aids. The same approach can be applied to many aspects of daily care and activities. 
• As dementia progresses, a person’s ability to initiate activities can become impaired. Invitational signage cues a person to start a satisfying activity.
• Signs should be attractive to the user and encourage performing a useful function that is needed frequently or every day. For example, create signage inviting someone to “please help put the groceries in the cupboard” (canned goods can be placed near the dining room or kitchen) or “please fold the clothes” (left in a basket on a table in a central location). 

In summary, keep messages simple and remember that repetition and consistency support learning. If a particular communication support doesn’t seem to work, problem solve (is the print too small, is the message too long or complex?) and try a different approach. Incorporate the older adult in creating the support and be creative!

¹American Speech-Language-Hearing Association, Technical Report, 2004.

Kelly Knollman-Porter, PhD, CCC-SLP & Vanessa Burshnic, PhD, CCC-SLP, Katherine Abbott, PhD. & Kimberly Van Haitsma, PhD. This work is licensed under the Creative Commons Attribution-NoDerivatives 4.0 International License. Based on a work at https://preferencebasedliving.com/. To view a copy of this license, visit http://creativecommons.org/licenses/by-nd/4.0/.