Communication in Caregiving

Communication in caregiving is very important as a substantial part of caregiving is care of chronic illness or serious conditions associated with aging.  Securing proper care through health care providers can be a daunting and frustrating process.  Also, care can be hindered due to communication problems between the care receiver and the caregiver.  This section focuses on communication between the caregiver and care receiver as well as how to more effectively communicate with health care providers.  This information can be used by the caregiver to increase effective communication and enhance the caregiving experience.

Communication between Caregivers and Care Recipients¹

• Breath

• Take a couple of deep breaths before starting a conversation.
• If the conversation becomes emotional or difficult take a couple of breaths to help you calm down and/or focus.

• Really listen

• Listen to what the person is saying.
• Try to determine what the person is hearing you say. 
• Listen to silence as silence allows someone to think about what is being discussed or how to respond.

• Ask Questions

• Find out what is really going on. 
• Are you assuming some things about what the other person is saying because you think you know everything that is going on.

• Use Body Language to Improve Communication

• Look the person in the eye. 
• Lean into the person or put a hand on the person’s arm or shoulder; remember that not everyone likes to be touched so this may not be effective.

• Slow Down

• Take your time. 
• Communicate at an even pace, this allows everyone to think through the conversation and how to reply.

• Pay Attention to What the Person is Saying and How They are Behaving

• Do the words and the behavior match.    
• Be aware that fear may make someone hesitate to say what is really going on. 
• Many care receivers have a fear of admitting problems and concerns in fear that it will lead to a further loss of independence.

• Talk directly to the person

• It may be easy for caregivers to “multi-task” as they prepare meals, do laundry, take someone to the grocery store, or accompany them to a doctor’s appointment. 
• It is important to set aside time to have one-on-one conversation. 
• This may save time in the long run because misunderstandings can be avoided. 
• If the care receiver feels heard and understood they may talk about something that is a concern or fear.

• Speak distinctly and clearly but not louder

• Some older adults do not like to admit that they cannot hear or understand the conversation around them. 
• The higher pitch of women’s voices may be a problem for older adults; consciously think to lower the voice pitch.

• Avoid arguing

• Listen to concerns and try to understand the other person’s experience and opinions. 
• Remember that it is still his or her life and care. 
• Focus on meeting unmet needs and not on conflict.

• Use humor when appropriate

• Humor can help ease tension. 
• Most caregivers and care receivers know each other well enough to find humor in the situation.

Communication when Complications Exist

Communication can be further complicated by the care recipient’s physical, mental, or emotional state.  Some conditions that can make communication more difficult include hearing loss, dementia and Alzheimer’s Disease. 

Communicating with the Hearing Impaired²

• Check to make sure that the hearing aid is turn on, adjusted and has a working battery.
• Be sure the individual sees you approach otherwise you may startle them.
• Face the hard of hearing person directly and be on the same level with him/her whenever possible.
• Try not to eat, chew or smoke while talking, speech will be more difficult to understand.
• Keep your hands away from your face while speaking.
• Recognize that hearing impaired people hear and understand less when they are tired or ill.
• Reduce or eliminate background noise as much as possible when carrying on conversations.
• Speak in a normal fashion without shouting. 
• Make sure that there is no light shining in the eyes of the hearing impaired person.
• If the person has difficulty understanding something, find a different way of saying the same thing, rather than repeating the original words over and over.
• Use simple, short sentences to make your conversation easier to understand.
• Write messages if necessary.
• Allow ample time to converse, being in a rush will compound everyone’s stress and create barriers to having a meaningful conversation.
• For signs and symptoms of hearing loss go to http:// www.ec-online.net/Knowledge/Articles/hearing.html

Communication and Dementia or Alzheimer’s Disease³

Some changes you may notice in a person with dementia

• They may have difficulty finding a word and so it is replaced with a related word instead of the one that is lost.
• They may not be able to understand what you are saying or only be able to grasp part of it.
• They may talk fluently but not make sense.
• Writing and understanding of the written word will deteriorate.
• They may be able to talk of the distant past but not of recent events.
• They may lose the normal social conventions of conversation and interrupt, ignore another speaker, not respond when spoken to or become very self-centered.
• They may have difficulty expressing emotions appropriately.

Ways to Improve Communication
Preserve self-esteem:

• Try not to talk down to the person or to treat them as a child: conversation should be simple, but remain on an adult level.
• Continue sharing activities and pastimes with the person and show them you value them.
• People still retain their feelings and emotions even though they may not understand what is being said, so do everything you can to preserve their dignity and self-esteem.
• Never discuss the person in front of others as if they were not present, even if you think they do not understand.

Speaking

• Remain calm and talk in a gentle, matter-of-fact way, keep sentences short and simple, focusing on one idea at a time.
• Talk about specific events that may be remembered or everyday things.
• Keep information simple.
• Allow plenty of time for what you have said to be interpreted.
• Speak slowly and clearly without raising your voice.
• Repeating a point using different words can be helpful.
• Incorporating information in your conversation which tell the person where they are, what is happening around them and who they are with can make them feel more secure and less confused.
• Using orienting names whenever you can such as “your son, Jack”.
• Try to tune into the feeling rather than the content of the conversation, do not attempt complex discussions.

The Environment

• Avoid competing noise or activities such as TV or radio.
• Make sure glasses, hearing aids and dentures are all correctly prescribed and well-fitting.
• If possible remain still and sit with the person while you are talking to them.  It will be easier for them to follow you and will show them that you are prepared to work at trying to understand what is being said.
• Face the person as you talk to them.
• Minimize hand movements that approaches the other person.
• Be respectful of the person’s personal space and observant of their reaction as you move closer. 
• Maintain regular routines which helps to minimize confusion and can assist communication
• Sit or squat beside a seated person, do not stand above them.
• If a person is a pacer, walk in step with them while you talk.
• Maintain eye contact and smile.  A frown may convey negative feeling to a person.
• When talking in a group, make sure that the person is not on the end of the row.  It is better to place the person in the middle so that the conversation is around them.

Simplifying Activities

• Break instructions into simple activities; for example name the piece of clothing they should put on rather than telling them to get dressed.
• As the condition worsens, break tasks into even smaller steps; explain what you are doing during each step.
• Focus on familiar tasks: introducing new tasks can be confusing.
• Make it easy for the person to join in a conversation by asking questions that need only a yes or no answer.

Finding Words

• If the person has difficulty finding a word, ask them to explain it in a different way or guess at their meaning and ask if you are correct.
• If they can’t think of the right word, try giving clues instead of immediately supplying it.
• Repeat key words if the person does not understand the first time around.
• Ask them to show what they are referring to.  Pointing to something will often help the person get the message across.

Verbal Tips

• Avoid upsetting arguments or allowing your own stress and exasperation to show.
• Use distraction when possible to help overcome upsets and frustrations.
• Argument over mistaken ideas should be avoided.
• Encourage laughter.

Body Language

• Pointing or demonstrating can help a person to understand what you are saying, touching and holding their hand may help keep their attention and show them that you care.
• Try to maintain eye contact when speaking and listening.

Asking Questions

• Ask only one question at a time to avoid confusion.
• Avoid too many choices; present only one option at a time.
• Ask questions which require only yes/no responses
• Give them plenty of time to respond.
• Try to be patient when the person asks the same question over and over again.

Suggestions to help with communication problems³

• Be flexible.
• Remember that each person is unique and each relationship is different so it is a question of trying things out to discover what works best for you.
• Talk to other caregivers and health care professionals and see what works for them.
• Do not expect too much; keep modifying your expectations at each stage of the disease so that they remain realistic.
• Remember that words are not the only form of communication: you will need to rely more heavily on nonverbal cues such as tone of voice, touch and movement to convey how you feel when the person you are caring for begins to have difficulty understanding conversation.
• Listen for and learn to recognize the feelings and emotions rather than the words.

Aids to Communicating³

• Use distraction if the situation looks like it may get out of hand.
• Showing and touching physical objects and pictures may help with memory and assist conversation.
• Music can be an excellent way of communicating, it can help a person recall words and express feelings.
• Old photos can be used to stimulate memories and recall events.

Communication with Health Care Professionals

Besides the ability to communicate with the care recipient, caregiving requires that ability to communicate with health care professionals.  This may be a new and daunting experience for caregivers who have had very little contact with the medical community prior to starting a caregiving role.

Tips for talking to Healthcare Professionals⁴
Before you go to your healthcare provider

• Make a list of questions, symptoms and concerns
• Ask a family member or friend to accompany you, if you wish
• If the results of the medical tests won’t be ready for a few days:

• Ask your doctors how your results will be returned to you
• Ask who will be available to explain the results to you

• If you need to ask questions later find out who you can talk to and the best times to reach them.

If your doctor or nurse advises you to change your diet or lifestyle or suggests you take medication

• Ask how these changes will help you fell better or improve your health
• Ask what might happen if you do not follow the recommendations
• Ask about specific behavior changes.  For example, if you need to increase your physical activity ask how long you should exercise and what type of activity will be best. If the doctor suggests you lose weight ask how much weight and how long that weight loss should take
• Ask about community services and support groups

Review your progress

• Ask what progress should be occurring with each specific condition.
• If you feel you are not making progress, share that with your healthcare provider and ask why your progress is so slow.
• Ask your doctor when you need to make another appointment to monitor your progress and who you may contact if you have questions in the meantime.

If you are taking may different types of medication

• Buy an inexpensive plastic pill box marked with the days of the week to help you to remember to take your medication
• When you visit your doctor take a list of all your medications, including over the counter drugs like cold medicine or aspirin; include any vitamins, minerals or herbs.

If your health care provider recommends increasing your physical activity

• Ask what kinds of activities you should be doing and how long you should do them
• Ask if you should wear special shoes or clothing
• Ask for referrals to health clubs and/or exercise specialist to help with starting an exercise program.

If your healthcare provider recommends stopping smoking, weight control or both:

• Ask for suggestions on support groups that can help you.
• Ask if medications could help you achieve your goals.
• Ask for pamphlets to help you and to provide further information.

Making the Most of a Doctor’s Office Visit⁵

• Be on time
• Get to know your doctor, this helps to build a relationship leading to mutual respect and trust
• Explain your problem as clearly as possible and be direct.  Bring a list of symptoms, times and days if possible.
• Identify your symptoms clearly and begin by describing the most serious symptoms first.  The doctor will want to know when the symptoms first appeared, how often they appear and how long they last.
• Clearly express observations and concerns about your health.  Don’t be afraid to express your fears or share advice or information you may have learned from your research.  Your doctor should be willing to confirm the facts and clarify misconceptions.
• Speak openly and honestly with your doctor.  Answer all the doctor’s questions honestly and completely.  This helps your doctor to make the correct diagnosis.
• Be a good listener.  Listen carefully to what your doctor has to say.  If you do not understand something let your doctor know so that the information can be clarified. 
• Repeat the information in your own words to make sure you understand what the doctor is saying
• Use questions to increase your understanding of the information.
• Take helpful notes; write down the highlights of your visit including special instructions from your doctor.
• Be sure to tell your doctor if you are satisfied or dissatisfied with your health and medical care.
• Ask for referrals if you feel that you need to see a specialist regarding a specific health problem.
• Ask your doctor if you may follow-up on the phone or email.  Some physicians have started to use email as a way to communicate with patients.

When your doctor has made a diagnosis⁶

• Take the time you need to come to terms with the diagnois.
• Get support from family, friends or a support group.
• Talk to your doctor about any questions or concerns you have and what to do next.
• Seek out information.
• Decide on a treatment plan.
• For a free booklet on these steps go to http://www.ahrg.gov/consumer/diaginfo.pdf

Getting a second Opinion⁷
General Tips: Here are some situations when it is appropriate to seek advice from a second doctor

• Your doctor recommends a second opinion.
• Your doctor recommends elective surgery.
• Your doctor has not reached a diagnosis or the diagnosis is not clear.
• Your medical condition is very rare or very seriou.s
• You are not getting the information you need from your doctor.

If your doctor doesn’t recommend a second opinion, but you feel that you need one:

• Be sure to tell your doctor that you will be seeking a second opinion, your doctor should not be offended; doctors understand that patients sometimes seek additional evaluation especially when a serious diagnois has been made.
• Ask your healthcare provider to make copies of your medical file, test results and treatment plan to show the second doctor.
• If your doctor disagrees with your decision, remember that it is not their decision to make.
• Your doctor may give you a list of referrals or you may seek another physician on your own.

Sources

1. Family Caregivers Online. (2004). Caregiver Communication. Retreived May 17, 2007 from http://www.familycaregiversonline.com/newsletter/jan-o4.doc
2. ElderCare Online. (n.d). Communicating with impaired elderly persons: Communicating with the hearing impaired. Retreived May 17, 2007 from http://www.ec-online.net/Knowledge/Articles/communication.html.
3. MyDr.com.au. (2001). Communication in dementia. Retreived May 17, 2007 from http://www.mydr.com.au/default.asp?article=2822
4. American Heart Association. (n.d.). Tips for Taling to Health Care Professionals. Retrieved May 22, 2007 from http://www.americanheart.org/presenter.jhtml?indentifier=113.
5. American Medical Association. (2001). Making the Most of an Office Visit: Medem Medical Library. Retrieved May 22, 2007 from http://medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZE13VDAJC&sub_cat=411.
6. Agency for Healthcare Research & Quality. (2005). Next Steps After a Diagnosis: Finding Information & Support. AHRQ Pub. no. 05-0049. Retrieved August 20, 2007 from http://www.ahrg.gov/consumer/diaginfo.pdf
7. American Medical Association. (1999). Getting a Second Opinion: Medem Medical Library. Retrieved May 22, 2007 from http://www.medem.com/search/article_display.cfm?path=11TANQUERY/M_ContentItem/ZZZ2UK1EAJC.html &soc=AMA&srch_typ=NAV_SERCH

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